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2012-241ORDINANCE NO. 2� 12-241 AN ORDINANCE ACCEPTING SEALED PROPOSALS AND AWARDING A PUBLIC WORKS CONTRACT FOR THE 1NSTALLATION OF A BELANGER CONDOR VEHICLE WASH SYSTEM AT THE CITY OF DENTON' S VEHICLE WASH FACILITY; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (RFP 4837-AWARDED TO PRO TECH SERVICE COMPANY, L.L.C. 1N THE AMOUNT OF $86,590.04). WHEREAS, the City has solicited, received and evaluated competitive sealed proposals for the construction of public worlcs or improvements in accordance with the procedures of State law and City ordinances; and WHEREAS, the City Manager or a designated employee has received and reviewed and recommended that the herein described proposals are the most advantageous to the City considering the relative importance of price and the other evaluation factors included in the request for proposals; and WHEREAS, the City Council has provided in the City Budget for the appropriation of funds to be used for the purchase of the materials, equipment, supplies or services approved and accepted herein; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 1. The items in the following numbered request for proposal for materials, equipment, supplies or services, shown in the "Request Proposals" on file in the office of the Purchasing Agent, are hereby accepted and approved as being the most advantageous to the City considering the relative importance of price and the other evaluation factors included in the request for proposals. RFP NUMBER CONTRACTOR AMOUNT 4837 Pro-Tech Service Company, L.L.C. $86,590.04 SECTION 2. By the acceptance and approval of the above numbered items of the submitted proposals, the City accepts the offer of the persons submitting the proposals for such items and agrees to purchase the materials, equipment, supplies or services in accordance with the terms, specifications, standards, quantities and for the specified sums contained in the Proposal Invitations, Proposals, and related documents. SECTION 2. The acceptance and approval of the above competitive proposals shall not constitute a contract between the City and the person submitting the proposal for construction of such public worlcs or improvements herein accepted and approved, until such person shall comply with a11 requirements specified in Request for Proposal 4837 including the timely execution of a written contract and furnishing of performance and payment bonds, and insurance certificate after notification of the award of the bid. SECTION 3. The City Manager is hereby authorized to execute all necessary written contracts for the performance of the construction of the public works or improvements in accordance with the proposal accepted and approved herein, provided that such contracts are made in accordance with the Bid Proposals, and documents relating thereto specifying the terms, conditions, plans and specifications, standards, quantities and specified sums contained therein. SECTION 4. The City Council of the City of Denton, Texas hereby expressly delegates the authority to take any actions that may be required or permitted to be performed by the City of Denton under RFP 4837 to the City Manager of the City of Denton, Texas, or his designee. SECTION 5. Upon acceptance and approval of the above competitive proposal and the execution of contracts for the public works and improvements as authorized herein, the City Council hereby authorizes the expenditure of funds in the manner and in the amount as specified in such approved proposal and authorized contracts executed pursuant thereto. SECTION 6. This ordinance shall become effective immediately upon its passage and approval. �6� PASSED AND APPROVED this the ��' — day of , 2012. � ' i , -; , �i' / �� , , MARK A. OUG , S, MAYOR ATTEST: JENNIFER WALTERS, CITY SECRETARY BY: � APPROVED AS TO LEGAL FORM: ANITA BURGESS, CITY ATTORNEY � BY: � 3-ORD- 4837 CONTRACT AGREEMENT STATE OF TEXAS 5 COUNTY OF DENTON � THIS AGREEMENT, made and entered into this 18th day of Septeinber A.D., 2012, by and between City of Dentoil of the County of Denton and State of TeYas, acting through George C. Ca.inpbell thereiulto duly authorized so to do, liereinafter termed "OWNER," aiid Pro-Tech Service Com�any, L.L.0 1701 S. Hi l�iway 121, Suite 406, Lewisville, TX 75067 of the City of Lewisville, County of Denton, and State of Texas, lZereiilafter termed "CONTRACTOR." WITNESSETH: That for and in consideration of fhe payinents and a�reen�ents hereinafter mentioned, to be made and perfoinZed by OWNER, and under the conditions expressed iiZ ihe bonds attached hereto, CONTRACTOR hereby agrees with OWNER to conznleilce and complete perfoi-�nance of the worlc specified below: RFP 4837 — Turi�lcey Installation of Belanger Kondar Car Wash System, exchidin� ille ��urchase and installation of the EJ Ward Billing Svstem in the amount of $86,590.04 and all extra worlc in connection therewith, Lu�der the terms as stated in the General Conditions of the agreement; and at his (or their) own proper cost and expense to fiirnish all inaterials, supplies, inacliinery, equipment, tools, superintendence, labor, insurazlce, and otlier accessories a�zd services necessary to complete the worlc specified above, in accordailce witll the conditions aud prices stated in the Proposal and the Performance and Paynieilt Sonds, attached hereto, and in accordai�ce with all the General Conditions of the Agreement, the Special Conditions, the Notice to Bidders (Advertisement for Bids), and Instructions to Bidders, as referenced herein aild on file in the office of the PLUChasing Agent, and in accordance with all local, state and federal laws; a.nd plans, which includes all maps, plats, blueprints, ai�d other drawings aa.1d prii7ted or written explanatory inatter thereof, and the Specifications therefore, as prepared by: Tlie Citv of all of wluch are refereilced herein and made a part hereof and collectively evide�lce and constitute the entire contract. CA-1 Independent Status It is mutually understood and agreed by and between City and Contractor that Contractor is an independent contractor and shall not be deemed to be or considered an employee of the City of Denton, Texas, for the purposes of income t�, withholding, social security taYes, vacation or sick leave benefits, worker's compensation, or any other City employee benefit. City shall not have supervision and control of Contractor or any employee of Contractor, and it is expressly understood that Contractor shall perform the sezvices hereunder according to the attached specifications at the general direction of the City Manager of the City of Denton, Texas, or his designee under this agreement. Indemnification Contractor covenants and agrees to and does hereby indernnify, hold harmless and defend, at its own expense, Owner, its officers, servants and employees, from and against any and all claims or suits for property loss or damage and/or personal injury, including death, to any and all persons, of whatsoever kind or character, whether real or asserted, arising out of the Work and services to be performed hereunder by Contractor, its officers, agents, employees, subcontractors, licensees or invitees, whether or not caused; in whole or in part, by the alleged negligence of the ofFicers, servants, employees, of the Owner. Contractor likewise covenants and agrees to, and does hereby, indemnify and hold harmless Owner during the performance of any of the terms and conditions of this Contract, whether arising out of in whole or in part, any and all alleged acts or omissions of officers, servants, or employees of Owner. The provisions of this paragraph are solely for the benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise, to any other person or entity. Choice of Law and Venue This agreement sha1L, be governed by the law of the State of Texas and venue for its construction and enforcement shall lie in the courts of Denton County, Texas. The CONTRACTOR hereby agrees to commence work on or after the date established for the start of work as set forth in written notice to commence work and complete all work within the time stated in the Proposal, subject to such extensions of time as are provided by the General and Special Conditions. The OWNER agrees to pay the CONTRACTOR in current funds the price or prices shown in the Proposal, which forms a part of this contract, such payments to be subject to the General and Special Conditions of the Contract. CA-2 Right to Audit The OWNER shall have the right to audit and make copies of the books, records and computations pertaining to this agreement. The CONTRACTOR shall retain such books, records, documents and other evidence pertaining to this agreement during the contract period and five years thereafter, except if an audit is in progress ar audit fmdings are yet unresolved, in which case records shall be kept until all audit tasks are completed and resolved. These books, records, documents and other evidence shall lie available, within 10 business days of written request. Further, the CONTRACTOR sha11 also require a11 Subcontractors, material suppliers, and other payees to retain all books, records, documents and other evidence pertaining to this agreement, and to allow the OWNER similar access to those documents. All books and records will be made available within a 50 mile radius of the City of Denton. The cost of the audit will be borne by the OWNER unless the audit reveals an overpayment of 1% or greater. If an overpayment of 1% or greater occurs, the reasonable cost of the audit, including any travel costs, must be borne by the CONTRACTOR which must be payable within five business days of receipt of an invoice. Failure to comply with the provisions of this section shall be a material breach of this contract and shall constitute, in the OWNER'S sole discretion, grounds for termination thereof. Each of the terms "books" "records" "documents" and "other evidence" as used above shall be construed to , , � , include drafts and electronic files, even if such drafts or electronic files are subsequently used to generate or prepare a fmal printed document. CA - 3 IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the year and day first above written. AT ST: ATTEST: APPROVED AS TO FORM: � i � ✓ �r�� .',�. � . . � .; ,_ �. CA-4 Ci of Denton O BY: �— ,. (SEAL) QcolCe,r,h S¢c�'►c� C.on�n L.L. C, CONTRACTOR � I`i Oa 5.1-�wU [c,�l S�,�. U ol� . L� :�.� � � ,� 1x ��t7 MAILING ADDRESS q�io�- o�o�� - � � O`� PHONE NUMBER �7 a- y 3�- 30 3(� FAX NUMBER �. SIGNATURE PRINTED NAME, (SEAL) PE�o�.vxA.NC� �ao�a STA�E �F'FEXAS COUNTY OF J�ENTON K'�TO�V `4x,I, MEN $y' THESE P.RESENTS: That Pro-Tech Service Corn an L.L_C.✓ �vhose address zs 1702 S. �iighway. 121, S ite 406; Lew7svilIe, TX 75067, hereinafter caIIed �'�� Wes rn Sure Com an � , a corporation organize� and existXng undex Yhe laws of t�e State of South Dakota � � fiilly authorized to transact busi_n.ess in the State of Texas, a.s 3urety, are held and fuax�ly bound unto the City of Denton, 2, municipa� corporation organized and existing under the Ia«�s af khe State a£ Texas, hereizzafter ea�iec�, p�c�c,�n,er, in pen,a.! s,am of Ei�htv six -thousand fi�t�e hwndred , ninetv dollars a.�d �our cents,��SSb.S90,04�1us ten percent of the stated penal suirx as an ad.ditional sum, of mone� r e p z e s e n t i n g a d di tio n a l coeu�t expenses, attorneys' fees, and liquidated damages axisuxg out af or connected with the below ider�tifiied Contract, in lawful money of the �Jnited States, to be pa.id 'zn Denton County, Texas, for tk�e payment af which suxn we1I and truly t� be made, we �ereby bind ouxselves, ou.r heirs, e��cutors, adminis�ratQ�-s, successoz�s, ar.d assig�.s, joi.n.tly and szverally, firmly by these pzesents. T�Zis Bond shali autamatacally be increased bq fihe a�ount o#� any Change order ar Supplern.ental Agreement, t�h�ch increa.ses the Contract price, bui i� no event shall a�hange Or�ier or Suppleme�.taI A.greement, which reduces t31e Contract price, decrease the penal sum of this Bond. 'i'�IE OBLIGA�'ZO� TO PAY SAME is conditio�ed as follows: Whereas, the Principal e�tered into a certaix�, Contraet, identified by Ordinance Number 201�-24?, wiih the City� of Denton, the O�wner, dated tla,e lSth day of Sepfembex A.D. 20�2�or i2.FP 4837 — T�kev InSt�ati(tE1 nf RalanaPr Tt.,,,ri,,,. n,... rTr....t a..._.___ _ ,,. . _ NOW, THEREFORE, if the Principal sha]1 �TeII, #�y an.d faiihfully per.fozx� and fuIfi�l all of the unde�tald�.gs, covenan,ts, terms; cot�ditions and agreeme�,ts of said Contra.ct in accordance. witlx th,e planis, Specifications anci Contract Documents ciuring the oxiginal ter_n tt�ereof and any extension thereof vvhich mav be �anted by the Owner, c�7it}� or without notice to the Surety, and dvriz�g the Iife of ap,y guaranty or warranty requirzd under this Conixact, and shall also �avell axld truly perform and #'ulf ll a1I the undertakings, covznalats, ternis, conditions and agreennents of an,y and all c�uly autho�ized modi,fications of s�i� Caniract fihat may hexea.�er be made, no�ice af v�%ni.ch modifications to the Suxety being hereby waived; and, if the Pri�-icipal shall repaax ancUax rep�ace ail de�ects due to faul� maiezials and woz�ansbip tb,at a�pear within a period of two (2) years from tlie date of final comple#ion and final acceptance of the Work by the Owner; and, if fhe Prineipal shall �ully inde�u�.ify and. saye harmless the Ow.ner from all costs and damages which Ou7n.er ma� suffer by rea,son of failure to so per.�ozm �erein and shall �fuily rezr�iburse and repa.y p�ynez a,jl ouhlay and expense which �1-ie O�wner may incx� in making good any default or deficiency, then this obligation shall be void; othezwise, it shall remain in fixia force and �ffzct. PB - 1 PRdVIDED FURTI-IER, that if any Iega1 action be filed upon this Bond, exclusive venue shall lie in Dentoz� Couniy, State of Texas. AIvD PROV�AEt) FUR1�R, that the said Sw-ety, for value received, hexeby stipulates and agrees that no change, extez�sion of time, alteration or addition to the temis of the Ca�ntiract, or to t%e Woz-�C to be performed tl�ereuz�der, or to the Plans, Spe�itications, �Drawings, etc,, accompanying the same, shall in anywise af�ect its obligation an this Bond, and it does �ereby 'v��aive natice of any s�ucl� ehange, extensioz� of time, alteration or add.ition io the terms of the Contract, or ta ihe Work to be perforned thereunder, ox to the Plans, �pecifications, Dravvings, e�c. This Bond is given pursuant to the pro�isions of C�apter 2253 o:F the Texas GQVernment Code: as ainer_ded, and ar.y oiher applicable statutes of the State oi Texas, The uz�dersigned and designated agent is hereby designated by the Surety hexein as the Resident A�ent in Dento� County to who� any requis�te natices may be deliver�d and on whom service of pzocess may be had in ma-e-�ers arisxng aut of such suretyship, as provided by Article 7.19-1 o�the Insurance Coce, Vernon's Ar�natated Civil Sta-rutes oz the Sta.te of Texas. IN WI'�NESS �NHE.REOF, this insfrument is executad in four ca ' s, eaeh one oF which. sha.1l be deemed an original, this the 12th day of October ; 2012 ATTEST: PRINCIl'AL -�= -. - - - . .. � — �i/ % — � - :. � i� : � �� .. �� ATTEST: . � BY: � S[JRETY Western Sur mpany 1 BY: �c✓- A OR� -FACT Raymon Ray Dyer 'The Resic�ent AgexEt of the Swrety i.n Den.ton Counly, Texas for delivery of :ao�xce az�d servioe of -t1�e pracess is: . NAME: Davis-Dyer-Max, Inc. � STREET ADDRESS: 3200 Broadway Blvd., S-400, Garland, TX 75043 (140TE: Date of Performance Bond rrtust be date of Contract. If Residentfigent zs nor a corporation, give aperson's name.) � PS-2 . . . . . . .c(�1-� �, �,,�� PA,Yl.V1ENT �OND STATE OF TEXAS • § COUNT�SC OF DENTOI� § KN4W ALL MEN BY THESE �RESENTS: That Pxo-Tech Service Gon�pGi�y, L.L.C. ✓ �.vl�ose address is 1702 Highway 121, ,�uate 406, Lewisville 'x'�, 750G7, hereinafter c�lled Principal, and _�/estern Suretv Companv�� , , a corporation Qrganized and existin� tinder tlle laws of ilie State of �uth Dakota , azZd fi:lly au.horized ic� transac� buszitess iiz t1xL State of Texas; as Surety, are held an.d firrnly bound unto tt�.e City of De_1eo�1, a municipa? cazporatioii organized and e�siing under t;b,e laws oi t;�e State of Te�as, '_•iereiilafter caIled O��ner; and unto aII �ersons, firrns, and corporatzons who n�ay fur�zish rnaterials for, or perfornl Labor upon, tt�.e huilding or ii�iprovements hereinafter r fei-red ia; in he l�enal s�t�x� of Ei�htv six thousa�ld. five hundred ninefiv dollars and four cents�86L590.04 �� la��fiil nioiley o� tiie U�iited States, to be paid in Dei�,ton, C01111�, Texas, £ax the paymenz of ��Iuch sum well and truly �o be made, �ve hereby bind oursel�ves, our heirs, executars, adzxtinisti-ators, successors, and assigils: jointly aiid sevarally, firmly by tliese pxesents. This Bon3 s�all autai�7aucGlly ba increased b5� the aan.ount oT any Change Order or Supplemental Agrzeinent �which increases the Contcact price, but in no eveat shal! a Cuange Order or SupplemeYital Agreeineilt ��l�ici� red�.�ces tize Cox�tract price decrease the peilaJ. surn of this Bond. TI-IE OBL�GATI4Ti T'O PAY SAME is conditioned as £ollo�uvs: W7zereas, thv Priu�,c;�a1 entered into a cez-taui Gontract, identi�ied by Ordinance Nux�aber 2012- 41, wirli the City of De;�ton, tlze Owner, dated the 18th day of September A.D. 2012 or RFP 4837—Turri�ey Installat�o�2 of Belan�er Ko dor Gar Wash � stern excrudin the urchase and installation of the EJ' Waa•d Bill'u�� Svstein NOV+�, THEREFORE, if �the Pri.ncipal shall well, truly atid faithfitli� perfot�x;. its du`ies ak�d ina�ce prompt pay�nent to al� persons, �irxns, subcontractors, corPoratio�zs atad c;aiu�ants supplying labar and/or matei-ial in the �rosecution of t1�e Work pro�rided for in said Co�itra.ct a�1d any and all du.ly autliorized �odif�cations af said Coniraci that zx�ay he_•e�.t�er be �nade, iidtice of wllicl� inodifications to tL�e Surety be;�.g hereby expxessly ��aived, theiz t�iis obliga`.ioi� sl�.all b� voi�; othercvise it sl�all rernain in full force and effect. PROV�ED FUR.TH�R, tlzat if any lagal action be filed dn tk�is �ai2d, eaclusive ventiie sha111ie in Deiitou Cou.nty, Texas. AND PRO�rIDED FLIRTHER, tl�at the said Surety, for value received, he�eoy stip� �lates aud agrees tliat no chan�e, e�teilsion of tizne, alterado�i ox addition to tlie terms of tl�e Cantr�ct, or .o tlie Worlc to be pei-£ormed thereux�der, or to the Pians, SpeaiBcations, Drawzz��s, etc., acco�panying �ihe saune, sha]I in anytivise aff'ect its obligatian ou this Bozld, and it does l�ereby waive ilotice o� any suc1� ctuwge, exter�sion of time, altera�ion or addition to t��e iez�s of tlie Contract, or to tl�e i7Joxlc :o be performed theretmdex, or to the Plans, Specifications, Dra��:ings, etc. .; 'I%is Bond is given pursuant to the provisions oi Chapter 2253 of the Texas Gover.ra�x�.e�;t Code, as axrke�zded, and any oiher applicable statutes of �,he State of Texas. The �un.dersi�ned anci designated agent is hereby designated by the Surety herein as the Resident Agent in Denton Coe�niy to �vhom a.uy�requisite notices may be detivered and on whom service of process may be had in matters arising out of sueh surety, as pro�+ided by rirticle 7.19-1 of the Tnsurance Code, Vernon's Annotated Civil Stan�.tes of the St�te of Texas. IN WTINESS WZIERE�F, this ir�.strument is executed in four c ies; each one of whicb shall be deemed a.� original, this the 12th day of October , 2012 � ,ATTEST: PRINCIPA.L � . - - - . ..r �� ✓�/ � / i . !' �.. •i' � a �_1�� I�•� - i �,� � ATTEST: � � B'k- SC..rRETi' Western Sur Co q, BY: O -IN-FACT , Raymon Ray Dyer The Resident Agent of the Surety in Denton County,. Te�as for delavezy of notice and ser� ice of the process is: �'�ty�j;: Davis-Dyer-Max, Inc. STREET ADDRESS: 3200 Broadway Blvd., 5-400, Garland, TX 75043 (.ND?',E: Daie of Payrnent Bond must be a'ate of Coniract. �f Resident Agent k� not a carpora�ior� give a,person's nrrme.) • ' •; . . . . .Ei �,��v �� ,�P e Com an tern Sur p y UVes ty pp�V�R OI�' ATTOItN�Y - C�RTII'I�D COPY BondNo. 71334422 Know All Men By The�e Presents, that WESTERN SUR�TY COMPAN , corporation dnly organized and existing under the law=_ of the State of Sauth Dalcota, and hAVing ita principal office in SiouK Falls, Sou Dakota (the "Company'�), daes by these presenta make; ccnstitute and appoint. F,AYMON F.AY DYER� 't t ue and lawful attorney(s}-in-fact, with full Power and authoxity hereby conferred, to execute, acknowledge and deliver for and on it: i s r behalf as `3uretY, b�nde for: / Principal: Pro—Tech Ser�=ice ��omp�.ny, �LC �✓ Obligee: Cits/ of Denton�/ Amotuit.: $500, 000. 00� and to bind the Company thereby as fullY end to the same extent as if such bonds wer and confirming a11 that the said attorneyis)- n� h the corporate seal of the Compaqv and duly attested b5� its Secretary, hereby ratifying' may do within the above stated limitation5. Said apPc�intment i= made imder and l�Y allthority of the fnllowing bylaw of Westarn Sure.ty Company which rema�ns infiill force and effect. "Scetion '. A11 bonds, policics, undcrtnlcings, Powcrs of Attorncy ar othcr obligations of the corporution shall bc axccuted in thc oarporate name of the Comp�Y bS tbe Prasident, Secretary, �y t=g$istant Searetary, Treasurer, or ax{y Vice President or by such other o�o�rs as the Board of Directors may authorize. The President, any Vlce President, Seeretary, anY Assistant Secxetary, or the Treasm'ex may appoint Attorneys in Fact or agents who shall have aut.hority t.o issue bonds, policies, or undertalcings in the name of the Company• The corporate seal is not ner.es=_ary for the ��idity of any bonds, Palicies, unde.rtalcings, Powers of Attorney or other obligations of the r.orPorat,ion. The signatura nf �ny sur.h nffir.Pr and thP enrPnratz SPaI mayhe printed hy far.simile." April 30 All authority hereby conferred shall e�cpire and terminate, without notice, unless used before midni�ht of ' 7 C11 3 , but until such time shall be irrevocable and in full force and effect. In VGitness Whereof, Western Surety Camp�y has caused these presents to be sig�eOdi y its Vice President, Paul T. Bruflat, and it: corporate s��g�}�a��xed tlus 11th dayof Octobcr �� °�`°_= SURE COMPANY �- __��,_ .��, � W E S T R �� ` z,,,., - .. .�'�r � � �;� . �� ' �'� � Paul T. rutlat, Vice President �' ��;, ; � �.'t� !� ¢= � ^� , ST��_ ,�'�Q??��-E�iTA ss Ti� _ ��• �- COUN�t��P' „ .� ubliu ersonall a �'e� On this 11th day of OCtok�el iii Llie ye�• �.01�- , Uefure tue, x twL•ai•y p ,1� y��'y� Paul T. Bruflat, who being to me duly sworn, acicnowledged that he signed the aboce Power of 4ttorney as the aforesaid officer o W.ES,PEgN g1J��y COIVIpA1VY and acknowledged said instrument to be the voluntary act and dee f said co o at'on. }irti�MVyYR0.ltirtihhti��hK { i S. PETRIK f ot�r5� Public - SouthDakota p EAL N�A� PUBLIC s f j�SOUTH DAKOTA s ititiyyhtitititi�ltiti4ti1ti��lYtitiY'� My Commission Expiras August 11, 2016 I thc undcreigned officor of Vdestorn Surety Company, n ateck corporation of thc Statc of South Dtilcotu, do hcreby cortify that thc at•tached Power of Attorney i= in full foice and effect and is irrevocable, and fwrthermore, that Section 7 of the bylaws of the Company as sr.t. fnrth in tha PowPr nf Att�rnPy is novr in fnrr.r.. 11th day� of In testimony whereof, I hava �h� eunto et my hand and seal of Western Surety CompanY this October , • C O M P A N Y WEST R SURE — Paul T. at, Vice President Form F5306-8-2012 Q �` �1 � \� �; State of Texas Claim Notice Endorsement To be attached to and form a part of Bond No. �1�34422 In accordance with Section 2253.021(� of the Texas Governrnent Code and Section 53.202(6) of the Texas Property Code any notice of claim to the named surety under this bond(s) should be sent to: CNA Surety 333 South Wabash Chicago, IL 6�604 Telephone: (312) 822-5000 Form F6944 Figure: 28 TAC §1.601(a)(3) 1 IMPORTANT NOTICE To obtain information or make a complaint: 2 You may contact Western Surety Company, Surety Bonding Cornpany of America or Universal Surety of Arnerica at 605-336-0850. 3 You may call Western Surety Company's, Surety Bonding Company of America's or Universal Surety of America's toll-free telephone number for information or to make a complaint at: 1-800-331-6053 4 You may also write to Western Surety Company, Surety Bonding Company of America or Universal Surety of America at: P.O. Box 5077 Sioux Falls, SD 57117-5077 AVISO IMPORTANTE Para obtener informacion o para someter una queja: Puede comunicarse con Western Surety Company; Surety Bonding Company of America o Universal Surety of America al 605-336-0850. Usted puede Ilamar al numero de telefono gratis de Western Surety Company's, Surety Bonding Company of America's o Universal Surety of America's para informacion o para someter una queja al: 1-500-331-6053 Usted tambien puede escribir a Western Surety Company, Surety Bonding Company of America o Universal Surety of America: P.O. Box 5077 Sioux Falls, SD 57117-5077 5 You may contact the Texas Department of Puede comunicarse con el Departarnento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion acerca coverages, rights or complaints at: de companias, coberturas, derechos o quejas al: 1-800-252-3439 6 You may write the Texas Department of Insurance: 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas: P.O. 6ox 149104 P.O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512) 475-1771 Fax: (512) 475-1771 Web: http:/Jwww.tdi.state.tx.us Web: http;//www.tdi,state.tx,us E-Mail: ConsumerProtection@tdi.state.tx.us E-Mail: ConsumerProtection@tdi.state.tx.us 7 PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact Western Surety Company, Surety Bonding Company of America or Universal Surety of America first. If the dispute is not resolved, you may contact the Texas Department of Insurance. 8 ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. Form F8365 DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Western Surety Cornpany, Surety Bonding Company of America o Universal Surety of America primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. CITY OF DENTON 16VSURANCE REQUIREMENTS FOR CONTRACTORS Bidder's attention is directed to the insurance requirements below. It is highly recommended that bidders confer with their respective rnsurance carriers or brokers to determine in advance of Bid submission the availability of insurance certificates and endorsements as prescribed and provided herein. If an apparent low biclder fails to comply strictly with the insurance requirements, that bidder rrtay be disqualified from award of the contract. Upon bid award, all insurance requirements shall become contractual obligations, which the successful birlder shall have a duty to maintai� tliroughout the course of this contract. STANDARD PROVISIONS: Without limiting any of the otheY obligations or liabilities of the Contr•actor, the Contr�actor shall provide and maintain until the contt�acted work has been completed and accepted by the City of Denton, Owner, the minimum insurance coverage as indicated hereinafter. As soon as practicable after notification of bid award, Contractor shall ftle with the Purchasing Department satisfactory certificates af insurance, containing the bid number and title of the project. ContYactor may, upon written request to the Purchasing Department, ask for clarification of any insurance requirements at any time; howeve�, Contracto�s are strongly advised to make such requests p�ior to bid opening, since the insuNance requirements rrtay not be modified or waived after bid opening unless a written exception has been submitted with the bid. Contractor shall not commence any work or deliver any mate�ial until he or she receives notification that the contract has been accepted, approved, and signed by the City of Denton. All insurance policies proposed or obtained in satisfaction of these requirements shall comply with the following general specifications, and shall be maintained in compliance wzth these gene�al specifications th�oughout the duration of the Contract, or longer, if so noted.• Each policy shall be issued by a company authorized to do business in the State of Texas with an A.M. Best Company rating of at least A- VII or better. Any deductibles or self-insured retentions shall be declared in the bid proposal. If requested by the City, the insurer sha11 reduce or elimixiate such deductibles or self-insured retentions with respect to the City, its officials, agents, employees and volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. • Liability policies shall be endorsed to provide the following: Name as additional insured the City of Denton, its Officials, Agents, Employees and volunteers. CI-9 That such insurance is primary to any other insurance available to the additional insured with respect to claims covered under the policy and that this insurance applies separately to each insured against whom claim is made or suit is brought. The inclusion of more than one insured shall not operate to increase the insurer's limit of liability. Cancellation: The City requires 30 day written notice should any of the policies described on the certificate be cancelled or materially changed before the expiration date. Should any of the required insurance be provided under a claims-made form, Contractor sha11 maintain such coverage continuously throughout the term of this contract and, without lapse, for a period of three years beyond the contract expiration, such that occurrences arising during the contract term which give rise to claims made after expiration of the contract shall be covered. Should any of the required insurance be provided under a form of coverage that includes a general annual aggregate lirnit providing for clauns investigation or legal defense costs to be included in the general annual aggregate limit, the Contractor shall either double the occurrence limits or obtain Owners and Contractors Protective Liability Insurance. • Should any required insurance lapse during the contract term, requests for payments originating after such lapse shall not be processed until the City receives satisfactory evidence of reinstated coverage as required by this contract, effective as of the lapse date. If insurance is not reinstated, City may, at its sole option, terminate this agreement effective on the date of the lapse. CI - 10 SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS: All insurance policies proposed or obtained in satisfaction of this Contract shall additionally comply with the following marked specifications, and shall be maintained in compliance with these additional speci�cations th�oughout the duration of the Contract, or longer, if so noted: [X] A. General Liability Insurance: General Liability insurance with combined single limits of not less than $1,000,000.00 shall be provided and maintained by the Contractor. The policy shall be written on an occurrence basis either in a single policy or in a combination of underlying and umbrella or excess policies. If the Commercial General Liability form (ISO Form CG 0001 current edition) is used: • Coverage A shall include premises, operations; products, and compleied operations, independent contractors, contractual liability covering this contract and broad form property damage coverage. Coverage B shall include personal injury. Coverage C, medical payments, is not required. If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and ISO Form GL 0404) is used, it sha11 include at least: Bodily injury and Properiy Damage Liability for premises, operations, products and completed operations, independent contractors and properry damage resulting from explosion, collapse or underground (XCL� exposures. Broad form contractual liability (preferably by endorsement) covering this contract, personal injury liability and broad form property damage liability. [X] Automobile Liability Insurance: Contractor shall provide Commercial Automobile Liability insurance with Combined Single Limits (CSL) of not less than $SOO,OQ0.00 either in a single policy or in a combination of basic and umbrella or excess policies. The policy will include bodily injury and property darnage liability arising out of the operation, maintenance and use of all automobiles and mobile equipment used in conjunction with this contract. Satisfaction of the above requirement sha11 be in the form of a policy endorsement for: any auto, or all owned, hired and non-owned autos. CI - 11 [X] Workers' Compensation Insurance Contractor sha11 purchase and maintain Worker's Cornpensation insurance which, in addition to meeting the minimum statutory requirements for issuance of such insurance, has Employer's Liability limits of at least $100,000 for each accident, $100,000 per each employee, and a$500,000 policy limit for occupational disease. The City need not be named as an "Additional Insured" but the insurer sha11 agree to waive all rights of subrogation against the City, its officials, agents, employees and volunteers for any work performed for the City by the Named Insured. For building or construction projects, the Contractor shall comply with the provisions of Attachrnent 1 in accordance with §406.096 of the Texas Labor Code and rule 28TAC 110.110 of the Texas Worker's Cornpensation Commission (TWCC). [] Owner's and Contractor's Protective Liability Insurance The Contractor shall obtain, pay for and maintain at all times during the prosecution of the work under this contract, an Owner's and Contractor's Protective Liability insurance policy nasning the City as insured for property damage and bodily injury which may arise in the prosecution of the work or Contractor's operations under this contract. Coverage shall be on an "occurrence" basis, and the policy shall be issued by the same insurance company that carries the Contractor's liability insurance. Policy limits will be at least combined bodily injury and property damage per occurrence with a aggregate. [ ] Professional Liability Insurance Professional liability insurance with limits not less than per claim with respect to negligent acts, errors or omissions in connection with professional services is required under this Agreement. [ ] Builders' Risk Insurance Builders' Risk Insurance, o� an All-Risk form for 100% of the completed value shall be provided. Such policy shall include as "Named Insured" the City of Denton and all subcontractors as their interests may appear. CI - 12 [ ] Commercial Crime Provides coverage for the theft or disappearance of cash or checks, robbery inside/outside the premises, burglary of the premises, and employee fidelity. The employee fidelity portion of this coverage should be written on a"blanket" basis to cover all employees, including new hires. This iype insurance should� be required if the contractor has access to City funds. Limits of not less than each occurrence are required. [ ] Additional Insurance Other insurance may be required on an individual basis for extra hazardous contracts and specific service agreements. If such additional insurance is required for a specific contract, that requirement will be described in the "Specific Conditions" of the contract specifications. CI - 13 ATTACHMENT 1 [X] Workers' Compensation Coverage for Building or Construction Projects for Governmental Entities A. Defuutions: Certificate of coverage ("certificate")-A copy of a certificate of insurance, a certificate of authority to self-insure issued by the commission, or a coverage agreement (TWCC- 81, TWCC-82, TWCC-83, or TWCC-84), showing statutory workers' compensation insurance coverage for the person's or entity's employees providing services on a project, for the duration of the project. Duration of the project - includes the time from the beginning of the work on the project until the contractor's/person's work on the project has been completed and accepted by the governmental entity. Persons providing services on the project ( subcontractor ui §406.096) - includes all persons or entities performing all or part of the services the'contractor has undertaken to perforxn on the project, regardless of whether that person contracted directly with the contractor and regardless of whether that person has employees. This includes, without limitation, independent contractors, subcontractors, leasing companies, motor carriers, owner-operators, employees of any such entity, or employees of any entity which fiu-nishes persons to provide services on the project. Services include, without limitation, providing, hauling, or delivering equipment or materials, ,or providing labor, transportation, or other service related to a pro�ect. "Services" does not include activities unrelated to the project, such as food/beverage vendors, office supply deliveries, and delivery of portable toilets. B. The contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any overage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all employees of the Contractor providing services on the project, for the duration of ihe project. C. The Contractor must provide a certificate of coverage to the governmental entity prior to being awarded the contract. D. If the coverage period shown on the contractor's current certificate of coverage ends during the duration of the proj ect, the contractor must, prior to the end of the coverage period, file a new certificate of coverage with the governmental entity showing that coverage has been extended. . E. The contractor shall obtain from each person providing services on a proj ect, and provide to the governmental entity: CI - 14 1) a certificate of coverage, prior to that person beginning wark on the project, so the governmental entity will have on file certificates of coverage showing coverage for all persons providing services on the project; and 2) no later than seven days after receipt by the contractor, a new certificate of coverage showing e�ension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project. F. The contractor shall retain all required certificates of coverage for the duration of the project and for one year thereafter. G. The contractor shall notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the contractor knew or should liave known, of any change that materially affects the provision of coverage of any person providing services on the project. H. The contractor shall post on each project site a notice, in the text, form and manner prescribed by the Texas Workers' Compensation Commission, informing all persons providing services on the project that they are required to be covered, and stating how a person may verify coverage and report lack of coverage. I. The contractor shall contractually require each person with whom it contracts to provide services on a project, to: 1) provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements, which meets the statutory requiremen�s of Texas Labor Code, Section 401.011(44) for all of its employees providing services on the proj ect, for the duration of the proj ect; 2) provide to the contractor, prior to that person beginrv.�.1g work on the project, a certificate of coverage showing that coverage is being provided for all employees of the person providing services on the project, for the duration of the proj ect; 3) provide the contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project; 4) obtain from each other person with whom it contracts, and provide to the contractor: a) certificate of coverage, prior to the other person begirmuig work on the projeci; and b) a new certificate of coverage showing extension of coverage, prior to the end of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the proj ect; CI - 15 5) retain all required certificates of coverage on file for the duration of the project and for one year thereafter; 6) notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the proj ect; and 7) contractually require each person with whom it contracts, to perform as required by paragraphs (1) -(7), with the certificates of coverage to be provided to the person for whom they are providing services. By si° ing this contract or providing or causing to be provided a certificate of coverage, the contractor is representing to the governniental entity that all employees of the contractor who will provide services on the project will be covered by workers' compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in the case of a self- insured, with the commission's Division of Self-Insurance Regulation. Providing false or misleading information may subject the contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions. K. The contractor's failure to comply with any of these provisions is a breach of contract by the contractor which entitles the governmental entity to declare the contract void if the contractor does not remedy the breach within ten days after receipt of notice of breach from the govemmental entity. CI - 16 A`�� DATE�MMIODIYYYY) �R CERTIFICATE �F LIABILI`TY INSURANCE ,�19�2012 THIS CERTIFiCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES N�OT AFFIRNWTIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLIClES BELOW. THIS CERTIFICA7E aF INSURANCE DOE5 H01' CONSTITl1TE A CONTRACT BETWEEN THE 15SUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerEificate holder is an AbDI710NAL INSURED, the policy(les) must be endorsed. If SUBROGATtON IS WAIVED, subJect to the terms and conditions of the policy, certain poticies may requlre an endorsemant. A statsment on this certificate does not confer rights to the �ertificate holder in lieu of such endorsement{s}. PRODUCER CAMERCT �chele MCGi11 Davis-Dyer-Max Insurance PHONe , �g�2�86A-0900 NCNo:�972�2�8-8400 a Member �f the Insurors Group DpA�ES;michele.magill@davis-dyer-max.com P. O. SOX �I9S4Z 9 INSURER S AFFOR�ING COVERAOE NAIC # Garland TX 75049 iNSUReRn:Travelers Insurance Com an 39357 iNSUReo iNSURERS:Charter Oak Fire 25615 Pro-Tech Service Co., L.L.C, iNSUReRC:Travelers Indemnit Com an CT 5682 �%�2 $. Hwy 121 #406 1MSURERP: � INSl1RER E : Lewisville TX 7b067 INSURERF: COVERAGES CER7IFICATE NUMBER:ZOi2-2013 Liab Certs REVI510N NUMBER: THIS IS TO CERTIFY THAT THE POLlCIES OF INSURANCE LIS7ED BELQW HAVE BEEN ISSUED TO'fHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER7AIN, TNE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. ILTR �0 HR POLICY EFF POLICY E%P LIMl7S TYPEOFIN9URANCE POLICYNUMBER MIQDIYYYY fD GENERAL LIABILITY EACH OCCURRENCE $ 1� 000 � OOO AMAGE ftENTED 100�000 X COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence S A CLAIMS-MADE ❑X OCCUR I-660-51B7Ci61 6/9/2012 6/9/2019 Mgp�p(Anyone erson $ 10,00Q PERSONALSADV INJURY 3 1 � 000! 000 GENERAL AGGREGATE S 2� 000 i 000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUC7S-COMPIOPAGG 3 2�000�000 X POLIGY PR� LOC S AUTOMOBILE LIABILITY COMBINED SINGLE IM 7 Eaeccldenl S 1 �00 000 X ANY AUTO 80DILY INJURY (Per peBan) S B X qUTOS�E� x Al1TOSULED A-6129C757-12^SEL 6/9/2012 6/9/2413 BODILY INJURY (Peraccident) S � NON•OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS Per accldenl S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE § S � U OO � OOO C. EXCE55 LIRB CLAIMS-MADE AOGREGATE $ 1� 000 � 000 oED � RETENTIONS 5,00 TSF-CUP-4209Y745 6/9/2012 6/9/2013 y WC STATU- OTf+ WOftKERS COMPEN5A710N ANO EMPLOYERS' LIABILI7Y ANY PROPRIETORJPARTNERIEXECUTIVE Y! N E,L. FACH ACCIOENT S OFFlCERfMEMBER FJCCLUDED? � N!A EL. DISEASE - EA EMPLOYE S (Mandalory In NH) If yea, describe under E.L, bISEA3E - POLICY LIMIT S pESCRIPTION OF OPERATIONS beloW � A Rentad & Leased Equipment I-660-5187c161 /9/2012 6/9/2013 �mltaflnaurenceS25,0o0 OESCRtPTION OF OPERATION91 LOCATIDNS! VEHICLES (Attach RCORb'101, Addlllanal Remerks Schedule, If mo�e spaee ie requlredj The General Liability & Automobile polioies inolude a blanket automati❑ addi�ionai isaured endorsement that providas additional insured status to the oertifioate holdar only when there is a wsitten contract between the named insured and aertifiaate holder. The Genera�. Liability & Automobile polioiea include a blanket automatio waiver o£ subrogation endorsement only when there is a wri�t.en contract between the named insured and tha oertifioate holdex. T SHOULDANYOF THEABOVE DESCRIBE� POLIGIES BE CANCELLED BEFORE TNE FJCPIRATfON DATE THEREOF, NOTICE W[LL BE DELIVERED IN pCCORDANCE WITH THE POLICY PROVISIDNS. City offDenton, Its �ffiaials, Agents, Em and Volunteers pUTHOR¢ED REPRESENTATIVE Materials Management Department 901B Texas Sireet Dent.on� T}C 76209 I,arry Hughaton/DMM �� ACOR� 25 (2010105) � 1968-2010 ACORD C�RPORATION. Atl rights reserved. INS�ZS (9(11(1l1.rillli Thu A(_f1R11 noma anrl Innn �ru ranicFnrnrl markc nf AC:f1Ril F Policy # I-660-5187C161 ' ' COMMERCIAL QENERAL LIABI LITY j.... �<< t m� m � o� o.� o.�. � � r" �� o..�� r�� ..�r V� o� � r� or,�.. o � V � :� OOi313 TH[5 ENDORSEIVIENT CHANtaES THE POLICV. PLEASE READ !T CAi��FULLY. BLANKET ADDITI�NAL INSURED--�INNE�S, LESS�ES aR CONTRAGTaRS This endorsement modiffes insurance provlded under fihe following; COMMERCIAL GENERAL LIABILITY COVERAGE PARI' PRQVI510NS: i 2. WHa IS AN fNSUR�D (SECT(�N ll) (s amended to include as an insured any person or arganiza- tlon (called hereafter "addltional lnsured") whom you have agreed In a written contract, executecf prlor to loss, to name as additlonal Insured, but only wlth res�ect to liability arlsing out of "your work" or your ongoing operatians for that addi- tional insured pertormed [�y you or for you. Wfth respect to the insurance afforded to Addf- tionai (nsureds the foflowing condltians apply; a. Limits of lnsuranca — The following fimits af Ikabfllty apply: 1. The limits which yau agreed to provicle; or 2. The Iimlts shown an the decfaratiorts, whichever Is less. b. This Insurance Is excess over any valid and collectihie Insuran�e unless you have agreed In a written contract for thls insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis ta any parsan or arganizatlon for whom you have purchased an Owners and Contractors Protective pollcy. b, to "bodlly EnJury," "property damage," "per- sanal injury," or "advsrtising InJury" arlsing out of the rendering of or the fallure to render any prafessionai servfces by or for you, in- cluding: . 1. 7he preparing, approving or falling to prepare or approve maps, drawings, opinions, •reports, surveys, change or- ders, designs or speclfiications; and 2. Supervlsory, Inspectian or engineering services. CG D 1 05 04 9� Copyrlght, The Travelers f ndemnfty �omparty, 1994. Page 1 of 1 lncludes CQpyrighted Materlal from Insurance Servlces Office, Inc. COMNfERCiAL GENERAL L�ABILITY THIS ENDORSEMENT CHANGES THE POLIC�. �Pl.EASE READ IT CAREEULLY, . � �.� . . . . . , . . . . . . . . .. :.. . .:: . -� ..,:.; : .:. ,>.,.; .... ,...., ,. . .. ,: :.:.. � : . � MANU�'ACTUR�R� A�ND 1NHO�.ESALERS XT�ND END_ORS�MENT . , _ , . , . .. .. This endorsement modifies insurance provided under ihe folkowing: COMMERCfAL GENERAL LIABILITY G�VERAGE PART GENERAL DESCRIPTtON OF COVERAGE � This endorsement broadens coverage. The foflowing listing [s a general coverage descriptian only. Limitations and exclusions may apply fo these coverages. Read all the PRO- VISIONS ofthis endorsement carefully to determine rights, duiies, and what is and is nat covered. A. Broadened Named Insured B. Blan�Cet Broad Form Vendors C. Limited Worldwide �iability Coverage —lnd�mnity Basis D. Damage To Premises Rented To You Exfension • Perils of fire, expioslon, lightning, smoke, water � Limit increased fo $300,Q0� �• BEanket Waiver of Subrogation F• Blanket Additional Insured — Managers or Lessors af Premises G• BlanketAdditional Insured — Lessor of Leased Equipment H. [ncidental Medical Malpractice l. Personal Injury — Assumed by Contract PROV[StONS A. �FtOADENED NAMED INSURED 1. The Named Insured in Item 1. af the Reclara- tions is as follows: The person or organfzation named in Item 9. 4f the Declarafions and any arganization, ather than a parfnership or joint venture, over which you maintain ownership or majority )n- terest on the effective data of the policy. However, coverage for any such organization will cease as of the date during the policy pe- riod fhat you na longer maintain ownership of, or majority interest ln, such organization. 2. WHO IS Af� INSURED (Section I� {tem 4.a. is deleted and replaced by the following: J. Exiension of Coverage — Bodily injury K. ln}ury to Go-Employees and CaVolunteer Workers L. Ai�craft Chartered witf� Crew M. Non-4wned Watercraft— Increased � from 25 feet to 50 �feet ' �� fV. Increased SupplementaFy Payments • Cost for bail bonds increased to $2,5fl0 • Loss of earnings increased to $5D0 per day O. Medical Payments ' Limit increased to $1o,00D per person P. Knowledge and Notice nf Occurrence or Offense Q. UnintentionalOmission R. Reasonable Foroe — Bodily Injury or Property Damage a. Coverage under this provision is afforded only until the 180th day after you acquire ar form fhe organization or the end of the policy period, whichever is earller, unless reported in writing ta us within 180 days. 3. This Provision A. doas not apply ta any per- son or organization far whlch cqverage fs ex- cluded by endorsement, B, BLANKET BROAD FORM VENDORS COV�R- AGE �� '�_�; .} WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (referred ta helow as "vendor") with whom you : have agreed in a written contracf, executed prior to loss, to name as an additional insured, bui only with respect to "podily injury" or "property dam- :�� ; age" arising out of "your producfs" which are dis- �• ,._ .' CG D1 87 11 03 �' Copyright, The Travelers lndemnity Company, 2003 Page 1 of 7 .� � �- , e, i ; `, `�'2 .� �^ a` � � �— �— a� o� � o��..' V �• e}� O� ��s C � G � . � o��.' o� u � rs.., ��+� 'y 00220.3 � � � � � . . • ' ' COMMERCIAL GENERAL LIABILITY THIS ENDORSEM�NT:CHAN��S THE POLICY.•PLEASE READ.IT�CAREF_ULLY. : OTHEI� :ff�SU,I�A�l�E,�- A.D...D,IT:fON;�4.L�;,.INSUREDS, . . . . :; . . ...., . This endorsement modifies insurance provided under the following: ' COMMERCIA� GENEF2AL LIABILITY COVERAGE PAR7 PROVISIONS � 6. The "personal injury" or "advertising injury" for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises o[at of an oP- (Seetion IV), Paragraph 4. (Other Insurancej, is fense committed amended as follows: � subsEquent ta ihe signing and execution of that 1. The foflowing is added to Paragraph a. Primary cantract or agrsement by you. �' '. �:� tnsurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any otF�er primary in- tract or wri�ten agreement that the Insurance pro- surance avaflable to you is deleied. vided 'to an additional insured under fhis 3. The following is added to Paragraph �h. Excess Covarage Parf must apply on a primary basis, ar Insurance, as an addiiional subparagraph under a primary and non-contributo�y basis, thIs insur- Subparagraph (�I): ance is primary to other insurance that is avail- That is avai[able to the insured when the insured able to such additlonal insured which covers such is added as an additional insured under any ofher additional insured as a named insured, and we policy, including any umbrella vr excess policy. w(II not share with fhat other insurance, provided .�. . '. �� .. . . . .. � • ihat: . . . . � . . , a. The "bodily injwry" or "property damage" for _ , , , . . : , , : . . , • which coverage is sought pccurs; and � . . � . . . . GG DO 37 04 05 Gopyright 2�05 The St. Paul Tra�el2rs Companies, Inc. All rights reserved. Page 1 of � COMMERCIAL GENERAL LIABILITY k�-.� .�' t�ibufed or sold in the regular course of the ven- t dor's business, subject to the following addifional °° ', provislons: ., ' , �'t. •�Limifs of [nsurance. The limits of insurance affarded ta the vendor shall be the limits , which you agresd to provide, or the limits shown on the Declar�tions, whiche�er is less. :'�, a� �; �= ,°- � o= P�� e= � d� �� o� � „� �. = a= � �� o. _ � U�� ,•�:"' � . , `�# �� 2. The insurance afforded fhe vendor does not • apply to: � � � a. "Bodily injury" or "proper#y damage" for� which the vendor is abligated to pay damages by reason of the assumptlon of liability in a contract or agreement. This exclusion does nat apply to liability for �damages that the vendor�would have in the absence of the contract or agraement; b. Any express warranty unaut4orized by . �,,yau� . . � . � . ... . c. Any physical or �chemical �change in the product made intentinnally by the vendor; ` d. Repackaging, unless unpacked sofely for � 'the purpose af insp�0ction, demonstration, � testing, o'r�the substitution of paris under inst�uctions from�the manufacturer, and then repackaged in the original confainer; e. Any failure ta make such inspections, ad- �� justments, tests or servicing as vendors �gree to make or normally undertaKe to maKe in the usual course of business, in connection with the distribution or sale of "your products"; f. Demonstratior�, �installatfon, servicing or repai�,operations, except such operations .pe ,rf.orrped . at the vendor's premises in connection wiih the sale of the product; g. Products which, after distribution or sale .,.. •by you, haV� been fabeled or relabeled or . used as a.�ontainer,.part or ingredient of �:.. �ny other thing or sub,stance .by ar for tf�e vendar; , . . ... . 3. This Provision�B. does not apply to: a. Any insured pe�rson or organization, from whom you have acquired 5uch products, or any ingredient, part or container enter- ing �� into, accampanying ar containing 'such products; " � b. Any vendor for which covarage as an ad- � ditional insured specifically is schedufed py endorsement; or c. Any of "your products" f�r which coverage �� is excluded by endorsement. C. LlMITED WORLDWIDE LIABILITY COVERAGE 1. The definifion of "coverage territor�" in DEFI- NITIQNS .(Section l/) is de{eted and replaced by the fallov�iing: � "Coverage territory" means: a, The United States of Arnerica (including its territories and possessions), Puerto Rico and Canada; b. lnternaiional waters or airspace, but anly if the injury or damage occurs in the course of�travef or transportation between any places incfuded in a. abave; or c. ;411 other parts of the world, excluding any country or jurisdiction whiah at the time af the "occurrance" or offense is the subject of trade or economic sanctions Imposed by the laws or regufation of the United States of America, but not including any country or jurisdiction fn which fhe in- surad's activfties are specifically permit� ted by any goverl�mental entity of the United States of:America, if the injury or damage arises out of: � . (1) Goods or products made or sold by you in the territory described in 1.a. , .above; vr . • . (2) (3) The activities of a person whose home is in fhe territory described in 9.a. above, but is away for a short time on your business; or "Personal injury" or "advertising in- jury" offenses that take place through the Interrtet or similar means of cammunication. - � 2. With respec# to claims or suits causecf by an "occurrence". within fhe "coverage territory" described in 'f.c, aboWe, the folfowing condi- tions appfy: . a. The coverage afforded hereunder sha{I be excess over any other valid and co[- lectible insurance availabfe to, the insured, whether primary, exaess, contingent or on any other�basis, except for insurance pur- chased spacifically by you to be excess of this policy. .. , .. p. This insurance is not, a substitute for "compulsory admitted insurance" in any jurisdictfon described in 1.c. above, Page 2 of 7 ,• Copyright, The Travalers lndemnity Company, 2003 • •GG b9 87 11 03 oozznn ��whether or not this insurance would qual- ify as "compulsory admitted insurance" in ��,a giv,en jurisdiction or is accepted by fhe appropriate authorities as proof of "com- pulsory admftted insurance". You agree to maintain "compulsory ad- mitted insarance" at the limits required by law. Your failure to do so will not invali- date the covarage afforded 6y this en- dorsement, buf we wifl only be Iiahle to the same extent we would have been [i- able had you maintained "comp�lsory admitted insurarrce". "Compulsory admitted insurance" means �insurance that is: G. (1) Required to be in-force to satisfy the �• fegal requirements of a given jurisdic- � tion; and (2) Issued by a State Fund or an insurer �� licensed cir permitted f�y law to do �• business in the jurisdiction where the .� property or exposur2 to loss is lo- �� .cated. � . � With respect�fa defending you against, or the investigati�n or settlement of, any claim or "suit" brought against you, the � follawing will apply: . '(1) The prouision of the Insuring Agree- ment reading "We will pay....." in Part .�::1. of COVERA�E A, and COVER- . • •AG� B. (Sectio� I — Coverages) is ,.. amended io read "We wili indemnify , . .the Insured fpr... ' ; .. .��(2) You must arrange to defend yourself �: �•.against, and investigate or settl�, any , , � claim or "suit"; (3} You will not make any settfement � . without our consent; �''-(4) We wifl pay axpenses incurred with � �•�our cartsent; � 3. (5) We may, at our discretion, participaie � � in defending you against, or in the 'settlement of, any claim or "suit". This.Provision C. does not apply: a. .To any of "your products" for which co�- .-erage is excladed by endorsement; or b, To "personal injury" or "adverfising injury" � if COVERAGE B. PERS�NAL AND AD- � VERTISfNG lNJURY L,IABILIiY is ex- � �cluded by endorsement. COMRlIERCIAL G��IERAL LIABILITY D. DAMAGE TO PREMISES RENTED 70 YOU .��5 �XTEI�51�N � .... . . . . � �` ` 4. The last paragraph of COVERAGE A. BOD- ILY INJI(RY AND PROPERTY DAMAGE LI- ASILITY {Seciion i— Coverages) is deleted artd replaced by the following: �� Exclusions c. tf�rough n. do not apply ta dam- age fo premises while rented fo you, or tem- porarily accupied by yau with pemtissian of the owner, caused by: ' a. Fire; b. Explosian; c. Lighining; d. Smoke resulting from such fire, explosion, ar lightning; or • e. Water. A separate limit of Insurance applies to tF�is caverage as descrlbed in LIMII'S OF [NSUR- ANC�. (Sectio n .III). . 2. ihis .insurance does not apply to damage to premises wf�ile,rented to you, or tempararily occupied, ,by you with ;,pe.t�Cnission of the owner, caused by:. , a. Ftupture, bursting, or operafion of pres- ;�`��' sure relief devices; . . � ' ,... b. Rupture or bursting due to expansion or �� swelling of ihe 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. 3. Pari 6. of LIMITS �'�F INSURANCE (Secfion � 111) is deleted and replaaed by the following: � Subject. to 5. above, ihe Damage To Prem- ises Rented To You Limit is the most we will � pay under�CaVERAGE A.�for damages be- cause of "property damage" to any one prem- ises while rented to you, or temporarily occu- �.: pied by yau with permission of the owner, . caused •by •fire, explosion, fightning, smQke ! .. resulting fram such ftre, explosion, or light- �. ning, or water. The damage To Premises Rented To You Limit will apply to all damage ` proximafely caused by the same "occur- rence", whether such damage results from ffre, explosion, lighining, smoke resulting from sueh flre, explosion, or lightni�g, or water, or any combinatian of any of these. �, � ; CG D1 87 11 q3 ' Copyrlght, The Trave[ers lndemnity Campany, 2003 Page 3 of 7 � ,� r� �< °�. r ''t ��:.a ..�. ..= ��— �� o� o= o� a� d� o� � = d� a= r`� a,. � o� � UM� � GOMMERCIAL GENERAL LIABILiTY E, F The Damage To Premises Rented To You : Limit will be the higher ofi �� a. $30�,000; or . �. The amo�nt shown an the Declarations � for Damage To Premises Rent�d To You Limit. 4. Under DEFINIT{OfVS (Section �, Paragraph a, of the definiti�n of "insured contract" is amended so that it doas not include that por- tion of the contract for a lease of premises • that indemnifies any person or •organization . far damage to premises while renied to you, or temporarily occupi�d by you vJith permis- sion of the ov,�ner, caused by: . a. � Fire; b. Explosion; . c. Lightning; � d. Smoke resulting from scach fire, explosion, ' or lightning; ar ' � � " e. Water. � 5. , Thjs Provision D. does not apply if coverage for Damage �To Pre�ises Rent�d, To You of COVERAGE A. BODILY INJURY AND � �'� PROP�RTY DAMAGE�L''IABILI7Y (Section 1– � ' 'Coverages) is excluded by endorsement. � BL.ANKE711VAIVER,OF SUBROGATION We waiv,e any rignt of recovery we rriay have against any person or organization because of payrnents we make for injury .or damage arising out of premises owned or occupied by or rented or .I,oaned to you; angoing operations performed by you or an your,behalf, done under a contract with that person or organization; "your wark"; or "your products". We waive fhis right where you ha�e agreed to do so as part of a written contract, executed by you priorta loss. �'.�� -�� -� BLANKET ADDITIONAL��IIUSURED – MANAG- ER5 OR LESSORS OF PRENfISES WHO IS AN �INSURED {Section'1� is amended to include as an insured any person or o�ganizafion (referred to below as "additional insured") with whom you have agreed in a written contract, exe- cuted prior to loss, to name as an addifiona{ in- sured, buk only with respect to liability arising out of the ownership, maintenance �or�usa �of that part of any premises leased to you, subject to the fol- [owEng pro�istons: • � � � ' � its shown on the Deciarations, whichever is less. 2. The insurance afforded to the additional in- sured does not apply to; - a. Any "occurrence" that tal<es place after � you cease to be a ienant in that premises; b. Any premises for which coverage is ex- ' cluded by endarsement; or c. Structural alterations, new construction or demolition operations performed by or on bahalf of such additionat insured. 3. The insurance afforded to fhe additional in- ,•sured is excess over any valid and collecfible insuranoe availab[e to such -additional in- sured, unless you have agreed fn a written contract for fhis insurance io apply on a pri- mary or coritributory basis. � �. BLANKET ADDITIOIVAL INSLIR�D – LESSOR OF LEASEQ EQUIPMENT WHO !S AN 1NSUFtED (Section II} is amended to include as an insured any person ar organization (referred to 6elow as "additional insured") with wham �you have agreed in a written contract, exe- cuted �prior to foss, to name as ,an additional in- sured, but only with respect to their liability arising out af the;maintenance„operation or.use by you of equipment leased to you hy such additional in- su�d, subject to the follawing provisions: 9. �imi#s of Insurance. The limits of�insurance afforded to the additiona{ insured shall be the Ilmits whieh you agreed to pr'ovlde, or the lim- its shown on the Declarations, whichever is less. � ' 2. The in5ura7Ce afforded to the additional in- sured does nat apply to: '.• a. Any "occurrencs" that takes place after • �the equipment lease expires; or � b. "Bodily injury" or "property damage" aris- ing out of the sole negligence of such ad- ditional insured. � • • 3. The insurance afforded to the additional in- sured is excess over any valic[ and colleciible insurance available to such addiEionaf in- .sur�d, unless you have agreed in a written � contract for this insurance to apply on a pri- mary or coniributory basis. � � � H. INGIDENTAL MEDICAL MALPRAGTICE �9. Limits of Insurance. The limits of insurance 7. 7he definition of "bodily injury" in DEFINI- (�� `� aff�rded io ihe additional insured shall be the 710NS {Section V) is amended to include "In- `�.;.:-�'' limitswhich you agreed to provide, orthe lim- ciden#al Medical Malpractice (njury". �. Page 4 of 7 . Copyright, The Travelers Indemnity Company, 2003 �CG D1 87 91 03 Oq224fi 2. The foflowing definition is added to DEFINI- TIONS (Section V): ''lncidental medical malpractice injury" means badily injury, mental anguish, sicknass or dis- ease .�ustained by a person, including death �.resulting from any of these at any time, aris- �ing oat af the repdering of, or failure to ren- c1er, the following services: a. Medical, surgical, dentaf, laboratory, x-ray •' or nursing service or treatmeni, advice or instru�tion, �or tt�e �elated #amishing of � � �food or beverages; •b. The furnishing or dispensing of drugs or medicat, �dental, or surgical supplies or � � �appliances; or � � c. First aid. ' d. "Good Samaritan services." As used in this Provision H., "Good Samaritan ser- �• �'vices" are t�►ose medical setvlces ren- dered or provided in an emergency and �. for w�ich no remuneration is demanded � or received. 3 . Paragraph �2.a.(1�(d) of WHO IS AN IN- ��SUREb '(Section II) daes not apply �to any �i-egistered nurse, "lice�tsed practicaf nurse, ' �emergen�cy meciical technician or paramedic °�employed by you, but only while perfarming •�the services described in paragraph 2. above �and while acting within the scope af their em- .: �: ployment by you. Any "employees" rendering .."Good Samaritan services" will be deemed to �.be ac�ing within the scope :of their employ- � � �rnent by you. � • 4. The following exclusian is added to paragraph � ,2. .Exclusions af COVERAGE A. -- BODILY INJURY AND PROPERTI' QAMAGE LIABIL- 1T1' (Section I — Cn�erages): (This insurance doe5 noi apply to:) Liability arising out of the willful vialation of a penal ��`statute ar�ordinance relating to the sale of �'pharmaceuticals �by or with the knowledge or consent of the insured. � � � 5. For the purposes of determining the applica- � ble limits of fnsurance, any act or omission, '�'together with all refated acts or omissions in the furnishing flf �fhe setvices described in paragraph 2. abo�e to any one person, wiil be considered one "occurrence". 6. This Provision H. does not apply if you are in the business or occupation of pro�iding any of . the servlces described in ,paragraph 2. above. COMMERCIAL GENERAL LIABILITY The irtsurance provided by this Provision H. --�,, shail be excess over any other valid and col- �, ': lectible insurance a�ailable to the insured, `� whether primary, excess, contingent or on any other basis, except for insu'rance pur- chased specifically by you to be excess of this pol'tcy. !, PERSONAL INJURY — ASSUIVIED BY CON- TRACT � ' 9. The Contracfival Li�f�ilify Excfusion in Part 2., Exclusions of COVERAG� B. PER- SONAL AND ADVERTlSING INJURY LIABIL- IN (Section 1— Coverages) is deleted and replaced by fhe following: (This insurance does not apply io:) 2. 3. Contracfual tiabifity "Advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusian does not apply to liability for damages that the insured would have in the �bsence of the contract ar agreernent. Subparagraph. f. of the definition. of "insured contraci" (DEFINITIONS; -. Section V) is de- leted and replaced by the fo(lowing: f. Thai part of any other contract or agree- ment ,pertaining to your business (includ- fng. an,jndemnifcation,of a municipa(ity in conneciion with work � performed for a ��municipality) under which you assume the tvrt �liabflity of another party to pay for "bodily injury," "propecry damage" or "per- �•sanal �injur�r" to.a third parfy or organiza- ..,.,. tion. Tort 'liability means a liability that w�uld be imposed by law in the,:absence of any contract or agreement. This Provision 1. does not apply if COVER- AGE B. PERSONA�. �AND ADVERTISING IN- JURY LIABILITY i5 excluded .by endorse- ment... .. .... .. J. E)(TEN510N .QF. ,COVEIZAGE, — . BODILY [N- JURY � � , . .. , . :.. r � The definition of "bodily injury" (DEFINITIONS -- 5ection V) is defeted and replaced by:the follow- � (n�: • , . � . . "Bodily injury" means bodi[y injury, mental an- guish, mental injury, shock, fright, disabilfty, hu- � miliation, sickness or disease sustained by a per- son, includinc� death resulting from any,affhese at any time. ' . �'. ..,� CG D1 8711 03 �� Copyright, The Travelers {ndemnity Company, 2003 Page 5 of 7 COMMERCIAL GENERAL LIABILITY „-�;-„t: K. fNJURY Ta CO-EMPLDYEES AND �O VOLUN- �. � 's . 1'�ER WORKERS ; . . . . . .. • ��;;:i' m= a� n� ._. N=- o= a= d..=.. d..:.. d; a— �.� d= o� � = o� o^ � U�� ..,— ..— �.: ..+� � 1. Your "employees" are fnsureds with respect to "bodily injury" to a co"employee" in the course of the ca='employee's" employment by :.you, or to your "volunteer�workers" while per- � ., .forming duties related io the conduct of your �•, business, �provided that this co�erage for your ��"employees" does rtot appfy to acts outside .��tita scope of fheir employment by you or while :performing duties unralated to the canduc# of your business. � � 2. Your "vol`unteer workers" are�'insureds with respect to "laodify injury" fo� a co"vofunteer ��worker".;while per€orming duties reiated to the �, oonduct of yaur business, or to your "emplay- ...ees" in �the course �of the "employee's" em- . ployment hy you, provided ihat this coveeage for yaur "vo(unteer workers" does not apply wF�ile perfo�ning duties unralated to.the con- duct of yout; business. . :, .. . 3. .subpara�raphs 2,a.(1)(a7, .(b) and. (c) and � "3.a. oF WHO IS.AN ,1NSUREp (Se,�fion (I) do nat,:appfy to "bodily injury".for wliich insurance is provided by,paragraph,l. or 2. abov�. L. AIRCRAFT CHARTERED WITH �CREW � 1. The following is added to the exceptions con- tained in the Aircraft, Auto Or Watercraft Exclusion in Parf 2., Exclusians of CO1/ER- AGE A. BODILY INJURY AND PROPERTY DAMAGE LIABlL1TY (Section I – Goverages}: (This exclusion ctoes not apply to:) Aircraft chartered wiih crew to any insured. 2. This Provisian L. does not apply if the char- tered aircraft (s owned by any insured. 3. 7he insurance provided By this Provision L. shall be excess over any other valid and col- lectibfe fnsurance available to the insured, whather prlm�ry, excess, contingent or on any other basis, except for insurance pur- chased specifccafly by you to be excess of thls policy. . M. NON-OWNED WA�ERCRAFi 1. 7he exception contained in Subparagraph (2j of the Aircraft, Au�o �r Watercraft Exclu- sion in Part 2., Exclusions of COVERAGE A. Bt']DILY INJURY AND PROPERIY LAMAGE LIABILITY (Section 1– Coverages) Es deleted and replaced bythe follawing: (2) A wa#ercraft you do not own that is: {a) Fifty feet long or less; and �. (b} Not being used to carry persons or property for a charge. 2. This Provision M. applies to any person who, with your expressed or implied consent, either uses or is responsibEe for the use of a water- craft. 3, The insurance provided by fhis Provision M. shall be excess aver any other valid and col- lectlbfe insurance available io the insured, whether primary, excess, coniingerrt or on any other basis, except for insurance pur- chased specifcalfy by yau to be excess of this palicy. ' ' " ' N. INCREASED SUPPLEMENTA}�Y PAl(MENTS Parts b. ��and d. of SUPPLEMENTARY PAY- MEN75 – COVERAGES A AND •B (Section I– Coverages) are amended as follows: �I. In Part b. the amount we will pay for the cost of ba[I bonds is increased to $250�. 2, 1n Part d. fhe amount we will pay�for loss of eamings is increased to $500 a day. O. MEDICAI. PAYIVIENTS – INGREASED LIM�TS 1, ParagraPh 7. of LIMiTS�••OF INSURANCE (Section tll) is amended to read as follows: 7. 5uhject to 5. above, the Medical Expense l.imit is #he most we will pay undee Cov- erage C. for all medical expenses be- cause of "badily injury" sustained by any one person, and will be the higher of. (a) $10,000; ar (b) The amount sFtown on the Declara- tionsfar Medfcal Fxpense Limit. 2. This Provlsion O. does not apply if GOVER- AGE C, MEDICAL PAYMENTS (Seciian f– Coverages) is excluded either by the pravi- sions of the Coverage Part or by endorsa- ment. P. KAfOWLEDGE AND IUOTICE OF OCCUR- R�NCE OR OFFENSE 1. The following is added to GOMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph �. (Duties In The Event of Oc- currence, Offense, Claim or Suit): Notice of an "occurrence" or af an offense which may result in a claim under this insur- ance shall ba given as soan as praciicabfe af- ter knowledge of the "occurrence" or offense Page 6 of 7 Copyright, The Travelers Indemnity Company, 2003 -:CG D1 87 11 03 002246 has heen reported to any insured fisted under .,Paragraph 1. of Section li — Who Is An In- � sured or,.an "empfoyee" (such as an insur- ance, loss confrol or risk manager or adminis- � trator) designated by you tu give such notice, � •Knowledge by other "employee(s)" �f an "oc- currence" or of an oifense does not impiy that you also have such knowledge. 2. Notice .shall be deemed prompi if given in good falth as soon as practicable to your workers' compensatlon insurer. This applies only if you subsequently give notice to us as soon as practicab{e after any insured listed under Paragraph 1. oi Seckion fl — Wha Is An Insured or an ."employee" (such as an. insur- ance, ioss control or risk manager or adminis- trator) �designated by you to give such notice discovers that the "occurrence", offense or claim may in�olve this policy. 3. However, this Frovision P. does not apply as respects the specific number of days within ,which you are required to notify us in writing � of the abrupt commencement of a discharge, release or escape af ,"poflutants" wf�ich � � causes "bodily irtjury" or "property�damage" .'��::which may otherwise be covered under this policy. • : . . . . . . . . COMMERCIAL GENERAL LIABILITY Q. UNINTENTIONAL OIVIISSION � ,N-�••:, ,. Tha following is added to CQMMERGIAL GEN- `-. ERAL L{ABIL.ITY GONDITIONS (Section I�, paragraph 6. (Representations): The unintentiona! omission of, or unintentional error in, any information pravided by you shall not prejudice yaur righfs under this insurance. How- ever, this Provision Q. does not affact aur right to colfect add[tional premium or to exercise our right af aancellation or nonrenewaf in accardance with appficable state insurance laws, codes or regufa- tians. R. REASONABLE FORCE — BODILY lNJURY OR PROPERTY DAN[AGE The Expecied �r lntended Injury Excfusion in Part 2., Exclusions of COVERAGE A. BODILY INJURY AND PR�FERTY DAMAGE LIABILITY (Section 1— Coverages) is deleted and replaced by the foliowing: (This insurance does not apply to:) � �xpected or Intended Injury or Damage "Bodily, injury", or "property damage" expected or i�tended from the standpainf of the insured. This exclusion does nat apply :to "bodily injury" or "property damage" resulting from the use of rea- ,:--• _ sonable force to proteci persons ar property. (, ,; GG D1 8711 a3 Copyrig[�t, The Travelers Indemnity GorrTpany, 2003 Page 7 of 7 ;� ,� �� Policy # BA-6129C757-12-SEL COMMERCIAL'`�UTO .�-�-n. �•� �� --THIS ENDaRSEMENT CHANGES THE PaLICY.� PLEASE.;�EAD IT CAREFUI:LY. � ., . .:�' ....r � . . .. . . .. i • . . . . . • ,'r':. � •• ' ..... . .. ;�:•..a. .., :ti:1 .. � . .. •:,... � , , . ...� � • . . • ... . . .., . y, . .. � :=� ,l:�BUS�lNESS AUTQ EXTENSION�;�ENDORS.EN1ENl' . ;,. � � �� H� � a� o� � o� o= ni`- � d� o^ �� a.��'_""' a� �_ � ;:; i. oa221� This endorsement madifies insurance provided underthefollowing: BUSIN�SS AUTO C01/ERAGE FORM With respect to cRVerage provided by this endorsement, the p�ovislons of�the Coverage Form �apply unless modi- fed by:the endorserqent.: , .. , . .. � � � ' � • � � � • • � � ' � :�: �<<:... •:,� •.:: � �:.�.; . GEI�ERAL DESCi21PTIO.IU �F COVERAGE — This endarsement broadens coverage. However, coverage for any injury, damage or madical expenses described in any of the proVfsions b� thls endorsement may he excfuded or fimited by.another endorsement to the Caverage Part, and these coverage broadening provisians do not apply to .<�., , . . .... : .,;.. the extent that coverage:is, exc�uded, or limited by such an endorserr�ent. The �foliowing listing is a�general cover- age.descriptidn anfy; :Lim(tations �and excfusions may apply to fhes� caverages. Rea.d. �a[I-.the provisions of this en- dorsement and.the rest'of your.policy carefufly to determine rights, duties, and what is and is not covered. A. BR�AD FORM NANIED INSURED B. 8L3ANK��T ADDI710NAL INSURED .....,..., . :;�+'��•. 'C.` `•EMRLOY�E H(REn AUTO `' • � • I7. .,EMPLOYEES �AS;�NSURED ; . . . . ... ., .�:.. ..,. . . �. SUPPLEMENTARY PAYMENTS — 1NCREASED , I..Iili,tl�5• ... ..�:;•:�.::: , �.:: . �: �F.`��`HIFZED �'A17T0�� '�` �1'IMITED WQRLDWIDE � ��CQVERAGE = INDEMNITY BASIS 1:�1 1,:'� �•.S�:i:�2�:�i�� .'.1�:�i C. yVAIV.ER O.F:DEDU�CTI6LE -•,C',aLASS ..`e •.;•' • :.4��' , PRQVI�J,ONS:...�, �, .. �� • . . •:ii:. A. ';:BROAD FURM NAMEQ INSURED •�,:,::;'��t;:..,,.- ? •• �,•�.,-�.. The �following �is �added io Paragraph A.1., Who Is �: �An :Insured; of. �S�GTION°��II =?LIABILfTY COV- .':�r>ERAGE:: :, . . .. . ... . .. . ..... '•�::•.�.. - ...��..,;�.rt;s� .. . •��:�,s `�'`.Any'.`orgamzation.you..newly acquire or form dur- '�' � rng the policy penod aver.:which you maintain � 50%�'or more ,ownership inieYesi and tF�at is not :�::�,.separate7y, insu're.d,.;fpr B;lisiness,; Auto Coverage. . Coiierage u`nderthis:'prnvision is;affardad only un- ..ti1,,�� 1�pth,ti�tay �afte� y4u..{acgu�re or form the or- ganization.,or the end.of.,t,he.po�ficy period, which- eve,r'is earl�er. '� ' . . ,•: s )... '� . � i•. i ;". i: �.F B, BLANKE��A,D,DITIQNAL!{�S�ED •'•��The foi{owing'�is'�added to'�'Paragraph c. in A.1., Who°'1s`i4n Insured,"'af �SEC710N II — LIABILITY COVERAGE: � ., . . ::� :<;.. •.: : °:; ��' �=�;4ny��person or�organization w�to is required under �� a written contract �or agreement between you and that person or organization, that is signed and H. H(RED AUTO p.MYSICAI:'�DAMAGE —�LOSS ..;;,�F,USE,-:II�C,R�ASEf]:L11VUT; �. �, .�.•; , '� PhiYS�CAL DAIVIi4GE •��-'�TRANSpORTATION EXRENSES — tNGREASED LIMIT ' � �� `J. �'�PERS�NAL EFFECTS� i�•, ..;�:.:' .�.�.`'.•.: ,� � K.��AIRB,AGS.:,,•; g'��, . � . . ;:r• ... . � .. . �:L. ;:NO.T,.ICE AND.:KNOWLEDGE �OF.,AGCIDENT OR LOSS � � :M;, �BLANK�T WAIVEI�,QF.S.UgRQGATION . � , . , .;�. . �...., ._ '•i .. .��i.'.. . .. , N. �UNfN,T.ENt10NAt_ ERRORS �R QMISSIONS . .., . ... .. � .., . ,. . , ._ . . . , . . :; � ... .::.� ,�;; �.; ...,�.,:..,� ...:: :.:.. ...:::�� :;�,,: �� 'executecl ' by �ybu ��`before the �"bodily injury" or "property damage" oceurs �and th'a"t' is in effect � during the pa(icy period; :�o be �named as an addi- tio.�7alapsurec{ �is an r:=in.sured"��fnr�Liabliity Cover- ., a�e, but`,qrl.ly for,dama9.es to, which this lnsurance ..applies,.�nd orily to ;the extent, thati,person or or- � ganizetion,:qualiFes �s., ari "insurQd" under the Who Is An:�nsure�,,prpv[s,ion .cont�med in Section lt. �� . ,. , � . C. EMPLOYE� H[k�EQ �41tT0 . . ., :�•� 1. ,.,Th� ;fpllowin,g, wis, added„to Paragr�ph .A.1., .. .�' Who 1$ Ybii� Ir�sulr�d, of,:SECT(ON, _Il..- LI- ' "ABILiTY�G,OVERAGE: � . . � ' � . : �.�..�,.;: :a:.;:��z,::-�� ..::. . .: . ....�..:::. :. An "employee" of yours is an "insured"<"while , operatin�; an r"auto�. hired, o,r.,rentQd.;.under a ��"contr�ct,.Qr.,agreemenk,in that;;",employee's" .',ri.ame;,with,your,perriiissiort, while`performing ,' �duties,.t�.�tated to,,thet conduct of.:your busi- , ness.� ,.� . ..: . :::. ... . . . �• - CA �T3 53�03'10 0 2010 The Travelers Indemnity Company. Page 1 of 4 (ncludes copyrighted material of lnsurance Services OFfloe,�lnc, wlth Its permission. COMMERCJAL �,UTO 2. T1�e.following:..replaces ;Para.grapll b. in B.5,,; •;:�� Other �[nsurance, of SECTION IV �- BUSI- N�SS �AUTO CONDITIONS: _ , ,,,. ,.,... � b. For�.Nired� Aufo fPhysical �Damage �Cover-� �` � ' age, the following are deemed to bs cov- ered "autos" you own: (i} Any co�ered "auto" you lease, hire, rent or barrow; and . : (2) ,Any co�er�d "auto" hired or renied�by your "employee" under a contract in that individual "employee's" name, • ,. . � �:with y�ur�-perxnission, while perform- . , ,. . .;. : .inq dufies �related � to the,;cond4i.ct, of � � . . . .. .: �your bu�iness. � . .. . . � . . .. . , � � • " 'However, any "auto".that is leaseii, �hired, •'�'�� rented or �borrowed with �a driver is not a �� covered "auto". � � . . � . . ... . . , � D. EMPLOYEES�'i4S 1NSURED �''. • � . � • i � : : . .. . . ... .. ... .r,k.. .., ..: The following Is"added �o Paragraph A.1., 1lUho Is � �An Insured, • of-SEC'�IQ.�1=;11 - 1.IA81L1TY GOV- ERAGE: � .. . , .. , .-,:,; � .. . � .. � .., , Any "employee" of yours is an "in�ured',:�,�ryhile us- ing a covered "auta" you d�n't own, hire.or_borrow in your business ar your persanal affairs.'� �" �� . 'SUPPL�IHIENI"ARY��PQYMENTS —.WCREASED LIMLTS . . '..: �:'�'.' 9. ��•The ��folfov5[ng � replaces��Paragraph � A:�.a.(2), of SECTION II — L.IABILITY GOVERAGE: ... �':;:.(2) �-�Up �to $3;400 ��for �cost �df� bai[ � bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" .. ,: . �.: ., we,;;cover. We;; da�.:not �have ,to.,:furnlsh ; tttese �boi�ds.,; . . . , . . � . ��=:�2. � The��following replaces F'aragraph A.E.a.(4), � � . �.� •ofSECTION �ll —°LIABILIT�' COV�ERAGE: �:� t, �.: ��: �:.:,-:..��:�� -.;:: .: ..;..,:„ .,.,,. '��: (4j �'All 're,a"sonable'gxpenses incurred ��bjr the ' ' � � �� '';insured" `at �ou� reguest, includj�g actual � ' ' loss�'of earnirigs, up„to .��SOp a,�ay be- ' � � � '' ` � � � `�ause �of fim'e `off from work � F. HIRED AUTO — LiIUIITED �II(QR�.�R�IIfIdE� COV- ERAGE�—INDEMIVITI(BASIS ' �' " �'The�fqUav�ring.repl,aces�Sybparagraph„(5).in Para- ''�' graph b.7.; Policy P�ri,pd,;,Fpverage.'Territory, of SECTiON IV »' BUSINESS AUTO `CONDI- ...•�:TIONS: . . . . . . ..:�:• �.��.. .. ..u.,:.. .. ... :� .• � �..� ,;,,.....�.,_ .:.��(5� �Anywfier��in the warld, except �ny aountry ar � � � �,,; jurisdiction whi[e ,aciy.�trade:, sanction, em� -� bargo, �;6r simllar �e�ulatio� ,im�ose� by the •; .,�;r.:: � '� �"United States of�Amerida�applies�to,and pro- hibits the transaction of business with ar .:.:�.within.�uah country or Jurlsdlcfiion; far•Liability ��Coverage for any covered "auta" that you lease, hire, rent or borr.a,,yv„without a driver for ' ;�;, a,period,of�30.;elays.or�Tess':and.that is not an "auto" you lease, hire, rent or borrow from any of your "employees", parEners (if you are �� a partnership), members (if��you ar,e �a limited liability _company} or members of their hause- halds. ' ' � . . , . (a} With respect to any claim made or "suit" brought autside 'fhe �United States �`�of America, the territories and,,possessions • � ��of'tfis �United States �of ��America, 'Puerto � � �•Rico and Canada; �' • �� ,(i} .;You:mUst arrange to defend.,the "in- � . . sured",,agai.r�st, and �nvestigate or set- . � � ' � ., fle, any such claim or '.'.suit". �nd .keep us advised of all proceedings and ac- �fions: � � � � � � • � ' � �� (ii) Neither you nor arty other involved : �-,"inSUred" :.will � �make any ��settlernent without our consent. (iii) We rnay,.at our.Cliscretion, participate in defen,aing,the "insure�". a�ai.r,�st, or in the�'setilement ��of,�"any` claim �or . . ., . .. .��suit": . ;>��, . n, ••�t:�: . . . , .,.. .., (iv) We wifl reimburse tha "insu'red" for , , . , � sums•�.tJ�at the "insur,�d" le.gally...,must �: paynasr damage� .because �qf.;"bodily injury", or. "property, c�ama,ge'; to.,which '�'� this irisurance'applies,�tti'a't'fhe "in- sured" pays with our,conse�t,.,b,�(t only up io the limit descri[ie'd'�in`Pa�a- ';:gr.aph C.;` L'imif Of •lnsurance;'af'SEG . . TIQN.II -�LIABILlT,,Y.COVERqGE. -� � � (v) • We will :::reimburse the ••"insured" for fhe reasonable expenses r�incurred :,;:yv,ith au['-:can$ent, fpr.,your.,investiga- :,� ., ��, � ' �io�, af sycf� ;clairps; an�,yQUr de�iense ' � ' o� the "insure�!".. a�ai�ist any.:such �:f.' .. .. •. .ti'i�.: .� ::. _.,, •:.S.y .:; ..� .4. : "su�t';,.�:bili,,onfy_,up: ta,.,and,.,.included ' ' ' `.';�.w�thin f�e �l�m�t des�ritie`d in :Para- � � � ' '�� "nranh c _ um�t Of Insurance. of . ., : . .:- •• -�: : , , . ' ,; SE' . Tl,O�I�, (!,„.,= ;I�IABILITY .. COVER � .:. AGE, and not in addition to.,such:limit. . :Our;. duty to make .,such,ipayment� �•= ��ends �vVherl'�ive have'used `up'�#he ap- , .,�:::•. �plieable.� limit�::of ,insur.ance �in ;�pay- � .. ; m�n#s ,Lfio�r�damages, set�lem�nts or defense expenses, , , • •:� :��=°��: � �: �•��. ..� . ; �....... ,: ::t.:. ::�:� {� .y'; (b) ;This insurance :is .ex�ess ovec;:apy valid ��•: ,•..;:.and .col,lepti6le other:insurance ,available ;� �� : . � ,. , . ... ,. . . . . . t. Page 2 of 4 � 2010 The Travelers Indemnity Cotnpany. CA �T$.53, Q3 :10 � fncludes copyrlghtad materlal of Insurance Services Office, Ine, with iis permisslon. ,,.,-.,,,,, �� . . �• :�to the "insured"��whether primary, excess i. � '<•contingent or�on any other basis. , �� {c) This insurance is not a substitute for re- � • �.':��qitired'�or compulsory i�surance ��in any � . .country outside the United States, its ter- . . . �.: ritories.a.r�d;pqsse.ssions,, Puerto;f�ico and .. .. ;,Canada�;. . , . � . �� . i .::: �� .': '*� :',:::>�' �= � ��. �r= � o� o= o� o� � �� -� d= o..- � o� a� m= z� ,:..�.., �,.:: ��•, .� •r �,�r� 002818 . . You agree to mafntain all requlred or �,Gom,�ulsa •ry insurance in any such coun- ;_ •try up to the.minirrlum limits required by �,local law. .Your .failure to comply with ;: compulsory insurance requirements wilf nat in�alidate, the coverage affarded hy this pblicy, but we will only be liable to the same e3ctent we woufd have been liable had you complied with tF�e eompulsory (n- surance requirements, (d) It is undersiood that we are not an admif- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Gan- ada. We assume no responsibility for the furni5hing of cerEificates of insurance, or for compfiance in any way with the laws af o#her counfries relating to insurance. G. WAIVER OF D�DUCTIBLE — GLASS The fdffowing is added to Pat'agraph D., Deducti- bte, of SECTIdN llt — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" wil( apply to gfass damage if the glass is repaired rather than replaced. H. HIRED AUTQ PHYS[CAL DAIVfAGE — LOSS OF USE -� INCREASED LIMiT The foflowing replaces the fast sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- 7101V Itl — 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", l. PHYSIGAL I�AMAGE — TRANSPORTATfON EXPENSES — iNCREASEt7 LIMIT COMMERCIAL'•AUTO J. 'PERSON,�L'EFFECTS � '''�.•�� : :::,�`.� -' :, ' • . . `'�The�following is�added to Paragraph A.4., Cover- �'• � age `Exteiisians; `�of .SECTION �ill. �=. :`P.HYSICAL •�DAMAGE �OVERAGE: ' • � • ° • • Personal EfFects - � � � . .,.v,.:..:; � � We wilf �pay up to $4dQ'`for "loss" to.�wearing ap- parel and other persorial effects which are; (7 ) pwned by, an "insured' ; and , (2) [n ar np your cover.ed "auto". This coverage appiies �bnly in the event of a total ' � theft of your covered "auto". ,:.�.;. No deductibles apply to this Personal Effects coverage_ K. AIRBAGS The following is added to Paragraph 8.3., Exclu- sions, of S�CTION ll[ — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. daes not apply to "loss" to one or more airbags in a cavered "aufo" you own that in- flate due to a cause ather than a cause of "loss" sef forth in Paragraphs A.1.b. and A.1.c., but only: a. If thaf "auto" is a covered "auto" for Compre- hensive Coverage under fhis policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inf{ated. Vlle wil� pay up to a maximum of $1,d00 far any one "loss". L. NOTICE AND KNOWLEDGE OF RCCIDENT OR LQSS The following is added ta Paragraph A.2.a., ofi SECTIaN IV — BllSINESS AUTO CONDITIONS: Your duty to give us ar our authorized representa- tive prompt notice of the "accident" or "lass" ap- plies onfy when the "accldent" or "loss" is known ta: {a) You (if you are an individual); (b) A partner (if you are a partnership); The following replaces the first sentence in Para- (c) A member (if you are a limited ifabi�ity com- graph A.4.a., Transportation Expenses, of pany); SECTlON I(I — 1�HYSICAL QAMAGE COVER- (d� An executive officer, director or insurance AGE: manager (if you are a corporation or other or- We will pay up to �5D per day to a maximum �f ganlzation}; ar $1,500 for ternporary transportation expense in- �e) Any "empioyee" aufhorized by you to give no- curred by you because of the total theft of a cov- tice of the "accident" or "loss". ered "auto" of the private passenger type, GA T3 53 03 � 0 � 201 o The Travelers Indeinnity Company. Page 3 of 4 [ncludes oopyrlghted materfa[ of lnsurance Servlces Offlce,'Ino, �wlth Its permisslon, GOMMERCIAL AUTO M. BLANKEi WAIVER OF•SUBR��ATION:••: �� :,..,The f.ollpwing replaces �P.a�agraph A.6., ;Transfer :, ��Of Rights df Recavety Against, D�hers �:Tq Us, of SLCTION N — BUSINESS �AUTO, �CONDI- TIONS: ... ., ,.,. .,,...... 5. Transfer Of Rig�ts .�f Reco�ery Against � �Others To Us,_ '� "� �" ' � �_ � ' . ,�.� . . , , �.r � . . , We waive any right of recov.ery we, may have against any person ar organization io the ex- tent required of you by � wi�itten contract signed and executed,prior to any "accident" or"foss", provided:thatthe "accident" or"loss" arises out af operations , cantemplated by . ." � . . . . ,. � � � . , �:. .. . �� . . . . .:-� . . •..., �.. . - � . , ... . . . , . . . : . . . . � .�. . . . . . . .�;� � . .. . . .. . . ,. ... , :� . : . . ,. - ..�1. . ... .. m � such ,contract. The waiver applies only to fhe person or �rganizatiar� .de$ignated in such r' .,�ontract. ...:. ,. :.. �. . ., . . :. . `: _ : N. UNIIU7ENT10NAL ERRORS OR OIV�iSSIaIVS The '�ollowing is ad�ied to Paragraph B.2., Con- � "` cealme"tit,�'� Misrepresentaiion;'� ��Or Fraud, of SECTION IV— �USINESS AU'TO CONDITIONS; The uriintentional �omission of, or unintentional ' erro� in, any informafion given by yrou shall not prejudice your rights under fihis insurance. How- ever �hfs provision does not affect our right fo col- fect additional premium or exerclse our right of cancetlation br�rion-renawal. �"�` � ' . � .. . � �,• . . . � � �:.... . ... , ,�.. .�.... .. , ,��........ „,..� .. , , .,. . .� , ...� � ... �,.. .. ., ( '; . . . � . .. .. , . -.... . • :. �', . i . .. . .. . .. .. . .. . � . � .. • j .• •.. . �.. ..'... • • .. . I .; • . ..... , • . , ..,.., , ...' . �. ; • ,. . . ,. . .,. ;� . � • , .. ,. • . . .:�., . , . . .. , . . ..,. . � . • ... :�� ,., .. . ... ..: .... .. ... .....s . . . . . .'�;t' . .. .. ' . ... • . : . . . , . �' ' I . ;� . . , . . , � • . ' • . .,. • • . . � • . . •� . .. • • '... . . . � i. .�, t, Page 4 of 4 � 201 o The rravelers Indemnity company. CA T3 5.3 43 10 ' Includes cppyrlghted matQrial of.lnsurance Sarv[ces OfFlce, Inc. with ifs permission. �� DATE(MMroDn � CERTIFICATE OF LlABILITY INSURANCE 07/23/12 7HIS CERTIFICATE IS ISSUE� AS A MATTER OF INFORMA7101d ONL.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER7IFICATE DOES NOT AFFIRMATIVELY OR NEGA7IVELY AMEND, EXTEND OR ALTER TNE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CaNTRACT BETWEEN THE 15SUING INSURER(S), AUTHORIZED REPRESENTATNE OR PRODUCER, ANO THE CERTIFICATE HOLDER. 1MPORTANT: If the certificaEe holder ls an ADDITIONAL INSUREp, the policy(ies) must, be endorsed. If SUBR�GATION IS WAIVED, subject to the terms and conditions of the policy, certain polictes may require an endorsement A statement on ihis certificate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER CONTACT Aon Risk Services, Inc ot Florida NAME: Aon Risk'SeNices, Inc of Florida 1001 Brickell Bay Dmre, Sude�{1100 PHDNE F,qx. Nliaml, FL 33131-4937 AIC No Ext : 80Q743-8130 A!C No � SDO-522-7574 EM811_ .. . . INSURED ADP TotalSource NH XXVIII, Ina iD200 Sunset Drive Miami, FL 33173 ALTERNATEEMPLOYER �i' Pro Tech Services Company LLC �/' 1702 S Highway �21 #4Q6 INSURER(S) AFFORDING INSURERA : New Hampshire Ins Co ��I INSURER B ; V INSURERC: � i�� l�\ `r� INSURER D : �� \ INSURER E: INSURERF:- � NAIC # 2384T COVERAGES CERTIFICATE NUMBER: 5D1477 REVISION NUMBER: THIS IS TO CERT7FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY RERIOb INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF HNY CON7RACT OR �THER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MqY PEF�fAIN, THE INSURANCE AF�DRDED BY THE PDLIClES DESCRIBED HEREIN IS SUBJECI" TO ALL THE TERMS, EXCLUSIONS AND CQN�ITIONS OF SUCH POUCIES. LtMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. �� : TYPE OF INSURANCE ANSR 5�p POLICY NUMBER POLICY EFF POIJCY EXP LIMITS MM/DDIYYYY MMlDD/YYYY GENERALLIA91LJiY EACHOCCURRENCE S� DAMAOETO RENTED COMMERCIAL GENERAL LIABILfTY aREMISES (Ea occurtence 5 � CLAIMS-MADE � OCCUR MED EXP An one erson S PERSONAL & ADV INJURY S GENERALAGGREGATE b GEN'LAGGREGATELIMITAPPUE5PER: PRODUCTS-COMP/OPAGG S POLICY PFiOJECT LOC $ AUTOMOBILE LIABILITY COMBINED SING LIMIT ' Fa accident $ �'0'NYA�T� BODILY INJURY por ereon S ACL OWNED SCHEOULED AUTO5 AUTOS BODILYINJURY eraaident 5 NON-0WNED PROPE DAMAGE HIRED AUTOS AU'fOS Per accident 5 5 UM6RELLA UAB OCCUR � EACH OCCURRENCE �$ EXCESS LIRB . CLAIMS-MADE AGGREGATE $ OEC RETENTION $ . i � WORKER$COMPENSATION f � / - � WCSTATU- , OTH- A AND EMPI.OYERS' LIABILITY y/ N WC 038D67787 7X"� 07lD7H2 O7I01/13 TORY LIMffS ER ANYPROPRIETOR/PAR'fNERIIXECUIIVE / OFFICERIMEMBER EXCUJDED? ❑ N/ A X" � EL. EACH ACCIDENT �� 2,00�,000 ' (Mandatory in NH) EL DISEASE- EA EMPLO $ Z,OOD,OOD If yes, desc�tbe untlar � DESCRIPTIONUF�OPERATIONSbelow EL.DISEASE-POLICYLIMIT $ 2,000,006 DESCRIPTION OF OPERATIONS! �OCATIONS / VEHICLES (Altae6 ACORD 101, AddiHanal Remarks Sehedule, if more space is required) WAIVER qF�UBROGATION IN FAVOR OF CI1Y OF OENTON�ITS OFFICIALS, AGENTS, �MPLOYEES AND VOLUNTEERS. AS RESPECTS OF J00 PERFORMED BY PRO-TECH SERVICES C�MPANY LLC AS REQUIRED BY 1fVRITTEN CONTRACT.�� All worksite emplayees worldng for the above named clfenl compeny, paid under AOP TOTALSOURCE, INC.'s payroll, are cavered under Ihe abuve stated policy. The above named client is an allemate employer under this pal�y. CERTIFICATE HOLDER CANCELLATION Ciry of Denton � A�aterials Nlanagement Department 901 B Texas Slreet Denton, TX 76209 ACOR� 25 (2010I05) SHOUL� ANY OF THE ABOVE �ESCRIBED POLICIES BE CANCELLEQ BEFORE TH@ EXP1RA710N � DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDAMCE WITH THE POLICY PROVISIONS. AU7HORIZED REPRESENTATIYE � ��on,�isk �"exv%�s, �rie o��Y��id'a OO 198B-2U70 ACORD CORPORATION. All rights reseroed. The ACORD name and logo are registered marks of ACORD / � / � POLICY HOLDER NOTICE CERTIFICATE HOLDER CANCELLATION NOTICE SCHED[TL� Should this policy be cancelled before the e�pir�ttion d�fe hereof, the praducer will endea�or to mai130 days written notice to the certificate holder named herein, but failure to do so shall impose �no obligation or liability of any ldnd upon the insurer, the producer, or the respective agents or represeutatives of each. SCfIEDUL�' CERTI'FTCATE FiOLDERS AS IDENTI.r]:�,D ON 1.HE MOST RECENT �?UARTERLY SCHEDULE OF CERTIFICATE HOLDERS PROVIbED BY THE INSUR.ED'S BROKER OF 1tECORD TO TH� JNSU.RER_ ,� �