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2021-178 PO 20210297- DOWL LLC
,.L FI/411 CITY RECORDER Purchase Order Fiscal Year 2021r Page: 1 of: 1 B, City of Ashland i ATTN:Accounts Payable lPurchase n • L Ashland,OR 97520 Order/� 20210297 T Phone:641/662-2010 0 Email: payable@ashland.or.us • V N C/O Public Works Department E DOWL, LLC I 61 Wlnburn Way N 4041 B STREET p Ashland, OR 97520 R ANCHORAGE Phone: 641/488-5347 T Fax:541/488.6006 _:—'3=[=1a[sl�c� Jc -Ec c c.=Lt q_1.1s}� F•-s I=1€=�e11���t=1=}eltJl(hI_sEihke� l , –_— _ __ �.�(k-[ —�-� • Scott Fleury • • i er:T i� ,PE 1 lmTi� 1 it �E;r u" i= � l�n,t,I ts° 1 t�'-,�h; _= 03/09/2021 6270 • Cityn S Accou Payable �I 1 CaGlFllfyl tSt`[ {, Independent Fee Estimate 1 Independent fee estimate review for the Taxiway Rehabilitation - 1.0 $3,000,00 $3,000,00 Project Personal Services Agreement(Less than$25,000) Completion date: April 1,2021 Project Account: _ ***************GL SUMMARY*************** 085700-604100 $3,000.00 • • • • • • • By: L.'"--A-..dider. Date: L uth•rized Signature 5 _ _�;� _ •.3 000.00 , • FORM#3 CITY OF A I'(:f�tlf,�;4:for ii r'tltt;{t ry taiaaii ASHLAND &BEQ�DB$B'�C ®N / Date of request: 03/08/2021 Required dale for delivery: Vendor Name DOWL LLC Address,City,State,Zip 8410 154th Avenue NE Suite 120 Redmond,WA 08052 ' Contact Name&Telephone Number Ken Nichols kntchols@dowl.coni • Email address , SOURCING METHOD ❑ Exempt from Competitive Btddinn 0 invitation to Bid 0 emergency El Reason for exemption: • Date approved by Council: .0 Form#13,Written findings and Authorization ` ❑ AMC 2,50 •__•(Attach copy of council communication) 0 Written quote or proposal attached ❑ Written quote or proposal attached (if council approval required,attach copy of CC) • ❑ Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon d Direct Award _(Attach copy of council communication) Contract# ❑ Verbal/Mitten bid(s)or proposal(s)' - 0 Request for Qualifications(Public Works) 0 State of Washington • Date approved by Council Contract# _(Attach copy of council communication) 0 Other government agency contract - Jntermediate Procurement ❑ Sole Source Agency • GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract# • • Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement • b (3)Written bids&solicitation attached 0 F0101/14,Personal Services$51(to$75K kenvy PERSONAL SERVICES Date approved by Council: • U Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid unlit (Date) Agreement approved by Legal and approved/signed by •• ❑ Less than$35,000,by direct.appolntment 0 Special Procurement City Administrator.AMC 2.60.070(4) ❑ (3)Written proposals&solicitation attached 0 Form/19,Request for Approval 0 Annual cost to City exceeds$25,000,Council 0 Form 114,Personal Services$5K to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: Valid until: (Date) Description of SERVICES • - Total Cost • Independent Fee Estimate review for the Taxiway Rehabilitation Project3,000:00. °:. :.;i. ,:.° • Item# Quantity Unit Description of MATERIALS Unit Price Total Cost . [] Per attached quotelproposal _ TOTAL COST Project Number Account Number o a a 7 0 0-a 0 4 1 0 0 Account Number - Account Number • 'Expenditure must be charged to the appropriate account numbers fomite 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,I certify li�I he City's public contracting requirements have been satisfied. Employee 4'�y. av)14U Q,'1, , Department Head. '4_ 2�r ' •,dQl��orgreater than$5,000) , Department ManagerlSupervlsor: City Manag: ___ - /dual ogreater than 525,000) Funds appropriated for current fiscal year: Y0• _...h� ..l Finan a 1'ectol-(Equal to orgreafer JO,$, .00) D to ) Comments: • Form 113-Requisition . PERSONAL SERVICES AGREEMENT (LESS TITAN$25,000) CONSULTANT:DOWL LLC. CITY OF ADDRESS: 8410 154th Avenue NE Suite 120 ASH LAND Redmond,WA, 98052 20 East Main Street Ashland, Oregon 97520 TELEPHONE: 425-869-2670 Telephone: 541/488-5587 Fax: 541/488-6006 EMAIL:knichols@dowl.com This Personal Services Agreement(hereinafter"Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and DOWL LLC, a Foreign Limited Liability Company ("hereinafter"Consultant"), for an Independent Fee Estimate Review of Scope for the Design of the Taxiway Rehabilitation Project. NOW THEREFORE,in consideration of the mutual covenants contained herein,the City and Consultant hereby agree as follows: 1. Effective Date and Duration: This Agreement shall become effective on the date of execution on . behalf of the City, as set forth below(the"Effective Date"), and unless sooner terminated as specifically provided herein, shall terminate upon the,City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore,but not later than April 1,2021. 2. Scope of Work: Consultant will provide a letter summary of the analysis and a complete fee estimate spreadsheet as more fully set forth in the Consultant's Proposal dated February 17,2021 which is attached hereto as"Exhibit A"and incorporated herein by this reference. Consultant's services are collectively referred to herein as the"Work." 3. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be mutually complementary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of the exhibits or-supporting documents. 4. All Costs Borne by Consultant: Consultant shall, at its own risk, perform the Work described above and, unless otherwise specified in this Agreement, furnish all labor, equipment, and materials required for the proper performance of such Work. 5. Qualified Work: Consultant has represented, and by entering into this Agreement now represents,that all personnel assigned to the Work to be performed under this Agreement are fully qualified to perform the service to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Page 1 of 6: Agreement between the City of Ashland and DOWL LLC 6. Compensation: City shall pay Consultant the sum of$3,000.00 (three thousand dollars) as full compensation for Consultant's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of $3,000.00 (three thousand dollars)without the express,written approval from the City official whose • signature appears below,or such official's successor in office.Payments shall be made within thirty (30) days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination. 7. Ownership of Work/Documents: All Work,work product, or other documents produced in furtherance of this Agreement as deliverables belong to the City, and any copyright,patent,trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. Such documents are not intended or represented to be suitable for reuse by the City or others or on any other project.Any modification or reuse without written verification of Consultant will be at City's sole risk. City shall indemnify and hold harmless Consultant and Consultant's Consultants from all claims, damages, losses, and expenses, including attorney fees arising out of or resulting,therefore. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. 9. Living Wage Requirements: If the amount of this Agreement is $22,002.43 or more, Consultant 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. Consultant is also required to post the notice attached hereto as"Exhibit B"predominantly in areas where it will be seen by all employees. 10. Indemnification: Consultant hereby agrees to indemnify, and hold City, its officers, employees, and agents harmless from any and all losses, claims, actions, costs, expenses,judgments, or other damages resulting from injury to any person(including injury resulting in death), or damage (including loss or destruction)to property,to the extent caused by the negligent performance of this Agreement by Consultant(including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform Work or services attendant to this Agreement).However, Consultant shall not be held responsible for any losses, expenses, actions, costs,judgments, or other damages, caused by the negligence of City. Consultant's defense obligations under this indemnity paragraph mean only the reimbursement of reasonable defense costs to the proportionate extent of Consultant's actual liability obligation hereunder. 11. Termination: - a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon not less than thirty(30) days' prior written notice delivered by certified mail or in person. c. For Cause. City may terminate or modify this Agreement, in whole or in part, effective upon delivery of written notice to Consultant, or at such later date as may be established by City under any of the following conditions: Page 2 of 6: Agreement between the City of Ashland and DOWL LLC i. If City funding from federal, state, county or other sources is not obtained and continued at • levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement; or If any license or certificate required by law or regulation-to be held by Consultant to provide the services required by this Agreement is for any reason denied,revoked, suspended,or not renewed. iii. The rights and remedies of City provided in this subsection(d) are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. 13. Assignment: Neither party shall assign this Agreement or subcontract any portion of the Work without the written consent of the other party,which shall not be urI easonably withheld. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant,warranty, certification, or obligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency;makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Agreement; or attempts to assign rights in, or delegate duties under,this Agreement. - 15. Insurance: Consultant shall, at its own expense, maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers,unless such employers are exempt under ORS 656.126.If exempt under ORS 656.126, Consultant shall certify such exemption to the City. b. Professional Liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars) per occurrence. This is to cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. 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,Death, and Property Damage. d. Automobile Liability insurance with a combined single limit, or.the equivalent, of not less than $1,000,000 (one million dollars)for each accident for Bodily Injury and Property Damage, including coverage for owned,hired or non-owned vehicles, as applicable. Page 3 of 6: Agreement between the City of Ashland and DOWL LLC e. Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits or intent not to renew the insurance coverage(s)without thirty(30) days' prior written notice from the Consultant or its insurer(s)to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement. The consultant's insurance is primary and non-contributory.As evidence of the insurance coverages required by this Agreement,the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. 16. Nondiscrimination: Consultant 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 any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations.Further, Consultant 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. 17. Consultant's Compliance With-Tax Laws: 17.1 Consultant represents and warrants to the City that: 17.1.1 Consultant 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; () Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (i) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 17.1.2 Consultant, 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 Consultant; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 18. Governing Law; Jurisdiction: This Agreement shall be governed and construed in accordance Page 4 of 6: Agreement between the City of Ashland and DOWL LLC with 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. 19. 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,by mailing using registered or certified United States'mail,return receipt requested,postage prepaid, or by electronically confirmed at the address or facsimile number set forth below: If to the City: City of Ashland—Public Works Department Attn: Contract Administrator 20 East Main Street Ashland, Oregon, 97520 With a copy to: City of Ashland—Legal Depai lment 20 E.Main Street Ashland, Oregon, 97520 If to Consultant: DOWL LLC 8410 154th Avenue NE Suite 120 Redmond,WA, 98052 20. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 21. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING BETWEEN THE PARTIES. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS,EITHER ORAL OR WRITTEN,NOT SPECIFIED HEREIN REGARDING THIS AGREEMENT. CONSULTANT,BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE,HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT,UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS PERMS AND CONDITIONS. 22. Certification. Consultant shall execute the certification attached hereto as "Exhibit C"and incorporated herein by this reference. Page 5 of 6: Agreement between the City of Ashland and DOWL LLC 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. CITY OF ASHLAND: DOWL LLC (CONSULTANT): By: 44w---".311A �i� By: 4vnifILTI/ji t'Sign Signature t, Kenneth S. Nichols Printed Name Printed Name PUS-lL, 2.£U'et�_ Aviation Practice Leader Title Title "3/q202.1 3/5/2021 ate Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. ij D ® 2 7 • Page 6 of 6: Agreement between the City of Ashland and DOWL LLC • EXHIBIT B C I T Y O F A S H L A N D, O R E G O N City of Ashland LIVING . ALL employers described WAG E below must comply with City . of Ashland laws regulating payment of a living wage. $15.74 per hour, effective June 30, 2020. Pit .. The Living Wage is adjusted annually every June 30 by the Consumer Price Index. Employees must be paid a portion of business of their 401K and IRS eligible living wage: employer, if the employer has cafeteria plans(including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the project or the employee. > For all hours worked under a business from the City of service contract between their Ashland in excess of > Note: For temporary and employer and the City of $22,002.43. part-time employees,the Ashland if the contract Living Wage does not apply exceeds$22,002.43 or more. > If their employer is the City of to the first 1040 hours Ashland,including the Parks worked in any calendar year. > For all hours worked in a and Recreation Department. For more details, please see month if the employee spends Ashland Municipal Code 50%or more of the > ln'calculating the living wage, Section 3.12.020. employee's time in that month employers may add the value working on a project or of health care, retirement, For additional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street,Ashland, OR 97520, or visit the City's website at www.ashland.or.us. Notice to Employers: This notice mustbe posted predominantly in areas where it can be seen by all employees. CITY OF • ASHLAND Page'1 of 1:EXHIBIT B EXHIBIT C CERTIFICATIONS/REPRESENTATIONS: Consultant,by and through its authorized representative,under penalty of perjury, certifies that(a)the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Consultant is not subject to backup withholding because: (i) it is exempt from backup withholding, or(ii) it has not been notified by the Internal Revenue Service(IRS)that it is subject to backup withholding as a result of a failure to report all interest or dividends, or(iii)the IRS has notified it that it is no longer subject to backup withholding. Consultant further represents and warrants to City that: (a) it has the power and authority to enter into this Agreement and perform the Work, (b)the Agreement,when executed and delivered, shall be a valid and binding obligation of Consultant enforceable in accordance with its terms, (c)the work under the Agreement shall be performed using that degree of care and skill ordinarily exercised under the same conditions by professionals practicing in the same field, at the same time and in the same or similar locality. and(d) Consultant is qualified,professionally competent, and duly licensed(if applicable)to perform the Work. Consultant also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, it is an independent contractor as defined in the Agreement, it is authorized to do business in the State of Oregon, and Consultant has checked four or more of the following criteria that apply to its business. (1)Consultant carries out the work or services at a location separate from a private residence or is in a specific portion of a private residence, set aside as the location of the business. (2)Commercial advertising or business cards or a trade association membership are purchased for the business. (3)Telephone listing is used for the business separate from the personal residence listing. (4)Labor or services are performed only pursuant to written contracts. (5)Labor or services are performed for two or more different persons within a period of one year. (6). Consultant's signature .160vA 0119; UL Date 3/5/2021 Page 1 of 1:EXHIBIT C • Act - BOWL February 17, 2021 Mr. Chance Metcalf Public Works, Engineering Project Manager 20 East Main ST Ashland, OR 97520 Subject: Independent Fee Estimate Taxiway Rehabilitation Project City of Ashland, Ashland Municipal Airport(CLIENT) Dear Mr. Metcalf: Thank you for your email solicitation to prepare an Independent Fee Estimate(IFE) for the referenced project. DOWL is willing and available to prepare the IFE according to the schedule listed in your email. I understand your schedule is as follows: Date Consultant Activity February 18, 2021 Receive ALP and Project Data Sheet February 18-28, 2021 Contracting February 28, 2021 Receive Scope and Blank Fee Estimate Spreadsheet March 12, 2021 Return Completed IFE Summary Letter CLIENT will provide the following: 1) Current ALP Set 2) Project Data Sheet 3) Scope of Work 4) Blank Fee Estimate Spreadsheet 5) Itemized list of subconsultant costs included in the fee estimate from the CLIENT's design consultant. DOWL will provide a letter summary of the analysis and a complete Fee Estimate Spreadsheet for a Lump Sum Fee of$3000.00. This fee assumes: 1) Others will prepare the necessary record of negotiations for FAA 2)Analysis of subconsultant costs will not require significant revisions of the Fee Estimate Spreadsheet 3) Two phone call or MS Teams discussions will occur with the CLIENT. Sincerely, DOWL 4ivA.SaltsC;f1j1 Kenneth S. Nichols, PE • Aviation Practice Lead DOWL will complete the IFE based on acceptance of this proposal by signature below. Accepted by Client: Name: Title: 425-869-2670 a 800-865-9847(fax)a 8410 154th Avenue NE,Suite 120 a Redmond,Washington 98052 a www.dowl.com TERRA Terra Insurance Company (A Risk Retention Group) Two Fifer Avenue, Suite 100 V - ---- --- ----------_.�.__._-_.._- Corte Madera, CA 94925 INSURANCE COMPANY DATE CERTIFICATE OF INSURANCE 02/22/21 CERTIFICATE HOLDER City of Ashland 20 East Main Street Ashland, OR 97520 This certifies that the"claims made"insurance policy(described below by policy number)written on forms in use by the Company has been issued. This certificate is not a policy or a binder of insurance and is issued as a matter of information only,and confers no rights upon the certificate holder. This certificate does not alter, amend or extend the coverage afforded by this policy. The policy of insurance listed below has 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 policy described herein is subject to all the terms,exclusions and conditions of such policy. Aggregate limits shown may have been reduced by paid claims. TYPE OF INSURANCE Professional Liability POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 221089 01/01/21 12/31/21 LIMITS OF LIABILITY $2,000,000 EACH CLAIM $2,000,000 ANNUAL AGGREGATE PROJECT DESCRIPTION Project Name:2023.15141.00 DOWL Project#:Independent Fee Estimate Review of Scope for the Design of the Taxiway Rehabilitation Project CANCELLATION: If the described policy is cancelled by the Company before its expiration date, the Company will mail written notice to the certificate holder thirty(30)days in advance,or ten (10) days in advance for non-payment of premium. If the described policy is cancelled by the insured before its expiration date,the Company will mail written notice to the certificate holder within thirty(30)days of the notice to the Company from the insured. ISSUING COMPANY: NAME AND ADDRESS OF INSURED TERRA INSURANCE COMPANY DOWL,LLC operating as (A Risk Retention Group) DOWL 8410-154th Avenue,N.E. bto Janata-- Redmond,WA 98052-3864 President N ® DATE02/23/202) AcoRcp CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS-A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Parker,Smith&Feek,Inc. tAHco No.Ext1:509-789-8350 (A/C No):509-931-0794 16201 E Indiana Ave,Suite 1000 E-MAIL Spokane Valley,WA 99216 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: National Fire Ins.Hartford INSURED INSURER B: Continental Insurance Co. DOWL,LLC 5000 Meadows Road,Suite 420 INSURER c: American Casualty Co.of Reading,PA Lake Oswego,OR 97035 INSURER D: 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. INSROLICY F.XP TYPE OF INSURANCE NSR ADDL SWVD POLICY NUMBER (UBR MM/DDY/YYYY) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY 6080818241 05/01/2020 05/01/2021 _EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 X COMMERCIAL GENERAL LIABILITY X X PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 15,000 K BI/PD DED:$10,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X LOC _ $ A AUTOMOBILE LIABILITY 6080881839 05/01/2020 05/01/2021 (E acccidennt)INGLE LIMIT ���DQE X ANY AUTO X X BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS — HIRED AUTOS AUTOS ON-OWNED (Per accident)PROPERTYDAMAGE $ $ B UMBRELLA LIAB K OCCUR 6080818255 05/01/2020 05/01/2021 EACH OCCURRENCE $ 1,000,000 K EXCESS LIAB CLAIMS-MADE X X AGGREGATE $ 1,000,000 DED K RETENTION$$10,000 $ C WORKERS COMPENSATION 6080818238 TORY LAMU- X OT H- AND EMPLOYERS'LIABILITY Y/N 05/01/2020 05/01/2021 ER ANY PROPRIETOR/PARTNER/EXECUTIVE USL&H,WC,Stop Gap E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A X Included (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under **USL&H,WC,Stop Gap 1000,000 DESCRIPTION OF OPERATIONS below , ,_.� -, E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) 2023.1514.1.00,Independent Fee Estimate Review of Scope for the Design of the Taxiway Rehabilitation Project City of Ashland is an additional insured on the general liability,automobile,and excess liability policies per the attached endorsements/forms... (See Attached Description) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 East Main St AUTHORIZED REPRESENTATIVE Ashland,OR 97520 I ©1988-2010 ACORD CORPORATION. All rights reserved. ' ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1 of 32 (EJ000) DESCRIPTIONS (Continued from Page 1 ) Coverage is primary and non-contributory on the general liability,automobile,and excess liability policies per the attached endorsements/forms. Waiver of subrogation applies on the general liability,automobile,workers compensation,and excess liability policies per the attached endorsements/forms. Notice ofcancellation for the general liability,automobile,workers compensation,and excess liability policies per the attached forms. • • • 2 of 32 (EJ000) CNA Blanket Additional Insured - Owners, Lessees or Contractors -with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided'under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, brat only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions,or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract;or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products-completed operations hazard,and only if: 1. the written contract requires you to provide the additional insured such coverage;and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition,or 10-01 edition of CG2010, or under the 10-01 edition of CG2037;or B. additional insured coverage with"arising out of language;or C. additional insured coverage to the greatest extent permissible by law; then paragraph I.above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance,the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract;or - B. a higher limit of insurance than required by the written contract. ' IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. 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;and 2. supervisory, inspection, architectural or engineering activities;or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance is amended to add the following,which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: Primary and Noncontributory Insurance CNA75079XX(10-16) • Policy No:6080818241 Page 1 of 2 Endorsement No: Insured Name: DOWL, LLC Effective Date: 05/01/2020 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc,,with its permission. CNA Blanket Additional Insured - Owners, Lessees or Contractors -with Products-Completed • Operations Coverage Endorsement With respect to other insurance available to the additional insured under which the additional insured is a named insured,this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above,this insurance will be excess of all other insurance available to the additional • insured. VI. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence,Offense,Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim,or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim;and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self-insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory,this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement,the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: • 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by. law. • All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,and expires concurrently with said Policy, CNA75079XX(10-16) Policy No: 6080818241 Page 2 of 2 Endorsement No: Insured Name: DOWL, LLC Effective Date: 05/01/2020 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. THIS PAGE INTENTIONALLY LEFT BLANK CNA Architects, Engineers and Surveyors General Liability Extension Endorsement services performed for the Named Insured under the Named Insured's direct supervision. All limitations that apply to employees and volunteer workers also apply to anyone qualifying as an Insured under this Provision: 24. SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows: A. Paragraph 1.b. is amended to delete the$250 limit shown for the cost of bail bonds and replace it with a$5,000. limit; and B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000. limit. 25. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure. 26. WAIVER OF SUBROGATION-BLANKET Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your work included in the products-completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2. was executed prior to the bodily injury, property damage'or personal and advertising injury giving rise to the claim. 27. WRAP-UP EXTENSION: OCIP,CCIP, OR CONSOLIDATED (WRAP-UP)INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs(C.C.I.P.) is attached,then the followingchanges apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor 2. Bodily injury or property damage included within the products-completed operations hazard that arises out of those portions of the project that are not residential structures. B. Condition 4.Other Insurance is amended to add the following subparagraph 4.b.(1)(c): This insurance is excess over: CNA74858XX(1-15) Policy No: 6080818241 Page 15 of 16 Endorsement No: Effective Date: 05/01/2020 Insured Name: DOWL, LLC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 6 of 32 (EJ000) CNACNA'PARAMOUNT Cancellation I Non-Renewal —Washington Wherever used in this endorsement: 1) Insurer means"we ,''us", "our"or the"Company"as those terms may be defined in the policy; and 2) Named insured means the first.person or entity named on the declarations page; and 3) "Insureds' means alt persons or.entities afforded coverage under the policy. Any cancellation, non-renewal or termination provisions in the policy are deleted in their entirety and replaced with the following: CANCELLATION AND NON-RENEWAL A. CANCELLATION 1. The:Named Insured may cancel the policy at arty time.To do so,the Named Insured must: a. return•the policy to the Insurer Or any of its authorized representatives indicating the effective date of cancellation;or b. provide a written notice by mail fax or e-mail to the Insurer or any of its authorized representative stating when the cancellation is to be effective; c. provide verbal notice to the Insurer or any of its authorized representative indicating when the cancellation is to be effective. The Insurer will promptly cancel the policy.upon notice of cancellation from the Named Insured the date the Notice is received or the date the Named Insured requests cancellation. 2. The Insurer may cancel the policy by mailing or delivering to the Named Insured and tp its producer written notice of cancellation; including theactual reason for the cancellation,at the last mailing address. known to the Insurer,at least: a. ten (10) days before the effective date of cancellation if the insurer cancels for non-payment of premium;or b. sixty (60) days before the effective date of cancellation if the Insurer cancels for any other reason. 3. Like notice of cancellation will also be mailed to any mortgage holder, pledge-or other person shown in the policy with an interest in any loss•whii:h may occur thereunder,at their last mailing address known to the Insurer: • 4. Notice of cancellation will state the effective date of cancellation.The policy.period will end-on that date_ If notice is mailed,proof of mailing will'be sufficient proof of notice. — B. PREMIUM REFUND • If this policy is canceled, the Insurer will send the Named Insured any premium refund due. Ifthe Insurer cancels, the refund will be pro rata. If the.Named Insured cancels,the refund will be on a•shortrate basis.The cancellation will be effective even if the Insurer has not made or not offered a refund_ CNA62814WA.(9-12) Policy No: 608083.8241 Page 1 of 2 Endorsement No: 26 Nat'l Fire Ins Co of Hartford Effective Date: 05/01/2020 Insured Name: DOWL, LLC Copyright CNA All Rights Reserved. 19 'Mobile Only those"autos"that are land vehicles and that would qualify under the definition Equipment of"mobile equipment"under this policy if they were not subject to a compulsory or Subject To financial responsibility law or other motor vehicle insurance law where they are Compulsory Or licensed or principally garaged. Financial Responsibility Or Other Motor Vehicle Insurance Law Only B. Owned Autos You Acquire After The Policy SECTION II-COVERED AUTOS LIABILITY Begins COVERAGE 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered A. Coverage next to a coverage in Item Two of the' We will pay all sums an "insured" legally must pay Declarations, then you have coverage for as damages because of"bodily injury" or"property "autos" that you acquire of the type described damage" to which this insurance applies, caused for the remainder of the policy period. by an "accident" and resulting from the ownership, 2. But, if Symbol 7 is entered next to a coverage maintenance or use of a covered"auto". in Item Two of the Declarations, an "auto" you We will also pay all sums an "insured"legally must • acquire will be a covered "auto" for that pay as a "covered pollution cost or expense" to coverage only if: which this insurance applies, caused by an a. We already cover all "autos" that you own "accident" and resulting from the ownership, for that coverage or it replaces an "auto" maintenance or use of covered "autos". However, you previously owned that had that we will only pay for the "covered pollution cost or coverage; and expense" if there is either "bodily injury" or b. You tell us within 30 days after you acquire "property damage"to which this insurance applies it that you want us to cover it for that that is caused by the same"accident". coverage. We have the right and duty to defend any C. Certain Trailers, Mobile Equipment And "insured" against a "suit"asking for such damages Temporary Substitute Autos or a"covered pollution cost or expense". However, we have no duty to defend any"insured" against a If Covered Autos Liability Coverage is provided by "suit" seeking damages for- "bodily injury" or this Coverage Form, the following types of "property damage" or a "covered pollution cost or vehicles are also covered "autos" for Covered expense" to which this insurance does not apply. Autos Liability Coverage: We may investigate and settle any claim or "suit" 1. "Trailers" with a load capacity of 2,000 pounds as we consider appropriate. Our duty to defend or or less designed primarily for travel on public settle ends when the Covered Autos Liability roads. Coverage Limit of Insurance has been exhausted 2. "Mobile equipment" while being carried or by payment of judgments or settlements. towed by a covered "auto". 1. Who Is An Insured 3. Any "auto"you do not own while used with the The following are"insureds": permission of its owner as a ,temporary a. You for any covered"auto". substitute for a covered "auto" you own that is out of service because of its: b. Anyone else while using with your permission a covered "auto" you own, hire a. Breakdown; or borrow except: b. Repair; . (1) The owner or anyone else from whom G. Servicing; you hire or borrow a covered"auto". d. "Loss"; or This exception does not apply if the e. Destruction. covered "auto" is a "trailer" connected to a covered "auto"you own. Page 2 of 12 ©Insurance Services Office, Inc., 2011 CA 00 01 10 13 8 of 32 (EJ000) (2) Your"employee" if the covered "auto" is These payments will not reduce the Limit of owned by that "employee" or a member Insurance. of his or her household. b. Out-of-state Coverage Extensions (3) Someone using a covered "auto" while While a covered "auto" is away from the he or she is working in a business of state where it is licensed,we will: selling, servicing, repairing, parking or Increase the Limit of Insurance for storing "autos" unless that business is (1) • yours. Covered Autos Liability Coverage to (4) Anyone other,thanyour "employees", meet the limits specified by a Y compulsory or financial responsibility partners (if you are a partnership), law of the jurisdiction where the covered members (if you are a limited liability "auto" is being used. This extension company) or a lessee or borroweror does not apply to the limit or limits any of their "employees", while moving specified by any law governing motor property to or from a covered "auto". carriers of passengers or property. (5) A partner (if you are a partnership) or a (2) Provide the minimum amounts and member (if you are a limited liability types of other coverages, such as no- company)for a covered "auto"owned by fault, required of out-of-state vehicles by him or her or a member of his or her the jurisdiction where the covered "auto" household. is being used. c. Anyone liable for the conduct of an We will not pay anyone more than once for "insured" described above but only to the the same elements of loss because of extent of that liability. these extensions. 2. Coverage Extensions B. Exclusions a. Supplementary Payments This insurance does not apply to any of the We will pay for the"insured": following: (1) All expenses we incur. 1. Expected Or Intended Injury (2) Up to $2,000 for cost of bail bonds . "Bodily injury" or "property damage" expected (including bonds for related traffic law or intended from the standpoint of the violations) required because of an "insured". "accident"we cover. We do not have to 2. Contractual furnish these bonds. Liability assumed under any contract or (3) The cost of bonds to release agreement. attachments in any "suit" against the "insured" we defend, but only for bond But this exclusion does not apply to liability for amounts within our Limit of Insurance. damages: (4) All reasonable expenses incurred by the a. Assumed in a contract or agreement that is "insured"at our request, including actual an "insured contract", provided the "bodily loss of earnings up to $250 a day injury" or "property damage" occurs because of time off from work. subsequent to the execution of the contract (5) All court costs taxed against the or agreement; or "insured" in any "suit" against the b. That the "insured" would have in the "insured" we defend. However, these absence of the contract or agreement. payments do not include attorneys' fees 3. Workers'Compensation • or attorneys'expenses taxed against the Any obligation for which the "insured" or the "insured". "insured's" insurer may be held liable under (6) All interest on the full amount of any any workers' compensation, disability benefits judgment that accrues after entry of the or. unemployment compensation law or any judgment in any "suit " against the similar law. "insured"we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. CA 00 01 10 13 ©Insurance Services Office, Inc., 2011 Page 3 of 12 9 of 32 (EJ000) 4. Loss Payment—Physical Damage 5. Other Insurance Coverages a. For any covered "auto" you own, this At our option,we may: Coverage Form provides primary a. Pay for, repair or replace damaged or insurance. For any covered "auto"you don't stolen property; own, the insurance provided by this Coverage Form is excess over any other b. Return the stolen property, at our expense. collectible insurance. However, while a We will pay for any damage that results to covered "auto" which is a "trailer" is the"auto"from the theft; or connected to another vehicle, the Covered c. Take all or any part of the damaged or Autos Liability Coverage this Coverage stolen property at an agreed or appraised Form provides for the"trailer"is: value. 1(1) Excess while it is connected to a motor If we pay for the "loss", our payment will vehicle you do not own; or include the applicable sales tax for the (2) Primary while it is connected to a damaged or stolen property. covered"auto"you own. 5. Transfer Of Rights Of Recovery Against b. For Hired Auto Physical Damage Coverage, Others To Us any covered "auto" you lease, hire, rent or If any person or organization to or for whom we borrow is deemed to be a covered "auto" make payment under this Coverage Form has you own. However, any "auto" that is rights to recover damages from another, those leased, hired, rented or borrowed with a rights are transferred to us. That person or driver is not a covered"auto". organization must do everything necessary to c. Regardless of the provisions of Paragraph secure our rights and must do nothing after a. above, this Coverage Form's Covered "accident"or"loss"to impair them. Autos Liability Coverage is primary for any B. General Conditions - liability assumed under an "insured 1. Bankruptcy contract". Bankruptcy or insolvency of the"insured"or the d. When this Coverage Form and any other "insured's" estate will not relieve us of any Coverage Form or policy covers on the obligations under this Coverage Form. same basis, either excess or primary, we will pay only our share. Our share is the 2. Concealment, Misrepresentation Or Fraud --proportion that the Limit of Insurance of our This Coverage Form is void in any case of Coverage Form bears to the total of the fraud by you at any time as it relates to this limits of all the Coverage Forms and Coverage Form. It is also void if you or any policies covering on the same basis. other "insured", at any time, intentionally 6. Premium Audit conceals or misrepresents a material fact a. The estimated premium for this Coverage concerning: Form is based on the exposures you told us a. This Coverage Form; you would have when this policy began. We b. The covered "auto"; will compute the final premium due when we determine your aThe c. Your interest in the covered "auto"; or estimated total p emium I will exp es.be rcredi ed d. A claim under this Coverage Form. against the final premium due and the first 3. Liberalization Named Insured will be billed for the balance, if any. The due date for the final If we revise this Coverage Form to provide premium or retrospective premium is the more coverage without additional premium date shown as the due date on the bill. If charge, your policy will automatically provide the estimated total premium exceeds the the additional coverage as of the day the final premium due, the first Named Insured revision is effective in your state. will get a refund. 4. No Benefit To Bailee—Physical Damage b. If this policy is issued for more than one Coverages year, the premium for this Coverage Form We will not recognize any assignment or grant will be computed annually based on our any coverage for the benefit of any person or rates or premiums in effect at the beginning organization holding, storing or transporting of each year of the policy. property for a fee regardless of any other provision of this Coverage Form. CA 00 01 10 13 ©Insurance Services Office, Inc., 2011 Page 9 of 12 10 of 32 (EJ000) POLICY NUMBER: 6080881839 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OFRECOVERY - AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DOWL, LLC Endorsement Effective Date: 05/01/2020 SCHEDULE Name(s)Of Person(s)Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS _ Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of 'Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. J • CA 04 4410 13 ©Insurance Services Office, Inc.,2011 Page 1 of 1 11 of 32 (EJ000) . . CNA Business Auto Policy Policy Endorsement :--ICANCELLATION BY US, T T ; I THIS ENDORSEMENT. CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS' COVERAGE FORM Paragraph 2. of Cancellation (Common Policy Conditions) is replaced by the following: 2. We may cancel this Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for non-payment of.premium, or -_ b. 60 days before the effective date of cancellation if we cancel for any•other reason. • All other terms and conditions of the policy remain unchanged This endorsement, which forms a parr of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. . Form No:G-17832-8112-20101 Policy No:BUA 6080881839 t Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:0510112020 Endorsement•No:28:Page: 1 of 1 Policy Page: 136 of 393 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St,Chicago,IL 60606 '°•Copyright CNA Alt Rights Reserved. CNA CNA Paramount Excess and Umbrella Liability Policy D. Coverage D - Key Employee Exclusions With respect to Coveraga D — Key Employee, this insurance does not apply to any actual or alleged: 1. Death or Disability death or permanent disability of a key employee relating to, or arising out of: a. nuclear reaction or radiation or radioactive contamination, however caused; b. sickness or disease, including mental illness or mental injury; c. pregnancy, childbirth, miscarriage or abortion; d. suicide, attempted suicide or self inflicted bodily injury, while sane or insane; e. the key employee's intoxication, impairment or otherwise being under the influence of alcohol or controlled substances; f. war, including undeclared or civil war; g. warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or h. insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. 2. Other Expenses a. expenses the Named Insured incurs which the Named Insured would not have incurred if the Named Insured had used all reasonable means to: i. find a permanent replacement for the key employee; and ii. reduce or discontinue the key employee replacement expense; as soon as possible after the Named Insured's permanent loss of the services of the key employee caused by a covered accident. b. additional expenses incurred due to the Named Insured's loss of the services of a permanent replacement appointed or hired to replace a key employee, however caused. However, this exclusion does not apply if the replacement employee is included in the definition as a key employee and the Named Insured's loss of the services of-the replacement employee is caused by a covered accident. IV. WHO IS AN INSURED The following persons or organizations are Insureds. A. With respect to Coverage A - Excess Follow Form Liability, the Named Insured and any persons or organizations included as an insured under the provisions of underlying insurance are Insureds, and then only for the same coverage, except for limits of insurance, afforded under such underlying insurance. B. With respect to the Coverage B-Umbrella Liability: 1. If the Named Insured is designated in the Declarations of this Policy as: a. an individual, the Named Insured and the Named Insured's spouse are Insureds, but only with respect to the conduct of a business of which the Named Insured is the sole owner, b. a partnership or joint venture, the Named Insured is an Insured. The Named Insured's members, the Named Insured's partners, and their spouses are also Insureds, but only with respect to the conduct of the Named Insured's business. Form No:CNA75504XX 103-2015)_ Policy No: Policy Page: 14 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co,333.S Wabash Ave,Chicago, IL 60604 Policy Page: 25 of 51 Copyright CNA All Rights Reserved. —�__ CNA CNA Paramount Excess and Umbrella Liability Policy or organization which may be liable to the Insured because of injury or damage to which this insurance may also apply; and vi. will not voluntarily make a payment, except at its own cost, assume any obligation, or incur any expense, other than for first aid, without the Insurer's prior consent. 3. Cooperation With respect to both Coverage A-Excess Follow Form Liability and Coverage B — Umbrella Liability, the Named Insured will cooperate with the Insurer in addressing all claims required to be reported to the Insurer in accordance with this paragraph 0. Notice of Claims/Crisis Management Event/Covered Accident, and refuse, except solely at its own cost, to voluntarily, without the Insurer's approval, make any payment, admit liability, assume any obligation or incur any expense related thereto. P. Notices Any notices required to be given by an Insured shall be submitted in writing to the Insurer at the address set forth in the Declarations of this Policy. Q. Other Insurance If the Insured is entitled to be indemnified or otherwise insured in whole or in part for any damages or defense costs by any valid and collectible other insurance for which the Insured otherwise would have been indemnified or otherwise insured in whole or in part by this Policy,-the limits of insurance specified in the Declarations of this Policy shall apply in excess of, and shall not contribute to a claim, incident or such event covered by such other insurance. With respect to Coverage A — Excess Follow Form Liability only, if: a. the Named Insured has agreed in writing in a contract or agreement with a person or entity that this insurance would be primary and would not seek contribution from any other insurance available; b. Underlying Insurance includes that person or entity as an additional insured; and c. Underlying Insurance provides coverage on a primary and noncontributory basis as respects that person or entity; then this insurance is primary to and will not seek contribution from any insurance policy where that person or entity is a named insured. R. Premium All premium charges under this Policy will be computed according to the Insurer's rules and rating plans that apply at the inception of the current policy period. Premium charges may be paid to the Insurer or its authorized representative. S. In Rem Actions A quasi in rem action against any vessel owned or operated by or for a Named Insured, or chartered by or for a Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. T. Separation of Insureds Except with respect to the limits of insurance, and any rights or duties specifically assigned in this Policy to the First Named Insured, this insurance applies: 1. as if each Named Insured were the only Named Insured; and 2. separately to each Insured against whom a claim is made. U. TransfePof Interest Form No:CNA75504XX 103-2015) Policy No: Policy Page: 21 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co,333 S Wabash Ave.Chicago,IL 60604 Policy Page: 32 of 51 Copyright CNA All Rights Reserved. CNA Paramount Excess and Umbrella Liability Policy Assignment of interest under this policy shall not bind the Insurer unless its consent is endorsed hereon. V. Unintentional Omission Based on Insurer's reliance on the Named Insured's representations as to existing hazards, if the Named Insured should unintentionally fail to disclose all such hazards at the effective date of this Policy, the • Insurer will not deny coverage under this Policy because of such failure. W. Waiver of Rights of Recovery The Insurer waives any right of recovery it may have against any person or organization because of payments the Insurer makes under this Policy if the Named Insured has agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. is in effect or becomes effective during the policy period; and 2. was executed prior to loss. VII.DEFINITIONS For purposes of this Policy, words in bold face type, whether expressed in the singular or the plural, have the meaning set forth below. Advertisement means a notice that is broadcast or published to the general public or specific market segments about the Named Insured's goods, products or services for the purpose of attracting customers'or supporters. For the purposes of this definition: A. notices that are published include material placed on the Internet or on similar electronic means of communication; and B. regarding web-sites, only that part of a web-site that is about the Named Insured's goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. Aircraft means any machine or device that is capable of atmospheric flight. Arbitration proceeding means a formal alternative dispute resolution proceeding or administrative hearing to which an Insured is required to submit by statute or court rule or to which an Insured has submitted with the Insurer's consent. Asbestos means the mineral in any form whether or not the asbestos was at any time airborne as a fiber, particle or dust, contained in or formed a part of a product, structure or other real or personal property, carried on clothing, inhaled or ingested, or transmitted by any other means. Authorized Insured means any executive officer, member of the Named Insured's risk management or in-house \ general counsel's office, or any employee authorized by the Named Insured to give or receive notice of a claim. Auto means: A. a land motor vehicle,trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or B. any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, auto does not include mobile equipment. Bodily injury means bodily injury,sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the bodily injury, sickness or disease. Claim means a: A. suit; or Form No:CNA75504XX(03-2015) Policy No: Policy Page:22 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co,333 S Wabash Ave,Chicago,IL 60604 Policy Page:33 of 51 Copyright CNA All Rights Reserved. CNA CNA Paramount Excess and Umbrella Liability Policy Endorsement �tANT(tIvcriON NO-N-RENEW'A"L.,EN130RSE(UIEfin-•iWA F11:0 fi0�lt'� Wherever used in this endorsement: 1.) Insurer means "we", "us", "our" or the "Company" as those terms may be defined in the policy; and 2) Named Insured means the first person or entity named on the declarations page; and 3) "Insureds" means all persons or entities afforded coverage under the policy. Any cancellation, non-renewal or termination provisions in the policy are deleted in their entirety and replaced with the following: CANCELLATION AND NON-RENEWAL I. CANCELLATION A. The Named Insured may cancel the policy at any time. To do so, the Named Insured must: 1. return the policy to the Insurer or any of its authorized representatives indicating the effective date of cancellation; or 2. provide a written notice by mail'fax or email to the Insurer or any of its authorized representative stating when the cancellation is to be effective; 3. provide verbal notice to the Insurer-or any of its authorized representative indicating when the cancellation is to be effective. • The Insurer will promptly cancel the policy upon notice of cancellation from the Named insured the date the Notice is received or the date the Named Insured requests cancellation. B. The Insurer may cancel the policy by mailing or delivering to the Named Insured and to its producer written notice of cancellation, including the actual reason for the'cancellation, at the last mailing address known to the Insurer, at least: 1. ten (1.0) days before the effective date-of cancellation if the insurer cancels for non-payment of premium; or - 2. sixty (60) days before the effective date of cancellation if the Insurer cancels for any other reason. C. Like notice of cancellation will also be mailed to-any mortgage holder, pledge or other person shown in the policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Inmirer. D. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. If notice.is mailed, proof of mailing will be sufficient proof of notice. II. PREMIUM REFUND If this policy is canceled, the Insurer will send the Named Insured ahy premium refund due. If the Insurer cancels, the refund will be pro rata. If the Named Insured cancels, the refund will be on a short rate basis. The cancellation will be effective even if the Insurer has not made or not offered a refund. III. NON-RENEWAL A. The Insurer can non-renew the policy by giving written notice to the Named Insured-and to its.producer, at the last mailing address known, at least sixty (60) days before the expiration date: If notice is mailed. proof of mailing will be sufficient proof of notice. Farm No;CNA62814WA,(09.20121 Policy No;CUE 6080818255 Endorsement Effective Date: Endorsement Expiration-Date: Policy Effective Date:•05(01(2020 Endorsement No:1;Page: 1 of 2 Policy Page: 44 of.51. Underwriting Company:The:Continental'Insurance Company, 151 N Franklin St, Chicago, IL 60606 ' i • aCopyright CNA All Rights Reserved. • • CNA CNA Paramount Excess and Umbrella Liability Policy Endorsement B. The notice•of non-renewal will state the actual reason for non-renewal. The Insurer will also mail written notice of non-renewal to any mortgage holder or other person shown in the policy with an interest in any loss which may occur thereunder, at•their last mailing address known to the Insurer. C. The Insurer must provide.to the Named Insured its renewal terms including the premium due at least twenty (20) days prior•to the expiration date of the current policy. If the Named Insured subsequently fails to pay the premium when due or procures coverage acceptable to it, then the coverage is nonrenewed. - IV. OTHER PROVISIONS The Insurer will mail notice of any change in rates or coverage to the Named Insured at least sixty (6O) days prior to the expiration date of the'policy. All other terms and conditions of the policy remain unchanged. This•endorsement, which forms a part of•and is for attachment to the policy issued by the designated Insurers,. takes effect on.the Policy Effective Date of said policy at the hour stated in saidpolicy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date.is shown below. • • Form No:CNA62814WA(09-20121 Poliey No:CUE 6080818255 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/6112020' Endorsement No:1:Page:2 of 2 Policy Page:45.of 51 Underrvriting Company: The Continental Insurance Company, 15:1 N Franklin St,Chicago,IL 60606 e Copyright CNA All Rights Reserved. , , • CNA Workers Compensation And Employers Liability Insurance Policy Endorsement MUM 'O`I RiRI�GHTrMEON RAtit ti HMEN I0WAN EN;►,; • - We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issuedby the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. • J Form No:WC OO 03 13(04-1984) Policy No:WC 6 80818238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/0112020 Endorsement No: Policy Page: Underwriting Company:American Casualty Company of Reading, Pennsylvania Copyright 1983 National Council on Compensation Insurance. 18 of 32 (EJ000) • C/VAEmployers Liability Insurance Workers Compensation And Policy Endorsement i COLORADO CANCELLATION ENDORSEMENT . - This endorsement applies only to the insurance provided by the policy because Colorado is shown in Item 3:A.. of the Information Page. Part Six (Conditions) Condition D. Cancellation is replaced by the following: D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take.effect. 2. We may cancel this.poiicy. We must mail by certified.mail or deliver to you advance written notice stating when the cancellation is to take effect. Ifwe cancel for-any of the following reasons, we will "mail or deliver not less than 10 days advance written notice:. 11) Fraud; (2) Material Misrepresentation; V (3) Non-payment of premium;or (4) Other reasons approved by the Commissioner. If we cancel for any other reason, we will mail or deliver not less than 30 days advance written notice. 3. The policy will end on the day and hour stated in the.cancellation notice. 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy is changed by this statement to comply with the law. All other terms and conditions.of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of•said policy at the hour stated in said policy, unless another effective date (th'e Endorsement Effective Date) is shown below, arid expires concurrently with said policy unless another expiration date is shown below. 1 Form No:0-18640-A107-1992) Policy No:WC 6 80818238 Endorsement Effective Date; Endorsement Expiration Date: Policy Effective Date:05/01/20201 { Endorsement No: 1;Page: 1 of 1 Policy Page: 73 of 117 Underwriting Company; American Casualty Company of Reading,Pennsylvania, 151 N Franklin St. Chicago.IL 60606 °Copyright CNA All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement ', ARIZONA CANCELLATION Old NONRENEWAL-jr ipRSEMENT This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. , Part Six-Conditions, Section D. (Cancellation), of the policy is replaced by the following: • D. Cancellation and Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us•stating when the cancellation is to take effect. 2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. 3. We may cancel this policy if you fail to pay premium when due, or when.one or both cit the parties to e professional employer agreement terminate the agreement. 4. If we cancel or nonrenew this policy, we must mail or deliver to you'and the Industrial Commission of Arizona at least 30 days' notice of the cancellation or nonrenewal. Mailing that notice to you. at your mailing address shown in Item 1. of the Information Page will be sufficient to prove notice. If we nonrenew this policy and fail to give you notice of nonrenewal, coverage will not extend beyond the ' policy period. 5. The policy period will end on the day and hour stated in the cancellation or nonrenewal notice. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the.Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently.with said policy unless another expiration date is shown below. - • Form No:WC 02 06 01 A(09.2015} Policy No:WC 6 80918238 Endorsement Effective Date: Endorsement Expiration Dale: Policy Effective Date:05/01/2020 Endorsement No: 15;,Page: 1 of 1 Policy Page: 88 of 1 17 Underwriting Company:American Casualty Company of Reading,Pennsylvania, 151 N Franklin St, Chicago,IL 60606 4'Copyright 2015 National Council on Compensation Insurance,inc.All Rights Reserved. • CNA Workers Compensation And Employers Liability Insurance Policy Endorsement • MONTANA AIIIIEeNDATOi?Y ENDORSEMENT This endorsement applies because Montana is shown in Item 3.A. of the Information Page. General Section, Section C. (Workers Compensation Law} of the policy is changed by-adding the following: The provisions of this.policy conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this policy. Part Six-Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancelation 1.. You may cancel this policy. You will mail or deliver advance written,notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We will provide you and the Montana Department of Labor and Industry not less than 20 days advance written notice stating when the cancellation is to take effect. We will provide the notice to you via Mail or via electronic delivery in accordance with the Electronic Delivery of Insurance Notices or Documents Act(MCA 33-15-601 et seq.). Mailing notice to you at your last known address or delivery via electronic means in compliance with.the Electronic Delivery of Insurance Notices or Documents Act will be sufficient to prove notice. 3. If this policy has been in effect for 60 days•or more, we may cancel only for one of the following - reasons: ' a. A nonpayment of premium; • b. A material misrepresentation; c. A substantial change in the risk we assumed under the policy unless it was reasonable for us to foresee the change or contemplate the risk when we issued the policy; d. A substantial breach of the duties, conditions or warranties under the policy; e. The Commissioner has determined that continuation of the policy would place us in violation of the laws of Montana; f. We are financially impaired; or g. Any other reason that is approved by the Commissioner.: 4. Our notice of cancetation will state our reasons for canceling. Part Six-Conditions of the policy is changed by adding the following: F. Nonrenewal 1. We may elect not to renew. We will provide you and your agent not less than 45 days advance written notice•stating our intention not to renew this policy. We will provide the notice to you via mail or via electronic delivery in accordance with the Electronic Delivery of Insurance Notices or Documents Act. Mailing notice to you at your last known address or delivery via electronic means in compliance with the Electronic Delivery of Insurance Notices or Documents Act will be sufficient to prove notice. 2. We do not have to renew the policy if you are insured elsewhere, accept replacement insurance, or request or agree to nonrenewal, or if the policy is expressly designated as being nonreneirvable. 3. Our notice of nonrenewal will state our reasons for not renewing. • i Form No:WC 25 06 01 8104-2016) Policy No:WG 6 80818238 Endorsement Efleclive.Date: Endorsemeht•Ezpiration Date: Policy Effective Date:0510.1!2020 Endorsement No: 19; Page: 1 of 2 Policy Page: 92.of 117 Underwriting Company:American Casualty Company al Reading,Pennsylvania; 151 N Franklin 5t, Chicago. IL 60606 o.Copyright 2015 National Council on Compensation•Insurance, Inc. Alt Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement All other terms and conditions of the policy•rernain unchanged•. This endorsement, which forms.a part.of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. • • Form No:WC 26 06 01 B(04=2016) Policy No:WC 6 13081.8238 Endorsement Effective Date: Endorsement Expiration Date: Policy-Effective Date:05/0112020 ( Endorsement No: 19:.Page:2 of 2 Policy Page:93 of 117 Underwiiling Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago.IL 60606 Copyright 2015 National Council on Compensation Insurance,Inc.All Rights Reserved. . . . , CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 1 NEVADA CANCEL1AtIQ JAND NONRENEWAL ENDORSEMENT w This endorsement applies to the insurance provided by this policy, because Nevada is shown in Item 3.A. of the Information Page. Part Six—Conditions, D. Cancellation of the policy is replaced by the following: A. Midterm Cancellation 1. You may cancel this policy by mailing or delivering advance written notice to us stating When the cancellation is to take effect. 2. We will provide you not less than 10 days notice if this policy is cancelled because you failed to pay a premium or remit an amount due because of an endorsement for a deductible when due. 3: We will provide you not less than 30 days.notice for any'other cancellation reason permitted under Nevada law, including failure to pay additional premium charged due to an audit of any payroll under the terms of the current or previous policy. 4. No policy of industrial insurance that has been in effect for at least 70 days•or that has been renewed may be cancelled, except on any one of the following grounds: a. A failure by the policyholder to pay,a premium for the policy of industrial insurance when due, including the failure.of the policyholder to remit an amount due because of an endorsement for a deductible; • b. A failure by the policyholder to: {1} Report any payroll; . (2) Allow the insurer to audit any payroll in accordance with the terms Of the policy Or any previous policy issued by the insurer; or _ (3) Pay any additional premium charged because of art audit of any payroll as required by the terms of the policy or any previous policy'issued by the insurer; c. A material failure.by the policyholder to comply with any federal or state order concerning,safety:or any written recommendation of the insurer's designated representative for loss prevention; d. A material change in ownership of the policyholder or any change in the policyholder's business or operations that; f_ , (1) Materially increases the hazard for frequency or severity of loss; (2) Requires additional or different classifications for the calculation Of premiums; or (3) Contemplates an activity that is excluded by any reinsurance treaty of the.insurer; e. A material misrepresentation made by the policyholder;'or f. A failure by the policyholder to cooperate with the insurer in'conducting an investigation of a claim. • 5. We cannot cancel thepolicy.when the referenced reasons are corrected by you within thetime Specified in'the written notice of cancellation, - B. Nonrenewal 1. We may elect not to renew the policy. We will provide to you a written•notice of our intention not to renew at least 60 days before the expiration date. Form No:WC 27 06 01 C110.2008) _ Policy No:WC 6 8081.8238 Endorsement Effective Date: Endorsement Expiration Date: .Policy Effective Date:.05l0112020 Endorsement No:-21;Page: 1 of.-2 Policy Page: 95 of 117 Underwriting Company: American Casually Company of Reading,.Pennsylvania; 151 N Franklin St, Chicago, IL 60606 Copyright 2008 National Council on Compensation Insurance,Inc, All Rights Reserved- - � . CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 2. We need not provide notice of our intention not to renew if you have accepted replacement coverage, if you have requested or•agreed to nonrenewal, or if the policy is expressly designated as'nonreviewable. C. Information About Claims Paid 1. If you request information for the.renewal of the policy, we will provide you with information regarding claims paid on your behalf. 2. We will provide the information within 30 working days after we receive your written request. We may Charge a reasonable fee for providing the information. D. Notices - 1. We will provide advance written noticeof cancellation or nonrenewal as provided in A and B above.This notice must be served personally on or sent by first-class mail or electronic transmission to the employer. 2. Notices will state the effective date of the cancellation or nonrenewal and will be accompanied by a written explanation of the specific reasons for the cancellation or nonrenewal. 3. A written notice of cancellation is not required if we mutually agree with you.to•cancel the policy and reissue.a new policy based upon a material change in the ownership or operation of your business. E. Compliance.With Law 1. Any of these provisions that conflict with a law',that controls.the cancellation or renewal or nonrenewal of the insurance in this policy is changed by this statement to comply with the law. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of End is for attachment to the policy issued by the designated Insurers, 'takes effect on the Policy Effective Date of said policy at the hour stated in said policy., unless another effective date {the Endorsement Effective Date) is shown below, and expires concUrrerttly with said policy unless another expiration date.is shown beloinr. • • Form.No:WC 27 06 01 C (10-2008) Policy No:'WC 6 8081.6238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/01/2020 Endorsement No:21:•Page: 2.of 2 Policy Page:96 of 117 Underwriting Company: American Casuati}I Company of Reading, Pennsylvania, 151 N Franklin St, • Chicago, IL 60606 - c Copyright•2008 National'Council on Compensation Insurance,Inc.All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement OKLAHOMA CANCELLATION,:NONRENEWAL' ANCKAAl1`IrG5[ENDORSEMENT This endorsement applies to the insurance provided by the policy because Oklahoma is shown in Item 3.A. of the Information Page. The Cancellation Condition in Part Six (Conditions) of the policy is.replaced by the following condition: D. Cancellation 1. You may cancel this policy. You must mail or deliver to us not less than 30 days advance written notice stating when the cancellation is.to take effect. Cancellation of coverage will be effective at 12:01 a.m. thirty (30) days after the date the cancellation notice is received by us, unless a later date is specified in the notice to us. You may cancel this policy effective less than 30 days-after written notice is received by us where.you have obtained other coverage or have,become a self-insurer. 2. We may cancel this polipy. We will mail to you advance written notice stating when the cancellation is to take effect. a. At any time during the policy period, we may cancel for nonpayment of premium. If we cancel for nonpayment of premium, we will mail notice of cancellation to you and to the Workers Compensation Commission at least 10 days before the cancellation is to take effect. b. If we cancel this policy for a reason other than nonpayment of premium, we will mail notice of cancellation to you and to the Workers Compensation Commission at least 30.days before the cancellation is to take effect. c. If this policy has been in effect for,more than 45 business days or is a renewal policy, we•may cancel for only one or more of the following reasons: (1) Nonpayment of premium; (2) Discovery of fraud or material misrepresentation in the procurement of the insurance or with respect to any.claims submitted under it; (3) Discovery of willful or reckless acts or omissions on the part of the named insured which increase any hazard insured against; i (4) The occurrence of a change in the risk which substantially increases any hazard insured against afterinsurance coverage has been issued or renewed; (5) A violation.of any local fire, health,safety, building, or construction regulation or ordinance with respect to any insured property or the occupancy thereof Which substantially increases any hazardinsured against; (6) A determination by the Insurance Commissioner that the continuation of.the policy would place theinsurerin violation of the insurance laws of this state;- (7) tate;(7) Conviction of the named insured of a crime having as one of its necessary elements an act ncreasing any hazard insured against; or (8) Loss of or substantial changes in applicable reinsurance. 3. Mailing notice of cancellation to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 4. The policy period.will end on the day and hour stated in the cancellation notice. Form No:WC 35,06 01 F(02-2014) Policy No:WC 6 8081 8238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/0112020.1 Endorsement No:23: Page: 1 of 3 Policy Page: 98 01117 Underwriting Company:American•Casualty.Company of Reading,Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Copyright 2013 National Council on Compensation.Insurance,Inc.All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 5. Any of these provisions that conflict with a taw that controls the cancellation of the insurance in this policy is changed by this statement to comply with the law. Part S(Conditions} of the policy is amended by adding the following provisions: F. Nonrenewal 1. If we elect not to renew this policy, we will mail or deliver written notice of nonrenewal to you at least 45 days before: a. The expiration date of this policy; or b. An-anniversary date of this policy,•if.it is written for a term longer than one year or with no fixed expiration date. 2, Any notice of nonrenewal will be mailed or delivered to you at the mailing address shown in Item 1 of the Information Page. If notice is mailed: a. It will be-considered to have, been given to you on the day it is mailed. b. Proof of mailing will be sufficient proof of notice. 3. If notice of nonrenewal is not mailed or delivered at.least 45 days before the expiration date or an anniversary date of this policy, coverage will remain in effect until 45 days after notice is.given. Earned premium for such extended period of coverage will be calculated pro rata based on the rates applicable to the expiring policy. 4. We will not provide notice of nonrenewal if: a. We, or another company within the same insurance group, have offered to issue a renewal,policy; or b. You have obtained replacement coverage or have agreed in writing to-obtain replacement coverage. 5. If we have provided the required notice of nonrenewal as=described above, and thereafter extend the policy for a period of 90 days or less, we will not provide an additional nonrenewal notice with respect to the period of extension. G_ Notice of Premium or Coverage Changes Upon Renewal 1. If we elect to renew this policy, we will give written notice of any premium increase, change in deductible, or reduction in limits or coverage, to you, at the mailing address shown in Item 1 of the Information Page. 2. Any such:notice will be mailed or delivered to you at least 45 days before: a. The expiration date of this policy; or An'anniversary date of this policy,f it is written for a term Ibnget than one year or.with no fixed expiration date. 3. If notice is mailed: a. It will be considered to have been given to you on the day it is mailed. b. Proof of mailing will be sufficient proof of notice. 4. If you accept the renewal, the premium increase or deductible, limits or coverage changes-will be effective the day following the prior policy's expiration or anniversary date. 5. If notice is not mailed or delivered at least 45 days before the expiration date or anniversary date of this policy, the premium, deductible, limits and coverage-in effect prior to the changes will remain in effect until the earlier of • Form No:WC 35 06 01 F(02.2014) Policy'No:WC 6 8081.8238 1 Endorsement Effective Date: Endorsement Expiration Dater Policy Effective Date:-0510.112020 Endorsement No:23; Page:2 of 3 Policy Page: 99'of 11.7 Underwriting Company:American Casualty Company of Reading,Pennsylvania, 151 N Franklin Si, Chicago,IL 60606 Copyright 2013 National Council on Compensation Insurance;Inc: All Rights Reserved. a CNA Workers Compensation And Employers Liability Insurance Policy Endorsement a. 45 days after notice is given; or b. The effective date of replacement coverage Obtained by you. 6. If you then elect not to renew, any earned premium for the resulting extended period of coverage will be calculated pro rata at the lower of the new rates or rates applicable to the expiring policy. 7. We will not provide notice of the following: a. Changes in a rate or plan filed with or approved by the Insurance-Commissioner or filed pursuant to the Property and Casualty Competitive Loss Cost Rating Act and applicable to an entire class of business; or • b. Changes based upon the altered nature of extent of the.risk insured; or. c. Changes in policy forms filed with or approved by the Insurance Commissioner and applicable to.an entire class of business. • All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another - effective date Ithe Endorsement Effective Date) is-shown below, and expires concurrently With said policy unless another expiration date is shown below. • Form No:WC 35 06 01 F102.20141 Policy No:WC 6 80818238 Endorsement Effective pate: ) Endorsement Expiration Date: Policy Effective Date:05/01/2020 Endorsement No: 23:Page:3 of 3 Policy.Page: 100 of 117 J ; Underwriting Company: American Casualty.Company of-Reading. Pennsylvania. 151'N Franklin St, Chicago,IL 60606 Copyright 2013 National Couiicil on Compensation Insurance,Inc.All Rights Reserved. 4 • CNA Workers Compensation And Employers Liability Insurance Policy iandorsemen OREGON CANdELIG,4,TIONLENDORSEMENT This endorsement applies only to the insurance•provided by the policy because Oregon is shown in Item 3.A. of the Information Page. The Cancellation Condition of the policy is•replaced by this Condition: 0. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us, stating when the cancellation is to take effect. If you provide for other insurance or self-insurance, your cancellation of coverage will take effect upon the effective'date of that insurance. 2. We may cancel this policy. We will mail to you advance written notice stating when the cancellation is to take effect. a. If we cancel based on our decision not to offer insurance to all employers within your premium category, we will mail the notice of cancellation at least 90 days before the cancellation is to take effect. b. If we cancel for other reasons, we.will.mail the notice of cancellation at least 45 days before the cancellation is to take effect. c. If we cancel for nonpayment, we will mail notice of cancellation at least 10 days•before the cancellation is to take effect. 3. Mailing notice to you at your last known mailing address will be sufficient to prove notice. 4. The policy period will end at 12:00 midnight on the day stated in the cancellation notice. 5. When coverage is placed with another carrier as of the.policy expiration date, a rejected renewal policy shall be withdrawn without charge, provided notice of nonrenewal is mailed and postmarked on or before the expiration date and is received from the insured by the insurer no laterthan 10 calendar days after said expiration date. All.other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of.said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is.shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No; WC 36 06 01 E(01-20081 Policy No:WC 6 80818238 Endorsement Effective•Date: Endorsement Expiration Date: Policy Effective Date:05/0112020 Endorsement No:27; Page: 1 o1 1 Policy Page: 104 of 117 Underwriting Company:American Casualty Company of Reading,Pennsylvania; 151 N Franklin St, Chicago,IL 60606 Copyright 2007 National Council on Compensation tnsurance..Inc.All Rights Reserved, • CNA Workers Compensation And Employers Liability Insurance Policy Endorsement WISCxbNSIN CAN:CE•l:-L`A�TIOICAND'NONRENEW.AL ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Wisconsin is shown in Item 3.A. of the Information Page. The Cancellation Section (0) of the Part Six — Conditions is.deleted and replaced by the following: A. Cancellation 1. You may cancelthis policy. You must mail or deliver advance written-notice to us stating when the cancellation is.to take.effect. If you purchase replacement insurance, the cancellation becomes effective on the date the new coverage becomes effective. If no replacement-coverage is purchased, the. cancellation will be effective thirty (30) days after receipt of written notice by the'Wisconsin Compensation Rating Bureau. 2. We may cancel this policy for any reason if the policy has,been in effect for less than sixty (GO) days. If the policy is issued for a term longer than one year or for an indefinite term, we may cancel the policy for any reason on an annual anniversary of the policy effective date. We may cancel the policy at any other time for the following reasons:` a. You fail to pay all premiums when due, however, we must deliver or mail, first class, not less than thirty (30) days advance written notice stating when the cancellation.is to take effect; b. A material misrepresentation; • c. A substantial breach of the obligations, conditions or warranties under the policy; or d. A substantial change in the risk we assumed under the policy unless it was reasonable for us to foresee the change or expect the risk when we issued the policy. 3. If we cancel for any permissible reason other than non-payment of premium, we must deliver or mail, first class, not less than ''thirty (30) days notice stating when the cancellation is to take•effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page.will be sufficient to prove notice, 4. The policy period will end on the day and hour stated in a notice of cancellation. B. Nonrenewal 1. You have the right to have the insurance renewed unless we deliver or mail to you not less than *sixty (60) days advance written notice stating our intention not to renew this policy. 2. We do not have to renew the insurance if you do not pay the renewal premium billing by the due date or if you accept replacement insurance, are insured elsewhere, requested or agree to nonrenewal, or'if the.policy is expressly designated as.being nonrenewable. 3. If we renew the insurance,we may use the policy forms, rates and rating plans We are then using for similar risks. We may limit the.policy to a term equivalent to the term of the expiring policy or one year, whichever is less. 4. If we.offet to renew the policy on less favorable terms, we will mail or deliver written notice of the new terms by first class mail to you,.the policyholder, at least sixty (60) days prior to the renewal date. The definition of "terms" does not include manual rates, experience modification factors, or classification of risks. Form No:WC 48 06,06 B101-20021 Policy No:WC 6'80818238 Endorsomont•Ellcetive Date: Endorsement Expiration Date: Policy Effective Date:05/01/2020 Endorsement No:32;Page: 1 of 2 Policy Page: 109 of 1.17 Underwriting Company:American Casualty Companyrol Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 a Copyright 2002:National Council on Compensation Insurance,Inc.All Rights Reserved. 6 CNA Workers Compensation And Employers Liability Insurance Policy Endorsement If we provide such notice within sixty (60) days prior to the renewal date, the new terms will not take effect until sixty (60) days after the notice is mailed or delivered, in which case, you, the policyhdlder, may elect to cancel the renewal policy at any time during the sixty (60)day period. The•notice will include a statement of your right to cancel. If you elect to cancel the renewal policy during the sixty (60) day period, the return premium or additional premium charges shall be calculated proportionally on the basis of the old premiums. We need not mail or deliver this notice if the only change adverse to you is a premium/increase that; (a) is less than 25%;•or,.(b) results from a.change based on your action that alters the nature and extent of the risk insured against, including, but not limited to, a change in the classifications for the business. * Any written agreement attached to and made a part of the'policy, between the insurance carrier and policyholder which extends the cancellation or nonrenewal notification timeframe, will supercede the aforementioned notification require'irlents found in items A.3., and B.1., respectively. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and.is.for attachment to the policy issued by the designated Insurers, takes•effect'on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is;shown below,and expires concurrently with said policy unless'another expiration date is shown below. Form No:WC 48 06 06 B(01-20021 Policy No:WC 6 B0818238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/01/2020" Endorsement No:•32:Page:2 of 2 Policy Page:.110 of 117 Underwriting Company: American Casualty Company of Reading,Pennsylvania, 151 N Franklin Si, Chicago, IL 60606 a Copyright 2002 National Council on Compensation Insurance,Inc. All Rights Reserved. 4 SHA Workers Compensation And Employers Liability Insurance Policy Endorsement ALASKA CANCELATION AND NONRENEWAL ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Alaska is shown•in Item 3.A. of the Information Page. The Cancelation Condition, as well as Part Five, Paragraph.6.2., of the policy is replaced by this Condition: D. Cancelation/Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the Cancelation is to take effect. If you cancel, the final premium will be calculated pro rata based on the time the policy was in force, and increased by a dancelatior)fee equal to 7.5 percent of the unearned premium, provided that the final premium will not be less.than the applicable minimum premium. 2. We may cancel this policy. We must mail or deliver to.you and the agent or broker of record advance written notice stating the reason for cancelation and when the cancelation is to take-effect. Such notice will be mailed or delivered not less than: a. 10 days before the effective date of cancelation if we cancel for conviction of the insured of a crime having as one of its necessary elements an act increasing a hazard insured against, or for discovery of fraud or material misrepresentation made by the insured or a representative of the insured in obtaining the insurance or by the insured in pursuing a claim under the policy; or b. 20 days before the effective date of cancelation if we cancel for nonpayment of premium, or for failure or refusal of the insured to provide the information necessary.to confirm exposure or determine the policy premium; or c. 60 days before the effective date of cancelation if•we cancel for any other reason.. 3. We will mail or deliver the notice to your last known address and the last known address of the agent or broker of record. 4. A post office certificate of mailing or certified mailing receipt will be sufficient to prove notice. 5. The policy period will end on the day and hour stated in the cancelation notice. 6. If we.decide not to renew this policy, we will mail written notice of nonrenewal, by first class mail, to you and the agent or broker of record at least 45 days before: a. the expiration date; or b.. the anniversary date if this policy has•been Written for more than one year or with no fixed expiration date. 7. We need not mail notice of nonrenewal,if: a. we have manifested in good faith our willingness-to renew; or b. you have failed to pay any premiumrequired for this policy; or c. you fail to pay the premium required for renewal of this policy. ' - 8. Any notice of nonrenewal will be mailed to your last known address and the last known address of the agent or broker of record. A post office certificate of mailing or certified mailing receipt will be sufficient. proof of notice.. Form No:WC 54 06 02404-1995) Policy No:WC 6 80818238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/01/20201 i Endorsement No: 35:Page: 1 of 2 Policy Page: 113 of 117 Underwriting Company: American Casualty Company of.Reading,Pennsylvania, 151 N Franklin St. Chicago, IL 60606 Copyright 1995 National Council on Compensation Insurance, Inc. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and'is for attachment to the policy issued by the designated Insurers, lakes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the•.Endorsement Effective Date).is shown below, and expires.concurrently with said policy unless another expiration date is shown below, • • • • • Form No:WC 54 06.02(04-1995) Policy No:WC 6 80818238 • Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/0112020 i Endorsement No:36;Page:2 of 2 Policy Page: 114 of 117 Underwriting Company: American Casualty Company of Reading,Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Copyright 1995 National Council on Compensation►Insurance,Inc.