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CP1917 #19-10 Deduct Meter Replacement Phase 1
CITY OF * * AtiBURN Nancy Backus, Mayor WASHINGTON 25 West Main Street * Auburn WA 98001-4998 * www.auburnwa.gov * 253-931-3000 February 11, 2020 CERTIFIED MAIL RETURN RECEIPT REQUESTED Eric Peterson Nordvind Sewer Service, LLC 1720 Loraine Street Enumclaw, WA 98022 NOTICE TO PROCEED RE: CP1917, Deduct Meter Replacement, Phase 1, Contract #19-10 You are hereby notified to proceed as of February 14, 2020 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 February 18, 2020. This project has 60 working days for completion. If you have any questions, please contact the inspector for the project, Josh Linkem at 253-876-1926 or the Contract Administration Specialist, Jenny Sebero at 253-931-3012. Sincerely, feffender, P.E. Project Engineer Public Works Department JB/js/as Enclosure cc: Shawn Campbell, City Clerk Jacob Sweeting, Assistant Director of Engineering/City Engineer Josh Linkem, Project Inspector Amanda DeSilver, Contract Admin Supervisor File 13.11 (CP1917) ENG -017, Revised 12/18 AUBURN* MORE THAN YOU IMAGINED CONTRACT Contract No. 19-10 THIS AGREEMENT AND CONTRACT, made and entered into, in duplicate, at Auburn, Washington, this !I day of Gl tv 2020, by and between the CITY OF AUBURN, WASHINGTON, a municipal orporation, and NORDVIND SEWER SERVICE, LLC, hereinafter called the CONTRACTOR. WITNESSETH: That, in consideration of the terms and conditions contained in the Contract Documents entitled "CP1917, Deduct Meter Replacement, Phase 1," 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 CP1917, Deduct Meter Replacement, Phase 1 — the removal of 57 deduct meters and the installation of 57 new irrigation meters for a unit bid price of $339,749.13 (three hundred thirty-nine thousand seven hundred forty-nine dollars and thirteen cents) and Washington State Sales Tax of $33,974.91 (thirty- three thousand nine hundred seventy-four dollars and ninety-one cents) for a total contract value of $373,724.04 (three hundred seventy-three thousand seven hundred twenty-four dollars and four cents) 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 60 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. Countersigned: this l day of �� V� �� r 2020 APPROVED AS TO FORM: Kendra Comeau, Acting City Attorney CITY OF AUBURN, WASHINGTON By MA 6jtBackus, Mayor NORDVIND;SEWER SERVICES, LLC t By Authorized Official Signature CONTRACT BOND CONTRACT NO. 19-10 BOND NO. PB00499800229 BOND TO CITY OF AUBURN, WASHINGTON KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, Nordvind Sewer Service, LLC, as principal, and Philadelphia Indemnity Insurance Company , a corporation, organized and existing under the laws of the State of Pennsylvania 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 _Three Hundred Seventy-three Thousand Seven Hundred Twenty-four and 041100 ($373,724.04) dollars, for the payment of which sum we jointly and severally bind 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 Washington and the Ordinances of the City of Auburn, Washington. Dated at Auburn, Washington, this day of�Z��, 20 'Z G . Nevertheless, the conditions of the above obligation are such that: WHEREAS, the City of Auburn on the day of --e k Lii et C(_ , 20'j_70, let to the above bounden principal a certain Contract. The said Contract beihg numbered 19-10, and providing for the construction of Project CP1917, Deduct Meter Replacement, Phase 1 - the removal of 57 deduct meters and the installation of 57 new irrigation meters (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 manner and within the time set forth: NOW, THEREFORE, 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 modifications 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 carrying on of said work and shall 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 performance of said work, and shall in all respects faithfully perform said Contract according to law, and shall indemnify and hold the City of Auburn, Washington, harmless from any damage or expense by reason of failure of performance, as specified in said Contract, and 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 terms 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 completion 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 Contract Completion. Notwithstanding 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 Contract Completion, 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 16th day of January 20 20 Nordvind Sewer Sebic , LLC Principal Philadelphia Indemnity Insurance Company Surety By O, Q,(�, - q_ Attorney in Fact Aliceon A. Kellner 1420 5th Ave Suite 3510 Seattle, WA 98101 Propel Insurance, 601 Union Street, Suite 3400, Seattle, WA 98101 (206)676-4200 Resident Agent's Address & Phone Number 933 PHILADELPHIA INDEMNITY INSURANCE COMPANY One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004-0950 Power or Attorney KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint Carley Espiritu, Christopher Klnvon, Cynthia L. Jay, Eric A. Zimmerman, lames B Binder, Jamie L. Marques, Karen C. Swanson, Kyle Joseph Howat, Allceon A. Kepner, Tamara A. Rinfteisen Annelies M. Richie, Heather L Allen, Jacob T Haddock Ally Rombach, Holli Albers Erica E. Mosley Alyssa J Lopez and Brandon K Bush of Bratrud Middleton Insurance Brokers Inc dba Propel Insurance its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed $50,000,000. This Power orAttorney is granted and is signed and scaled by facsimile under and by the authority of the following Resolution adopted by the Board of I)uectors of PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14' of November, 2016 RF,SOLVED: That the Board or Directors hereby authorizes the President or any Vice President of' the Company: (1) Appoint Attorneys) in Fact and authorize the Attomey(s) in Fact to execute on behalf of the Company bonds and undertakings, eontraets of indemnity and other writings obligatory in the nature thereof and to attach the seal of the Company thereto, and (2) to remove, at anytime, any such Attomey-in-Fact and revoke the authority given And, be it FURTHER RESOLVED: That the signatures of such officers and the seal orthe Company may be affixed to any such Power of Attomey or certificate relating thereto by facsimile, and any such Power of Attorney so executed and certified by facsimile signatures and laesimile seal shall be valid and binding upon the Company in die future with respect to any bond or undertaking to which it is attached IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORU,FD OFFICE THIS 27"' DAY Oh OCTOBER, 2017 t 9.' (Seal) •• Robert D O'Leary Jr, President & CEO Philadelphia indemnity Insurance Company On this 27"' day of October, 2017, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY, that the seal affixed to said instrument is the Corporate seal of said Company-, that the said Corporate Seal and his signature were duly affixed SduuoNNTlir'i NpfANUL` R- gM'•wvN,ilry�,l4 Notary Public: `Ur�✓+.MJr nnr,d+„ .urn�aa� entai�� . residing at - (Notary Seal) My commission expires: I �n@ 1` � Bala Cynwyd, PA Scntembcr 25.2021 I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE. COMPANY, do hereby certify that the foregoing resolution orthe Board of Directors and the Power of Attorney issued pursuant thereto on the 27" day of October, 2017 are true and correct and are still in full force and effect I do further eertify that Robert D O'Leary Jr. who executed the Power of Attomey as President, was on the date of execution of the attached Power of Attorney the duly elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this of , awl SNA V 20 Edward Sayago, Corporate Secretary PHILADELPHIA INDEMNI•rY INSURANCE COMPANY Page 1 of 2 Agent and Company Lookup ` °Orders Independent Review Decisions PHILADELPHIA INDEMNITY 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: PHILADELPHIA INDEMNITY INSURANCE COMPANY Registered address Mailing address Corporate family group: TOKIO MARINE HOLDINGS INCONE BALA PLAZA SUITE ONE BALA PLAZA SUITE GRP O 100 400 Organization type: PROPERTY BALA CYNWYD, PA 19004 BALA CYNWYD, PA 19004 Doing Business As (DBA): Unavailable WAOIC: 1100 NAIL: 18058 Status: Active Admitted date: 11/26/1985 Ownership type: STOCK b�fck, to, top Company change history o View changes back,,lo, top Telephone Telephone 610-617-7900 610-538-2272 Types of coverage authorized to sell o Insurance types Casualty Disability Marine Property Surety Vehicle � = ��ck, to,top Agents and agencies that represent this company (Appointments) o View agents View agencies 'r back, to,top Company complaint history o View complaints back to,top https://fortress.wa.gov/oic/eonsumertoolkit/Company/CompanyProfile.aspx?WAOIC=54b... 1/29/2020 Page 2 of 2 Orders issued since 2010 0 No orders are found 1i back•to•top Premium tax filings by tax year o 2018 2017 2016 2015 ........... .. . 11 back, tgtop National information on insurance companies Want more information about this company? The NAIC's Consumer Information (CIS) page allows you to retrieve i.national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. back, tp•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 Grou Ratin s� Standard and Poor's,•Cori) M.00d•y's Investors Service Fitch IBCA, „Duff and_Phelps Rat,inc�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 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. back to top .................. https:Hfortress.wa.gov/oic/eonsumertoolkit/Company/CompanyProfile.aspx?WAOIC=54b... 1/29/2020 Page 1 of 7 132 Shares Philadelphia Indemnity Insurance Company (a member of Tokio Marine US PC Group) AM Best #: 003616 NAIC #: 18058 FEIN #: 23-1738402 Address: One Bala Plaza Suite 100 Bala Cynwyd, PA 19004-1403 UNITED STATES hone: 610-617-7900 ax: 610-617-7940 Jeb: www.phly.com Best's Credit Ratings Financial Strength Rating View Definition Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date: Follow 0—i Print this page A++ (Superior) p (Pooled) XV ($2 Billion or greater) Stable Affirmed December 12, 2019 June 30, 1981 Long -Term Issuer Credit Rating View Definition Long -Term: Outlook: Action: Effective Date: Initial Rating Date: aa+ Stable Affirmed December 12, 2019 June 03, 2005 http://constmers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=003616&PPP= 1/29/2020 BOND IN LIEU OF RETAINAGE (Retainage Bond -RCW 60.28) Bond No. PB00499800230 KNOW ALL PERSONS BY THESE PRESENTS, THAT Nordvind Sewer Service, LLC 1720 Loraine St, Enumclaw WA 98022 a corporation organized under the laws of the State of Washington and registered to do business in the State of Washington as a contractor, as Principal, and Philadelphia Indemnity Insurance Company, a corporation organized under the laws of the State of Pennsylvania and registered to transact business in the State of Washington as surety, as Surety, their heirs, executors, administrators, successors and assigns, are jointly and severally held and bound to the City of Auburn, Washington, hereinafter called CITY, and are similarly held and bound unto the beneficiaries of the trust fund created by RCW 60.28, in the sum of five percent (5%) of all amounts earned by the Principal on the contract described below. THE CONDITIONS OF THIS BOND OBLIGATION ARE THAT: WHEREAS, on the r' day of 4b20, the Principal executed Contract No. 19-10 with the CITY for Project Num r CP1917, Deduct Meter Replacement, Phase 1; and WHEREAS, said contract and RCW 60.28 require the CITY to withhold from the Principal the sum of five percent (5%) from monies earned by the Principal on estimates during the progress of the construction, hereinafter referred to as earned retained funds; and WHEREAS, the Principal has requested that the CITY not retain any earned retained funds as allowed under RCW 60.28; NOW, THEREFORE, the condition of this obligation is such that the surety is held and bound to the CITY and to the beneficiaries of the trust fund created by RCW 60.28 in the sum of five percent (5%) of the final contract cost which shall include any increases due to change orders, increases in quantities of work, addition of new items of work, or otherwise, hereafter referred to as the final contract cost. If all purposes of RCW 60.28 and all contract obligations are fulfilled, then this obligation shall be null and void; otherwise, it shall remain in full force and effect until release is authorized in writing by the CITY. IT IS FURTHER EXPRESSLY AGREED THAT: 1. The liability of the Surety under this bond shall not exceed five percent (5%) of the final contract cost, if no monies are retained by the CITY pursuant to RCW 60.28 on estimates during the progress of construction. Retainage Bond Page 1 of 3 ENG -050, Revised 9/18 2. In the event this bond ceases to comply with CITY standards, the CITY reserves the right to resume the actual withholding of earned retained funds according to the contractor's designated option for management of retainage under RCW 60.28.011(4). In the event the CITY resumes withholding of earned retained funds, the liability of the Surety under this bond shall not exceed the actual amount of the earned retained funds which were covered by this bond and released by the CITY prior to resumption of actual withholding. 3. The Surety hereby consents to and waives notice of any extension in the time for performance of the contract, assignment of obligations under the contract, or contract alteration, amendment, or change order. 4. Any suit under this bond must be instituted within the time period provided by applicable law with venue in King County, Washington. This bond and any proceeds therefrom shall be subject to all claims and liens and in the same manner and priority as set forth for retained percentages in RCW 60.28. 5. Until written release of this obligation by the CITY, this bond may not be terminated or canceled by the Principal or the Surety for any reason. Any extension of time for the Principal's performance on the contract, assignments of obligations under the contract, or any amendment to the contract or change orders of any kind shall not release the Surety from its obligation under this bond. 6. The contractor shall comply with all applicable requirements of RCW 60.28. 7. RCW 60.28 requires the CITY to accept a retainage bond in lieu of withholding earned retained funds and the Surety hereby waives any defense that this bond or bond form is void or otherwise not authorized by law. 8. Any claim or suit against the CITY to foreclose the liens provided for by RCW 60.28 shall be effective against the Principal and Surety and any judgment under 60.28 against the CITY shall be conclusive against the Principal and Surety. WITNESS our hands this 21st day of January 2020 PRINCIPAL: Nordvind Sewer Service, LLC 1720 Loraine St. Enumclaw, WA 98022 By: � A (Signature of Authorized Representative) i Print/Type Name Retainage Bond Page 2 of 3 ENG -050, Revised 9/18 Philadelphia Indemnity Insurance Company SURETY: By: rt '----- (Signature of Attorney in -Fact for Surety") Aliceon A. Keltner (Typed Name of Attorney -in -Fact) Dated 1/21/2020 Local Agent Name, Phone, & Address Propel Insurance 601 Union Street, Suite 3400 Seattle, WA 98101 206-676-4210 CITY OF AUBURN: Accepted By: ./,L Jacob Sweetir(g, Ass6fant Dir or of Engineering/City Engineer Dated: Approved as to form: —.��Kendra Comeau, Acting City Attorney *This bond must be accompanied by a fully executed Power of Attorney appointing the Attorney -in -Fact before it becomes effective. Retainage Bond Page 3 of 3 ENG -050, Revised 9/18 Page 1 of 2 Agent and Company Lookup Orders Independent Review Decisions PHILADELPHIA INDEMNITY INSURANCE COMPANY Chan,g,e,.History I Licensing. I Appointments Complaints Orders National„Info Ratings Tax,.Fili.n,gs Back to Search General information Contact information Name: PHILADELPHIA INDEMNITY INSURANCE COMPANY Registered address Mailing address Corporate family group: TOKIO MARINE HOLDINGS BALA PLAZA SUITE ONE BALA PLAZA SUITE GRP 0 .100 400 Organization type: PROPERTY BALA CYNWYD, PA 19004 BALA CYNWYD, PA 19004 Doing Business As (DBA): Unavailable WAOIC: 1100 NAIL: 18058 Status: Active Admitted date: 11/26/1985 Ownership type: STOCK ba,ck, to, top Company change history o View change back„to„top Telephone Telephone 610-617-7900 610-538-2272 Types of coverage authorized to sell o. Insurancetypes Casualty Disability Marine Property Surety Vehicle , hack, to,top .. Agents and agencies that represent this company (Appointments) o, View agent View agencies back, tp,lop Company complaint history o View complaints ^t back,tp,tpp https:Hfortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=54b... 1/29/2020 Page 2 of 2 Orders issued since 2010 ca No orders are found 11 back, to, top Premium tax filings by tax year o 2018 2017 2016 2015 ...... ........ .............. .. . beck, 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 financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. back. tp.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 Groin Ratin�s� Standard and Poor's Corp Mood,y',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 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. back, to, top llttps://fortress.wa.gov/ois/eonsumertoolicit/Coinpany/CompanyProftle.aspx?WAOIC=54b... 1/29/2020 Page 1 of 7 132 Shares Philadelphia Indemnity Insurance Company (a member of Tokio Marine US PC Group) AM Best #: 003616 NAIC #: 18058 FEIN #: 23-1738402 Address: One Bala Plaza Suite 100 Bala Cynwyd, PA 19004-1403 UNITED STATES Phone: 610-617-7900 Fax: 610-617-7940 Web: www.phly.com Best's Credit Ratings Financial Strength Rating View Definition Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date: Follow A Print this page A++ (Superior) p (Pooled) XV ($2 Billion or greater) Stable Affirmed December 12, 2019 June 30, 1981 Long -Term Issuer Credit Rating View Definition Long -Term: Outlook: Action: Effective Date: Initial Rating Date: aa+ Stable Affirmed December 12, 2019 June 03, 2005 http://consumers.ambest.com/CompanyProfle.aspx?BL=36&ambnum=003616&PPP= 1/29/2020 Client#: 183963 NORDSEWE ACOR®TM CERTIFICATE OF LIABILITY INSURANCE F.ATE(MM/DD/YYYY) 1/16/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Propel Insurance Seattle Commercial Insurance 601 Union Street, Suite 3400 Seattle, WA 98101-1371 CONTACT Trisha Thompson PHONE g00 499-0933 FAX 866 577-1326 A/C, No, Ext): A/C, No ADDRIEss: Trisha.Thompson@propelinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Ohio Security Insurance Company 24082 INSURED Nordvind Sewer Services LLC INSURER 13: The Ohio Casualty Insurance Company 24074 INSURER C: 25129 SE Green Valley Rd Auburn, WA 98092 INSURER D: PREMISESa occurrence $1,000 000 MED EXP (Any one person) $15,000 INSURER E: INSURER F: CUVERAGE5 CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE NSRLSUBR WVD POLICY NUMBER MM/DD/YYYY MM/DD%YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE1:9 OCCUR BKS59648686 04/28/2019 04128/2020 EACH OCCURRENCE $1,000,000 PREMISESa occurrence $1,000 000 MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECOT F-1 LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAS59648686 04/28/2019 04/28/202 tINGLE LIMIT $1,000,000 (CEO, a.cideDS X ANY AUTO BODILY INJURY (Per person) $ X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY Y BODILY INJURY Pe (Per accident) $ PROPERTY DAMAGE Per accident $ B UMBRELLA LIABX OCCUR ES059648686 11/01/2019 04/28/202 EACH OCCURRENCE $5,000,000 X _TIDED EXCESS LIAB CLAIMS -MADE Over GL only AGGREGATE $5,000,000 RETENTION $ $ LOYERIY/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A BKS59648686 WA Stop Gap 04/28/2019 04/28/202 P)OAWORKERSNSATION TH- E.L. EACH ACCIDENT $1,000,000 E,L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Leased/Rented BKS59648686 04/28/2019 04/28/2020 $150,000 limit Equipment $1,000 deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The General Liability, Auto Liability and Umbrella Liability policies include a blanket automatic additional insured endorsement that provides additional insured status only when there is a written contract between the named insured and the entity that requires such status. RE: CP1917 - Deduct Meter Replacement, Phase 1 City of Auburn is named as an Additional Insured, per the attached. City of Auburn Public Works Department 25 W Main Street Auburn, WA 98001 ACORD 25 (2016/03) 1 of 1 #S3981471/M3893209 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TT00 This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY CG 88 10 0413 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 — 6 FELLOW EMPLOYEE EXTENSION — MANAGEMENT EMPLOYEES 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 Under Paragraph 2. Exclusions of Section I — Coverage A— Bodily Injury And Property Damage Liability, 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. 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: 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 following: 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 0413 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. 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 systems; or 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 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 "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Liberty Mutual Insurance CG 88 10 0413 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 advertising 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 exposures; 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 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. 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 Conditions. © 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 rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; 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 "occurrence" 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 issued 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 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. © 2013 Liberty Mutual Insurance CG 88 10 0413 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 additional 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. 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. 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 employment 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 professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. © 2013 Liberty Mutual Insurance CG 88 10 0413 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 8 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 "employees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and 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 intoxication 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: 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: 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. Representations: 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 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, sickness or disease. © 2013 Liberty Mutual Insurance CG 88 10 0413 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. Transfer 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 The injury or damage occurs subsequent to the execution of the written contract or written agreement. © 2013 Liberty Mutual Insurance CG 88 10 0413 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 COMMERCIAL GENERAL LIABILITY CG 88 60 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EACH LOCATION GENERAL AGGREGATE LIMIT 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 operations at a single "location" owned by or rented to you: 1. A separate Each Location General Aggregate Limit applies to each "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Each Location 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 Each Location General Aggregate Limit for that "location". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Each Location General Aggregate Limit for any other "location". 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 Each Location 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 operations at a single "location" 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 Each Location 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 Each Location General Aggregate Limit. D. For the purposes of this endorsement, the following definition is added to Section V — Definitions: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. CG 88 60 12 08 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 1 This page has been left blank intentionally. COMMERCIAL AUTO AC 85 01 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGEINDEX SUBJECT PROVISION NUMBER ACCIDENTAL AIRBAG DEPLOYMENT 13 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 4 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 21 AMENDED FELLOW EMPLOYEE EXCLUSION 6 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 15 BODILY INJURY REDEFINED 25 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 3 EXTRA EXPENSE -BROADENED COVERAGE 11 GLASS REPAIR - WAIVER OF DEDUCTIBLE 17 HIRED AUTO COVERAGE TERRITORY 23 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 7 LOAN / LEASE GAP (Coverage Not Available In New York) 16 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 2 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 18 PERSONAL EFFECTS COVERAGE 12 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 9 PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM 14 PRIMARY AND NON-CONTRIBUTORY -WRITTEN CONTRACT OR WRITTEN AGREEMENT 24 RENTAL REIMBURSEMENT 10 SUPPLEMENTARY PAYMENTS 5 TOWING AND LABOR 8 TRAILERS - INCREASED LOAD CAPACITY 1 TWO OR MORE DEDUCTIBLES 19 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 20 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 22 SECTION I - COVERED AUTOS is amended as follows: 1. TRAILERS - INCREASED LOAD CAPACITY The following replaces Paragraph C.1. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I - COVERED AUTOS: "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 1 of 7 SECTION II - LIABILITY COVERAGE is amended as follows: 2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION II - LIABILITY COVERAGE, Paragraph A.1. - Who Is An Insured is amended to include the following as an "insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specificall y to apply in excess of this policy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy. Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 3. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an "insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto'; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance. 5. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 2 of 7 6. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: SECTION II - LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage is excess over any other collectible insurance. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 7. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss". 8. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 3 of 7 9. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph AA.a. Coverage Extensions, Transportation Expenses of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500. 10. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex- penses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lessor vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 12.13. 11. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 12. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V - DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securi- ties. 13. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 4 of 7 14. PHYSICAL DAMAGE DEDUCTIBLE - VEHICLE TRACKING SYSTEM SECTION III - PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 15. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: Exclusions 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de- signed solely for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 16. LOAN / LEASE GAP COVERAGE (Not Applicable In New York) A. Paragraph C. Limit Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss' b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur- ance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a "Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto"; g. Security deposits not refunded by a lessor; In. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto"; i. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss". © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 5 of 7 C. SECTION V - DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a 'loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. 17. GLASS REPAIR -WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 18. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to 'loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any 'loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 19. TWO OR MORE DEDUCTIBLES Under SECTION III - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible , it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the 'loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep- tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 6 of 7 21. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the follow- ing: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or "loss" took place; (b) The "insureds" name and address; and (c) The names and addresses of any injured persons and witnesses. 22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 23. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured's" responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. 24. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE- MENT The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, General Conditions, B.5. Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". SECTION V - DEFINITIONS is amended as follows: 25. BODILY INJURY REDEFINED Under SECTION V - DEFINITIONS, Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 7 of 7 This page has been left blank intentionally. Page 1 of 2 Agent and Company Lookup Orders Independent Review Decisions OHIO SECURITY INSURANCE COMPANY Change.,Hi.story Licensing, Appointments Complaints Orders National._Info Ratings Tax„F%lings Back to Search General information Name: OHIO SECURITY INSURANCE COMPANY Corporate family group: LIBERTY MUT GRP U Organization type: PROPERTY Doing Business As (DBA): Unavailable WAOIC: 1007 NAIL: 24082 Status: Active Admitted date: 06/11/1974 Ownership type: STOCK t back to,tov Company change history o View changes t hack to top Contact information Registered address Mailing address 62 MAPLE AVE 175 BERKELEY ST KEENE, NH 03431 BOSTON, MA 02116 Telephone Telephone 513-867-3023 617-357-9500 Types of coverage authorized to sell o Insurance types Casualty Marine Ocean Marine Property Surety Vehicle ,cr� Ai p,�ck,to,top Agents and agencies that represent this company (Appointments) o View agents View ageni.. ^i beck ta, toP Company complaint history o View complaints t back, to, top https://fortress.wa.gov/oie/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=%2f... 1/27/2020 Page 2 of 2 Orders issued since 2010 ca. View orders back to top Premium tax filings by tax year o. 2018 2017 2.016 2015. hack, to. top National information on insurance companies Want more information about this company? The. NAIC"s„Consumer Information (CISH 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. hack 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 _ m Weiss.Group. Ratings Standard and Poor's Cor Moo_dyus Investors Service Fitch IBCA,ff and Phelps RatingR! _.__. 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. back, to, top https:Hfortress.wa.gov/oic/constimertoolkit/Company/CompanyProfile.aspx?WAOIC=%2£.. 1/27/2020 132 Shares Ohio Security Insurance Company (a member of Liberty Mutual Insurance Companies) AM Best #: 002379 NAIC #: 24082 FEIN #: 31-0541777 Address: 175 Berkeley Street Boston, MA 02116 UNITED STATES Phone: 617-357-9500 Fax: 513-603-3179 Web: www.LibertyMutualGroup.com Best's Credit Ratings Financial Strength Rating View Definition Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date: Page 1 of 7 Follow] A Print this page A (Excellent) r (Reinsured) XV ($2 Billion or greater) Stable Affirmed May 30, 2019 June 30, 1958 Long -Term Issuer Credit Rating View Definition Long -Term: Outlook: Action: Effective Date: Initial Rating Date: a Stable Affirmed May 30, 2019 July 21, 2005 http://consumers.ambest.com/CompanyProf-ile.aspx?BL=36&ambnum=002379&PPP= 1/27/2020 Page 2 of 7 u Denotes Under Review Best's Rating Licensing: (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. http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002379&PPP= 1/27/2020 Page 1 of 2 Agent and Company Lookup Orders : Independent Review Decisions OHIO CASUALTY INSURANCE COMPANY THE Cha.ng.e..History i Licensing, i Appointments i Complaints i Orders i Notional_Info, i Ratings i Tax..Fi.lins Bacic to Search General information Name: OHIO CASUALTY INSURANCE COMPANY THE Corporate family group: LIBERTY MUT GRP U Organization type: PROPERTY Doing Business As (DBA): Unavailable WAOIC: 1001 NAIL: 24074 Status: Active Admitted date: 04/10/1926 Ownership type: STOCK back, to, top Company change history o View changes back, to, top Contact information Registered address Mailing address 62 MAPLE AVE 175 BERKELEY ST KEENE, NH 03431 BOSTON, MA 02116 Telephone Telephone 513-603-2400 617-357-9500 Types of coverage authorized to sell o Insurance types Casualty �. Disability Marine Ocean Marine Property Surety Vehicle back, to, top Agents and agencies that represent this company (Appointments) o, View agents View agencies back to top Company complaint history o View complaints ��ck,to,top https://fortress.wa.gov/oie/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=00... 1/27/2020 Page 2 of 2 Orders issued since 2010 0 View orders back, to tog Premium tax filings by tax year o 2018 2017 2016 20151 ? back to tog .................. National information on insurance companies Want more information about this company? The„NAIL'S Consu..me..rInformation (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. i b�ck,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 Core Moo_du's Investors„S,ervice 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. l�,�ck, to, tog https J/fortress.wa.gov/oie/consumertoo lkit/Company/CompanyProfile.aspx? WAOIC=00... 1/27/2020 132 Shares Ohio Casualty Insurance Comr (a member of Liberty Mutual Insurance Companitj5) Page 1 of 7 AM Best #: 002378 NAIC #: 24074 FEIN #: 31-0396250 Address: 175 Berkeley Street Boston, MA 02116 UNITED STATES Phone: 513-603-2400 Fax: 513-603-3179 Web: www.LibertyMutua]Group.com Best's Credit Ratings Financial Strength Rating View Definition Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date: [Follow] 0-4 Print this page A (Excellent) p (Pooled) XV ($2 Billion or greater) Stable Affirmed May 30, 2019 June 30, 1924 Long -Term Issuer Credit Rating View Definition Long -Term: Outlook: Action: Effective Date: Initial Rating Date: a Stable Affirmed May 30, 2019 July 21, 2005 http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002378&PPP= 1/27/2020 Page 2 of 7 u Denotes Under Review Best's Rating Licensing: (Current since 11/05/2018). The company is licensed in the District of Columbia, Guam and all states. http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002378&PPP= 1/27/2020 CITY OF AUBURN CONTRACT CHANGE ORDER AGREEMENT NO. 1 Contract No.: Contract 19-10 Project Name: CP1917, Deduct Meter Replacement, Phase 1 Contractor: Nordvind Sewer Service 1720 Loraine St Enumclaw,WA 98022 The Contractor is hereby directed to make the changes to the Contract as described herein. This document and all attachments are a supplement to the contract. All work, materials, measurements and unit bid prices for the type of construction involved shall be in accordance with the contract documents of the above named project unless stated otherwise in this change order. Summary of Proposed Changes: 1. ADD pay item C01-1 listed in the table below.This item is a credit for City supplied large meter boxes and lids. 2. DECREASE quantity for pay item 15 listed in the table below.This quantiy reduction is for the deletion of Site 52-Meter Number S83793371, 22 30th Street NE. 3. INCREASE quantity for pay item 15 listed in the table below.This quantiy increase is for the addition of Site 58-Meter Number S83793390, 22 30th Street NE. Contract Time shall be extended by 7 working days. The Contract time is extended by 7 working days. Sec. Quantity Unit Price Total Price Item Sch. No. Item Description (+1-) Units ($) C01-1 A 7-15 Large Meter Box and Lid 3 EA (244.54) $ (733.62) 15 A 7-15 Water Service Connection 1-1/2 Inch Diam. -1 EA 1,519.09 $ (1,519.09) 15 A 7-15 Water Service Connection 1-1/2 Inch Diam. 1 EA 1,519.09 $ 1,519.09 Subtotal $ (733.62) Washington State Sales Tax(10%)on applicable items $ (73.36) TOTAL $ (806.98) Base Amount Total incl.Tax 1. Total Cost this C/O $ (733.62) $ (806.98) 2. Total Cost Previous C/O $ - $ - 3. Original Contract Amount $ 373,724.04 $ 373,724.04 4. Revised Contract Amount $ 372,990.42 $ 372,917.06 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. 7/7/2020 Contractor: &..L_._ 2020.07.07 Date Project Manager: 12:52:24-07'00' Date City Engineer: �" `�'�"� 07/10/2020 Date Approved by: 1 1161 ayor, Ci Auburn Date Approved as to form: N L..3 1(612,0 Attorney �� Y Y Date ENG-028, Revised 01/19 Page 1 of 1 BUDGET STATUS SHEET Project No: CP1917 Project Title: Deduct Meter Replacement,Phase 1 Project Manager: Jeffrey Bender Updated: July 7,2020 U Project Initiation @ Change Order 0 60%PS7E Review 0 Final Acceptance Project Initiation Date: April 15,2019 0 90%PS&E Review 0 Consultant Fee Advertisement Date: December 3,2019 0 Advertisement 0 Monthly Update Award Date: January 6,2019 0 Award Funds Budgeted Funding 2019 2020 2021 Future Years Total 460 Fund-Water $ 23,975.00 $ 476,025.00 $ - $ - $ 500,000.00 Total $ 23,975.00 $ 476,025.00 $ - $ - $ 500,000.00 Estimated Costs Activity 2019 2020 2021 Future Years Total Design Engineering-City Costs $ 22,800.00 $ - $ - $ - $ 22,800.00 Construction Engineering-City Costs $ 647.00 $ 46,500.00 $ - $ - $ 47,147.00 Bid Advertisement $ 528.00 $ - $ - $ - $ 528.00 Materials Testing $ - $ 500.00 $ - $ - $ 500.00 Construction Costs $ - $ 373,724.00 $ - $ - $ 373,724.00 Authorized Const Contingency $ - $ 56,000.00 $ - $ - $ 56,000.00 Change Order No.#1 $ - $ (807.00) $ - $ - $ (807.00) Total $ 23,975.00 $ 475,917.00 $ - $ - $ 499,892.00 460 Water Budget Status 2019 2020 2021 Future Years Total 460 Funds Budgeted $ 23,975.00 $ 476,025.00 $ - $ - $ 500,000.00 460.Funds Estimated $ 23,975.00 $ 475,917.00 $ - $ - $ 499,892.00 460 Funds Actual $ 23,975.00 $ 138,676.00 $ - $ - $ 162,651.00 Percent Complete(Actual/Estimated) 100% 29% 0% _ 0% 33% 460 Fund Contingency(Budgeted-Estimated) $ - $ 108.00 $ - $ - $ 108.00 460 Funds Remaining to Date(Budgeted-Actual) $ - $ 337,349.00 $ - $ - $ 337,349.00 * CITY OF Nancy Backus, Mayor ../AU B P.N WASHINGTON 25 West Main Street * Auburn WA 98001-4998 * www.auburnwa.gov * 253-931 3000 August 13, 2020 CERTIFIED MAIL RETURN RECEIPT REQUESTED Eric Peterson Nordvind Sewer Service, LLC 1720 Loraine Street Enumclaw, WA 98022 RE: Contract No. 19-10 Project No. CP1917, Deduct Meter Replacement Phase 1 Final Pay Estimate Letter Dear Eric Peterson: Enclosed is your Final Payment in the amount of$155,437.32. The total contract amount for this project as shown on your Final Pay Estimate is $372,917.06. Please be aware that contract completion and final acceptance will not be granted prior to receipt of Affidavits of Wages Paid for your firm and all Subcontractors, and that incorrect information supplied to L & I may delay clearance of your Bond until payment of industrial insurance by all Subcontractors is verified. If you have any questions, please contact Jenny Sebero, Contract Administration Specialist, at 253-931-3012. This notification does not constitute contract completion/final acceptance. Sincerely, Jeffrey Bender, P.E. Project Engineer Public Works Department JB/js/as Enclosure cc: Shawn Campbell, City Clerk Josh Linkem, Project Inspector File 13.11 (CP1917) ENG-142-ELH, Revised 02/19 AUBURN * MORE THAN YOU IMAGINED mm i i Aa 11111111111 11111 1 1 9489 0090 0027 6064 0159 70 City Hall CITY OF * "`j* 25 W MAIN ST © AUBURN WA 98001-4998 WASHINGTON Eric Peterson Nordvind Sewer Service, LLC 1720 Loraine Street Enumclaw, WA 98022 111111111111'11141111"111'111111 ,1II1l111'IIIIIIIIIIIIIIII'III CITY.OF AUBURN,STATE OF WASHINGTON 98001 ACCOUNTS PAYABLE CHECK NO. 459946 i4T'INVOICE'NUMBEP. ., '1PcK•FiDATE.,ervr1-:P,,D NUMBER.ft.wu_`i..itt44)E8CRIPTION?Y':.muc;?e FIS,05I, ,,i'4,00. .09COUNT^84130WMOUNT4 e?eet, 19-10/#4 08/10/2020 20-000617 CP1917 DEDUCT METER REPLACEMENT, PH, 0.00 155,437.32 • • • • • ( ,I PLEASE DETACH BEFORE DEPOSITING • V•R I DO NOT ACCEPT THIS CHECK UNLESS THE PINK LOCK&KEY ICONS FADE WHEN WARMED AND YOU CAN SEE HEXAGONS IN A DUAL•TONE:TRUE WATERMARK WHEN HELD TO THE LIGHT ' - ' KeyBank National Association 19-10 1 Ki' s -* Au4um,lNeaMn ton 88001_ VOID 6 MONTHS "�ACCOUNTSPAYABLE * v yarrkEY2YOU CLAIMS CHECK AFTER CHECK DATE 1250 �; CITY OF . sem v ', CITY OF AUBURN .. .. D 4_.� E�M°a 7 :� 1,;b � ;, ' " k.ECK� .,'lv Aa �,S:0: . 6' o W M.IN TFEET A'r' ,° ,,,. I. 032910 08/17/2020 459946 .*****155,437.32 �' TW.,' V TON 98001 .....�,t.,Y WA ' I N GTO yo;: PAY One Hundred Fifty Five Thousand Four Hundred Thirty Seven Q stand Thirty E Two Cents •TO TT5 ' N,OF DVIND SEVEk ERVICE LL•C1 ,.�aaai Ii I••-• • r I r .l r... aTx ,, Mm.5: ORDER• 251`29 SE 9REEN y/�LLEY RDI , 1 .„ �� , I I AI BURN, WA 980921 I � I I >, `'' �g, a. ', .�" ` : S....,.1 I •• �. 4 li. I - l +1., r'r,l .1...h �:a,�n z Jt' 1�tia ) I i .',.w.,';fs.:C:lh :1 1 •,! 5 ,Y,d . i..,4;L P{tekhftd{ .rt'3 .r .-�.,.,,:-r"nly.!. 1 1.'KYi,'! ,T... t F� ,r z .t 4�` '� itV:4'�S.sy't.;l,,'/ U t 7A. !'7- 3', " 4 l e 7. q. :(Irli :I'.a 3T, t. ts,"s t. ?? }t ' !'tj'-q^;�:;v. ?t.* 1; '7 i:' 5 .Y. ,., �ttt... 1'.:,grh.s t •!yr *a rr`k -',�:.'�'� .kk S.irf'�jr, �., ,S '"_ .,'iF.`'L: '`k- rt d '' 1 1j04,0,2,-„,..4,� ' . ' : ,. 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