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HomeMy WebLinkAbout2020-046 PO 20200396- Grabowski Paving LLC prim ) Purchase Order 'a Fiscal Year 2020 Page: 1 of: 1 r- es- B City of Ashland _ , I ATTN:Accounts Payable 20 E. Main Purchase 20200396 Ashland,OR 97520 Order T Phone:541/552-2010 - O Email:payable@ashland.or.us • ✓ H C/O Public Works Department E GRABOWSKI PAVING LLC I 51 Winburn Way NPO BOX 3212 p Ashland, OR 97520 8 : CENTRAL POINT, OR 97502 Phone:541/488-5347 R T Fax: 541/488-6006 • ---_- - - - ---- --- - — -- Paula•BrownT 04/21/2020 5356 l Cit Accounts Pa able Trench Patch • 1 Trench patch City electrical trench IPCO 1 $4,675.0000 $4,675.00 Goods and Services Agreement(Less than$25,000) Completion date: 05/31/2020 Project Account: E-201325-999 ***************GL SUMMARY*************** 081200-704200 '.4 675.00 • • i �, By:`"-�' Date: ��� Authorized Signature =�--4 $4,675.00 y---r.. I //6"--,v_ e--6-1 4' e'e..-e--e----4 FORM #3 C/'"/tii /6 0 CITY OF A request for a Purchase Order AS H LAN D REQUISITION 7--D D V 4 Date of request: 4I -110 ` Required date for delivery: Vendor Name Grabowski Paving LLC Address,City,State,Zip PO Box 3212 Central Point,OR 97520 Contact Name&Telephone Number Mike Grabowski 541-601-3906 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: 0 Invitation to Bid ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council:_ 0 Written quote or proposal attached ❑ Written quote or proposal attached _(Attach copy of council communication) _(If council approval required,attach copy of CC) ❑ Small Procurement ' 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: ❑ State of Oregon ❑fi Direct Award _(Attach copy of council communication) Contract# Cl Verbal/Written bid(s)or proposal(s) ❑ Request for Qualifications(Public Works) 0 State of Washington Date approved by Council: Contract#_ (Attach copy of council communication) ❑ Other government agency contract Intermediate Procurement 0 Sole Source Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES ❑ Special Procurement 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 0 Form#9,Request for Approval Agreement approved by Legal and approved/signed by ❑ Less than$35,000,by direct appointment 0 Written quote or proposal attached City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached Date approved by Council:_ 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Trench patch City electrical trench at IPCO 4,675 00 ,, Item# Quantity Unit Description of MATERIALS Unit Price Total Cost IIIPer attached quote/proposal ,':.TOTAL COST "` Project Number 201325 _ Account Number 081200 : 704200 Account Number - Account Number - *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form l certify that th City's public contracting requirements have been satisfied. I Employee:\� CRU*6 Department Head: /5-4104' ?vzd (Equal to or greater than$5,000) Department Manager/Supervisor: City Administrator. (Equal to or greater than$25,000) Funds appropriated for current fiscal year: YES / NO Deputy Finance Director-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: Grabowki Paving LLC CITY OF PROVIDER'S CONTACT: Mike Grabowski -ASHLAND 20 East Main Street ADDRESS: PO Box 3212 Ashland,Oregon 97520 Central Point, OR 97520 Telephone: 541/488-5587 PHONE: 541-601-3906 Fax: 541/488-6006 This Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Grabowki Paving LLC, (a domestic limited liability company) ("hereinafter"Provider"), for trench patching City electrical trench at Independent Way project. 1. PROVIDER'S OBLIGATIONS 1.1 Provide trench patching City electrical trench at Independent Way project as set forth in the "SUPPORTING DOCUMENTS"attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." .};,,,,,,—c 55 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder,a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. ?e,„ AAN- ked r t,rea 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, rte,and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an"occurrence" and not a"claims made" form,and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together,.they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Agreement between the City of Ashland and Grabowski Paving LLC 1.3 Provider shall,at its own expense,maintain Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $21,507.75 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter,to all employees performing Work under.this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as"Exhibit A"predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$4,675.00 as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursementunder this Agreement exceed the sum of$4,675.00 without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing._ Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to.procure similar types of goods and services from:other providers in its sole discretion. 3:2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance,paid leave,and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations,and representations between the parties,- whether written or oral. Page 2 of 6: Agreement between the City of Ashland and Grabowski Paving LLC i -5i 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue,and expressly consents that, upon motionof the other party, any case may be dismissed or its venue transferred,as appropriate,so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against anyand all claims, suits, actions, losses,damages, liabilities, costs, and expenses of any nature resulting from, arising out of,. or relating to the activities of Provider or its officers, employees,contractors, or agents under this.Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts Of God, strikes,lockouts,accidents,or other events beyond the control of the other or the other's officers, employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving.to the fullest extent permitted the intent of Provider and the City set forth in this Agreement.. 3.11 Deliveries will be F.O:B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects, fraud, and warranties. 3.12 The City may inspect and test the Goods. The. City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code,ORS Chapter 72(UCC). 3.13 Provider represents and warrants that the Goods are new, current, and.fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture.Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" • The Provider's complete written Proposal dated March 26,2020. . . Page 3 of 6; Agreement between the City of Ashland and Grabowski Paving LLC 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under.this Agreement and at law or in equity,including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratoryor injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue anyremedy or remedies singly,collectively, successively or in any order whatsoever. 5.2 Inno event shall City be liable to Provider forany expenses relatedto termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6.' TERM AND TERMINATION 6.1_ Term .. This Agreement shall be effective from thedateof execution on behalf of the City as set forth below (the "Effective Date"), and shallcontinue in full force and effect until May 31, 2020, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty(30) days' prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement,with cause,bynot less than fourteen (14) days' prior written notice if the cause is not cured withinthat fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity.: 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery,by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Public Works Department Attn: Chance Metcalf . 20 E.Main Street Ashland, Oregon 97520 Phone: (541)488-5587 With a copy to: City of Ashland—Legal Department 20 E.MainStreet Ashland,OR 97520 Phone: (541)488-5350 If to Provider: Grabowski Paving LLC . Page 4 of 6: Agreement between the City of Ashland and Grabowski Paving LLC ' v Attn:Mike Grabowski PO Box 3212 Central Point, OR 97520 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider, for a period of no fewer than six(6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. • 9.2 Provider's failure to comply.with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. Page 5 of 6: Agreement between the City of Ashland and Grabowski Paving LLC nr� CITY OF ASHLAND: GRABO: I PAVING LL (PROVIDER): By: By: fl l rte . d Signature Signaturen/ .P.Oti G 00.42w ( c kue i ll"VGJ3V�,.-4C v Printed Name Printed Name P4444 Won/4( Dirtze..rvez.- Title Title d' GC,41" as 2010 Date Date (W-9 is to be submitted with this signed Agreement) 5€e otA cln-ed 1lj_c Purchase Order No. „v6( CAV.+ C See c fitzt1.5es [a c 6f Cav,ra-c La, e-e cA-4+eif-tne0) 55 Page 6 of 6: Agreement between the City of Ashland and Grabowski Paving LLC •Grabowski Paving LLC Grabowski 'lb proposal PO Box 3212 PAVING._ Central Point, OR 97502 LLC CCB#213159 Date Estimate# (541)601-3906 — (541)826-5264 Fax 3/26/2020 955 email—grabowskipaving@centurylink.net Customer City of Ashland 51 Winburn Way Job Name/information Ashland, OR 97520 . 640 Tolman Creek Job Site Address Ashland Description of Work to be Performed. Total Asphalt Patching Excavate the crushed rock, haul away the debris. Patch 2250 square feet of 4,675.00 trench with 3 inches of asphalt compacted. Payment Information/Terms Total Price $4,675.00 Total Due Upon Completion Any balance that is due pursuant to the terns and provisions of this agreement and remain unpaid after 30 days may be assessed interestat a rate of 18%per annum on unpaid balance. Contractor warrants all work to be free of defects in material and workmanship fora period of one year from the date work is completed.The sole and exclusive remedy of the buyer and obligation of contractor for matters set forth in this agreement and the work done by the contractor whether on warranty,contract,or negligence is the repair of the defect.Any change to the above described work made by the customer may result in a change of the total price.Customer has the right to resolve disputes through negotiation directly with the contractor.Acceptance of this proposal acknowledges that this proposal is also to serve as a notice of right to lien the above listed job site property. Upon ACCEPTANCE to have work done please Sign this form which will serve as.a contract for the above described work and return to Grabowski Paving LLC. Authorized Signiture for Grabowki Paving LLC /7i +Oder" . This Proposal may be withdrawn if not accepted within 10 days. member/manager Customer Acceptance The above prices, specifications and conditions are satisfactory and are hereby accepted Grabowski Paving LLC is herby authorized to do work as specified. Signature of Acceptance Date Printed Name of Customer Signing Contract.. • • Ciient#:172243 , GRABPAVI • ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM'/ODIYYYY) 4/03/2020 • 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 CONTACT Marcia Hawkins . _ Propel Insurance PHO,NNEo,Ext): (800 499-0933 FAXA1C,No):866 577-1326 .• ,AIC • Medford Commercial Insurance E-MAI Ess: rnarcia.hawkins@P ropelinsurance.com ADDR • P O Box 936 INSURER(S)AFFORDING COVERAGE • NAIC# Medford,OR,97501 . . . INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B:SAIF Corporation .. 3619.6 Grabowski Paving LLC INSURER C: • PO Box 3212 INSURER D: . Central Point,OR 97502 • - INSURER E: • . INSURER F: - .'. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: . THIS IS TO CERTIFY THAT THE POLICIES OF'INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD . INDICATED. .NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY'PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE.BEEN REDUCED BY PAID CLAIMS. /NSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR /NSR V= POLICY NUMBER ' (MM1DDNYYY) (MMIDDNYYY) A X COMMERCIAL GENERAL LIABILITY, EPP0436407 05101/2019 05/01/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR ' ' PREMISES(Ea o cur enee) $500,000 X PD Ded:$500 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO • - POLICY JECT LOC PRODUCTS-COMP/OP AGG. x2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 'EPP0436407 05/01/2019 05/01/2020 (E°acddW INGLE LIMIT $1,000,000 X ANY AUTO - BODILY'INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Peracddent) S AUTOS ONLY AUTOS • HIRED NON-OWNED PROPERTY DAMAGE $ - AUTOS ONLY _ AUTOS ONLY (Per accIdent) $ A x UMBRELLA LIAB X OCCUR ' EPP0436407 05/01/2019 05/01/2020 EACH OCCURRENCE $1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $1,000,000 • DED RETENTION$ _ $ B WORKERS COMPENSATION 871247 ' 05/01/2019 05/01/2020 X STATUTE ER AND EMPLOYERS'LIABILITY • ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EL.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? y N J A. • ' (Mandatory In NH) • E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under EL.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below • DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) • City of Ashland its officers,agents and employees are additional insured per attached endorsement • • CERTIFICATE HOLDER ' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • Cit• y of Ashland its Officers, THE EXPIRATION DATE- THEREOF, NOTICE WILL BE DELIVERED IN agents and employees ACCORDANCE WITH. THE POLICY PROVISIONS. 20 East Main Street - • Ashland,OR 97520 • AUTHORIZED REPRESENTATIVE 1 oG"`.C'C r�is""`'L' ' ©1988-2015 ACORD CORPORATION.All rights reserved. 'ACORD 25(2016103) 1 of 1 The ACORD name and logo are.registered marks of ACORD . #S4081796/M3617537 MNIJOO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disclose Hazards 8 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments 10 6. Voluntary Property Damage(Coverage a.)and Care,Custody or Control Liability Coverage(Coverage b:) 10 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured-Specified Relationships: 11 x Managers or Lessors of Premises; x Lessor of Leased Equipment; x Vendors; x State or Political Subdivisions-Permits Relating to Premises; x State or Political Subdivisions-Permits;and x Contractors'Operations 10. Broadened Contractual Liability-Work Within 50' of Railroad Property 16 11. Property Damage to Borrowed Equipment 16 12. Employees as Insureds—Specified Health Care Services: .. 16 X Nurses; x Emergency Medical Technicians;and . x Paramedics 13. Broadened Notice of Occurrence 16 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, except as provided below 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You . The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unlessotherwise stated$ 4. Supplementary Payments a. Bail bonds: $ 1,000 .. . . b. Loss of earnings: $ 350 5: Medical Payments Medical Expense Limit: . $ 10,000 Includes copyrighted material of Insurance GA 233 OR 0910 Services Office,Inc.,with its permission. •Page 1 of 16 6. VoluntaryPropertyDama Damage(Coverage a.)and Care,Custody or Control Liability Coverae (Coverage b.) Limits of Insurance(Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units (e) Other b. Care, Custody or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: 2) Our right and duty to 1. Employee Benefit Liability.Coveragedefend ends when we a. The followingis added to SECTION I havel used upf the insuapplrance cable limit of insurance. - COVERAGES: Employee Benefit in the payment of Liability Coverage. judgments or settle- (1) Insuring Agreement ments. (a) We will pay those sums that No other obligation or Habil- the insured becomes legally ity to pay sums or perform obligated to pay as dam- acts or services is covered ages caused.by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pay- sured, or of any other per- ments. son for whose acts the in- (b) This insurance applies to sured is legally liable, to . damages only if the act, er- which this insurance ap- ror or omission, is. negli- plies. We will have the right gently committed in the and duty to defend the in- "administration" of your sured against any "suit' "employee benefit program"; seeking those damages. and However, we will have no duty to defend against any 1) .Occurs during the poi- "suit" seeking damages to icy period; or which this insurance does not apply. We may, at our 2) Occurred prior to the discretion, investigate any effective date of this report of an act, error or endorsement provided: omission and settle any a) You did not have claim or "suit" that may re- . •. . knowledge of a suit.But: claim or "suit' on 1) The amount we will pay or before the ef- for damages is limited festive date of this as described in SEC- endorsement. TION III - LIMITS OF You will be INSURANCE; and deemed to have Includes copyrighted material of Insurance GA 233 OR 0910 Services Office,Inc.,with its permission. Page 2 of 16 knowledge of a 1) Failure of any invest- • claim or "suit" ment to perform; when any "author- ized representa- 2) Errors in providing in- tive; formation on past per- formance of investment i) Reports all, or vehicles; or any part, of the act, error or 3) Advice given to any omission to us person withrespect to . . or any other that person's decision insurer; to participate or not to participate in any .plan ii) Receives a included in the "em- written or ver- ployee benefit pro- bal demand or .. gram". claim for dam- ages because (f) Workers' Compensation of the act,error and Similar Laws or omission; Any claim arising out of your and failure to comply with the b) There is no other mandatory provisions of any applicable insur- workers' compensation, un- ance. employment compensation insurance, social security or (2) Exclusions disability benefits law or any similar law. This insurance does not apply to: (g) ERISA (a) Bodily Injury, Property Damage or Personal and Damages for which any in- Advertising Injury .. sured is liable because of li- ability imposed on a fidud- Bodily injury", "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any intentional, dishonest, (h) Available Benefits fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, , extent that such benefits are committed by any insured, . available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations;under (j) Employment-Related any plan included in the Practices "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- •any: ance of Investment / Ad- (1) Refusal to employ; vice Given With Respect to Participation . (2) Termination of em- ployment; Any claim.based upon: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. Page 3 of 16 • (3) Coercion, demotion, tors are insureds, but only evaluation, reassign- with respect to their duties ment, discipline, defa- as your officers or directors. mation, harassment, Your stockholders are also humiliation, discrimina- insureds, but only with. re- tion: or other. employ- sped to their liability as ment-related practices, stockholders. acts or omissions;or • (e) A trust, you are an insured. (4) Consequential liability Your trustees are also in- as a result of(1), (2)or sureds, but only with respect (3)above. to their duties as trustees. This exclusion 'applies (2) Each of the following is also an whether the insured may be insured: held liable as an employer Each of your "employees'' or in any other capacity and (a)). . to any obligation to share who is orwas authorized to damages with or repay administer your "employee someone else who must benefit program". pay damages because of (b) Any persons, organizations the injury. or "employees" -.having (3) Supplementary Payments proper temporary authoriza- tion to administer your"em- SECTION I - COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS -COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee.Benefit Liabil- spect to . duties as such. ity Coverage, SECTION Il -WHO IS That representative will AN INSURED is deleted in its entirety have all your rights and du- and replaced by the following: ties under this Coverage (1) If you are designated in the Dec- Pan. larations as: (3) Any organization you newly ac- (a) An individual, you and your quire or form, other than a part- spouse are insureds, but nership, joint venture or limited only with respect to the con- liability company, and over which duct of a business of which you maintain ownership or ma- you are the sole owner. jority interest, will qualify as a Named Insured if no other simi- (b) A partnership or joint ven- lar insurance applies to that or- ture, you are an insured. ganization. -However, coverage Your members, your part- under this provision: ners, and their spouses are also insureds but only with (a) Is afforded only until the respect to the conduct of 180th day after you acquire your business. or form the organization or the end of the policy period, (c) A limited liability company, whichever is earlier; and you are an insured. Your members are also insureds, (b) Does not apply to any act, but only with respect to the error or omission that was conduct of your business. committed before you ac- Your managers are insur- quired or formed the organi- zation. rgani- zation. eds, but only with respect to their duties as your manag- c. Limits of Insurance - ers. As respects Employee Benefit Liabil (d) An organization other than a ity Coverage, SECTION 'III -LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company,you tirety and replaced by the following: are an insured. Your "ex- ecutive .officers" and direc- t GA 233 OR 0910 Includes copyrighted material of Insurance Services Office,Inc.;with its permission. Page 4 of 16 1 (1) The Limits of Insurance shown in amount stated in the Decla- Section B. Limits of Insurance, rations as applicable :to 1. Employee Benefit Liability Each Employee. The limits } Coverage and the rules below of insurance shall not be re- fix the most we will pay regard- duced by the amount of this less of the number of deductible. (a) Insureds; (b) The deductible amount stated in the Declarations (b) Claims made or "suits" applies to all damages sus- brought; tained by any one "em- (c) Persons or organizations ployrre", including such making claims or bringing "employee's" dependents "suits"; and beneficiaries, because, of all ads, errors or omis- (d) Acts,errors or omissions;or sions to which this insur- ance applies. (e) Benefits included in your "employee benefit program". (c) The terms of this insurance, • (2) The:Aggregate Limit shown in tnocluding those with respect. Section B. Limits of Insurance,. } 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement is defend the insured the most we will pay for all dam- against any "suits" ages because of acts, errors or seeking those dam- omissions negligently committed ages; and in the "administration" of your "employee benefit program". 2) Your duties, and the duties of any other in- . . (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission,or claim, of Insurance,. 1. Employee apply irrespective of the ap- t Liability Coverage of plication of the deductible this endorsement is the most we will pay for all damages sus- amount. tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductibleamount to such "employee's" dependents effect settlement of any and benefiaaries,as a result of: claim or"suit"and, upon no- (a) An act, error,or omission; or tification of the action taken, you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions,' regard-. deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, negligently committed in the As respects Employee Benefit Li- "administration" of your "em- ability Coverage, SECTION IV - ployee benefit program". COMMERCIAL GENERAL LIABIL- ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- ceed, and:will be subject to the (1) Item 2. Duties in the Event of limits and restrictions that apply Occurrence, Offense, Claim or to the payment of benefits in any Suit is deleted in its entirety and plan included in the "employee replaced by the following: benefit program". 2. Duties in the Event of an (4) Deductible Amount . Act, Error or Omission, or Claim or Suit (a) Our obligation to pay dam- ages on 'behalf of the in- a. You must see to it that sured. applies only to the we are notified as soon amount of damages in ex- as practicable of an act, cess of the deductible error or omission which. Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. Page 5 of 16 may result in a daim. surance may also To the extent possible, apply. i notice should include: d. No insured will, except (1) What the act,errorat that insured's own or omission was cost, voluntarily make a and when it oc- payment, assume any curred; and obligation, or incur any expense without our (2) The names and consent. addresses of any- one who may suf- (2) Item 5. Other Insurance is de- fer damages as a leted in its entirety and replaced result of the act, by the following: • g error or omission. 5. Other Insurance b. If a daim is made or If other valid and collectible "suit" broughtagainst insurance is available to the any insurreed,,you must: insured for a loss we cover (1) Immediately re- under this Coverage Part, cord the specifics our obligations are limited of the claim or as follows: "suit" and the date received;and a. Primary Insurance (2) Notify us as soon This insurance is pri- as practicable. mary 'except when c. below applies. If this in- You must see to it that surance is primary, our we receive written no- obligations are not af- tice of the daim .or fected unless any of the "suit"as soon as practi- other insurance.is also cable. primary. Then, we will share with all that other c. You and any other in- insurance by the volved insured must: method described in b. (1) Immediately send below. us copies of any b. Method of Sharing demands, notices, summonses or.le- If all of the other insur- gal papers re- ance permits contribu- ceived in connec- tion by equal shares, tion with the daim ' . we will 'follow this or"suit'; method also. Under this approach each insurer (2) Authorize us to ob- contributes equal tain records and amounts until it has other information; i ' paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of whichever comes first. the daim or de- If any of the other in- fense against the surance does not per- "suit';,and mit contribution by (4) Assist us, ' upon equal shares, we will our request, in the contribute; by limits. enforcement of Under this method, any right against each insurer's share is based on the ratio of its any person or or- applicable limit of in- surance to the total ap- may be liable to plicable.limits of insur- the insured be- ance.ofall insurers. cause of an act, error or omission c. No Coverage to which this in- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. . Page 6 of 16 , This insurance shall not providing some or all of the cover any . loss for following benefits to "em- which the insured is en- ployees", whether provided titled to recovery under 'through a"cafeteria plan"or any other insurance in otherwise: • force previous to the ef- fective date of this a. Group life. insurance; Coverage Part. group accident or health insurance; den- e. .Additional Definitions tal, vision and hearing plans; and . flexible As respects Employee Benefit Li- - spending accounts; ability Coverage, SECTION V - provided that no one DEFINITIONS is amended as fol- otherthan an "em- lows. .. ployee" may subscribe, • (1) The following definitions are to .such benefits and. added: such benefits are made generally available .to 1. "Administration"means: those "employees" who satisfy the plan's eligi- a. Providing information to bility requirements; "employees", including. . their dependents and . . b. Profit .:sharing . plans, beneficiaries, with re- employee . savings sped to eligibility for or plans, employee stock scope of "employee ownership.plans, pen- benefit programs"; ' sion plans and stock subscription plans, pro- s b. Interpreting the "em- vided that no one other j ployee . benefit pro- than' an . "employee" grams"; may subscribe to such c. Handling records in benefits and such connection with the benefits are made gen- "employee benefit pro- erally available to all grams"; or 'employees .who are eligible under the plan d. Effecting, .continuing or for such benefits; terminating any "em- c. Unemployment insur- ployee's" participationance, social security in any benefit included inbenefits, workers' coin- inrthe "employee bene- pensation and disability fit ppograam benefits; and However, "administration" ' „ d. Vacation plans, includ- does not include: ing buy and sell 'pro- a. Handling payroll deduc-- grams; leave of ab- tions; or sence programs, in- cluding military, mater- b. The failure to effect or ' nity, family, and civil maintain any insurance leave;tuition assistance or adequate limits of plans; transportation coverage of insurance, and health club subsi- including but not limited .' ' dies. to unemployment in- surance, social security (2) The following definitions are de- benefits, workers' corn- leted in theirentirety and re- pensation and disability placed by the following: benefits. 21. "Suit" means a civil pro- 2. "Cafeteria plans" means ceeding in which money plan authorized by applica- damages because of an act, ble law to allow"employees" error or omission to which to elect to pay for certain this insurance applies are benefits with pre-tax dollars. alleged."Suit"includes: 3. "Employee 'benefit pro- :.a. An arbitration proceed- grams" means a program . ing in which such dam- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. Page 7 of 16 ages are claimed and The exdusions under SECTION to which the insured I - COVERAGES, COVERAGE must submit or does A. BODILY INJURY AND submit with our con- PROPERTY DAMAGE LIABIL- sent; ITY,2. Exclusions;other than i. b. Any: other alternative War -and the Nuclear Energy Liability Exclusion, are deleted dispute resolution pro- and the following are added: ceeding in which such damages are claimed This insurance does not apply to: 11 and to which the in- sured.submits with our (a) 'Property damage": consent;or 1) Assumed in any con- c. An appeal of a civil pro- tract;or ceeding. . .. 2) Loss caused by or re- 8. "Employee"means a person suiting from any of the actively employed, formerly following: employed, on leave of ab- a) Wear and tear; sence or disabled, or re- tired. "Employee" includes a b) Rust, corrosion, leased worker"."Employee" fungus, decay, de- does not include a "tempo- terioration, hidden rary worker". . . or latent defect or 2. Unintentional Failure to Disclose Hoz- pquality in arils prcauses 'operty that causes it to dam SECTION IV-COMMERCIAL GENERAL age or destroy it- LIABILITY CONDITIONS, 7, Represen- self; tations is hereby amended by the addi- c) Smog; tion of the following: break- Based on our dependence u your rep- d) Mechanical on p p yo p down including resentations as to existing hazards, if un- rupture or bursting intentionally you should fail to disdose all caused by cen- such hazards at the inception date of your . trifugal force; policy, we will not reject coverage under this Coverage Part based solely on such . e) Settling, cracking, failure. shrinking or ex- 3. Damage to Premises Rented to You pension; or a. The last Subparagraph of Paragraph f) Nesting or infesta- tion, 2. SECTION I - COVERAGES, . aor was discharge COVERAGE A. - BODILY INJURY or release or waste secre- AND PROPERTY DAMAGE, 2. LI- products ABILITY Exclusions is herebyde- tions, rodentsby insects, or, birds, or leted and replaced by the following: other animals. Exclusions c.through q.do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow: ping, smoke or soot to premises in while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or b. The insurance, provided under SEC- lam t the, earth move- TION I-COVERAGES, COVERAGE ' A. BODILY:INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. • 3) Water under the ground surfacepressing on, or (1) As respects Water Damage Le- flowing orseeping gal Liability,as provided in Para- through: graph 3.b.above: Includes copyrighted material of Insurance GA 233 OR 0910 Services Office,Inc.,with its permission. Page 8 of 16 a) Foundations, one "occurrence" to which walls, floors or this insurance applies. paved surfaces; (3) The amount we will pay is limited b) Basements, as described in Section B. Lim- whether paved or its of Insurance, 3. Damage to not; or . Premises Rented to You of this endorsement. c) Doors,windows or other openings: 4. . Supplementary Payments (c) Loss caused by or.resulting Under SECTION I - COVERAGE, SUP- from water that leaks or PLEMENTARY PAYMENTS - COVER- flows from plumbing, heat- AGES A AND B; ing, air conditioning, or fire protection systems caused a. Paragraph 2. is replaced,by the fol- by or resulting from freezing, lowing: unless: Up to the limit shown in Section B. I 1) You; did' your best to Limits of Insurance, 4.a.Bail Bonds i of this endorsement for cost of bail maintain heat in the building or structure; or bonds required because of accidents or trafficlaw violations arising out of • 2) - You drained the equip- . . the use of any vehicle to which the ment and shut off the Bodily Injury Liability Coverage ap- water supply if the heat plies. We do not have to furnish was not maintained. . these bonds. (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- lowing: 1) Plumbing, heating, air conditioning, fire pro- All reasonable expenses incurred by tection systems, or . the insured at our request to assist us other equipment or ap- in the investigation or defense of the pliances;or claim or"suit",including actual loss of earnings up to the limit shown in Sec- 2) The interior. of any tion B. Limits 'of Insurance, 4.b. building or structure, or Loss of Earnings of this endorsement to personal property.in per day because of.time off from the building or structure work: causedby orresulting from rain, .snow, sleet . 5: Medical Payments or ice, whether driven by wind or not. The Medical Expense Limit of Any One Person as stated in the Declarations is c. Limit of Insurance amended to the limit shown in Section B. Limits of Insurance, 5. Medical Pay- The Damage to Premises Rented to Merits of this endorsement. You Limit as shown in the Declara- tions is amended as follows: 6. Voluntary.Property Damage and Care, (2) Paragraph 6. of SECTION III - Custody or Control Liability Coverage LIMITS. OF INSURANCE is a. Voluntary Property_ Damage Cov- hereby deleted and replaced by .erage the following: We will pay for"property damage"to 6. Subject to 5. above, the property of others arising out of op- Damage to Premises erations incidental to the insured's Rented to You Limit is the business when: most we will pay under COVERAGE A. BODILY (1). Damage is causedby the in- INJURY' AND PROPERTY ' sured; or DAMAGE LIABILITY, for ' (2) Damage occurs while in the in- damages because of"prop- sured's possession. erty damage" to premises while rented to you or tern- With .your consent, we will make porarily occupied by you these payments regardless of fault. with permission of the ' owner, arising 'out of any Includes copyrighted material of Insurance GA 233 OR 0910 ' ' Services Office,Inc.,with its permission. Page 9 of.16 } b. Care, Custody or.Control Liabilitydeductible amount as has been Coverage " _ paid by us. SECTION I .- COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or ERAGE.A. BODILY INJURY AND Acquired Organizations PROPERTY DAMAGE LIABILITY, 2. SECTION II - WHO IS AN INSURED is Exclusions,j.Damage to Property, SECTION as follows: Subparagraphs(3), (4)and(5)do not apply to "property damage" to the Subparagraph a. of Paragraph 4. is property of others described therein. hereby deleted and replaced by the fol- With respect to the insurance provided by lowing: this section of the endorsement, the fol- a. Insurance under this provision is af- lowing additional provisions apply: . forded only until the 180thday after a. The Limits of Insurance shown in the you acquire or form the organization Declarations are replaced by the lira-' or the end of the policy period, its designated in Section B.Limits.of '.whichever is earlier; Insurance, 6. Voluntary Property 8. Waiver of Subrogation Damage and Care, Custody or Control Liability Coverage of this SECTION IV COMMERCIAL GENERAL endorsement with respect to cover- LIABILITY CONDITIONS, 9. Transfer of age provided by this endorsement. Rights of Recovery Against Others to These limits are inclusive of and not Us is hereby amended by the addition of in addition to the limits being re- the following: placed. The;-Limits of Insurance shown in Section B. Limits of Insur- We waive any right of recovery we may ance, 6. Voluntary Property Dam- have because of payments we make for age and Care, Custody or Control injury or damage arising out of your ongo- Liability Coverage of this endorse ing operations or"your work",done under. ment fix the most we will pay in any a written contract requiring such waiver one "occurrence" regardless of the with that person or organization and in- number of: cluded in the "products-completed opera- tions hazard". However, our rights may (1) Insureds; only be waived prior to the "occurrence" (2) Claims made or "suits" brought; giving rise to'the injury or damage for which we make payment under this.Cov- or erage Part. The insured must do nothing.; (3) Persons or organizations making after a loss to impair our rights. At our re- claims or bringing"suits". quest,the insured will bring"suit'or trans- fer'those rights to us and help us enforce b. Deductible Clause. those rights: (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- on your behalf applies only to the fied_Relationships amount of damages for each "occurrence"which are in excess a. The following is hereby added to of the deductible amount stated SECTION II-WHO IS AN INSURED: in Section B. Limits of Insur- (1) Any person or organization de- ance, 6. Voluntary Property scribed in Paragraph 9.a.(2) be- Damage and Care, Custody or ' ' low'(hereinafter referred to as Control Liability Coverage of additional insured)whom you are this endorsement. The limits of required to add as an additional insurance will not bereduced by , insured under this Coverage Part the application of such deducti- by reason of: ble amount. A' en (2) Condition 2.Duties in the Event ' (a) ment; contract or agree- of Occurrence, Offense, Claim or Suit, applies to each claim or (b) An oral agreement or con- "suit"irrespective of the amount. tract where a certificate of insurance showing that per- (3) We may pay any part or all of the son or organization as an deductible amount to effect set- additional insured has been tlement of any claim or "suit" issued, and, upon notification of the ac- . tion you shall promptly re- is an insured, provided: imburse us for such part of the ' Includes copyrighted material of Insurance iGA 233 OR 0910 Services Office,Inc.,with its permission. Page 10 of 16 (a) The written or oral contract or use of equipment leased or agreement is: to you by such person(s) or 1) Current . in effect or organizations(s). However, Currently this insurance does not ap- becomes effective dur- ply to any "occurrence" ing the policy period; which takes place after the and equipment lease expires. 2) Executed prior to an (c) 'Any person or organization "occurrence" or offense (referred to below as ven- i to which this insurance . dor) with whom you have would apply; and agreed per Paragraph (b) They are not specifically 9.a.(1) above to provide in- named as an additional in- surance, but only with re- sured under any other pro- spect to "bodily injury" or vision of, or endorsement 'property damage" arising added to, this Coverage out of"your products"which Part .are distributed or sold inthe regular course of the ven- (2) Only the following persons or or- dor's business, subject to ganizations are additional insur- ' ' the 'following additional ex- eds under this endorsement,and : elusions: insurance coverage provided to 1) The insurance afforded such additional insureds islim- ited as provided herein: the vendor does not apply to: (a) The manager or,lessor of a premises leased to you with a) "Bodily injury . or whom you have agreed per "property damage" Paragraph'9.a.(1) above to for which the ven- provide insurance, but only dor is damages t o with respect to liability anis- pay mageby ing out of the ownership, reason of the as- maintenance or use 'of that sumption of liability part of a premises leased to in a contract or you, subject to the following agreement. This additional exclusions: exclusion does not apply to liability for `� This insurance does not. ap- damages that. the ply to: vendor would have in the absence of 1) Any"occurrence"which . ' the contractor takes place after you agreement; cease to be a tenant in that premises; b) Any express war- ranty unauthorized 2) Structural alterations, by you; new construction or demolition operations c) Any physical or performed by or on be- chemical change half of such additional in the product insured. made intentionally by the vendor; (b) .Any person or organization . from which you lease d) Repackaging, ex- equipment with whom youcept when un- have agreed per Paragraph packed solely for 9.a.(1) above to provide in- the purpose of in- surance. Such person(s) or , spection, demon- organization(s)are insureds, station, testing, or but only to the extent that the substitution of the liability for'bodily injury", parts under in- "property damage" or "per- structions from the sonal and advertising injury" manufacturer, and is caused byyour negli then repackaged gence, acts.or omissions in in the original.con- the 'maintenance, operation tainer; Includes copyrighted material of Insurance GA 233 OR 0910 Services Office,Inc.,with its permission. Page 11 of 16 i • e) Any failure to Part with respect make such inspec- to such products. tions, adjustments, tests or servicing ( ) An d . state political subdi- y or as the vendor has vision with which you have agreed to make or agreed per Paragraph normally under- 9.a.(1) above to provide in- takes to make in surance, subject to the fol- the usual course of • lowing additional provision: business, in con- This insurance applies only nection with the with respect to the following distribution or sale hazards for which the state of the products; or political subdivision has f) Demonstration, in- issued a permit in connec- stallation,servicing tion with premises you own, or repair opera- rent or control and to which tions, except such this insurance applies: operations per- 1) The existence, mainte- formed at the yen- .nance,repair,construe- { dor's premises in tion, erection, or re- connection with moval of advertising the sale of the signs, awnings, cano- product; pies, cellar entrances, g) Products which, coal holes, driveways, after distribution or manholes, marquees, sale by you, have hoist away openings, been labeled or re- sidewalk vaults, street labeled or used as banners, or decorations a container,part or and similar exposures; ingredient of any Or ' other thing or sub- 2) The construction, erec- stance by or for tion, or removal of ele- the vendor; or vators;.or h) "Bodily injuryor 3) The ownership, main- "property damage" tenance, or use of any arising out of the elevators covered by negligence, acts or this insurance. omissions of the vendor, its em- (e) Any state or political subdi- ployees or anyone vision with which you have else acting on its agreed per Paragraph behalf. 9:a.(1) above to provide in- 2) This insurance does not surance, subject to the fol- apply to any insured lowing provisions: person or organization: 1) This insurance applies From whom you only with respect to op- a) erations performed by have acquired you or on your behalf such products, or for which the state or any ingredient, political subdivision.has part or container, • issued a permit entering into, ac- companying or 2) This insurance does not containing . such apply to "bodily injury", products;or "property damage" or "personal and advertis- b) When liability in- ing injury"arising out of eluded within the operations performed "products- for the state or political completed opera- subdivision. tions hazard" has been excluded un- (f) For "your work" performed der this Coverage . in Oregon, any person or Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. Page 12 of 16 organization with which you (a) Subparagraphs (e), ,(f) and • have agreed per Paragraph (g)do not apply to"bodily in- 9.a.(1) above to provide in- jury' or "property damage" surance, but only to the ex- included within the "prod- tent that the liability is ucts-completed operations caused by "your work" per- hazard"; formed for that additional in- { sured and only to the extent (b) Subparagraphs (a), (d), (e) { that such liability is caused and(g)do not apply to"bod- s by your negligence or the ily injury", "property darn- negligence of those acting age" or "personal and ad- on your behalf. A person or vertising injury' arising out organization's status as an of the sole negligence or insured under this provision willful misconductof the ad- of this endorsement contin- ditional insured or its "em- ues for only the period of ployees"; or time required.by the written (c) Subparagraph(f)and (g)do contract or agreement, but not apply to "bodily injury", in no event beyond the expi- "property damage" or "per- ration date of this Coverage sonal and advertising injury" Part. If there is no written arising out of: contract or agreement, or if no period of time is required 1) The rendering of, or by the written contract or failure to render, any agreement, a person or or- professional services ganization's status as an in- byyou or on your be- sured under this endorse- half, but only with re- ment ends when your op- spect to either or both erations for that insured are of the following opera- completed. tions: (g) For "your work" performed a) Providing engi- in the "coverage territory" neering, architec- but not in Oregon, any per- tural or surveying son or organization with services to others; which you have agreed per and Paragraph 9.a.(1) above to provide insurance, but only b) Providing, or hiring with respect to liability aris- independent pro- ing out of "your work" per- fessionals to pro- formed for that additional in- vide, engineering, sured by you or on your be- architectural or half. A person or organiza- surveying services tion's status as an insured .. in connection with underthis provision of this construction work endorsement continues for you perform. only the period of time re 2) Subject to Paragraph 3) quired by the written con- below, professional tract or agreement, but in no services include: event beyond the expiration date of this Coverage Part. a) Preparing, approv- If there is no written contract ing, or failing to or agreement,or if no period prepare or ap- of time is required by the prove, maps, shop written contract or agree- drawings, opin- ment,'a person or organiza- ions, reports, sur- tion's status as an insured veys, field orders, under this endorsement change orders, or ends when your.operations - drawings and for that insured are corn- specifications;and pleted. . b) Supervisory or in- (3) Any insurance. provided to an spection activities additional insured designated performed as part under Paragraph 9.a.(2): of any related ar- Includes copyrighted material of Insurance GA233 OR 0910 Services Office,Inc.,with its permission. Page 13 of 16 chitectural or engi- : primary to other insurance neering activities. . available to the additional 3) Professional services insured except: do not include services 1) •As otherwise provided within construction in SECTION IV means, methods, tech- COMMERCIAL GEN- niques, sequences and ERAL LIABILITY procedures employed CONDITIONS, 5. by you in connection Other Insurance, b. with"construction work Excess Insurance; or you perform. 2) For any other valid and (d) Subparagraphs (f) and (g) collectible insurance do not apply to "bodily in- available to the addi- jury' or 'property damage" tional insured as an ad- arising out of"your world'for ditional insured by at- which a consolidated (wrap- tachment of an en- up) insurance program has dorsement -to another been provided by the prime . .insurance.policy that is contractor!project manager written on an excess or Owner of the construction basis. In such case,the project in which you are in- coverage provided un- volved. der this .endorsement b. Only with regard to insurance pro- shall also be excess. vided to an additional insured desig- (2) Condition 11. Conformance to nated under Paragraph 9.a.(2) Sub- Specific Written Contract or paragraphs (f) and (g) above, SEC- -Agreement is hereby added: • TION III-LIMITS OF INSURANCE is amended to include: 11. Conformance 'to Specific Written Contract or The limits applicable to the additional Agreement insured are those specified in the written contract.or agreement or in a. With respect to addi- the Declarations of this Coverage tional • insureds de- Part, whichever are less. If no limits scribed in Paragraph are specified in the written contract or 9.a.(2)(f)above only: agreement, or if there is no written If a written contract..or contract or agreement, the limits ap- agreement between plicable to the additional insured are you and the additional. those specified in the Declarations of insured specifies that this Coverage Part The limits of in- suran.ce are inclusive of and not in coverage for the addi= tional insured: addition to the limits of insurance shown in the Declarations. (1) Be provided by the c. SECTION IV-COMMERCIAL GEN- Insurance Ser- ERAL LIABILITY CONDITIONS is vices Officea tional insured formdi- hereby amended as follows: number CG 32 61, (1) Condition 5. Other Insurance is CG 32 62 or CG amended to include: 32 63; or - (a) Where required by a written- . •(2) Include coverage contract or agreement, this for completed op- insurance is primary and/or erations; or noncontributory as respects (3) Include coverage any other insurance policy.. for"your work"; issued to the additional In- sured, and such other in- and where the limits or surance policy shall be ex- coverage provided to, cess and / or noncontribut- - the additional insured is ing, whichever applies, with . more restrictive than this insurance. was specifically re- (b) -Any insurance provided by contra in thatwrittenthis endorsement shall be contraeror agrr eement, the terms. of Para.- Includes ara=Includes copyrighted material of Insurance GA 233 OR 0910 . Services Office,Inc.,with its permission. . : Page 14 of 16 graphs 9.a.(3)(a)or 9.b. agreement specifies • above,or any combina- the Insurance Services tion thereof, shall be in- Office additional , in- terpreted as providing sured form number CG the limits or coverage 20 10 but does not required by the terms of specify which edition,or the written contract or specifies an edition,that agreement, but only to does not exist, Para- the extent that such Gm- graphs 9.a.3.b. and its or coverage is in- 9.b. of this .endorse- cluded within the terms ment shall not apply of the Coverage Part to and Paragraph which this endorsement .. 9.a.(3)(a) of this en- is attached. dorsement shall apply. b. With respectto addi- 10. Broadened Contractual Liability-Work tional insureds de= Within 50' of Railroad Property scribed :in- Paragraph 9.a.(2)(g)above only: It is hereby agreed that Paragraph f.(1)of Definition 12. "Insured contract" (SEC- If a written contract or TION V-DEFINITIONS)is deleted. agreement between you and the additional 11. Property Damage to Borrowed Equip- insuredspecifies that ment coverage for the addi- a. The following is hereby added to Ex- tional insured: ciusion j. Damage to Property, of a. Be provided by the Paragraph .2., Exclusions of SEC- Insurance Ser- TION I-COVERAGES, COVERAGE vices Office addi- A. BODILY INJURY AND. PROP- tional insured form ERTY DAMAGE LIABILITY: number CG 20 10 Paragraphs (3) and (4) of this exclu- or CG 20 37 sion do not apply to tools or equip- (where edition ment loaned to you, provided they are specified); or not being,used to perform operations b. Include . coverage at the time of loss. for completed op- b. With respect to the insurance pro- erations; or vided by this section of the endorse- c. Include -coverage ment, the following additional provi- for"your work"; scions apply. and where the limits or (1) The Limits of insurance shown in coverage provided to the Declarations arereplaced by the additional insured is the limits designated in Section more restrictive than . B. Limits of Insurance, 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These limits are in- the terms of Para- clusive of and not in addition to graphs 9.a.(3)(a), . the limits being replaced. The 9.a.(3)(b)or 9.b.above, Limits of Insurance shown in or any combination Section B. Limits of Insurance, thereof, shall be inter- 11. of this endorsement fix the preted as providing the most we will pay in any one"oc- limits orcoverage re- .. currence" regardless of the quired.by the terms of number of: the written contract or (a) Insureds; agreement, but only to the extent that such lim- . . . (b) Claims made or ' "suits" its or coverage is in- . brought; or cluded within the terms of the Coverage Part to (c) Persons or organizations which this endorsement making claims or bring is attached.If, however, suits". the written contract or Includes copyrighted material of Insurance GA 233 OR 0910 Services Office,Inc.,with its permission. Page 15 of 16 't (2) Deductible Clause a. Nurses; (a) Our obligation to pay dam- b. Emergency Medical Technicians; or ages on your behalf applies only to the amount of dam- c. Paramedics, ages for each "occurrence" ' in the jurisdiction where an "occurrence" which are._in excess of the or offense to which this insurance applies Deductible amount stated in takes place. Section B. Limits of Insur- • ance, 11. of this endorse- . 13. Broadened Notice of Occurrence ment. The limits of insur- ance will not be reduced by Paragraph a. of Condition 2. Duties in the application of such De- the Event of Occurrence, Offense, ductible amount. Claim or Suit(SECTION IV-COMMER- CIAL GENERAL LIABILITY CONDI- (b) Condition 2. Duties in the TIONS)is hereby deleted and replaced by Event of Occurrence, Of- the following: fens Claim orclaim Suit, ap" t clai • plies to each m or"suit" a. You must see to it that we are notified : irrespective of the amount. as soon as practicable of an "occur- rence"or an offense which may result (c) We may pay any part or all in a claim.To the extent possible,no- of the deductible amount to tice should include: effect settlement of any • claim or"suit"and, upon no- (1) How, when and where the "oc= tification of the action taken, currence"or offense took place; 1 you shall promptly reim- (2) The names and addresses of burse us for such part of the any injured persons and wit- 1 deductible amount as has nesses;and been paid by us. 12. Employees as Insureds - Specified (3) The nature and location of any Health Care Services injury or damage arising out of the occurrence or offense. It is hereby agreed that Paragraph This requirement applies only when 2.a.(1)(d) of SECTION II - WHO IS AN the"occurrence" or offense is known INSURED, does not,apply to your "em- to an"authorized representative". ployees" who provide professional health care services on your behalf as duly Ii- censed: i Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. Page 16 of 16 i