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Resolution - 2016-R0054 - Record USA - 02/11/2016
Resolution No. 2016-R0054 Item No. 5.18 February 11, 2016 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the act of the City Manager in executing, on behalf of the City of Lubbock, Contract No. 25100653, F1ipFlow Door Installation, by and between the City of Lubbock and Record USA, of Monroe, North Carolina, and all related documents is hereby ratified in full. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on February 11, 2016__ __ GLEN OBER SON. MAYOR ATTEST: Rebe ca Garza, City Secretary APPROVED AS TO CONTENT: l„ Kelly Cam bell, Director of Aviation APPROVED AS TO FORM: Mitc atterw e, irst Assistant City Attorney RES.Record USA -Contract 25100653 January 20, 2016 City of ,,fLubbock PURCHASE ORDER TEXAS TO: RECORD USA PO BOX 3099 MONROE North Carolina 28111-3099 Page - 1 Date - 01/07%2016 Order Number 25100653 000 OP Branch/Plant 4615 SHIP TO: CITY OF LUBBOCK LUBBOCK INTERNATIONAL AIRP 5401 N. MLK BLVD. LUBBOCK Texas 79401 INVOICE TO: CITY OF LUBBOCK ACCOUNTSPAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 BY: M +A- , ector chasing &Contract Management Ordered 01/07/2016 Freight Requested 01/07/2016 Taken By T FLORES Delivery PER E QUINTANILLA REQ 46875 EMERGENCY PURCHASE Description; Supplier Item F1ipFlow door installation Terms NET 30 INSURANCE REOUIRED: Ordered Unit Cost L' M Extension Request Date 1 000 218,000.0000 EA 218,000.00 0107 2016 Total Order 218,000.00 r Commercial General Liability, per occurrence- Worker's Compensation General Aggregate - $1,000,000 Employers' Liability— $500,000 Products-Comp/Op AGG - $1,000,000 Personal & Adv. Injury - $1,000,000 Contractual Liability - $1,000,000 Automotive Liability General Aggregate - $1,000,000 City of Lubbock is named as an additional insured on a primary and non-contributory basis with a waiver of subrogation in favor of the City of Lubbock on liability coverages. To include products of completed operations endorsements. Waiver of subrogation provided on the workers' compensation. Copies of endorsements are required. i record your global padner for entrance solo6ons January 6, 2016 Lubbock Preston Smith International Airport Steve Nicholson 5401 N. Martin Luther King Blvd, Unit 389 Lubbock, TX 79403 Re: Exit Lane Breach Technology Proposal Steve, Thank you for the opportunity to provide you with the following proposal to remove the current revolving door, install the F1ipFlow unit and finish the opening with storefront at both exit corridors, as discussed. Scope of work: Remove revolving doors, provide 110V, install temporary walls, install the F1ipFlow units, replace / reuse the aluminum storefront, testing, commissioning, training of staff with a one (1) planned maintenance ............... $218,000.00 Exclusions: CAT6 Cabling, IP Addresses, POE, permits and taxes. With the stainless cladded finish, we would be looking at beginning installation March 14th We look forward to working with you and the airport. Regards, Bill Seibert Sales Manager Airports record automatic door systems 4324 Phil Hargett Court, Monroe, North Carolina, USA 28110 800 438 1937 704 289 9212 Fax 704 289 2024 www.recorddoors.com City of Lubbock Purchasing and Contract Management Emergency Purchase Explanation Justification for Emergency Acquisition This form must be completed for emergency acquisition of goods and services, such that the public health, welfare, or safety will be vitally affected and the City's usual acquisition procedures cannot be followed without causing financial or operational damage to the City. If more space is needed, please attach additional page(s). An emergency exists when there is an actual or potential disruption related to an essential service or other circumstances when supplies or services are needed for immediate use in work that may vitally affect the public health, welfare, or safety. 1. Emergency purchase order/contract number assigned: 25l 00W3 on(date): 11,111to 2. Material Or Services Purchased (general description): Removal of existing revolving doors, provide 110 VAC, install temporary walls, install FlipFlow automatic door units, replace/reuse the aluminum storefront, testing, commissioning, training of staff, one-year warranty. 3. Nature And Cause Of Emergency Affecting Safety, Health Or Welfare Of The Public. State the reason for the emergency acquisition by explaining what the emergency is and/or what caused the emergency situation. Be concise but describe the emergency completely: Doors are necessary to deter security breaches at airport. Existing revolving doors have failed and are obsolete. 4. Public Health, Welfare, or Safety and Financial/Operation Damage to City. State the public health, welfare, or safety that may be vitally affected and the financial or operational damage that will occur if needs are not satisfied immediately (do not merely state that a loss or damage will occur): The airport has already suffered one security breach due to the existing door failure. Further breaches will lead to significant TSA security fines. 5. Reason for Failure to Anticipate Need. State the reason(s) why the needs for the acquisition were not or could not be anticipated, so that the items could have been acquired through the City's usual procedures: Existing doors have suddenly broken down and are unable to be repaired. 6. Vendor Name: Record Automatic Door Systems 7. Note: If repair work by contract using FEMA funds, 1) document that contract IS NOT with contractor listed on the List of Parties Excluded from Federal Procurement or Non -Procurement Programs, published monthly by the U.S. General Services Administration; 2) CANNOT enter into a contract that is contingent upon receiving FEMA funds; and 3) keep in mind FEMA does not fund "Cost Plus" (percentage of cost) contracts. 8. Total Actual Cost of Emergency Purchase: $ 218.000.00 Account Number: 92191.9251.30000 Prepare By: Steve Nicholson Department: Aviation Date Prepared: otiosi2016 9. Attach invoice and any other s rt document and forward to purchasing depa men for review and approval. I1�0 10. Approved by Purchasing: Date: Director of Purchasing aM Contract Management PUR-75 (Rev 12.2012) City Of Lubbock Purchasing and Contract Management Sole Source Justification This form must be completed for each requisition/contract that provides for proprietary (sole source) acquisition of goods and services valued at a total amount of $3,000 or more. If more space is needed, please attach additional page(s). Inadequate justification or documentation for a request for non-competitive procurement will result in a solicitation of bids. Vendor: Record Automatic Door Systems Requisition: 46875 Product/Service: Install new automatic door systems - remove old doors Estimated annual expenditure for the above commodity or service: $ 218,000.00 1. Unique Features. Specify the unique features or characteristics of the goods or services that are requested: Removal of existing revolving doors, provide 110 VAC, install temporary walls, install FlipFlow automatic door units, replace/reuse the aluminum storefront, testing to meet TSA security requirements, commissioning, training of staff, and a one-year warranty. 2. Special Needs. Briefly explain why the unique specifications restrict the requisition to one manufacturer or provider: Due to the unique and specialized requirements of this particular installation at the airport and to mitigate the security impacts that have arisen with the failure of the existing exit door systems at the airport, this manufacturer provides the best solution for this situation. 3. Other Sources. State the reason or reasons why competing products are not satisfactory, e.g. a justification for the proprietary (sole source) acquisition: 4. Initial all entries below that apply to the proposed purchase. Attach Request for Exemption front Local Govt Code 152 (form PUR-010) containing complete justification and support documentation as directed in initialed entry. (More than one entry will apply to most sole source products/services requested). Please allow UP TO 45 DAYS to process Sole Source Justification. 1. ❑ Sole Source request is for the original manufacturer or provider, there are no regional distributors. (Attach the manufacturer's written certification that no regional distributors exist. Item no. 4 also must be completed.) 2. ❑ Sole Source request is for the only greater West Texas area distributor of the original manufacturer or provider. (Attach the manufacturer's --- not the distributor's — written certification that identifies all regional distributors. Item no. 4 also must be completed.) 3. ❑ The part/equipment are not interchangeable with similar parts of another manufacturer.(Explain in separate memorandum.) 4. ❑■ This is the only known item or service that will meet the specialized needs of this department or perform the intended function. (Attach memorandum with details of specialized function or application.) 5. ❑ The parts/equipment are required from this source to permit standardization. (Attach memorandum describing basis for standardization request.) 6. ❑ None of the above is applicable. A detailed explanation and justification for this sole source request is contained in attached memorandum. Page I of 2 PUR 70 (12/2012) The undersigned requests that Texas Local Government Code §252.021 Competitive Bidding and Competitive Proposal Requirements be w ed e/�n t t t e vendor identified as the supplier of the service or material described in this sole sourc 'u tificat' a th ri d a sourc��tu Tificaa sole source for the servic or material. Department Head Signature Director Mignature Aviation General Govt. t/ (l r/ ( Le Department Division (PURCHASING DEPARTMENT USE ONLY) Date Approved by Purchasing Director: Date: �r1� Disapproved By: Date: Reason for Disapproval: Page 2 of 2 PUR 70 (1212012) REQUEST TO PURCHASE GOODS OR SERVICES & CONTRACT INFORMATION (Pu rt 1 Initial Procurement Process) Document # Description of Goods or Services to be purchased Estimated Amount $218,000 00 Removal of existing revolving doors, provide 110 VAC, CCTV camem, install temporary walls, install new automatic door units, replace/reuse the aluminum storefront, testing, commissioning, training of staff, and a one-year warranty. Requesting Department Aviation Contact Name Steve Nicholson Title Deputy Director - Operations & Safety Tel # 8D6-775-2036 E-mail 8 smcholson;-eZmylubbock us Will Vendor be on City Property? 13 No 0 Maybe (Explain below) 0 Yes (Explain below) How will this be delivered' Equipment will be shipped in and installed by factory installation technicians Explain Company will be removing existing doors and installing new automatic door units, including testing, commissioning, and training. Revt by: Si ttrlFx nlilu under ?5,000 t Heal: averS25,000-Drector Title rDirclnrorl)e rtnalitHeadONLY) SpeciBcations'Scope of Work Attached (Email to m:dvnrera-nnhrbbnck.us) ( AUTHORIZATION REQUIRED FOR THE FOLLOWING IFAPPLICABLE I El Asbestos may be present in the building, but sampling has shown none of the materials to be disturbed contain asbestos for the proposal scope of work. (1f the original scope of work changes, the Asbestos Coordinator must be notified) ❑ The work area contains asbestos materials that must be addressed before continuing the proposed work. (The contractor must contact the Asbestos Coordinator prior to performing any work), ❑ The work proposed is exterior to the building, therefore it is the responsibility of the Contractor to follow all state, local and federal regulations regarding worker safety and waste disposal. Signature of Asbestos Coordinator (forANYproject involving a Chyjacility) Date Signature of Facilities Director (/orANYprojectinvolvingaCityjaciRty) Date City departments must obtain review and approval of specifications from the Fleet Services Director when specifications include rolling stock (e.g., autos, trucks, off-road equipment, farm equipment, trailers, utility/service bodies, etc.). IfFederol frrnds are involver, please see 49 CFR 665, Pre-auard/Posl De/ivety ojRolling Stock. Signature of Fleet Services Director Date City departments must obtain approval from the Director of Information Technology when specifications include the configuration of any computer systems, computer hardware, computer software, or computer peripherals. Signature of Director of Information Technology Date Charge Advertising & Reproduction Capital Projects 8304 20000 Cost CentedGrants Cost Center/Project No 92191 Account 9251 30000 Phase Cost Center/Project No Account Phase Cost Center/Project No. Account Senior Financial Analyst Signature _ Purchase Order Only Enter a Requisition Number 46875 Term Contract of year(s) + Renewals Is this a One Time Service?: El Yes 0 No FUNDING .8304 Appropriated Amount Available Amount (Phase is only for Capital Projects) Phase Budget Director Signature. GENERAL SERVICES State Funding Federal Funding Items can be awarded on an [3 item -by -item El all -or -none PUBLIC WORKS PROJECTS / JOC (Job Order Contract) Estimated Engineer Amount listed on Bid Sync $ PROJECT NUMBER: NUMBER OF DAYS FOR COMPLETION OF WORK: 8 ❑ Calendar or QWorking Days LIQUIDATED DAMAGES per Day - Amount must be reasonable amount of anticipated or actual damages for each day the completion of work is delayed — generally not enforceable if damages are intended to serve as a penalty or are far in excess of the amount of damages that may be reasonably forecast. (If blank, $25/day will be used) BASIS FOR LIQUIDATED DAMAGES AMOUNT: (If blank, Liquidated Damages amount will default to S25/day.) PUR-12 (REV 2016) INSURANCE (Copies or Endorsements will be Required) TYPE OF INSURANCE ,GENERAL LIABILITY Commercial General Liability ElOther Claims Made occurrence QQ/�W{(HIIeavy Equipment XCU -CA SdInclude Products of Complete Operation Endorsements PROFESSIONAL LIABILITY ❑ AUTOMOTIVE LIABILITY ❑ Any Auto EXCESS LIABILITY ❑ Umbrella Form COMBINED SINGLE LIMIT General Aggregate C D0 J Products-Comp/OpAGG Personal & Adv. Injury Contractual Liability I' a .^r, Fire Damage (Any one Fire) Med Exp (Any one Person) General Aggregate (�-i'e_/155 Each Occurrence Aggregate GARAGE LIABILITY ❑ Any Auto Auto Only - Each Accident ❑ __- Other than Auto Only: Each Accident Aggregate © BUILDER'S RISK E3100%of the Total Contract Price E7INSTALLATION FLOATER ❑ 100% of the Total Material Costs ❑ POLLUTION AR ARGO ORKERS COMPENSATION Sou, u � } MPLOYERS' LIABILITY O R COPIES OF ENDOSEMENTS ARE REQUIRED ity of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis. o include Products of Completed Operations endorsement. Waiver of subrogation in favor of the City of Lubbock on all coverages IMPORTANT: All procurepiettfs procureMUST be reviewed by Risk Management for determination of insurance requirements, irony, prior to submission of this form to the Purchasina Dotiartment. i for purchase only of equipment Signature of Risk Management Coordinator Date CONTRACT INFORMATION (Part 2 Required for Contract :Sward) (TJpe or Print all injornmtion with the exception oj.S'ignatures and Signature Dates) City Council Agenda Date: Check all that apply ❑ Revenue Generating ❑ Grant Funds ('lfeither is steeled. the Rist. Managenvul Co irdmaior siummuire is not requiredl Risk Manager Director of Fiscal Policy _ City Manager Direct Report Date Date _ Date -_ Orieinalina Dejrartmryl pufd "hrdividnnl.R oongJilr far Enm1 nt QinIrAd Terns and Cunirml Compflunce: (Erectned contracts will he available on I..+.crfirhe. Contact IT for 4cresr,1 Department Aviation •Name. Steve Nicholson Phone Number 806-775-2036 Title Deputy Director - Operations and Safety Information for VendorlContractor/Agency or Other Entity City of Lubbock is contracting with: Name of Entity Record Automatic Door Systems Address: 4324 Phil] Hargett Court (This address will be used to mail Contract) City Monroe State NC Zip 28110 Contact Name Bill Siebert Phone No 800-438-1937 Fax No 704-289-2024 Email: (scanned Comma wIII be E -milled) Notice to Proceed + 8 © Working ❑ Calendar Days Not to Exceed Amount: $220,000 00 Original Contract Amount 5218,000 00 ❑ Amendment ❑ Change Order No of Amount S No of Amount S No, of Amount S No of Amount S No. of Amount S No of Amount $ New Contract Amount:S New Contract Amount:S Part 2 requires one copy of the original contract or anfendmentr'change ortler Contract Checklist (Not applicable to Change Orders orAmendments) 1. Is the individual or owner of this business an officer or employee of the City of Lubbock Note If Yes, City policy may not allow us to write a contract for this individual vendor If unsure, check with Legal. 2 If federal or state funded, does the contract include all clauses required by federal or state statutes, and executive orders and their implementing regulations' 3. If the purchase. -transaction involves the purchase, lease, or acceptance as a gill of real estate, has an environmental site assessment (ESA) been performed on the property'! If No, contact Environmental Compliance at (806) 774.2989 PUR-12 ( REV 2016) SAM Search Results List of records matching your search for Search Term: RECORD* USA* No Search Results January 07, 2016 10:33 AM Page 1 of 1 ')tate eIof Debarred Vendor List ks of November 2, 2015, the following vendors have failed to comply with their contracts and have been debarred from loing business with the State of Texas for the period of time indicated. Whether they are listed below or not, the lebarred vendors include the vendors' successors in interest as defined in RULE §20.102(b)(4). Vendor ID Number Vendor Name/Address Date of Debarment Length of Debarment Daystar Residential, Inc 17603361605 3926 Bahler May 17, 2011 5 Years Manvel TX 77578 DBuilders2 LLC 11343506066 PO Box 248 September 19, 2011 5 Years Mansfield TX 76063 Smith Housewares and Restaurant Supplies 1562456928900 500 Erie Blvd November 12, 2014 5 Years Syracuse, NY 13202 Twiss Associates '14194500 19 Compo Rd September 23, 2011 5 Years South Westport CT 06880 Walker's Electric Company 1520 Park St Beaumont TX 77701 1743261315000 Also: August 28, 2012 5 Years Walkers Electric Company Calvin G. Walker Stacy Walker Walker Electric Company LLC 1520 Park St Beaumont TX 77701-5527 1272447273800 Also: August 28, 2012 5 Years Walkers Electric Company Calvin G. Walker Stacy Walker n 2015, the Texas Legislature passed House Bill 855, which requires state agencies to publish a list of the three most :ommonly used Web browsers on their websites. The Texas Comptroller's most commonly used Web browsers are ✓licrosoft Internet Explorer, Google Chrome and Apple Safari. ittp:Hcomptroller.texas.gov/procurementlproglvendor_performance/debarred/debarred vendors_print.html 1/7/201( Teofilo Flores From: Marta Alvarez Sent: Wednesday, January 13, 2016 3:07 PM To: Teofilo Flores; Kelly Campbell; Steve Nicholson; Dawnita Germain -Bonne Subject: Re: Airport PO Record USA - Revolving Door Yes. Kelly Steve please enter agenda comments for the emergency purchase order. Thanks Sent by Outlook for Android On Wed, Jan 13, 2016 at 12:58 PM -0800, "Teofilo Flores"<TKFlores<«maiLci.lubbock.tx.us> wrote: Good Afternoon, Marta, Lainey approved the insurance for Record USA, Inc for the purchase for the Airport. This is the emergency purchase order for the revolving doors for $218,000. I have attached the unexecuted copy for reference. Would you like me to sign the PO and send the purchase order out? Thank you, Teofilo Flores, CTP Senior Buyer City of Lubbock - Purchasing & Contract Management 1625 13th Street, RM 204 Lubbock, Texas 79401 T: 806-775-2168 F: 806-775-2164 AC40RO CERTIFICATE OF LIABILITY INSURANCE /DDNYYY) I TYPE OF INSURANCE dDiSC su INSD WVD POLICY NUMBER 1/DATE(M 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 Watson Insurance 245 East Second Avenue(A/ Gastonia NC 28053 CONTACT NAME: lean Hope Ext), PHONE 704-865-8584 j�1C• No 704-866-9866 I -MAQ L jhope@watsoninsurance.com EAD INSURER(S1 AFFORDING COVERAGE NAIC MED EXP (Any one person) $5,000 _# INSURER A:Travelers Property Cas CO of 125674 INSURED RECOR-5 INSURER B :Travelers Ind. Co of Amer TIA 25666 Record USA, Inc. P. O. Box 3099 INSURER C :Travelers Indemnity Co. IND 25658 INSURER D: Monroe NC 28110 INSURER E : 1 INSURER F COVERAGES CFRTIFICOTF NIIMRFR• 1512471935 I3C11101n41 ►n n111e— _—._.__ ___-._.-_.-.__.-. --__ 1�V ♦111 V1. Iv nuGm. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE dDiSC su INSD WVD POLICY NUMBER POLICY EFF POLICY EXP MM/DDIYYYY MMIDD/YYYY LIMITS B X 1 COMMERCIAL GENERAL LIABILITY Y Y CLAIMS -MADE X❑ OCCUR Y6307522RO37TIA15 9/30/2015 9/30/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 5100,000 MED EXP (Any one person) $5,000 x XCU PERSONAL &ADV INJURY 1$1,000,000 X Contractual GEN'L AGGREGATE LIMIT APPLIES PER: RPOLICY =X JE� LOC GENERAL AGGREGATE 1 $2,000,000 PRODUCTS - COMP;OPAGG 52,000,000 X OTHER: Stop Gap Liab JEL 51,000,000 C AUTOMOBILE LIABILITY Y Y Y8108283136201ND15 9/30/2015 9/30/2016 COMBINED Ea accident I 51,000,000 1 X X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS x NON -OWNED TOS BODILY INJURY (Per person) $ BODILY INJURY (Per accadent) $ PROPERTY DAMAGE $ Per accident S A X UMBRELLA LIAB X OCCUR Y Y YSMCUP828311632TIL15 9/30/2015 9/30/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE S5,000,000 DED I x I RETENTIONS0 1 S B WORKERS COMPENSATION y YHUB6500L065TIA15 913012015 9/30/2016 AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED' FN] N / A X 1 STATUTE x ER E EACH ACCIDENT 51,000,000 E L DISEASE - EA EMPLOYEE, S11,000,0100 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LI MIT I 51,000,000 B Installation Floater Y6307522RO37TIA15 9/30/2015 9/30/2016 Limit (Special) $100,000 Deductible $500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is Additional Insured under the General Liability blanket endorsement attached to the policy. Coverage is primary and non-contributory. Waiver of Subrogation applies on the General Liability and Workers Compensation policies. Umbrella follows form. City of Lubbock Purchasing Department PO Box 2000 Lubbock TX 79457 ACORD 25 (2014/01) CANC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: I. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured B. Blanket Additional Insured — Broad Form Vendors C. Damage To Premises Rented To You • Perils of fire, explosion, lightning, smoke, water • Limit increased to $300,000 D. Blanket Waiver Of Subrogation E. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises F. Blanket Additional Insured — Lessors Of Leased Equipment G. Incidental Medical Malpractice H. Personal Injury — Assumed By Contract 1. Amended Bodily Injury Definition J. Bodily Injury To Co -Employees And Co -Volunteer Workers K. Aircraft Chartered With Crew L. Non -Owned Watercraft — Increased From 25 Feet To 50 Feet M. Increased Supplementary Payments • Cost of bail bonds increased to $2,500 • Loss of earnings increased to $500 per day N. Medical Payments - Increased Limit O. Knowledge And Notice Of Occurrence Or Offense P. Unintentional Omission Q. Reasonable Force — Bodily Injury Or Property Damage PROVISIONS B. BLANKET ADDITIONAL INSURED — BROAD A. BROADENED NAMED INSURED FORM VENDORS 1. The following is added to SECTION II — WHO The following is added to SECTION II — WHO IS IS AN INSURED: AN INSURED: Any organization, other than a partnership or joint venture, over which you maintain owner- ship or majority interest on the effective date of the policy qualifies as a Named Insured. However, coverage for any such organization will cease as of the date during the policy pe- riod that you no longer maintain ownership of or majority interest in, such organization. 2. The following replaces Paragraph 4.a. of SECTION II — WHO IS AN INSURED: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, unless reported in writing to us within 180 days. Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Arises out of "your products" which are dis- tributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: r:r; nA 5R n7 11 ,n om a rtie rrn--are i.,,(o. n r., r,,.,,,,o„v All rinhtC racPm i Pane 1 of 7 COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- dor will be the limits which you agreed to pro- vide in the written contract or agreement, or the limits shown in the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in "your products" made intentionally by such vendor; (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products"; (6) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your prod- ucts"; or (7) "Your products" which, after distribution or sale by you, have been labeled or rela- beled or used as a container, part or in- gredient of any other thing or substance by or for such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products', or any ingre- dient, part or container entering into, accom- panying or containing such products; or b. Any vendor for which coverage as an addi- tional insured specifically is scheduled by en- dorsement. C. DAMAGE TO PREMISES RENTED TO YOU JURY AND PROPERTY DAMAGE LIABIL- ITY: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Para- graph 6. of Section III — Limits Of Insurance. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning smoke resulting from such fire, explosion, or lightning; or wa- ter. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire; explosion; lightning; smoke resulting from such fire, ex- plosion, or lightning; water; or any combina- tion of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem - COVERAGES — COVERAGE A BODILY IN- ises Rented To You Limit. Pana 9 of 7 n 2n : z rho rr. —l.r. 1,.,4o ih, r' --n„ All rinhtc mconro i CG D4 58 07 13 3. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, ex- plosion, or lightning; or (5) Water. is not an "insured contract"; 4. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner; D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph B., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. E. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to name as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: COMMERCIAL GENERAL LIABILITY a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have signed and executed that contract or agree- ment; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) "Bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is com- mitted, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, manager or lessor. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. F. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an additional in- sured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertis- ing injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have Ch Ptd .r,R A7 13 rr4 )n 11 Tho T--f.rc I.H.—ry r' --mi, 411 rinhte rocanrarl Papp 3 of 7 COMMERCIAL GENERAL LIABILITY signed and executed that contract or agree- ment; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Decla- rations of this Coverage Part, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury' or "property damage" caused by an 'occurrence" that takes place, or "personal injury" or "ad- vertising injury" caused by an offense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. G. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, "occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services" to a person. 2. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; c. First aid; or 3. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to any "bodily injury" arising out of any providing or failing to provide "incidental medical services' by any of your "employees", other than an employed doctor. Any such "employees" providing or failing to provide "incidental medical services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in the providing or fail- ing to provide "incidental medical services' to any one person will be considered one "oc- currence". 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees' for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED. H. PERSONAL INJURY — ASSUMED BY CON- TRACT d. "Good Samaritan services". 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION "Good Samaritan services" means any emer- — COVERAGES — COVERAGE B PER- gency medical services for which no compen- SONAL AND ADVERTISING INJURY LI- sation is demanded or received. ABILITY: Pane 4 of 7 n In, l Tho Tr, Inrc ln.+amn t„ r mmnnnv All rinhfc rccani H CG D4 99 07 13 e. Contractual Liability "Personal injury" or "advertising injury" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for damages because of "personal injury" assumed in a con- tract or agreement that is an "insured contract", provided that the "personal injury" is caused by an offense com- mitted subsequent to the execution of the contract or agreement. Solely for 1. the purposes of liability assumed in an "insured contract", reasonable at- torneys fees and necessary litigation expenses incurred by or for a party other than an insured will be deemed to be damages because of "personal injury", provided that: (a) Liability to such party for, or for the cost of, that party's defense J. has also been assumed in the same "insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this in- surance applies are alleged. The following replaces the third sentence of Paragraph 2. of SUPPLEMENTARY PAY- MENTS — COVERAGES A AND B: K. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily In- jury And Property Damage Liability or Para- graph 2.e. of Section I — Coverage B — Per- sonal and Advertising Injury Liability, such payments will not be deemed to be damages because of "bodily injury", "property damage" or "personal injury", and will not reduce the limits of insurance. 3. The following replaces Paragraph 2.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B: d. The allegations in the "suit" and the in- formation we know about the "occur- rence" or offense are such that no conflict appears to exist between the interests of COMMERCIAL GENERAL LIABILITY the insured and the interests of the in- demnitee.- 4. n- demnitee;4. The following replaces the first subparagraph of Paragraph f. of the definition of "insured contract" in the DEFINITIONS Section: f. That part of any other contract or agree- ment pertaining to your business (includ- ing an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury," "property damage" or "per- sonal injury" to a third person or organiza- tion. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily in- jury" in the DEFINITIONS Section: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per- son, including death resulting from any of these at any time. BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraph (1)(a) above does not apply to "bodily injury" to a co -"employee" in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. AIRCRAFT CHARTERED WITH CREW The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with crew to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. L. NON -OWNED WATERCRAFT 1. The following replaces Paragraph (2) of Ex- clusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: r_r; nA 5R n7 13 n')nil Tho Tri„oi rmm Ali rinhfc rocs rv.ri PnoP 5 of 7 COMMERCIAL GENERAL LIABILITY (2) A watercraft you do not own that is: (a) Fifty feet long or less; and (b) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 2. of SECTION 11— WHO IS AN INSURED: Any person or organization that, with your ex- press or implied consent, either uses or is re- sponsible for the use of a watercraft that you do not own that is: (1) Fifty feet long or less; and (2) Not being used to carry any person or property for a charge. M. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: b. Up to $2,500 for cost of bail bonds re- quired because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES.- d. OVER- AGES:d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. N. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION 111— LIMITS OF INSURANCE: 7. Subject to S. above, the Medical Expense Limit is the most we will pay under Coverage C. for all medical expenses because of "bod- ily injury" sustained by any one person, and will be the higher of: (a) $10,000; or (b) The amount shown on the Declarations of this Coverage Part for Medical Expense Limit. O. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known to you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture, lim- ited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, no- tice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individual who is: (i) A partner or member of any part- nership or joint venture,- (ii) enture;(ii) A manager of any limited liability company; (iii) A trustee of any trust; or (iv) An executive officer or director of any other organization; that is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company, trust or other organi- zation to give notice of an "occur- rence" or offense. (3) Notice to us of such "occurrence" or of- fense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the °'occurrence" or offense as soon as prac- ticable after any of the persons described in Paragraphs e.(1) or (2) above discov- Pane R of 7 rri )nl7 rho T --lege 1,,,1o,.,,, ih, r1-- , All nnhfe r—nrorl CG D4 5a 07 13 ers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorse- ment that provides limited coverage for "bod- ily injury" or "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement. P. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional er- ror in, any information provided by you which we relied upon in issuing this policy will not prejudice COMMERCIAL GENERAL LIABILITY your rights under this insurance. However, this provision does not affect our right to collect addi- tional premium or to exercise our rights of cancel- lation or nonrenewal in accordance with applica- ble insurance laws or regulations. Q. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the in- sured. This exclusion does not apply to "bod- ily injury" or "property damage" resulting from the use of reasonable force to protect any person or property. (_f; fld .riR n7 11 0 Will Th. rr.vaio— r- v 411 rinhfc mean nri Pane 7 of 7 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION If — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense F. HIRED AUTO — LIMITED WORLDWIDE COV- of the "insured" against any such "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident'. I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for 'loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or 'loss" ap- plies only when the "accident" or 'loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident' or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident' or "loss", provided that the "accident' or "loss" arises out of operations contemplated by COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How - N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: POLICY NUMBER: Y-630-7522R037-TIA-15 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 09-29-15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN GENERAL AGGREGATE A WRITTEN CONTRACT WHICH IS IN EFFECT DURING LIMIT SHOWN ON THE THIS POLICY PERIOD, TO PROVIDE A SEPARATE DECLARATIONS. GENERAL AGGREGATE LIMIT; PROVIDED THAT, THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from "occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)-01 POLICY NUMBER: (YHUB-6500L06-5-15) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER INCLUDING VILLAGE GREEN OF EAST DUNDEE CONDO ASSN 605 BARRINGTON AVENUE EAST DUNDEE IL 60118 CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos, 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016-3795 record automatic door systems Monroe, NC United States Date Filed: 01/19/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the goods or services to be provided under the contract. Purchase Order 25100653 FlipFlow Door Installation 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Seibert, Bill Monroe, NC United States X Heintel, Ann Monroe, NC United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. ignature of authorized agent of cont acting business entity AFFIX NOTARY STAMP / SEAL ABOVE ' I Sworn to and subscribed before me, by the said Q f �r��C�l ConL nl I$l— this the day ofqQ, 20 1 Lo to certify which, witness my hand and seal of office. —J�— ,c'. Jew. 11 VVI Coyy�Yytissi on cyly cs : 3I2I S Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath I-orms provided by texas Ethics Commission www.ethics.state.tx.us Version V1.0.34032 CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016-3795 record automatic door systems Monroe, NC United States Date Filed: 01/19/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 01/20/2016 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the goods or services to be provided under the contract. Purchase Order 25100653 FlipFlow Door Installation 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Seibert, Bill Monroe, NC United States X Heintel, Ann Monroe, NC United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms proviaea by I exas ttmcs commission www.ethics.state.tx.us Version V1.0.34032