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CP1913 #19-14 Sewer Manhold Ring & Cover Replacement
CITY OF AUBURN Nancy Backus, Mayor WASHINGTON 25 West Main Street * Auburn WA 98001-4998 * www.auburnwa.gov* 253-931-3000 August 27, 2019 CERTIFIED MAIL RETURN RECEIPT REQUESTED Max Stickley Pavement Maintenance of Washington, LLC 19411 Green Valley Road Auburn, WA 98092 RE: Award of Contract- Contract No. 19-14 Project No. CP1913, Sewer Manhole Ring & Cover Replacement Letter of Award Dear Mr. Stickley: Bids for construction of the above-referenced project were opened by the City Clerk at Auburn City Hall on Tuesday, August 20, 2019, at 11:00 AM. Five (5) responsive bids were received and have been tabulated. Your firm submitted the lowest responsible bid. The total award amount including Washington State sales tax is $115,280.00. On August 23, 2019, the Public Works Director approved award of the project to your firm. This letter serves as your notification of award for the subject project and is a contract specification. Please execute and return the following documents to the attention of Amanda DeSilver, Contract Administration Supervisor, within seven (7) calendar days after receipt of this letter. a) Contract, in duplicate. b) Declaration of Option for Performance Bond or Additional Retainage, in duplicate. c) Certificate(s) of insurance naming the City of Auburn as additional insured, in duplicate, for all required insurance coverages. Please include the Contract Number, Project Number and Project Name on the certificate(s). A pre-construction meeting has been scheduled for 11:00 AM on Tuesday, September 10, 2019, in Conference Room#1, located on the second floor of One East Main Street,Auburn. The City requires that the Contractor have the appropriate personnel at the pre-construction meeting. This would include, at a minimum, the project manager and the on-site superintendent. The Contractor is encouraged to include any of their staff or sub-contractor staff they feel are critical to the project. The Contractor shall submit electronically one (1)day prior to the pre-construction meeting: a) Preliminary Progress Schedule for the first 30 working days. b) Breakdown of lump sum items as applicable except For, Mobilization. c) SPCC Plan per Section 1-07.15(1) of the Contract Documents. ENG-008,Revised 8/18 AUBURN 'k MORE 'MAN YOU IMAGINED Pavement Maintenance of Washington, LLC August 27, 2019 Page 2 of 2 Please bring the following items to the pre-construction meeting: a) Requests to sublet work for all subcontractors and lower tier subcontractors. b) Emergency call list. c) A schedule of equipment and labor rates, as outlined in Section 1-09.6 (Force Account)to be utilized in the event of any Force Account activities. As noted in the contract documents, a Notice to Proceed will be issued within five (5) working days of the contract execution date, which is the date the contract has been fully executed by the City. If you do not have a current Business License to work in the City of Auburn, an application has been included and should be returned to the Customer Service Center, One East Main Street, Auburn, as soon as possible. All subcontractors and lower tier subcontractors working on the project must also have a City of Auburn business license. Please contact me at 253-804-5063, or the Contracts Administration Supervisor, Amanda DeSilver at 253-876-1980 with any contract administration related questions. Sincerely, c J- ey Bender, P.E. Project Engineer Public Works Department JB/ad/as Enclosures cc: Shawn Campbell, City Clerk Debra Alvarez, Project Inspector File 13.11 (CP1913) ENG-008, Revised 8/18 CITY OF AUBURN Nancy Backus, Mayor WASHINGTON 25 West Main Street * Auburn WA 98001-4998 * www.auburnwa.gov * 253-931-3000 September 13, 2019 CERTIFIED MAIL RETURN RECEIPT REQUESTED Max Stickley Pavement Maintenance of Washington, LLC 19411 Green Valley Road Auburn, WA 98092 NOTICE TO PROCEED RE: Project No CP1913, Sewer Manhole Ring & Cover Replacement, Contract#19-14 You are hereby notified to proceed as of September 13, 2019 with the work on the above- referenced project, within the time period specified, in accordance with the provisions of the contract documents, copy enclosed. Your first working day will be September 16, 2019.This project has 40 working days for completion. If you have any questions, please contact the inspector for the project, Debra Alvarez at 253-876-1922 or the Contract Administration Supervisor, Amanda DeSilver at 253-876-1980. Sincerely, 'Ryan Vondrak, PE Capital & Construction Engineering Manager Public Works Department RV/ad/as Enclosure cc: Shawn Campbell, City Clerk Jacob Sweeting, Assistant Director of Engineering/City Engineer Jeff Bender, Project Engineer Debra Alvarez, Project Inspector File 13.11 (CP1913) ENG-017, Revised 12/18 AUBURN * MORE THAN YOU IMAGINED CONTRACT Contract No. 19-14 THIS AGREEMENT AND CONTRACT, made and entered into, in duplicate, at Auburn, Washington, this 13 day of ..Se_OtAvtbc.c, 2019, by and between the CITY OF AUBURN, WASHINGTON, a municipal corporation, and Pavement Maintenance of Washington, LLC, 19411 SE Green Valley Road, Auburn, WA, 98092, hereinafter called the CONTRACTOR. WITNESSETH: That, in consideration of the terms and conditions contained in the Contract Documents entitled "CP1913, Sewer Manhole Ring and Cover Replacement," which are by this reference incorporated herein and made a part of this Contract, the parties hereto covenant and agree as follows: I. The CONTRACTOR shall do all work and furnish all tools, materials and equipment for Project CP1913, Sewer Manhole Ring and Cover Replacement — replacement of failing sewer manhole rings and covers and providing applicable traffic control at various locations throughout the City for a unit bid price of one hundred and four thousand, eight hundred dollars ($104,800.00) and Washington State Sales Tax of ten thousand, four hundred and eighty dollars ($10,480.00) for a total contract value of one hundred and fifteen thousand, two hundred eighty dollars, ($115,280.00) 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 40 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. II. 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. IV. It is further provided that no liability shall attach to the CITY OF AUBURN, WASHINGTON 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 hereinabove written. CITY OF AUBURN, WASHINGTON By Na ackus, Mayor Countersigned: this /r`day of 5-tp1f.Alb-e,-;2019 APPROVED AS TO FORM: Q eve Gross, City Attorney PAVEMENT MAINTNEANCE OF WASHINGTON, LLC By w Authorized Official Signature * Declaration of Option CITY OF � ���- A For Performance Bond or Additional Retainage WASHINGTON (Contracts Under$150,000 only) Project No. CP1913, Sewer Manhole Ring & Cover Replacement Contract No. 19-14 Note: This form must be submitted at the time the Contractor executes the Contract. The Contractor shall designate the option desired by checking the appropriate space. Pavement Maintenance of Washington, LLC 19411 Green Valley Road Auburn, WA 98092 The Contractor elects to: ❑ 1. Furnish a performance bond in the amount of the total contract sum, in which case the City shall hold back retainage in the amount of five percent (5%.) An executed performance bond on the required sum is included with the executed contract documents. '14, 2. Have the City retain, in lieu of performance bond, ten percent (10%) of the total contract amount for a period of thirty (30) days after final acceptance or until receipt of all necessary releases from the State Department of Revenue and the Department of Labor and Industries and settlement of any liens filed under Chapter 60.28 RCW, whichever is later. In choosing Option 2, the Contractor agrees that if the Contractor, its heirs, executors, administrators, successors, or assigns shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the Contract, and shall faithfully perform all the provisions of such contract and shall also well and truly perform and fulfill all the undertakings, covenants, terms, conditions and agreements of any and all duly authorized modifications of the Contract that may hereafter be made, at the time and in the manner therein specified, and shall pay all laborers, mechanics, subcontractors, and materialmen, and all persons who shall supply such person or persons, or subcontractors, with provisions and supplies for the carrying on of such work, on his or her part, and shall indemnify, defend and hold harmless the City of Auburn and its officials, agents, and employees from any claim for such payment, then the funds retained in lieu of a performance bond shall be released at the time provided in said Option 2; otherwise, the funds shall be retained until the Contractor fulfills the said obligations. Pavement Maintenance of Washington, LLC Signature VV I � V Printed Na e Ey\n bkA Title, PaTtler Date �'" 12' ENG-114, Revised 11/18 ACOREP L.---- CERTIFICATE OF LIABILITY INSURANCE l DATE(MM/DO/YYYY) 09/03/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT English Insurance Group,LLC PHONE Kristie English FAX 5005 200th Street SW Suite 102 EMA�o.Ext): (425)673-7948 INC,No): (425)673-7942 LYNNWOOD,WA 98036 ADDRESS: kristie@englishinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIC# License#: 245177 INSURER A: OHIO SECURITY INSURANCE COMPANY 24082 INSURED INSURER B: MUTUAL OF ENUMCLAW 14761 PAVEMENT MAINTENANCE OF WASHINGTON,LLC INSURER C: National Union Fire Insurance Company of Pittsb 24074 DBA PMOW LLC,SOUTH EASTERN ASPHALT SERVICES,SEAS 19411 SE GREEN VALLEY RD INSURER D: AUBURN, WA 98092 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 84 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR( TYPE OF INSURANCE ADDL SUBR' POLICY EFF POLICY EXP LTR INSD WVD I POLICY NUMBER (MMIDDIYYYY) IMMIDD/YYYYL LIMITS A X COMMERCIAL GENERAL LIABILITY Y 1I BLS59286086 11/26/2018 11/26/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I X I JE a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY CPP0024376 11/26/2018 11/26/2019 (Sae cdeDn SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS 1 - HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) _ `` _ UMBRELLA LIAB X OCCUR EBU018232547 12/19/2018 11/26/2019 EACH OCCURRENCE $ 2,000,000_ X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ $ A ANDEMPLOYERSWORKERS ELABILOTY YIN BLS59286086 11/26/2018 11/26/2019 X STATUTE ERH Stop Gap ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000_ i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as Additional Insured when required by written contract per attached form CG 88100413. CP1913,Sewer Manhole Ring&Cover Replacement,Contract 19-14 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Auburn ACCORDANCE WITH THE POLICY PROVISIONS. 25 West Main Street AUBURN, WA 98001 AUTHORIZED REPRESENTATIVE I ,v -C� 17.---7-77414 (KRE) ' V ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by KRE on September 03,2019 at 03:13PM ENDORSEMENT No. 19 This endorsement,effective 12:01 AM: December 19, 2018 Forms a part of policy no: EBU 018232547 Issued to: PAVEMENT MAINTENANCE OF WASHINGTON LLC By: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. Prime ExpresssM Additional Insured Endorsement -- Primary and Non-Contributory This policy is amended as follows: Section VII. DEFINITIONS, Paragraph N. is amended to include the following additional provision: Insured means: Any person or organization for whom you are performing operations when you and such person or organization have agreed in visiting in a contract or agreement that such person or organization is an additional insured on your policy, but only if such person or organization is included under the coverage provided by Scheduled Underlying Insurance. Such person or organization is an additional insured only with respect to liability arising out of Your Work at the location(s) designated in such contract or agreement. This provision does not apply to liability arising out of the sole negligence of such person or organization for its own acts or omissions or those of its employees or anyone else acting on its behalf. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization. All other terms, definitions, conditions, and exclusions of this policy remain unchanged. Authorized Representative or Countersignature (Where Applicable) 105514(5/10) AH 2894 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 s 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 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 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. © 2013 Liberty Mutual Insurance CG 85 83 04 13 Includes copyrighted 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 II - 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: 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. E. 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 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 COMMERCIAL GENERAL LIABILITY CG 88 70 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S) - GENERAL AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. For all sums which the insured becomes legally obligated to pay as damages caused by"occurrences" under Section I—Coverage A- Bodily Injury And Property Damage Liability, and for all medical expenses caused by accidents under Section I—Coverage C Medical Payments,which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of"bodily injury"or"property damage" included in the"products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by"occurrences" under Section I—Coverage A-Bodily Injury And Property Damage Liability, and for all medical expenses caused by accidents under Section I—Coverage C Medical Payments,which cannot be attributed only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. When coverage for liability arising out of the"products-completed operations hazard" is provided, any payments for damages because of"bodily injury"or"property damage" included in the "products- completed operations hazard"will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply. CG 88 70 12 08 Includes copyrighted material of ISO Properties, Inc.,with its permission. Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 22 92 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SNOW PLOW OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Within the "products-completed operations haz- ard", Exclusion g. under Section I -Coverage A - Bodily Injury And Property Damage Liability does not apply to any "auto" used for snow plow oper- ations. CG 22 92 12 07 © ISO Properties, Inc., 2006 Page 1 of 1 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 PAGE NON-OWNED AIRCRAFT 2 - NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY -ELEVATORS 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 I - 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. ® 2013 Liberty Mutual Insurance CG 88 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 10 -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. Any one 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. 3. 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 indemnifies 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 Liberty 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.a. 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.c. 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 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 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 Declaratio ns. 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 III - 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 II -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 II - 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 43 effective in your state. O. 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. © 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 AUTO EA 99 11 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL BUSINESS AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The following changes revise SECTION I — COVERED The coverage that applies is the same as the AUTOS coverage provided for the vehicle being replaced. Paragraph C.1. is deleted and replaced with the Physical Damage Coverage is extended to the following: temporary substitute auto for the lesser of the 1. Trailers following number of days: a. "Trailers" with a load capacity of 2,000 1. The number of days reasonably required to pounds or less designed primarily for travel repair or replace the covered "auto" that is out on public roads; or of service; or b. "Trailers" designed primarily for travel on 2. 30 days. public roads when: The following changes revise SECTION II — LIABILITY (1) Pulled by an owned private passenger COVERAGE auto specifically described in Item The following is added to Paragraph A.1.: Three of the Declarations as a covered d. Blanket Additional Insured "auto" for Liability Coverage under this Coverage Form; and Any person or organization that you are required to include as an additional insured (2) Not used for business, farming or on this Coverage Form in a written contract ranching purposes. or agreement that is signed and executed Private passenger auto means a motor by you before the"bodily injury"or"property vehicle of the private passenger, station damage" occurs and that is in effect during wagon, pickup or van type designed for use the policy period is an "insured" for Liability on public highways and subject to motor Coverage, but only for damages to which vehicle registration. this insurance applies. The following is added: A person's or organization's status as an D. Temporary Substitute Autos—Physical Damage additional insured under this endorsement ends when your contract or agreement with If Physical Damage Coverage is provided by this such person or organization ends. Coverage Form, the following types of vehicles are also covered "autos" for Physical Damage The Limits of Insurance applicable to the Coverage: Additional Insured are those specified in the written contract or agreement but not more Any "auto" you do not own while used with the than the Limits of Insurance specified in the permission of its owner as a temporary substitute Declarations of this policy. The Limits of for a covered "auto" you own that is out of service Insurance applicable to the Additional because of its: Insured are inclusive of and not in addition 1. Breakdown; to the Limits of Insurance shown in the declarations for the Named Insured. 2. Repair; This Coverage does not apply to lessors of 3. Servicing; leased"autos". 4. "Loss"; or 5. Destruction. EA 99 11 03 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 1 of 6 e. Broadened Named Insured 2. Towing Any business entity newly acquired or We will pay up to $200 for a covered "auto" for formed by you during the policy period towing and labor costs incurred each time the provided you own 51% or more of the covered "auto" is disabled. However, the labor business entity and the business is not must be performed at the place of disablement. separately insured for Business Auto This coverage is excess over Coverage. Coverage is extended up to a maximum of 180 days following acquisition a. any limit shown in the Declarations for or formation of the business entity or until towing and labor costs; and the end of the policy period, whichever b. any other collectible insurance. comes first. This coverage applies only for an "auto" f. Employee Hired Auto covered on this policy for An"employee"of yours is an "insured"while c. Comprehensive or Specified Causes of operating an "auto" hired or rented under a Loss Coverage; and contract or agreement in that "employee's" d. Collision Coverage. name, with your permission, while performing duties related to the conduct of The following is added to Paragraph A.3 your business. Glass Repair—Waiver of Deductible Paragraphs A.2.a.(2) and A.2.a.(4) are deleted and No deductible will apply to glass breakage if replaced with the following: such glass is repaired in a manner acceptable 2. Coverage Extensions to us rather than replaced. a. Supplementary Payments Paragraph A.4.a. is deleted and replaced with the (2) Up to $5,000 for cost of bail bonds following: (including bonds for related traffic law 4. Coverage Extensions violations) required because of an a. Limited Rental Reimbursement or Travel "accident" we cover. We do not have to Expense furnish these bonds. We will pay up to $75 per day to a (4) All reasonable expenses incurred by maximum of $2,250 for rental the "insured" at our request, including reimbursement expenses for the rental of actual loss of earnings up to$500 a day an "auto" or other transportation expense because of time off from work. incurred by you because of "loss" to a Paragraph B.5. is deleted and replaced with the covered "auto" which is covered by following: Comprehensive, Specified Causes of Loss, 5. Fellow Employee or Collision coverage under this policy. No deductible applies to this coverage. "Bodily Injury"to: (1) We will pay only for those expenses a. Any fellow "employee" of the "insured" incurred as a result of a covered "loss" arising out of and in the course of the fellow occurring during the policy period "employee's" employment or while beginning 24 hours after the "loss" and performing duties related to the conduct of ending, regardless of the policy's your business. This exclusion does not expiration, with the lesser of the apply to an "insured" who occupies a following number of days: position as an officer, manager or (a) The number of days reasonably supervisor.; or required to repair or replace the b. The spouse, child, parent, brother or sister covered "auto". If "loss" is caused of that fellow"employee"as a consequence by theft, this number of days is of Paragraph a. above. added to the number of days it The following changes revise SECTION III—PHYSICAL takes to locate the covered "auto" DAMAGE COVERAGE and return it to you; or This coverage applies only for a covered "auto" for (b) 30 days. which Physical Damage Coverage is provided for on (2) Our payment under this Coverage this policy. Extension (4.a.) is limited to the lesser Paragraph A.2. is deleted and replaced with the of the necessary and actual expenses following: incurred or the maximum amount shown, $2,250. A. COVERAGE EA 99 11 03 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 2 of 6 (3) Coverage under this Coverage "loss", and such equipment is Extension (4.a.) does not apply while designed to be solely operated by there are spare or reserve "autos" use of the power from the "auto's" available to you for your operations. electrical system, in or upon the (4) If a covered "auto" is described or covered "auto". designated as a covered "auto" on (b) We will pay with respect to a endorsement EA 99 01, the coverage covered "auto" described in the provided by this extension is excess Schedule for "loss" to any over coverage provided by accessories used with the endorsement EA 99 01. electronic equipment described in The following is added to paragraph A.4. Paragraph (1)(a) above. However, this does not include tapes, records c. Tapes, Records and Discs or discs. We will pay for "loss" to tapes, records, (2)Exclusions compact discs, or other similar devices The exclusions that apply to Physical used with audio, visual or data electronic Damage Coverage, except for the devices. exclusion relating to Audio, Visual and (1) We will pay only if the tapes, records, Data Electronic Equipment, also apply compact discs, or other similar devices: to coverage provided by this extension. (a) Are your property or that of a family In addition, the following exclusions member; or apply: (b) Are the property of an "employee" We will not pay, under this extension, using a covered "auto" in your for either any electronic equipment or business affairs at the time of the accessories used with such electronic "loss"; and equipment that is: (c) Are in a covered "auto" which (a) Necessary for the normal operation sustains other covered "loss" under of the covered "auto" or the Comprehensive or Collision monitoring of the covered "auto's" coverage at the time of the "loss" to operating system; or tapes, records, compact discs, or (b) An integral part of the same unit other similar devices. housing any sound reproducing (2) The most we will pay for "loss" under equipment designed solely for the this Coverage Extension (4.c.) is$200. reproduction of sound if the sound reproducing equipment is (3) Physical Damage Coverage provisions permanently installed in the apply to this coverage, except that any covered "auto" in the opening of the deductible applicable to dash or console normally used by Comprehensive or Collision coverage the manufacturer for the installation does not apply to this Coverage Extension (4.c.). of a radio. d. Audio, Visual and Data Electronic (3) Limit of Insurance Equipment With respect to coverage under this (1) Coverage extension the Limit of Insurance provision of Physical Damage (a) We will pay with respect to a Coverage is replaced by the following: covered "auto" described in the (a) The most we will pay for all"loss"to Schedule for"loss"to any electronic audio, visual or data electronic equipment that receives or equipment and any accessories transmits audio, visual or data used with this equipment as a result signals and that is not designed of any one "accident" is the lesser solely for the reproduction of sound. of: This coverage applies only if the equipment is permanently installed (i) The actual cash value of the in the covered "auto" at the time of damaged or stolen property as the "loss" or the equipment is of the time of the"loss"; removable from a housing unit which is permanently installed in the covered "auto" at the time of the EA 99 11 03 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 3 of 6 (ii) The cost of repairing or g. Camper Bodies replacing the damaged or In the event of a "loss" to a detached stolen property with other "camper," physical damage coverage will property of like kind and quality; apply as if it were part of the covered "auto" or on which it is rated. (iii)$500. h. Contents of a Travel Trailer, Camper or (b) An adjustment for depreciation and Motor Home physical condition will be made in When a Travel Trailer, "Camper" or Motor determining actual cash value at Home is a scheduled auto for physical the time of the "loss". damage coverage, we will pay up to $1,000 (c) If a repair or replacement results in for "loss" to personal property belonging to better than like kind or quality, we you or a family member that is within the will not pay for the amount of Travel Trailer, "Camper" or Motor Home. betterment. We will pay up to $250 for"loss"to personal (4) Deductible property belonging to you or a family member that is outside the Travel Trailer, No deductible applies to this coverage. "Camper" or Motor Home. The insurance provided by this extension is (1) We will not pay for"loss" to: excess over any other collectible insurance. (a) Articles carried or held for sale, e. Custom Signs and Decorations storage or repairs, or for later Physical Damage coverage on a covered delivery; goods kept to show or sell; "auto" may be extended to "loss"to custom or theatrical wardrobes. signs and decorations including custom (b) Business, store of office furniture or murals, paintings or other decals or equipment. graphics. (c) Records or accounts, money, Our limit of liability for loss to custom signs bullion, deeds, contracts, evidences and decorations shall be the least of: of debt, securities,tokens or tickets, (1) Actual cash value of the stolen or stamps in current use or damaged property; manuscripts. (2) Amount necessary to repair or replace (d) Animals, private passenger "autos," the property; or motorcycles, aircrafts, boats or any (3) $500. other motorized vehicles or their equipment, furnishings or f. Personal Effects Coverage appurtenances. (1) Physical Damage Coverage on a (e) Equipment or accessories while covered "auto" may be extended to your Travel Trailer, "Camper" or "loss" to your "personal effects" or, if Motor Home is leased or rented to you are an individual, the "personal any organization or any person effects" of a family member, that are in other than you or a family member. the covered "auto" at the time of the (2) The maximum we will pay for "loss" is "loss". the lesser of: (2) "Personal effects" as used in this (a) The actual cash value of the extension means tangible property that personal property at the time of is worn or carried by the "insured". "Personal effects" does not include "loss"; tools, jewelry, money, securities, radar (b) The cost of repairing the damage; or laser detectors, or tapes, records, or discs or similar audio, visual or data (c) The cost of replacing the damaged electronic equipment. personal property with other (3) The most we will pay for any one "loss" personal property of like kind, under this coverage extension is $500. condition, quality and value. No deductible applies to this extension. The insurance provided by this extension is excess over any other collectible insurance. EA 99 11 03 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 4 of 6 i. Vacation Expense Allowance If hired "autos" are covered "autos" for Liability We will pay you $50 per day to a maximum Coverage and if Comprehensive, Specified of $500 for extra expenses when a Travel Causes of Loss or Collision Coverages are Trailer, "Camper" or Motor Home is a provided under this coverage form for any scheduled auto for physical damage "auto" you own, then the Physical Damage coverage, and the Travel Trailer, "Camper" Coverages provided are extended to "autos" or Motor Home: you hire of like kind and use, subject to the following: (1) Is damaged or destroyed and is uninhabitable; and a. The most we will pay for any one "loss" is $50,000 or the actual cash value or the cost (2) While being used for vacation purposes to repair and replace, whichever is less, within the policy period. minus a deductible; Extra expenses must by supported by b. The deductible will be equal to the largest receipts or other valid evidence. deductible applicable to any owned "auto" The following is added to Paragraph A.: for that coverage; 5. Extra Expense—Broadened Coverage c. Hired Auto Physical Damage coverage is We will pay for the direct expense of returning a excess over any other collectible insurance; stolen covered "auto" to you. We will pay only and for those covered "autos" for which you carry d. Subject to the above limit, deductible and Comprehensive or Specified Causes of Loss excess provisions, we will provide coverage Coverage. This coverage will only apply to equal to the broadest coverage applicable vehicles recovered inside the 48 contiguous to any covered "auto"you own. United States. This coverage does not apply to If a limit for Hired Auto Physical Damage is an "auto"we deem a total "loss". indicated in the Declarations, then that limit 6. Auto Loan/Lease Gap Coverage replaces, and is not in addition to, the $50,000 In the event of a covered total "loss" to a limit indicated above. covered "auto" described or designated in the The following is added to Paragraph B.3.a.: Schedule or in the Declarations, we will pay up Airbag Coverage—Accidental Deployment to $2,000 for any unpaid amount due on the However, this exclusion does nota I to the lease or loan for a covered "auto" less: unintended inflation of an airbag if the inflation a. The Amount paid under the Physical is caused by mechanical or electrical Damage Coverage section A.1. of the breakdown. policy; and The following is added to Paragraph C.2. b. Any: New Vehicle Replacement Cost (1) Overdue lease/loan payments at the time of the"loss"; If, however, a "loss" occurs to your covered "auto" within 180 days of your purchase of the "auto" and, (2) Financial penalties imposed under a we deem the covered "auto"to be a total "loss"and lease for excessive use, abnormal wear it has not been previously titled under the motor and tear or high mileage; vehicle law of any state, we will pay at your option: (3) Security deposits not returned by the a. the cost to replace the covered "auto" with a Lessor; new"auto" of like make, model and year; or (4) Costs for extended warranties, Credit b. an amount equal to the original purchase price Life Insurance, Health, Accident or you paid to acquire the vehicle, including taxes, Disability Insurance purchased with the but excluding any extended warranties and loan or lease; and licensing fees. (5) Carry-over balances from previous This coverage applies only to a covered "auto" of loans or leases. the private passenger, light truck or medium truck 7. Hired Auto Physical Damage Coverage type (20,000 lbs. or less gross vehicle weight). EA 99 11 03 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 5 of 6 The following changes revise SECTION IV — The following changes revise SECTION V — BUSINESS AUTO CONDITIONS DEFINITIONS The following is added to Paragraph A.2.a.: The following is added: Amended Duties in the Event of an Accident, Q. "Camper" means a portable dwelling unit without Claim, Lawsuit or Loss axles or wheels that has been manufactured for However, this duty is only required when the attachment on the bed of a pickup truck to be used "accident" is known to: for casual travel or camping. (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. The following is added to Paragraph A.: 6. Blanket Waiver of Subrogation We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident"because of payments we make for damages under this coverage form. The following is added to Paragraph B.2.: Unintentional Failure to Disclose Hazards Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business Auto Coverage Form or at any time during the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. Paragraph B.5.b. is deleted and replaced with the following: a. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered"auto". The following is added to Paragraph B.5. d. To the extent required by an "insured contract", this insurance is primary on behalf of the additional insured, and any other insurance maintained by the additional insured is excess and not contributory with this insurance. If the "insured contract" does not require this provision, then Paragraph a. above will apply. EA 99 11 03 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 6 of 6 9/10/2019 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=1007 Consumer tool Agent and Company Lookup Orders Independent Review Decisions OHIO SECURITY INSURANCE COMPANY Change History I Licensing I Appointments I Complaints I Orders I National Info I Ratings I Tax Filings Back to Search General information Contact information Name: OHIO SECURITY INSURANCE COMPANY Registered address Mailing address Corporate family group: LIBERTY MUT GRP 0 62 MAPLE AVE 175 BERKELEY ST Organization type: PROPERTY KEENE, NH 03431 BOSTON, MA 02116 Doing Business As (DBA): Unavailable Telephone Telephone WAOIC' 1007 513-867-3023 617-357-9500 NAIC: 24082 Status: ACTIVE Admitted date: 06/11/1974 Ownership type: STOCK ^back to top ........................ Company change history o View changes back......to...t....op. .......... Types of coverage authorized to sell a insurance nce types Casualty Marine }}}}Ocean Marine Property 1 Surety [Vehicle ^back to top ......................... Agents and agencies that represent this company (Appointments) a View agents View agencies back to top ............................. Company complaint history o [View complaints https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=1007 1/2 9/10/2019 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=1007 pack to top. Orders issued since 2010 o View orders • back to top Premium tax filings by tax year o 2018 2017 2016 2015 2014 ?backtotop 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. • ock 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 Standard and Poor's Corp Moody'sInvestors Service Fitch IBCA Duff and Phelps Ratings Disclaimer: Links to external or third-party websites are provided solely for visitors'convenience. Links you take to other sites are done so at your own risk and our office accepts no liability for any external linked sites or their content. Be aware that not all financial rating companies use the same rating processes. • backto,top. https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=1007 2/2 9/10/2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002379&PPP= Imp110 Coe Life&Retirement Home&Auto Health&Disability Other Lite Events 113 Ohio Security Insurance Company Follow I at Print this Rggg (a member of Liberty Mutual Insurance Companies) AM Best#:002379 NAIC#24082 FEIN#31-0541777 Address: 175 Berkeley Street Phone: 617-357-9500 Boston,MA 02116 Fax: 513-603-3179 UNITED STATES Web: www.LlbertyMutualGroup.com Best's Credit Ratings Financial Strength Rating View Definition Long-Term Issuer Credit Rating View Definition Rating: A(Excellent) Long-Term: a Affiliation Code: r(Reinsured) Outlook: Stable Financial Size Category: XV($2 Billion or greater) Action: Affirmed Outlook: Stable Effective Date: May 30,2019 Action: Affirmed Initial Rating Date: July 21,2005 Effective Date: May 30,2019 Initial Rating Date: June 30,1958 u Denotes Under Review Best's Rating Licensing: Licensed Territory:(Current since 12/12/2014).The company is licensed in the District of Columbia,AL,AK,AZ,AR,CA,CO,CT, DE,FL.GA,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC.ND,OH,OK,OR,PA,RI,SC,SD,TN, TX,UT,VT,VA,WA,WV,WI and WY. Total Assets DPW-Top Lines of Business $16,300,000 $16.200.000— i �_ 1 f. ^ • i. r $18000,000— ._ 27.51% $15,800,000— 6 a $15,700.000 $ . .- I $15,600,000 I 201e 2017 2016 2015 2014 "'-Commercial Multiple Peril Auto(Commercial) —Data Years --Workers'Compensation Company Attributes Industry: Insurance Business: Property/Casualty Business Status: In Business Entity: Operating Company Consolidated Type: Affiliated Single Company Organization Type: Stock Statement Type: NAIC PC Last Statement: 2nd Quarter 2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002379&PPP= 1/5 9/10/2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002379&PPP= Top Line(s)of Business(based upon Direct Premiums Wntten) Top State(s)of Business (based upon Direct Premiums Written) 1.Commercial Multiple Peril(View Definition) 1.California 2.Auto(Commercial)(View Definition) 2.Texas 3.Workers Compensation(View Definition) 3.Washington 4.Other Liability(Occurrence)(View Definition) 4.Florida 5.Products Liability(View Definition) 5.New Jersey consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002379&PPP= 2/5 9/10/2019 https://fortress.wa.gov/oic/consumertoolkiUCompany/CompanyProfile.aspx?WAOIC=869 Consumer tools Agent and Company Lookup Orders Independent Review Decisions MUTUAL OF ENUMCLAW INSURANCE COMPANY Change History I Licensing I Appointments I Complaints I Orders I Financial..Statements I National Info I Ratings I Back to Search l General information Contact information Name: MUTUAL OF ENUMCLAW INSURANCE COMPANY Registered address Corporate family group: MUTUAL OF ENUMCLAW GRP 0 4000 KRUSE WAY PLACE Mailing address Organization type: PROPERTY PLACE 1460 WELLS ST Doing Business As (DBA): Unavailable BLDG 3 #200 ENUMCLAW, WA 980: LAKE OSWEGO, OR 97035 WAOIC: 869 Telephone NAIL' 14761 Telephone 360-825-2591 Unavailable Status: ACTIVE Admitted date: 01/02/1900 Ownership type: STOCK back to top Company change history o. ................................. .... View changes back to to1E Types of coverage authorized to sell o Insurance types Casualty Disability Marine Property Surety Vehidle P back to top Agents and agencies that represent this company (Appointments) o View agents View agencies 1'back to top Company complaint history o View complaints ?back to top Orders issued since 2010 0 View orders back to cod; ...................... Premium tax filings by tax year o https://fortress.wa.gov/oic/consumertoolkiUCompany/CompanyProfile.aspx?WAOIC=869 1/2 9/10/2019 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=869 2018 2017 2016 2015 2014 P back to top Company financial statements and supplements 9 View financial statements back to top National information on insurance companies Want more information about this company?The NAIC's Consumer Information(CIS) page allows you to retrieve national fina complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. ?hack to[op. Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability. Some of these companies charge services. A.M. Best Weiss Grou Ratin s Standard and Poor's Corn Mood 's Investors Service Fitch IBCA Duff and Phelps Ratings Disclaimer:Links to external or third-party websites are provided solely for visitors'convenience.Links you take to other sites are done so at your own risk and our offi. liability for any external linked sites or their content. Be aware that not all financial rating companies use the same rating processes. t back to top https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=869 2/2 9/10/2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=000374&PPP= Lite&Retirement Home 8 Auto Health 8 Disability Other Life Events 113 Mutual of Enumclaw Insurance Company Fellow ti P^nt Mi52agg (a member of Enumclaw Insurance Group) AM Best#:000374 NAIC#14761 FEIN#:91-0217580 Address: 1460 Wells Street Phone: 360-825-2591 Enumclaw,WA 98022 Fax: 360-802-3656 UNITED STATES Web: www.mutualofenumclaw.com Bests Credit Ratings Financial Strength Rating View Definition Long-Term Issuer Credit Rating View Definition Rating: A-(Excellent) Long-Term: a- Financial Size Category: IX($250 Million to$500 Million) Outlook: Stable Outlook: Stable Action: Affirmed Action: Affirmed Effective Date: November 05,2018 Effective Date: November 05.2018 Initial Rating Date: May 23,2007 Initial Rating Date: June 30,1953 u Denotes Under Review Best's Rating Licensing: Licensed Territory:(Current since 01/21/2015).The company is licensed in AK,AZ,CO,ID,MT,NV,NM,OR,UT and WA. Total Assets DPW•Top Lines of Business $780,000,000 maisW1` mi $760,000,000a $740,000,000 $720,000,000 111 MIN $700,000,000rI b—zw .,; $680.000.000 , I 111 11 11 $6600 ::IIIi' 19.17% $640..000,00coosa0 9 $620,000,000 1' � �� �• 11r if --AutoG (Personal) $600,000,000 'Q ---Commercial Multiple Peril 2018 2017 2018 2015 2014 Homeowners Multiple Peril —Auto(Commercial) Data Years —Farmowners Multiple Peel Company Attnbutes Industry: Insurance Business: Property/Casualty Business Status: In Business Entity: Operating Company Consolidated Type: Affiliated Single Company Organization Type: Stock Statement Type: NAIC PC Last Statement: 2nd Quarter 2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=000374&PPP= 1/5 9/10/2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=000374&PPP= Top Line(s)of Business(based upon Direct Premiums Wnnen) Top State(s)of Business (based upon Direct Premiums Written) 1.Auto(Personal)(View Definition 1 1.Washington 2.Commercial Multiple Peril(view Definition) 2.Oregon 3.Homeowners Multiple Peril(New Definition) 3.Arizona 4.Auto(Commercial)(view Definition 1 4.Idaho 5.Farmowners Multiple Peril(View Definition) 5.Utah consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=000374&PPP= 2/5 9/10/2019 https://fortress.wa.gov/oic/consumertoolkiUCompany/CompanyProfile.aspx?WAOIC=927 Consumer tools Agent and Company Lookup Orders Independent Review Decisions NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA Change History I Licensing I Appointments I Complaints I Orders I Network Access Reports I National Info I Ratings LBack to Search,J General information Contact information Name: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA Registered address Mailing addr Corporate family group: AMERICAN,INTL GRP 0 2704 COMMERCE DR SUITE B 175 WATER ST 1 Organization type: PROPERTY HARRISBURG, PA 17110 NEW YORK, NY 1 Doing Business As (DBA): Unavailable Telephone Telephone WAOIC' 927 212-770-7000 212-770-7000 NAIC: 19445 Status: ACTIVE Admitted date: 03/03/1904 Ownership type: STOCK back to top ............................ Company change history o View changes back to top Types of coverage authorized to sell o 'Insurance types Casualty 'Disability Marine Ocean Marine Property Surety_.._ Vehicle ^back[o top Agents and agencies that represent this company (Appointments) o View agentsj View agencies Tbacktotop. Company complaint history o View complaints ^back to top Orders issued since 2010 o View orders ^: back to top ............................ https://fortress.wa.gov/oic/consumertoolkiUCompany/CompanyProfile.aspx?WAOIC=927 1/2 9/10/2019 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=927 Premium tax filings by tax year a 2018 2017 2016 2015 2014 back to too Network access reports o View Network Access Reports back to top National information on insurance companies Want more information about this company?The NAIC's Consumer Information.(CIS.).page. allows you to retrieve national fina complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. back to_tgp Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability. Some of these companies charge services. A.M. Best Weiss�Grou� Ratin�s_� 'Standard and Poor's Corp Moody's Investors Service. Fitch IBCA Duffand Phel•s Ratin•s Disclaimer:Links to external or third-party websites are provided solely for visitors'convenience.Links you take to other sites are done so at your own risk and our offii liability for any external linked sites or their content. Be aware that not all financial rating companies use the same rating processes. 1.back to top, https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=927 2/2 9/10/2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002351&PPP= a Go. Life&Retirement Home&Aulo Health&Disability Other Life Evenly 113 shag: National Union Fire Ins Co Pittsburgh PA Follow 4 Pnnt this page (a member of American International Group) AM Best It:002351 NAIC#'.19445 FEIN#:25-0687550 Address: 175 Water Street Phone: 212-770-7000 18th Floor Fax: New York,NY 10038 Web: www.aig.com UNITED STATES Best's Credit Ratings Financial Strength Rating View Definition Long-Term Issuer Credit Rating View Definition Rating: A(Excellent) Long-Term: a Affiliation Code: p(Pooled) Outlook: Stable Financial Size Category: XV($2 Billion or greater) Action: Affirmed Outlook: Stable Effective Date: July 12,2019 Action: Affirmed Initial Rating Date: April 06.2005 Effective Date: July 12.2019 Initial Rating Date: December 31,1907 u Denotes Under Review Best's Raring Licensing: Licensed Territory:(Current since 07/03/2019).The company is licensed in the District of Columbia,Guam,Northern Manana Islands,Puerto Rico and all states.The company is licensed for reinsurance only,in Argentina,Aruba,Azerbaijan,Chile,China,Colombia, Dominican Republic,Ecuador,Egypt,El Salvador,Guatemala,Honduras,India,Israel,Jamaica,Kenya,Mexico,Netherlands,Nicaragua, Panama,Paraguay,Philippines,Saudi Arabia,South Korea and Uruguay. Total Assets DPW-Top Lines of Business $27,000,000,000 $26.500.000,000 i 4. .- $26,000,000,000 417-yg.e, $25.500,000.000 tl : 'f z 825,000.000,000 - A�,t 524,500,000,000 "1 „fa. e $23,000,000,000.; -f I f-I —Other Liability(Claims-made) I Inland Menne $22.500,000,000 I —Other Liability(Occurrence) 2018 2017 2016 2015 2014 —Accident and Health—Ocean Marine —Workers'Compensation —Data Years —Auto(Commercial) Company Attributes Industry: Insurance Business: Property/Casualty Business Status: in Business Entity: Operating Company Consolidated Type: Affiliated Single Company Organization Type: Stock Statement Type: NAIC PC Last Statement: 2nd Quarter 2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002351&PPP= 1/5 9/10/2019 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002351&PPP= Top Lines)of Business (based upon Direct Premiums Written) Top State(s)of Business (based upon Direct Premiums Written) 1.Other Liability(Claims-made)(View Definition) 1.California 2.Inland Marine(view Definition) 2.Texas 3.Other Liability(Occurrence)(View Definition) 3.New York 4.Accident and Health(View Definition) 4.Other Alien 5.Ocean Marine(View Definition) 5.Washington consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002351&PPP= 2/5 CITY OF AUBURN CONTRACT CHANGE ORDER AGREEMENT NO. 1 Contract No.: Contract 19-14 Project Name: CP1913, Sewer Manhole Ring&Cover Replacement Contractor: Pavement Maintenance of Washingon, LLC 19411 SE Green Valley Road Auburn, WA 98092 The Contractor is hereby directed to make the changes to the Contract as described herein. This document and all attachments are a supplement to the contract. All work, materials, measurements and unit bid prices for the type of construction involved shall be in accordance with the contract documents of the above named project unless stated otherwise in this change order. Summary of Proposed Changes: 1. Contractor purchased 15 manhole casting from the City. 2. 3. The Contract time is extended by working days. Sec. Quantity Unit Price Total Price Item Sch. No. Item Description Units ($) (+/_) 6 A 7-05 Manhole Castings 15 EA (318.37) $ (4,775.55) $ Subtotal $ (4,775.55) Washington State Sales Tax(10%) on applicable items $ (477.56) TOTAL $ (5,253.11) Base Amount Total incl. Tax 1. Total Cost this C/O $ (4,775.55) $ (5,253.11) 2. Total Cost Previous C/O $ - $ - 3. Original Contract Amount $ 136,280.00 $ 136,280.00 4. Revised Contract Amount $ 131,504.45 $ 131,026.90 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 above described changes. All other costs are non-compensable. All other terms and conditions of the Contract remain unchanged. Counterparts: This agreement may be executed in multiple counterparts, each of which shall be one and the same Agreement and shall become effective when one or more counterparts have been signed by each of the parties and delivered to the other party. Contractor: /v 11//_. 119 Date Project Manage -U. Date City Enginee : < a2 , .4 s/i" // l z /1 Date Qf Approved by: • • rA'.. .. a • ' oV4tf Auburn Date IL Approved as to form: `'���� 1))1(,j9 City Ci Attorney ate ENG-028, Revised 01/19 Page 1 of 1 CITY 01 AU BIJ RN Nancy Backus, Mayor WASHING 1 N 25 West Main Street 4 Auburr WA 98001-4998* www.auburnwa.gov * 253-931-3000 March 23, 2020 CERTIFIED MAIL RETURN RECEIPT REQUESTED Max Stickley Pavement Maintenance of Washington, LLC 19411 Green Valley Road Auburn, WA 98092 RE: Contract No 19-14 Project No. CP1913, Sewer Manhole Ring & Cover Replacement Contract Completion and Acceptance Dear Mr. Stickley: In accordance with Section 1-05.12 of the Contract Specifications, the above referenced contract is considered complete and accepted as final. Your retainage in the amount of $8.900.31 will be released within 30 days provided all necessary releases have been received and there are no outstanding claims against the retainage. If you have any questions, please contact Amanda DeSilver, Contract Administrative Supervisor at 253-876-1980. Sincerely, oc e Jacob Sweeting, P.E. City Engineer/Assistant Director of Engineering Services Public Works Department JS/ad/as cc: Shawn Campbell City Clerk Matt Larson Senior Project Engineer Jeffrey Bender Project Engineer File 13.11 (CP1913) ENG-075, Revised 03/19 Au RN * MORE THAN YOU IMAGINE[:)