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CP1322 American Electrical Services, Inc Contract 14-16
CITY OF t ADBURN Nancy Backus, Mayor WASHINGTON 25 West Main Street * Auburn WA 98001 -4998 * www.auburnwa gov * 253- 931 -3000 October 2, 2014 CERTIFIED MAIL RETURN RECEIPT REQUESTED American Electrical Services, Inc. P O Box 1350 Buckley, WA 98321 NOTICE TO PROCEED RE: Project #CP1322, Annual Traffic Signal Improvements, Contract #14 -16 You are hereby notified to proceed as of October 3, 2014 with the work on the above - referenced project, within the time period specified, in accordance with the provisions of the contract documents (copy enclosed). This project has 3C working days for completion. If you have any questions, please contact the City Inspector for the project, Steve Bowen at 253 - 288 -3145 or the Contract Administration Specialist Amanda DeSilver at 253 -876 -1980 Sincerely, 'r , 'tngrid Ga P E. Asst. irector of Engineering Services & City Engineer Community Development & Public Works Department IG /ad /mt Enclosure cc: Dani Daskam, City Clerk Luis Barba, Project /Engineer Steve Bowen, Project Inspector File 13.11 (CP1322) AUBURN* MORE THAN YOU IMAGINED CONTRACT Contract No. 14 -16 THIS AGREEMENT AND CONTRACT, made and entered into, in duplicate, at Auburn, Washington, this day of (X -c7t r 2014, by and between the CITY OF AUBURN, WASHINGTON, a municipal corporation, and American Electrical Services, Inc. PO Box 1350, Buckley, WA, 98321, hereinafter called the CONTRACTOR. WITNESSETH That, in consideration of the terms and conditions contained in the Contract Documents entitled "CP1322, Annual Traffic Signal Improvements," which are by this reference incorporated hereii"'and made a part of this Contract, the parties hereto covenant and agree as follows. 1. The CONTRACTOR shall do all work and furnish all tools, materials and equipment for Project CP1322, Annual Traffic Signal Improvements — the construction of pedestrian and traffic signal modifications such as, APS push buttons, flashing yellow arrow left turn operation, vehicle detection loops, vehicle detection camera systems, signal head backplates with yellow reflective tape, signal head relocation and new auxiliary signal heads for a total contract value of one hundred thirty -two thousand, seven hundred and eleven dollars, ($132,711 00) in accordance with and as described in the Contract Documents which are by this reference incorporated herein and made a part hereof, and shall perform any alterations in or additions to the work provided under this Contract and every part thereof This Contract shall be executed by the Contractor and returned to the City within 7 calendar days after the receipt of the dated notification of award and the Contract time shall commence within 5 working days after execution of the Contract by the City and so designated on the Notice to Proceed. Physical completion shall be within 30 working days of the date on the Notice to Proceed. If said work is not completed within the time specified, the CONTRACTOR agrees to pay liquidated damages to the CITY OF AUBURN, as specified in Section 1 -08.9 (Liquidated Damages) of the Standard Specifications. The CONTRACTOR shall provide and bear the expense of all equipment, work and labor of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in this Contract and every part thereof, except such as are mentioned in the Contract Documents to be furnished by the CITY OF AUBURN 11 The CITY OF AUBURN hereby promises and agrees with the CONTRACTOR to employ, and does employ the CONTRACTOR to provide the materials and to do and cause to be done the above described work and to complete and finish the same according to the Contract Documents and the terms and conditions herein contained and hereby contracts to pay for the same according to said Contract Documents and the aforesaid proposal hereto attached, at the time and in the manner and upon the conditions provided for in this Contract. III. The CONTRACTOR for himself, and for his heirs, executors, administrators, successors, and assigns, does hereby agree to the full performance of all the covenants herein contained upon by part of the CONTRACTOR. axvi IV It is further provided that no liability shall attach to the CITY OF AUBURN, WAS14 NGTON by reason of entering into this Contract, except as expressly provided herein. IN WITNESS WHEREOF the parties hereto have caused this Contract to be executed the day and year first heremabove written. Countersigned: this �r day of 201� ATTEST Danielle E. Daskam, City Clerk APPROVED AS Daniel B Heid, CITY OF AUBURN. WASHINGTON By c) Backus, Mayor AMERICAN ELECTRIC SERVICES, INC By .XV11 Official Signature �� i4'1• YYlonwap, t�✓lps�de� CONTRACT BOND CONTRACT NO 14 -16 BOND NO 17299 BOND TO Cl fY OF AUBURN, WASHINGTON KNOW ALL MEN BY THESE PRESENT; That we, the undersigned, American Electrical Services, Inc. PO Box 1350, Buckley, WA. 9R'21, as principal, and western National Mutual Insurance Company a corporation, organized and existing under the laws of the State of Minnesota _ as a surety corporation, and qualified under the laws of the State of Washington to become surety upon bonds of contractors with municipal corporations, as surety, are jointly and severally held and firmly bound to the City of Auburn, Washington. in the penal sum of one hundred thirty-two thousand, seven hundred and elcyen dollars, {$132,711.00), for the payment of which sum we jointly and severally hind ourselves and our successors, heirs, administrators or personal representatives as the case may be. This obligation is entered into in pursuance of the Statutes of the State of Washing=ton and the Ordinances of the City of Auburn, Washington. Dated at Auburn, Washington, this i day of OL40b,u _ 2014 Nevertheless, the conditions of the above obligation are such that: WHEREAS, the City of Auburn on the 15th clay, of September, 2014, let to the above bounden principal a certain Contract. The said Contract being numbered 14 -16. and providing for the constntctiou of Project CP1322, Annual Traffic Signal Improvements - pedestrian and traffic signal modifications such as, APS push buttons, flashing yellow arrow left turn operation, vehicle detection loops, vehicle detection camera syst rns, signal head backplates with yellow reflective tape and new auxiliary signal heads (which Contract is referred to herein and is made a part hereof as though attached hereto), and WHEREAS, the said principal has accepted, or is about to accept. the said Contract, and undertake to perform the work therein provided for in the mamrer and within the time set forth: NOW, TI- IEREFORE, if the above bounden principal shall faithfully and truly observed and comply with the terms, conditions, and provisions of said Contract in all respects and shall well and truly and fully do and perform all matters and things by them undertaken to be performed under said Contract, upon the terms proposed therein. and any and all duly authorized modificat ons of said Contract that may hereafter by made, and within the time prescribed therein, and until the same is accepted and shall pay all laborers, mechanics, subcontractors and material men, and all persons who shall supply principal or subcontractors with provisions and supplies for the can-ying on of said work and silall hold said City of Auburn, Washington, harmless from any loss or damage occasioned to any person or property by reason of any carelessness or negligence on the part of said principal or any subcontractor in the perfonnancc of said work, and shall in all respects faithfully perform said Contract according to lave, and shall indemnify and held the City of Auburn. Washington, harmless from any damage or expense by reason of failure of performance, as specified in said Contract, and XXV11i The undersigned principal and the undersigned surety present this contract bond related to the Contract, PROVIDED that this document shall not be enforceable unless and until the City of Auburn awards and executes the Contract to the undersigned principal. No obligations under this bond, for the performance of the above- referenced contract, shall be enforceable until the City of Auburn has executed the contract to the undersigned principal. The Surety, hereby agrees that modifications and changes may be made in the terns and provisions of the aforesaid Contract without notice to Surety, and any such modifications or changes increasing the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this Contract Bond in a like amount, such increase; however, not to exceed twenty — five percent (25 %) of the original amount of this bond without the consent of the Surety PROVIDED, however, that after the acceptance of this Contract and the expiration of the lien period, and if there are no liens pending, then the penal sum of this bond, shall be reduced to either ten percent (10%) of the value of the improvements to the City or two thousand dollars ($2,000). whichever is greater, to warranty against defects appearing or developing in the material or workmanship provided or performed under this Contract within a period of one (1) year after acceptance. Not withstanding the reduction of this bond, the principal and surety shall hold the City of Auburn harmless from all defects appearing or developing in the material or workmanship provided or performed under this Contract within a period of one (1) year after acceptance, THEN and in that event this obligation shall be void; but otherwise it shall be and remain in full force and effect. It is hereby expressly agreed that if any legal action is necessary to be brought under the conditions of this bond, that the decisions of the Courts of the State of Washington shall be binding. IN WITNESS WHEREOF, the above - bounden parties have executed this instrument this 23rd day of September , 2014. ` AJ rktican Electrical Services, Inc Western Company Surety By (/3ulle crakw, Anomey in Fact clo Hentschell & Associates, Inc. 621 Pacific Avenue Suite 400, Tacoma, WA 98402 (253) 272 -1151 Resident Agent's Address R. Phone Number xxix W WESTERN NATIONAL I.mwu,c. iAV Na,ImJNMV^W ^Y POWER OF ATTORNEY II Villa 111i " "lo, IIIIIIiruiillll I ill KNOW ALL MEN BY THESE � Karen ,Assoc ralkgrinKc. #g445)aml Joanne Reinenmeyer and Th mutual omas insurance 'company, does Insurance Company, a Minnesota make, constitute and appoint Karen Smith, Julie omas Hentschell oc , Its true and lawful Attorney(s) -in -Fact, with full power and authority for and on behalf of the Company as surety, to execute and deliver and affix the seal of the Company thereto (if a seal is required) bond, undertakings recognizances or other written obligations in the nature thereof, (other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self- insurance workers= compensation_bonds_guarahteeing payment of benefits, hazardous waste remediation bonds or black lung bonds), as follows All written instruments in an amount not to exceed ar aggregate of Five Million and no /100 -- Dollars ($5,000,000.00) for any single obligation, regardless of the number of instruments Issued for the obligation Power ofd Attorney nfi is signed and sealed b facsimile er and ofit f thl o' a s d said Attorneys meeting Fact, pursuant to these presents, are ,11 y n 0 dauthonty, �f ttof directors at a meeting held on September 28, 2010. This Western National Mutual Insurance Company c Setlea b rn'9 thereby, 6 2pl the'yl� �I o e dopted by the board df directors of c ratified and confirmed. This appointment is mad � he boa RESOLVED h h president, a vi rp File following resolutions a an o In e i Mutual Insurance RESOL that the es de t, a y vice p es dent,or assistant vice president in conjunction with the secretary or any assistant secretary, may appoint attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, and said officers may remove any such attorney -In -fact or agent and revoke any Power of Attorney previously granted to such person RESOLVED FURTHER that any bond =u`ertakingwecogriizande, ocsuretyship obligation shall be valid and binding upon the Company (i) when signed by the president, anyvice`presidentorassistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary; or — (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attorney -in -fact or agent, or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued iss uedbyth the Company such person or persons. li i i i RESOLVED t t f any h' cer l and h h seal the company ma y be i,r Power o 11 1 , I - I 1 ° of Attr ney or certification thereof auth oriz gthe sep and, deliv s of y undertaking, cognizance, o other suretyship obligations of the Company and s naturean ea whe n all have he same fo ca d effect a g , manually affixed. IN WITNESS WHEREOF, Western National Mutual Insurance Company has caused these presents to be signed by its proper officer and its corporate seal to be affixed this 4th day of February 2014 `.`gyp......... L OJ� Jon R Hebeisen, Secretary Larry A Byers, Sr Vice President STATE OF MINNESOTA, COUNTY OF DAKOTA individuals and officers of the Western National Mu ual aInlsuran e Company who executed the above instrument, and tome known to wl the ,III' On this 4th ! day of February, 2014, personally!,, Larry Byers they each acknowledged the execution of the same, and being by me duly sworn, did severally dispose and say, that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. JENNIFERAYOUNG NOTARY PUBLIC MINNESOTA �W CmnmiWwe,yaem.al, vole Jennifer A. Young, Notary Public My commission expires January 31 2016 CERTIFICATE II''II I, the undersigned assistant secrets of the We stern d dto nal M � om y, Minnesota corporation, CERTIFY that foregoing and attached w, r of Attrne n full fi st as n been,lrevoke d, antl furthermore, thathe Resolutions off eb and f di rectors set forth tt the Power Attorney, now in force. e? P'4t W.;SEAL Signed and sealed at the City of Edina, MN this?( -day ot>P> 'p m'? N-T Jennifer A. Young, Assistant Secretary c c a o o y e a I- 9 hAF � R 7J Kill Page 1 of 2 }t Search > WESTERN NATIONAL MUTUAL INSURANCE COMPANY WESTERN NATIONAL MUTUAL INSURANCE COMPANY General I Contact i Lcensmg I Appointments I Complaints I Orders I National Info I Ratinhs Back to Search General information Name: WESTERN NATIONAL MUTUAL INSURANCE COMPANY Corporate family group: WESTERN NATL MILT GRP what is mir Organization type: PROPERTY WAOIC: 500687 NAIC: 15377 Status: ACTIVE Admitted date: 09/20/2011 Ownership type: MUTUAL back to top Contact information Registered address Mailing address 5350 W 78TH ST PO BOX 1463 EDINA, MN 55439 -3101 MINNEAPOLIS, MN 55440- 1463 Telephone Telephone 952- 835 -5350 952 -835 -5350 Types of coverage authorized to sell V,hatuthi. Insurance types _ _ -- Casualty Marme — — -- Ocean Marine Property Surety_ Vehicle bark to top Agents and agencies that represent this company (Appointments) 101:at „tb View agents View agencies - balk h, top Company complaint history ohatsthri View complaints ^ bat, to top Disciplinary orders 2008 -2014 Y,hat is 1bi9 No d,sopllnary orders are found The orders posted here are unverified electronic duplicates of the official orders actually entered. To be certain you have the official version of the order as entered, request a hard copy from Renee Moines at 360 - 725 -7047 or email legal @oic.wa.gov Looking for other orders' Our online orders search allows you to search a ten year history of all orders, including enforcement orders, administrative orders, and general orders. http: //Nvww. insurance .wa.gov /consumertoolkitI Company lCompanyProfile.aspx ?WAOIC = 9/26/2014 Page 2 of 2 ^ ba k to top National information on insurance companies Want more information about this cori The NAIC's Consumer Information (CIS) page allows you to retrieve national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. ^ back to top Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability Some of these companies charge for their services. A.M. Best Weiss Group Ratings iStandard and Poor's Corp _ iMoody's Investors Service JRtch IBCA, Duff and Phelps Ratings �l back to top http: / /www. insurance .wa.gov /consumertoolkit/ Company /ConipanyProfile.aspx ?WAOIC= 9/26/2014 A.M. Best's Consumer Insurance Information Center Page l of 1 �(A...nM, ��++B4el�ssLt''s�t!� j}tyy ����}}���jt� ((!��Qp (.'� r���y {I on's1�t't1,er tFtsigla Izen CgptiR i1i Member Center Logln l Sign UQ Need Coverage? How Does Your Insurer Rate? State Insurance Information Find Insurers by state or coverage type Emerz company Name F=11 Guild a slate Cpnsumer Home I Terms to Know I Why a Best's Rating is Important I Cgntart Us © Llfe & Retirement O Health & Disability Q Gar & Home O Other Llte Events Western National Mutual Insurance Co 9 Prim this pope r memoe, ur we stem IN atonal Insu,anm Group Auto (Personal) Mew DeOnuwn i AM Bes1Y 00658 NF.. 15317 FEIN 04104300_5 Workers' Compensation Wine Ortutinn) Address P 0 Box 1463 Phone 952- 835 -5350 Homeowners Multiple Peril of Dewiienn I Minneapolis, MN 55449 Fax 952 -921 -9295 Auto (Commercial) New Dunn -11 UNITED STATES Web onsi wnias cold Other Liability (Occurrence) Ns-w Derrvgos) Best's Ratings View Dehninon Need More information? Purchase an Insurer record, complete with Financial Strength Rating A rating history , market share and a list of Outlook Stable for$995 Effectme Date December 12, 2013 (Affirmed) ( ) V ew Samole Reoort Via,S m,l.R p. Financial Size Category I% ($260 Million to $500 Million) Licensing The company Is licensed In AZ, CO, ID, IL, IA, KS, MN, MT, NE, NV NO OR, SO UT, WA and WI Top Line(s) of Business dease uoss Dseo v,wwsums wneren1 1 Auto (Personal) Mew DeOnuwn i 2 Workers' Compensation Wine Ortutinn) 3 Homeowners Multiple Peril of Dewiienn I 4 Auto (Commercial) New Dunn -11 5 Other Liability (Occurrence) Ns-w Derrvgos) Top States) of Business Ieasm u,oirenlairn swsesm 1 Minnesota 2 Wisconsin 3 Illinois 4 Iowa 5 South Dakota Visit our NewsRoem for the latest News and Press Releases for this company and Its A M Best Group Terms of Use All Information provided on the AM Best website, Including but not limited to text, data, ratings, reports, Images photos, graphics, and charts is awned by or licensed to AM Best Company and is protected by United States copyright laws and iMema tonal treaty provisions A M Best and its licensors retain all copyright and other proprietary rights to the website content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third Panes, or stored In a database or retrieval system In any forth for commercial purposes without the poor written permission of the A M Best Company All unauthorized use of Bests Credit Ratings or other published information Is strictly prohibited By logging Into Best's Member Center or accessing this site you accept and agree to be bound by our complete Terms or Use Crammer Seduce I Product SU000rt I Member Centel I Contact Into I Careers About A M Best I Site I Privacy Policy I Second I Terms of Use I Legal 3 L¢ensino Copynght 0 2014 A M Best Company, Inc ALL RIGHTS RESERVED A M Best WodGwrde Headquarters, Ambest Road, Oldwlck, New Jersey, 08858, U S A http: /hvww3.ambest.com/ Consumers /CompanyProtile.aspx ?BL =36 &ambnum= 000658 &P 9/26/2014 AI° ® CERTIFICATE OF LIABILITY INSURANCE ) 9/24/2014 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 HENTSCHELL & ASSOC INC One Pacific Building 621 Pacific Ave., Suite 400 Tacoma WA 98402 CONTACT Anne Cutting g PHONE (253)272 -1151 FAX .(353)2]2 -1]35 E-MAIL .annec @hentschell.com DRESS INSURERS AFFORDING COVERAGE NAICM INSURER A American Fire and Casualty Co. 24066 INSURED American Electrical Services, Inc. P.O. BOX 1350 Buckley WA 98321 INSURERB Ohio Security Insurance Co. 24082 INSURERC'O110 Casualty Insurance Co. 24074 INSURER O. Auburn, WA 98001 INSURER E $ 1,000,000 INSURER X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:14 -15 GL,AUTO,UMB REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLILYNUMBER POLICY EFF MM ODIYYYY POLICY EXP IMMIDDIYYYYI LIMITS AUTHORIZED REPRESENTATIVE GENERALLIABILITY Community Development & Public Worker Dept 25 West Main Street Auburn, WA 98001 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $ 1,000,000 A CLAIMS -MADE OCCUR X 1CA55618773 /2/2014 /2/2015 MED EXP (Any one person ) $ 15,000 PERSONAL B ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,000 $ POLICY X PRO- LOC JFCIT AUTOMOBILE LIABILITY EO MDINIBDI SINGLE LIMIT 11000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HX X AS55618773 /2/2019 /2/2015 BODILY INJURY (Per accident) $ par. Ee (DAMAGE $ HI RED AUTOS X AUTOSWNED Medical payments $ 5 000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 L. EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,00 $ 1US055618773 /2/2014 /2/2015 A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICEWMEMBER EXCLUDED'+ (Mandatory in NH) NIA A Stop Gap RA55618773 /2/2014 /2/2015 EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYE $ 1,000,000 I(yes, describe under DE SCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) RE: Contract No. 14 -16 Project No CP1322, Annual Traffic Signal Improvements. City of Auburn is additional insured per form CG8810 04 13. Completed operations coverage included per form CG8583 04 13. Coverage is primary and non contributory per CG8810 04 13. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 (201005) 01 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Auburn Engineering Division AUTHORIZED REPRESENTATIVE Community Development & Public Worker Dept 25 West Main Street Auburn, WA 98001 Anne Cutting /AJC)"` ACORD 25 (2010/05) INS025 (201005) 01 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT NON -OWNED AIRCRAFT NON -OWNED WATERCRAFT PROPERTY DAMAGE LIABILITY - ELEVATORS PAGE 2 2 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 3 ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON - CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS /MALPRACTICE AND WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES 6 NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc , with its permission. Page 1 Of 8 With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON -OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured; 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot In command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON -OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following. This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY - ELEVATORS 1. Under Paragraph 2. Exclusions of Section 1 - Coverage A - Bodily Injury And Property Damage Liabil- ity, Subparagraphs (3). (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance; The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of Section I -Coverage A -Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow- ing Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. m 2013 Liberty Mutual Insurance CG 86 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 8 b. The last paragraph of subsection 2. Exclusions is replaced by the following Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits Of Insurance. 2. Paragraph 6. under Section III -Limits Of Insurance is replaced by the following 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to a. Anyone premise (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection Sys- tems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 1 As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnities any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract" E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES A AND B 1. Under Supplementary Payments -Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following- d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit ", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1 Paragraph 2. under Section II - Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused in whole or in part by a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "per- sonal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Libeny Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8 b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization, or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury", "property damage ", or "personal and ad- vertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard" (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar expo- sures, or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. However- 1 The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.e. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.e. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor The insurance provided by this endorsement applies only if tko written contract or written agreement is signed prior to the "bodily injury" or "property damage" We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi- tions. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured. b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs. c. "Bodily injury ", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying services, including (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occur- rence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "Bodily injury" or "property damage" occurring after- (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS endorsement is- sued by us and made a part of this policy 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance. a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. H. PRIMARY AND NON - CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend- ed as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 8 b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non - contributory, this insurance is excess over any other insurance for which the addi- tional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. I. ADDITIONAL INSUREDS • EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy 1 The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable, a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified In a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section 111 - Limits of Insurance of this policy, whichever are less. these limits are inclusive of and not in addition to the limits of insurance available under this policy J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS /MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II - Who is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injury" (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co- "employee" while in the course of his or her employ- ment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co- "employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above, (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing profes- sional health care personnel to others, or if coverage for providing professional health care ser- vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, includes the direct supervision of other "employ- ees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and ® 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services office, Inc., with its permission. Page 6 of 8 advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury ", or caused in whole or in part by their intoxica- tion by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee" K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section It - Who Is An Insured is replaced by the following 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However- a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization, and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre- sentations: Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV - Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence ", offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section 11- Who Is An Insured or a person who has been designated by them to receive reports of "occurrences ", offenses, claims or "suits" shall have received such notice from the agent, servant or "employee" N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. 0. BODILY INJURY REDEFINED Under Section V - Definitions, Definition 3. is replaced by the following 3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sick- ness or disease. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance services Office, Inc., with its permission. Page 7 of 8 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following- a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8- Trans- fer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agree- ment. O 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 COMMERCIAL GENERAL LIABILITY CG 85 83 04 13 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED CONTRACTORS - PRODUCTS /COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. under Section II - Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract or written agreement. Such person or organization is an additional insured but only with respect to liability for "bodily injury" or "property damage 1. Caused by "your work" performed for that additional insured that is the subject of the written contract or written agreement, and 2. Included in the "products- completed operations hazard" However- a) The insurance afforded to such additional insured only applies to the extent permitted by law; and b) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the 'bodily injury" or "property damage" We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Conditions. B. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: 1. 'Bodily injury" or "property damage" that occurs prior to you commencing operations at the s location where such "bodily injury" or "property damage" occurs. 2. 'Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any a professional architectural, engineering or surveying services including: a. The preparing, approving or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawing and specifications; and b. Supervisory, inspection, architectural or engineering activities. O 2013 Liberty Mutual Insurance CG 85 83 04 13 Includes oopynghted material of Insurance Services Office, Inc., with its permission Page 1 of 2 C. With respect to the Insurance afforded by this endorsement, exclusion I. Damage To Your Work of Paragraph 2. Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: I. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard" •— D. With respect to the insurance afforded to these additional insureds, the following is added to Section 11 - Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: p c 1 Required by contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declaration. whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declaratio ns. sE. With respect to the insurance afforded by this endorsement, Section IV - Commercial General Liability Conditions is amended as follows: 1 The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claims Or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under 5 this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. Paragraph 4. of Section IV - Commercial General Liability Conditions is amended as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non - contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ® 2013 Liberty Mutual Insurance CG 85 83 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 2 A Search > AMERICAN FIRE AND CASUALTY COMPANY AMERICAN FIRE AND CASUALTY COMPANY General I Contact I Licensing I Appantments I Complaints I Orders I National Info I Patings Back to Search General information Name: AMERICAN FIRE AND CASUALTY COMPANY Corporate family group: LIBERTY MUT GRP What i5 this? Organization type: PROPERTY WAOIC: 68 NAIC: 24066 Status: ACTIVE Admitted date: 07/01/1981 Ownership type: STOCK ' back ro too Contact information Registered address 62 MAPLE AVE KEENE, NH 03431 Telephone 513- 867 -3000 Types of coverage authorized to sell What is lbr? Insurance types Casualty Marine Ocean Marine Property Surety Vehicle ^ back to top Agents and agencies that represent this company (Appointments) Whal1s Ibis: View agents View agencies Stick to top Company complaint history What is this? View complaints ^ back to top Disciplinary orders 2008 -2014 k,,bat „tb,=, Year _Order Numbe_ r 2012 _— 12- 0253__ 1 Page 1 of? Mailing address 175 BERKELEY ST BOSTON, MA 02116 Telephone 617- 357 -9500 The orders posted here are unverified electronic duplicates of the official orders actually entered. To be certain you have the official version of the order as entered, request a hard copy from Renee Moines at 360 - 725 -7047 or email legal @oic.wa.gov Looking for other orders? Our online orders search allows you to search a ten year history of all orders, including enforcement orders, administrative orders, and general orders. ^ back to lop http: / /www. insurance .wa.gov /consumertooIkit/ Company /Compan),Profile.aspx ?WAOIC =68 9/26/2014 Page 2 of 2 National information on insurance companies want more information about this company? The NAIC's Consumer Information (CIS)_page allows you to retrieve national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. Nck romp Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability Some of these companies charge for their services. A.M Best_ _ Weiss Groin Ratings _ Standard and Poor's Corp _ —I Imoody's Investors Service IFdch IBCA, Duff and Phelps RatingL ^ back to top http: / /www. insurance .wa.gov /consumertoolkit/ Company /CompanyProfile.aspx ?WAOIC =68 9/26/2014 A.M. Best's Consumer Insurance Information Center Page 1 of 1 —A.M. BetsMt'psC F y� /� ggnsuliii# 11k±Rt; ran L E(LG rf -0 Member Center Lot�ln I $fin U2 Need Coverage? How Does Your Insurer Rate? State Insurance Information FFndmsutetn by state m roverage type Enters corn Name FMI Beletls slate Consumer Home I Term; m Knom I 'Ab) a Best'; Ratng IS Important I Contact Us Life 8 Retirement O Health 8 Dlsablhty Q Car 8 Home O Other Life Events American Fire and Casualty Company Print this pane (a mein e, orboem mutual insurance Compossesl AM Besttl loss Plain It 21. FEIN* Sn- 0141790 ' Address 175 Berkeley Street Phone 513-503 -2400 Boston, MA 02116 Fax 513-603 -3179 UNITED STATES Web www LbertvMUtualGrouo cord Best's Ratings ViewDetmrtion Need More information? Financial Strength Rating A Purchase an Insurer repot complete with Outlook Stable rating history, market share and a list of ive insurers 'I. Effective Date September 24, 2014 (Affirmed I V p Sample Repo for $ 9 95 w Financial Size Category XV ($2 Billion or greater) ma Licensing: The company Is licensed in the District of Columbia, AL, AK, AZ, AS CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KS, KY IA, MD, MA, MI, MN, MS, M0, MT NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SO, TN, TX, UT, VA, WA, WV, WI and WY 11 Top Line( s) of Business cased upon oLea wemluimwrmant 1 Commercial Multiple Peril (vew De stns t 2 Auto (Commercial) of.. Denent 3 Workers' Compensation crew De n no t 4 Other Liability (Occurrence) ryew Defil 5 Auto (Personal)fuew Defimllnn) Top States) of Business tried upon DiNu raermums wnvent 1 Washington 2 Pennsylvania i.. 3 California 4 New Jersey 5 Texas Visit our New a Room for the latest News and Press Releases for this company and Its A M Best Group ._ _ --- --- - - - ------------ Terms of Use ICI All information provided an the A M Best website, including but not limited to text, data ratings, reports, images, photos, graphics, and charts is owned by or licensed to A M Best Company and Is protected by United States copyright laws and international treaty provisions A M Best and Rs licensors retain all copyright and other proprietary rights to the website content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third Ponies, or stored in a database or retrieval system in any form for commercial purposes without the prior written permission of the A M Best Company. All unauthorized use of Best's Credit Ratings or other published information is strictly prohibited By logging into Best's Member Center or accessing this site you accept and agree to be bound by our complete Terms of Use Customer Service I Product Su000rc l Member Center I Contact ne I Careers About A M Best I Si;,Ma I Pnvacv Police I Security I Terms of Use I Legal 3 LiCensrna Copynght 0 2014 A M Best Company, Inc ALL RIGHTS RESERVED A M Best Worldwide Headquarters, Arrest Road, Diawick, New Jersey, 09858, U S A http: /hvwxv3.ambest.com/ Consumers/ CompanyProfile .aspx' ?BL= 36 &ambnarril 128 &P 9/26/2014 }R Search > OHIO SECURITY INSURANCE COMPANY OHIO SECURITY INSURANCE COMPANY General I Contact I Licensing I Appointments I Complaints I Orders I National Into I Ratings Back to Search General information Contact information Name: OHIO SECURITY INSURANCE COMPANY Registered Corporate family group: LIBERTY MUT GRP address Organization type: PROPERTY 62 MAPLE AVE KEENE, NH 03431 WAOIC: 1007 NAIC: 24082 Telephone 513- 867 -3023 Status: ACTIVE Admitted date: 06/11/1974 Ownership type: STOCK - back to top Types of coverage authorized to sell ,hot isfli nsurance types Marine n Marine bah to top Agents and agencies that represent this company (Appointments) ,vnat is tnis View agents View agencies bait to top Company complaint history b,hot Is this? View complaints ^ back to top Disciplinary orders 2008 -2014 V ,hat is tbis> (Year Order Number 2012_ I12 -0253 Page 1 of 2 Mailing address 175 BERKELEY ST BOSTON, MA 02116 Telephone 617 - 357 -9500 The orders posted here are unverified electronic duplicates of the official orders actually entered. To be certain you have the official version of the order as entered, request a hard copy from Renee Moines at 360 - 725 -7047 or email legal @oic.wa.gov Looking for other orders? Our online orders search allows you to search a ten year history of all orders, including enforcement orders, administrative orders, and general orders. bah to top http: /hvww. insurance .wa.gov /consumertoolkit/ Company /CompanyProfile.aspx''WAOIC= 9/26/2014 Page 2 of 2 National information on insurance companies Want more information about this company? The MAIC's Consumer Information_ (CIS) page allows you to retrieve national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. ^ bad to cop Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability Some of these companies charge for their services. Best_ 'Weiss Group Ratings Standard and-Po or's Corp Moody's Investors Service Fitch IBCA, Duff and Phelps Ratings ^ back to top http: // v""v. insurance. wa. gov /consuinertool kit / Company /ConipanyProfile.aspx ?WAOIC= 9/26/2014 A.M. Best's Consumer Insurance Information Center Page 1 of 1 As../M�y, Best's M KL�1ccyy��Ef�yr�iinnqp /'�q�t(,AG il,.gnr8 timer ln-Su ag ,"! , C,4 ?I teF III Member Center Login l Sign Up Need Coverage? How Does Your Insurer Rate? State Insurance InformationII, Find Insurers by state or coverage type Eoter s Company Name �� selerla Slate IConsumer Home I Terms to Know I My a Best s Rabng Is Important I Contact Us © Life 8 Retirement © Health & Disability 0 Car & Home O Other Life Events Ohio Security Insurance Company A PD,tttis Daaa P i^ere er of Leenr M owe 24082con'Eill # AM aeMp 0]3]9 NAICY 3008] FEltlp 310601777 Address 175 Berkeley Street Phone 513603 -2400 Boston, MA 02116 Fax 513-603-3179 '.. UNITED STATES web www LibetivMutualGroup coin I Best's Ratings ViewDeonitlon Need More information? Financial Strength Rating A Purchase an insurer report, complete with Outlook Stable rating history share and a list of I Effective Data September 24, 2014 (Affirmed ) competitive insurers for $ 9 95 Financial Size Category XV (f2 Billion or greater) C`ey Vie, Sample Rem, Licensing: The company Is licensed In the District of Columbia, AL, AK, AZ, AR, CO, CT, DE, FL, GA, ID, IL, IN, IA, KS, KY LA, MD, MA, MI, MN, MS, M0, MT, NE, NV, NJ, NM, NY NC, ND, OH, OK, OR, PA, RI, SC, S0, TN, T$ UT, VA, WA, VvV, WI and WY Top Lines) of Business Ibeeea.mn Daea p —orre w,menf 1 Commercial Multiple Peril lmew D,nnniont 2 Auto (Commercial) New Deemenn 1 3 Workers' Compensation (vmw Di, nmuii ) 4 Other Liability (Occurrence) New Deenmon) 5 Products Liability New Dnonitiol) Top State(s) of Business teased upon Direct wenaums voider) 1 Washington 2 Texas 3 Colorado 4 Oregon 5 New Jersey Visit our NewsRoom for the latest News and Press Releases for this company and Its AM Best Group Terms of Use All Information provided on the A M Best webslte, Including but not limited to text, data ratings, reports, Images, photos, graphics, and charts Is owned by or licensed to A M Best Company and is protected by United States copyright laws and international treaty provisions A M Best and its licensors retain all copyright and other proprietary rights to the webslte content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Thnd Parties, or stored In a database or retrieval system in any forth for commercial purposes without the prior written permission of the A M Best Company All unauthorized use of Best's Credit Ratings or other published Information Is strictly prohibited By logging Into Best's Member Center or accessing this site, you accept and agree to be bound by our complete Terms of Usa Customer SeN ce I Product SuPew llvlember Center l Contact Info l Careers About A M Best I Site Mao I Pnvacv POhw I Security I Terms of Use I Legal 3 Licensing Copynght®2014AM Best Company, Inc ALL RIGHTS RESERVED A M Best Worldwide Headquarters, Ambest Road, Gir lck, New Jersey, 084358, U S A http: / /www3.ambest.com/ Consumers/ CompanyProfile .aspx' ?BL= 36 &ambnum= 002379 &P 9/26/2014 Page I of 2 }R Search > OHIO CASUALTY INSURANCE COMPANY THE OHIO CASUALTY INSURANCE COMPANY THE General I Contact I Licensing I Appointments I Complaints I Orders I National Info I Ratings Back to Search General information Contact information Name: OHIO CASUALTY INSURANCE COMPANY THE Registered Corporate family group: LIBERTY MUT GRP %Vhat,�t,,> address Organization type: PROPERTY 62 MAPLE AVE KEENE, NH 03431 WAOIC: 1001 NAIC: 24074 Telephone 513- 603 -2400 Status: ACTIVE Admitted date: 04/10/1926 Ownership type: STOCK back to to, Types of coverage authorized to sell ,,batstb. Insurance types Casualty Disa_billty Marine Ocean Marine Property FSurety_ ehicle ^ ba!k to tcp Agents and agencies that represent this company (Appointments) View agents View agencies " bad to tap Company complaint history O,hat i.[Ns> View complaints back b top Disciplinary orders 2008 -2014 Year Order Number 2012 L12 -0253 Mailing address 175 BERKELEY ST BOSTON, MA 02116 Telephone 617- 357 -9500 The orders posted here are unverified electronic duplicates of the official orders actually entered. To be certain you have the official version of the order as entered, request a hard copy from Renee Moines at 360 -725 -7047 or email legal @olc.wa.gov Looking for other orders? Our online orders search allows you to search a ten year history of all orders, including enforcement orders, administrative orders, and general orders. ^ bad to tap http: / /vt�vNv. insurance .wa.gov /consumertoolkitI Company lCompanyProfile.aspx ?WAOIC= 9/26/2014 Page 2 of 2 National information on insurance companies Want more information about this company? The NAIC's Consumer Information (CIS)_page allows you to retrieve national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. ^ "C^ to top Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability Some of these companies charge for their services. 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State Insurance Information Find Insurers by state or coverage type Entera company rvame = soled a Stale Consumer Home I Terms to Know I Vvhy a Best's Rating Is Important I Conuad U= Life 8 Retirement O Health 8 Disability Q Car & Home O Other Lde Events Ohio Casuaky Insurance Company A Print this pace la member of Lii eriy Mutual Insurance Companies) AM anin#01318 .PICA Nm< FEIN* 31- OoN250 Address 115 Berkeley Street Phone 513-603 -2400 Boston, MA 02116 Fax 513-603 -3119 UNITED STATES Web cow 1-heloMUtualGrouo can Best's Ratings View Definition Need More information? Financial Strength Rating A Purchase an insurer report, complete with Outlook Stable rating history, market share and a list of Effective Date September 24, 2014 (Affirmed) competitive Insurers for $ 9 95 Financial Size Category XV ($2 Billion or greater) View Sample Repon Licensing: The company Is licensed In the District of Columbia and all slates Top Lines) of Business (loosed upon oared memiuim wrmenf 1 Other Liability (Occurrence) (view Demmer) 2 Surety Nrew oennninn) 3 Commercial Multiple Peril me. Dannihon) 4 Auto (Commercial) (vie. oerovnm ) 5 Workers' Compensation New Definition ) Top States) of Business (b.eee open curl Premiums woven) 1 New Jersey 2 Washington 3 Pennsylvania 4 Texas 5 New York Visit our NewsRoom for the latest News and Press Releases for this company and Its A M Best Group Terms of Use All mfoanation provided on the A M Best websile, including but not limited to text, data, ratings, reports, Images, photos, graphics, and coeds Is awned by or licensed to A M Best Company and Is protected by United States copyright laws and International treaty provisions A M Best and Its licensors retain all copyright and other proprietary rights to the websile content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third PaNes, or stored In a database or retrieval system In any form for commercial purposes without the pnor written permission of the A M Best Company All unauthorized use of Best's Credit Ratings or other published mfor ustion is strictly prohibited By logging Into Best's Member Center or accessing this site, you accept and agree to be bound by our complete Terms of Use CustomerServirelPfoJucl n I Maureen Center I Conlr %t Info I Careers About A M Seed Ste Ma l Pnvacv PJl.c Siam I Terms of Use l Leval s Licensing Copynght® 2014 A M Best Company, Inc ALL RIGHTS RESERVED A M Best worldwide Headquarters Ambest Road, Old ck, New Jersey, 06958, U S A http: / /www3.ambest.com/ Consumers /ConipanyProtile .asps ?BL= 36 &,ambnuni- 002378 &P 9/26/2014 WASHINGTON Escrow Agreement For Retainage Declined AMERICAN ELECTRICAL SERVICES, PO BOX 1350, BUCKELY, WA, 98321 (CONTRACTOR) acknowledges that they have been offered the option of setting up an escrow agreement for their retainage on Contract No 14 -16, Project No CP1322, ANNUAL TRAFFIC SIGNAL IMPROVMENTS The CONTRACTOR declines to set up an escrow agreement and understands that the City will hold the 5% retainage with no interest until the project is complete, accepted by the City, and all releases and liens have been satisfied. Title File 13 11 (CP1322) AUBURN *MORE THAN YOU IMAGINED CITY OF AUBURN CONTRACT CHANGE ORDER AGREEMENT NO. I Contract No., Project No. and Project Title: Contract No. 14 -16, Project No. CP1322 Annual Traffic Sugnal Improvements Contractor Name and Address: American Electrical Services, Inc. P.O. Box 1350 Bucklev. WA 98321 The Contractor is hereby directed to make the changes to the Contract as described herein. This document and all attachments are a supplement to the contract All work_ materials and measurements for the type of construction involved shall be in accordance avith the contract documents of the above named project unless stated othencise in this change order Summary of Proposed Changes: 1. Three (3) Non- Compensable working days added to the Contract for the following reasons: a) Remove and reinstall faulty video detection camera cable which was installed at the intersection of 15th St SW and Industry. b) Relocate one 3- section signal head (westbound) at the intersection of Lakeland Hills Way and Lake Tapps Parkway. Signal head to be installed at location verified by the engineer. c) Procurement of faulty pushbutton equipment. Contractor to install new pushbutton on ppb pole at the intersection of Auburn Way North and 8th St NE. The Contract time is extended by days. Item Sch. Sec. No. Item Description Quantity ( +/-) Units I Unit Price (S) Total Price ( +/-) $ - 3., Original ConttactAmount $ 132,711.00 Contract Time Extension Only 4. Revised Contract Amount S 132,71 1.00 $ 132,711.00 $ Subtotal Washington State Sales Tax (9.5 %) on applicable items TOTAL $ $ $ This change order constitutes full and complete compensation for all labor. equipment. materials. overhead, profit. any and all indirect costs, and time adjustment to perform the ahove described changes All other costs are non- compensable. / -27 -/3 Contractor: 9�% / Inspector: Project Manager: City Engineer: Approved by: K \Forms \Change0rder.x1s Auburn D, m /-17 -Ir S� . Base Amount Total incl. Tax 1. Total Cost this CIO is 4, $ 2. Total Cost Previous CIO '$,' - $ - 3., Original ConttactAmount $ 132,711.00 $ 132,711.00 4. Revised Contract Amount S 132,71 1.00 $ 132,711.00 This change order constitutes full and complete compensation for all labor. equipment. materials. overhead, profit. any and all indirect costs, and time adjustment to perform the ahove described changes All other costs are non- compensable. / -27 -/3 Contractor: 9�% / Inspector: Project Manager: City Engineer: Approved by: K \Forms \Change0rder.x1s Auburn D, m /-17 -Ir S�