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Home My WebLink About22-72 A-1 Chip Seal Company Approving Construction Contract 06-08-2022RESOLUTION N0.22-72 A RESOLUTION OF THE BOARD OF TRUSTEEN OF THE TOWN OF FIRESTONE, COLORADO, APPROVING A CONSTRUCTION CONTRACT BETWEEN THE TOWN OF FIRESTONE AND A-1 CHIPSEAL COMPANY FOR CHIPSEAL SERVICES IN THE ST VRAIN RANCH AND RIDGE CREST SUBDIVISIONS WHEREAS, the Town of Firestone ("Town") is in need of Chipseal services for the St. Vrain Ranch and Ridgecrest Subdivision Project, and WHEREAS, the Town issued an invitation for bids for the work and capon review of those submitted selected A-1 Chipseal Company as the lowest re,ponsive and responsible bidder. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE TOWN OF FIRESTONE. COLORADO: The Constriction Conhact beriveen the Town of Firestone and A-1 Chipseal Company for the St. Vrain Ranch and Ridge Crest Subdivisions Project is approved in substantially the same form as the copy attached hereto and made a part of this resolution and the Mayor is authorized to execute the Contract on behalf of the Town. INTRODLICED, READ J William Clerk OPTED this 8th day of June, 2022. b so N TOWN O FIREST E, C'OLORADO Drew Alan Peterson, Mayor CONSTRUCTION CONTRACT :THIS CONSTRUCTION CONTRACT (the "Construction• Contract" Qr 'Agreement") is, made and entered into this 8th�dayof,Junei 202? (the "Effective Date"), by and between the TOWN OF FIRESTONE, a Colorado municipal corporation wltb an address ol;of 9950 Park Avenue, Firestone; Colorado 80504 (the "Town" or the "Owner), -and AUNEtNIrSEALCf3MPAW an independent contractor with-kprincipal place of business at2505 E'74'h,•Ave Denver,, Colorado-80229 ("Contr#ctor') (etch a "Party" and collectively the "Parties"). WHEREAS, 4he Town requires services; and WHEREAS, Contracto1 00 beers found by the Town as having the expertise and experience to pei:forrrt the required services: fVOW THEREFORE, for;tie consideration hereinafte[ set !Forth; ttie. receipt and sufficiency'of which are hereby acknowledged; the Parties agree as follows: !. SCOPE. Ft? W�?RK A. Contractor shall complete all Work and perform ail Services wiiictt .are described or reasonably° implied from the -:Scope of4Work set forth in Exhibit A and the Contract Documents, attached hereto and Incorporated herein by this re erence and !mown as: 2022 Chipseal Program (Si022.9220). A-0NE CFrIPSEA[ COMPANY 131 A change in the Scope oT VVOrK shall rtOt D@ .@Ti@ctive unless authonzed as a Written amendment to this Agreement or4change order in accordance with the *Contract* Documents. 'If Contractor proceeds, without such written authorization, Contractor shall be deemed to have waived, any, claim for additional compgnsation, including a olaim b4sed on the theory of unjust enrichment, quantum rnent .or implied contract, Excdpt as expressly provided herein, no agent, employee, or representative of the Town Is authorized to modify any term of this Agreement, either directly or implied by a course of action, C. Within 14 days of the Effective Contract mate; Contractor shall provide the performance fond and labot & material payment bone and certificate of irisUrance required by the contract Documents. IL Re,,,, serve. a rJAUX I a,a; :, In. ,. A. The Work shalt be substahtlally completed within 90 days of, the Effective Date 'of this contract, arid,shah continue until. Contractor completesthe-Scope of,Services to the satisfaction o#'the Town, or until terminated:as, provided herein. B. Either Party may terminate4his.Agreement upon 30 days advance written troticoo The Town shall pay Contractor for :a11 work previously authorized and completed prior to the 4date of termination. If, however;, Contractor has :substantially or materially breached this Agreement;. the. Town shall have any remedy or right of set-off available at law and :equity. C. Should a delay in completion constitufe a compeirsable 100onventence to the•Town:and its residents, the liquidated damages established in this. Section shall be enforced. Such damagds are not a penalty, theparties recognizethe�delays, expense and-difficuities Involved proving the actual loss suffered by the Town: if the:Vorkis not completed on time. For each .day thatail-or a portion of the Work is delayed beyond the deadlines.set forth in'Section ill'hereof, plus any extensions thereof,ailowed;-the Contractorshall be assessed the amount of twoahundrod, fifty dollars ($250) each day uritil'the Work'is.complete.. IV. COMPENSATION Iri consideration far the:completion of the Warkby Contractor, the. Town•shall pay Contractor, subject fo all of the- terms and conditions. of the wContract Documents, an amount not to exceed -,$700,0.00.56 (the "Contract Price"). The-ContractiPrice shail.inciude all fee$,. costs and expenses incurred by. Contractor, and no additional amounts shall be*paid by the Town•fctsuch" fees, costs -and expenses: V. PAYMENT PRQCEDURES Contractor may submit Applications1or Payment forcoompleted work per the UNT-PRICE BID -FORM or the LUMP4UM BiD FORM,,Contractcr may submit periodic invoices,6which shall be paid ay the Town i0hin 30 days oftecelpt. VI.. RESPDNS1BIl,ITY A. Contractor hereby warrants thatlt is-.gtralitied to. assume the .respQnsipilit'ies and render�the services -described herein and has all requis'ite.corporate authority and licenses in •good standing, 'required bylaw. B. The Work performod by Contractor shall be in accordance with generally accepted practices and the.levet of competency presently maintained by -other practicing contractors In •the same or similar type of work in the.applicable community. C: The, Work performed by Contractor hereunder shall be done in compliance with applicable taws, ordinances, spies and regulations, including the Keep Jobs in Colorado.Act, C.R,S. 8�17-101, et:seq: the, "Act") and the, rules ddopted by*the Division of Labor of the Colorado Department oof Labor,and Employment.impiementing the Act.(the "Rules"),. A. The 'foyvn's.review, .approval or aceeptarice of, or payment for anycompleted Work.shall not be construed to operate.as*a waiver of any rights undorAhis'Construction Canlradtorlof any cause -of action arising out of the performance of this, Construotion Contract; E, Couiiracmor houpy warrants to I e.Town that all materials and.equipment used in the Work, and, r ade,a part of the Work; or placod.perrn mntiy.in the Work,.shallU new,unless otherwise specifeedth th Contract Documents. Contractor. further warrants that all equipment and ,materials shall be of good quality, conform ,to the requirements of the{Contract Documents and will be free from defects. All WonC; materials,. or equipment not canforming,to the Contract 0ocuments.shall be considered defective, F. The,ContractoC shall -warrant and guarantee all materials and equipment furnished under the Contract thd.all Workiperformed for one year -after the, date of Substentlai Completion. Under this warranty, Contractor agrees to repair orlepface, at its :own expense, any Work that is found to be defective. The eXpiratioo of the warranty pefio�d shall in no way limit the Towns legal or equitable, remedies; or the period in which. such remodies may be asserted-jor work .Aegligehtly -or defectively performed. VII. OINNERSH P Anv,materials; items, and work specified.ln the Scope of Work,, and any and.ail relafed documentation and materials provided or developed: by Contractor shall be exclusively owned by :the Town. Contractor expressly acknowledges and agrees that- all work performed under the Scope :of Work constitutes..a "work ma4e,fdr hire," Tothe extent; if hat"pll,cthat It&does not.constitute.awork Amade for hire," u ontractorkhereby transfers, seils� and assighs tp the Town all of its right; title,. and interest in such work,, Theo Town may, with respeetto,ail.or.'any#tUon,ofsuch work, use, pUblish,-display, reproduce, distribute;.destroy,.alter, retouch, modify, adapt, .translate, or change such Work 'without providing noticef to or receiving consentfrom Contractor. VOL INDEPENDENT CONTRACTOR "Contractor is an independent contractor.. Notwithstanding any other provision of thin Construction Contract, ail personnel assigned: by Contractor to perform work under the terms of this Construction Contract shall be;: and`remain at ail limes,, employees,;or agents of Gontractorfor all purposes,- Conir.actorshall make no representat'oft that it 'is, a Town employee for any purposes. 1X, INSURANCE, A, Contraotoragrees,to proour�artd train#air,-af its:own cost, a policy or policies of insurance sufficient.to insure against .all liability, claims, demands, .and o#her obligations assumed oy Contractor pursuantto this Construction Contract. At a:minirnuifm, Contractor shall procure and:rnaintao, and shall cause any, subcontractor to procure and maintain; -the insurance coverages listed :below, with forms and insurers acceptable AU the Town. 1. Worker's Compensation insurance as required by law. 2: Commercial Cenera(.Liability insurprice with mllilmgm combined -single limits of $1,000,000 each occurrence: and :$2;000,000 general aggregate. Thek policy shall be applicable to<ali premises and -operations,: and shall Include coverageJor bodilylnjury, broad, form property damage, personal injury (including, coverage for contraotual and employee -acts),.blanket contractual, .products, -and completed operations.. The poll6cy'shall contain: a severability of interests provision, and shall include the Town and the Town's.officem,, employees.,;and contractors as additional insureds. No additional insured endorsement, shall contain any exclusion fot bodily injury or property damage arising from completed: operations. B. Such insurance.shail be iri additionto anyottier insurance -requirements. imposed by law: The-covetages afforded under the policies shall not- becanceled, terminate6or.materiailychanged without at least 30 days prior written notice. to the Town. In the case of any claims -made: policy, the necessary retroactive dates --and � exterldedreporung periods shall be procured. to maintain such continuous, coverage, Any insurance carried by the Town, its officers, Its employees, or its contractors shall be .excess and -not contribatorj+ insurance to. That .provided by Contractor. Contractor shall be solely responsible for any deductible lossesvhder anyypolicy, C. Contractor.shailprovide ko the Town a cerkflcateof insurance. as evidence tfiat.ttie.rim quired policies are in full-force,and effect, The certificateashall identify this Construction: Contract. X, jIII DE�iN1FICATION. Contractor agrees to Indemnify and .hold harmless the Town and. its officers, insurers, volunteers, representafive,.agents; employees, heirs. and..assigns from and against -all claims, liability; damages, losses;, eXpenses: and demands, including attorney fees, on account of Injury, loss, or damager.including without limitation claft arising from bodily injury, personal injury; sickness,.disease, death, property loss or damage, or4,any-ot4er-loss of any kind whatsoever, which arise out -of or are in any manner connected with: this ConsWotion-Coritract If such injury, joss,.or damage is caused !n whole or in.part by, the>act,.ornisslion, error, professional error, mistake, negligence, ork other fault of Contractor, any subcontractor of Contractor, or -any office(, employee, representative; bragentlof Contractor, or which arise out of a -worker's- compensation claim of any employee' of,Contractor or of any employee of..any subcontractor.of Contractor, Xl. WORKERS WITHOUT AUTHORIZATION A. Certification, By entering Into this Construct rtifion Contract, Contractor hereby certifies that;: at the -time of�thia,.certification, it does, not knowingly,employ ffor contract with a wormer without authorization., as that term is defined iri C:R:S.'§ 8.17:5-101(9),:as ainei ded,,who will perform work under thisvConstructioh ut 1 II WLEMA' 11111 Contract and that Contractor will participate In either the E-Verify Program admiiriistered by the. U.S:. Department of Homeland Security and Social Security Administration or the Department Program administered by the Colorado Department of Labor and employment -to confirm the employment eligibility of all employees who.are newly hired to perform work.onder this Construction Contract. B. Prohibited Acts. Contractor r shall not knowingly':employ or contract with" a, vWoikeI without authorization, as'that term is defined" in,C.R.S. § &17.5=101(9}, as amended, torperform "work uridermthis" Construction Contract, or enter into a contract with a subcontractor "that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with a worker without authorization, "as that term is defined in C,R.S. § 8.17.b-`10,1(9); as"amended,to perform work under this Construction Contract. C, Verification, 1. If Contractor has employees,, Contractor. has confirmed the employment" eligibility of all employees who .are newly tiire6 to perform work under this Construction Gontract:`through- participatiah in either. the E=Verify Program or the Department Program. 2. Contractor shall n©t use iris E-Verify, Program or Department Program proeedtires An undertake pre-employmeriVscreening of job applicants while this Construction Contract -is being performed. 3, .If Contractor obtains actual knowledge that's subcontractor performing Work- under .this Construction Contract: knowingly ;employs of contracts6 with .a worker of authorization, as that term is defined in CARS. § &17.5-101.(9), as amended; who ,is performing work under this Construction Contract; Contractor shall; notify the subcontractor and the Town within 3 days that. Contractor has actual knowledge that the subcontractor is employing or contraoting vuittl`a worker without authorization, as, that tern 4s- defined in C.R.Sak § B-17.5-101(9), as amended, who is performing work under this Construction Contract; and terminate 'the subcontract with the, subcontractor if within 3 .days of receiving the notice required pursuant to subsootron 3 hereof, the. subcontractor does not_stop employing or contracting with the worker Without authorization who is performing work under this .Construction Contract; except thdt Contractor shall" not terminate the subcontract if during such 43 days the subcontif ctort provides information to establish that the subcontractor has, riot knawingiy emptoyed orcontcacted with a worker without authorzation, as that. term is defined in C:R.S. § V 7.5-101(9), as .amended, who is performing work under "this con contract; Contract: p. ,Duty to Cohtpiy with Investigations, ton tractor:shall comply with any reasonable request by the: Colorttdv Departm®nt of:L�twr and Employment made in tne. course of an investigation conducted pursuant to C.R.S.. § 8- T&i 09(5)(a) to ensure'that Contractor is complying with the terms of ihis.Section XL Et Affidavits, If Contractor -does not *have employees, Contractor shall sign the "No Employee Affidavit"f attaehied hereto. if Contractor WIshes10 verify the lawful *presence, of newly hired employees who perform work 'under the Construction Contract via the department program, Cori factor shall: sign the "Department Program Affidavit" attached hereto. XtI. CONT.IZACT OOC.UMEI 1 14 The Contract Documents,, which comprise the: entire agreement betwean the' Town and Contractor conc eming the 3cope.of Seryicoi, Consist of the following: A, �xhibjt to this Construction Gant'ract:. 1, Exbiblt.A Scope of Work. .2.. Exhibit 5: UnitvPrica Bid Farm, B. Performance Bond and tabor &Materiel Payment' Band. C. Notice of Award. D. Notice& to Proceed. E. "Specifications" bearing the title, F. "Drawingconsisting ofI .G=. Addendum numbers: 1. Addendum #1: 2. Addendum #2: N. The fallowing which may be delivered orissS�ed after the Effective Date,.gf the GonSt>tiction Contract and are attached hereto:. All writtan amendments and other documents amending; modifying, or supplemetitinglof-Athe COtract Qocgments. There are no Contract Documents other Than those listed, above in this Section XII. XIl1. MI5CELl.ANE0U5 A. Governiri,� t:awand Venue. This Corisfruction Contract shall be gavemed by the laws:of the State Iof"Colatdo; and any lagai action concerning the prAvisions Hereof shall ba brought inUeld County,. Colorado. @, No. Waiver, =Delays in enforcement or the waiver of any one or mor'O defaults or brmie hes_of this Construction Contraci�tiy the Town shal[not constitute a waiver. of any of the other terms or obligation Qf this Cas�structibn Ctlr{tr�Ct: CO Infeoration. This. Gbnstructiob Contract and any attached exhibits constitutes Ahe entire agreement betweenq.the`Parties, superseding all prior oral nr written pommuntoati ns: p0, T -ird?arnes, i here'are no intendsd third-party.berieficiall es 1b iiiis CoanstYuction.Contrai4 5, N, otio$� My -notice under this Consuuction_wntract shall be in wrng, &Ind:shail be deemed suff~icierit�when directly .presented or sent pre-poid, first class U.S, Mail to the Party at the address set forth pn the first pags.of this k9feement, PC Severability, If .any provi;,iori of this Construction Contract is found by .a court of competent jurisdiction to be.unfawftif�or unenforceable for°any reason, the remaining provisiofis hereof behall remain In full force and effect. G, Modification, ThisConstruction Contract: may only be modified. upon written ag'reenient of the' Parties. M, ssi nm .n , Neither. tiiSs.Gonstructian Contract nor any of the Ahts or obtfgatio6s of the Paities,shall behassigned,by'elther.Party.withoutthe written consent of thff: other. mental lmmanit .The Town and its officers, attomejrs and employees,are relying. on, and; do not We -NO or intend to waive by any proyisign of #Ills Agreement, the mohetary. limitations or any other rights,. immunities, and pt�otectiorls provided by the Colorado GovernMental Immunity,Act, C;R.S. §.24- �g-1a1', etseq:, as amended, orotherwisa available lo.the Town,and'its sofficers, attorneys or employees. J: Ri h, a t�s and emedies. The rights and .remedies of'the Town under this Construction. Contractareln addition to&any otherrights and remedies providefty law. The.expiration of thls:Gonslruptioh contract shall in no way limit.the Town's legil or equitable remedies,, or the period.in, 'which such remedies may bwasserted, forwork negligently or defectively performed; K, Subiect.ia Annual Appropriation. Consistentwith Article X,s� 20 of the Colorado Constitutivnj any financial obligation of the Town not performed during the current fiscal year is subject to annual appropriation; .shall extend only to monies currently appropriated, and shall not consfitute a mandatory charge,.requirement, debt or liagility beyond .tile purreriffisool year. IN WITNESS WHEREOF, the Parties have executed ihis Construction Contract as of the Effective Date. �E�ToiVF fop fpospflo..� m4 ATTF G'f A -ONE Chip�eal STAT�..QF COLORADD couNT� of Colorado }, Pt • E, COLORAp0 Drew Peterson, Mayor Daniel J. Gryzmala, President sea/ voN 11/09/1992 •'c�� o a Ao°•*pos' to The foregoing, instrtrmen� was s.4J.bscribed; sworn to antlacknoiuledged b fore n1ethis ,.� day of Vam -_ ;eua, by U ALPArmouxtulU as WE_ of Afoot MQYMLA ac My commission expires: 04-02 20:X5 �� STAE,i�HANIE W— q��ls � otary Public State of Colorado Notary ID # 20054012221 Commission Expires 04.n7_ �t rlIII l[k-17r1IBM NO EMPL(JYEE AFFIDAVI I To be completed only if Contractor has no, employees 1. Check_and c.omplete. ane: ❑ lam a sole proprietR.r d ' g business as I do notcu�renfly employ any individuals: Should mploy any'employees. during the tern of.my Agreement with the Town of Firestone 4the "Town"), I Jce that -Al will comply with the lawful presence yedfication requirements outlined in that Agreement. OFF ❑ I, E� corporation, limited liability compavyJ, fhat does not curlenily e irvdividuals:tuing the.term of my Agreement with the Town, l rtl verification requirements outlined in that Agreement. 24 dheck one. I Cj I am 4 United States aitizeh or** perm ent resident. awnerJmemberlshareholder of � (specify type of entity -- i.e., oy any individuals. Should I.employ any that 1 will comply with thQ lawful presence TheTown must verify this stafemenf Wreviewing one of fhe following !#ems: ■ A ualid Colorado driver's tense or a Cotolado ider?fifloation card; A United States milita card or a military dependent's identification card; A United States Cb t. Guard Merchant Mariner card, A Native Americ Tribal document; ■ in the case .of resident •of another state, 07o driver's, license or stete4ssbed ident�cation card from fh state .of residence,, if that state requires the applicant to prove lawful presence prior th .�ssuance'ofthe identification card; or ■ Any of r documents or combination of documents listed in the Town's "Acceptable Doc ants .for Lawful pr®Santa Verification" chart That prove both Contra tit' nship/iawfuf presence and identity, QR ❑ ] am herwise lawfully present in.the United States pursuant to federal law: A racfor must verify This statement through -fhe federaf Systematic Alien Verification of Enfitlemenf SAVE r). program, and provide such verification to fhe Town. Signature Date DEPARTMENT PROGRAM AFFIDAVIT To. be completed only it Contractor participates In the Department of Labor lawful PresOce Verification Program iDaniel J. Gryzmala _.__,'as a public contractor under contract with the Town of Firestone (the irm "Town y affthat: 1. I have examined or uiilll examine the legal work status'of all:employees who are newly hired for employment to pertorm work under this public contract for seiviceg ("Agreement") with the Town within 20, days after such hiring date; 2. I have retained or wilt retain file.copies of all docutnenis required by 8 U.S.C. § 1324a, which, verify the employment eligibility and identity of newly hired employees who perform work udder this. agreement; and 3. employees Signature 1 have not and will not alter ot• falsify. the identification documents for my newly hired this Agreement. nieyf. Gryzmala, President STATE OF COLORADO ) s/19/zozz Date ss. COUNTYOf; } The foregoing instrument warms subscribed, .sworn to and, acknowledge before me this day of 2022, by _ as 2f of. My commission expires: �.-p�_?p� (SEAL) STEPHgNIE 1NgLLIS Notary Public State of Colorado Notary ID N 20054012221 Commission Expires 04-02-2025 :O I 01 EXHIBIT A SCOPE QF WORK Contractor's Duties During the term of this Construction Contract, Contractor shall perform the following duties, as directed by the Town: 2022 Chipseai Program (S2022-9229) Contractor shall Chip seal St Wain Ranch and Ridgecrest subdivisons. • The Town will do pothole patching and any cracksealing repairs as needed before the contractor starts. • Contractor shall restripe roadways. • Contractor shall reinstall all thermoplastic markings. Work to start no later than 6/20/2022 Substantial completion in 90 days full completion in 120. • Contractor shall provide and maintain all traffic control devices and measures for the protect as well as all resident notification. • All Towns standards and specifications to be followed to include the procedures outlined in the Towns Street, Curb and gutter maintenance/Replacement SOP to ensure stormwater compliance including installation and maintenance of stormwater contra) measures. _ _ A, . A^ Design?bidld= i UNIT -PRICE B1D FORM 2022 Chip Seal Ptogram (52022.9229) _a 'U J $ %.JCe+) •t' 1'd`�.5. yt rSj� 1:•. Ut �l 7 tf�l � �'fGv�Z ,j (t� e ♦J.+ ih �. 4 W,J.`tt 1 s^t 't. �.111 `.'t r t'ri' 1 i;".T, $.1 `t • i6 Sly� fCa •' F i �ry-.t {�'/'. t� � ('-+3 .4 .A i({Y t.r t'}tt'. L c 'j t 7Sc1Fv � e?.? ..At: l�Jr.•�(/ rat:'YIr � 5 � ! fYY F Yi 1=U ;! 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J3fi Li.'r�t..•l:ti.•.,.:.1C..1 ,`i?iSF, 4t3s`t� •:> 3 s*. v'h �r . yj{j Y 'i?` J.�. � tt �� u'�w l`...:1 �F•"�. yip ;}f,. h2iLo 4 y J.�. 7i�•.'"'.iL�`.i.,.v`i.YL�...x�.. 1 • ! ! • ! • t 11111324 f" I III Alhermoolastic Paveffient, Markldg$ :f r i •• II f• TrWo'Controland Resid6nMot1floationt � IIIII Ifi if � ifa nl aryl:': : / / 1.1 ►► 11► 11 e . k: frQ I�Mlti9f � • i iJ i If f .• •ILA i, tin f fill t1k 11 ijft ,�.. FS � t 1 � L 4r r �t r"t=f-.4, 1`•i ;?�i.:�4`� '?ik;�,�'l�th%sn� h 3� M F. � � l�H �!+ iij7}�t 1 t `(�� +tsStX:tr1 2 �L°� rrr"i'u =i.5t r. i�Y �E )�It �t4N •�Y,(y{?� )� � { ) t 1 �f ; i17 i Sk , r 4 S[t5 ,;ihy � t i �'. Y �r` 1{ ♦JZ IG l �" ,�y ' ` �j,C ��P�jyGja%i�p`-�1 ] !�}y( / l� ��la �` Y^ 1 �•.1 •�fftt �::IJ`Lh�yt�...•,at� ,. s i � �,1. �Kjxii ,�}�l {w i � �f)_ i1 �{y'jj.jYJ�T""'i � im�t y�y7 ), i j'HH..� � !� �f t'�t 'L'��J1�1!- �X.� 4U+jit `..%_{ti.>y�!•eY.t.J 1+s`yl�� }r xi�,P �iil'T�.'� �- i '�,•';�li) iiJ\{,t tl y�YiYj,l��77'�'Y% jF�} �T3 i� ��., -:I f 1 r. L)c' ��.)! , 1} tS,•^?,`�.lLt{'gift 4'Y Als4 `: !.4 .x�'h i'rG'\�lti'it:.irSJ'.\��t�K-J.�.4,iiui`1 lly.. • ! r Sealfoo Ridgedrest!! • 700924 Epoxy :• ► i 1 1 1 1'1 if �`M 1•�111�I •f •i• 1, ii Replace f1 !1 f f 1 and, Roldent • f 1! 11 • M '1 ` 'sir Ili f .' •: t/1 it 111 1! • 11I 111111 �r I. Jill I► for MitloAtidn f 1 f i /► Hdlb;f: . hl it ail ►1 .UnitvPdce,for*Pot Page'7 of 20 Any singular reference to Contractor, Surely, Owner ar other party shall be considered plural where applicable. CONTRACTOR (Name and Address): SURETY (Nar»e, and Address of Principal Place of A-1 Chlpseal Company Western Surety CompanBUsiness): 2505 E. 74th Avenue Denver, CO 80229 OWNER (Name and Address}: Tgwn of Firestone 151 Grant Avenue (P.O. Box 100) Firestane, CO 8t)520 CONTRACT iSi N. Franklin Street Chicago, IL 60606 Effective Date of Agreement: (Date the Agreement is Signed by Firestone) Amount: Seven Hundred Thausand and S6/10Q•-•($700,000.56) Description (Name and Location): BONA 2022 Chipseat Program - (SZQ22.9229) Firestone, CA Band Number: 30159576 Date (Nof earlier fhan Effective Date of Agreement): June 8th, 2oz2 Amount: Seven Hundred Thousand and 56/iQ0•--(�700,000.56) Modifications to this Bond Form: None June 8th, 2022 _2. �� ^_�EJGDG G-610 Performance Bond �� Prepared by the Engineers Jolnt Contract Documents Committee. [I Surety and Contractor, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Performance Bond to be dul an authorized officer, agent or representative. CQN7RACTQR AS PRINCIPAL A-i Cttlpseal Company Contractor's Nweond Corp( By: �P,se�'•co Gr.• �. ; •Gp�tPORq ' S�al� 1/09/i 992 •Su stern_Surety Company (Seal) :ty's Name and Corporate Seal _ of Attorney) Print Name Attest: Attest: Jody 1. Anderson Print Name Attorney -In -Fact Witness Title Note; Provide execution by additional parties, such as folnt venturers, if necessary. Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to Owner for the performance of the Contract, which is incorporated herein by reference. 1. If Contractor performs the Contract, Surety and Contractor have no obligation under this Bond, except to participate in conferences as provided in Paragraph 2.1. 2. If there is no Owner Default, Surety's obligation under this Bond shall arise after: 2.1 Owner has notified Contractor and Surety, at the addresses described in Paragraph 9 below, that Owner is considering declaring a Contractor Default and has requested and atkempted to arrange a conference with Contractor and Surety to be held not later than 15 days after receipt of such notice to discuss methods of performing the Contract. If Owner, Contractor and Surety agree, Contractor shall be allowed a reasonable time to perform the Contract, but such an agreement shall not waive Owner's right, if any, subsequently to declare a Contractor Default; and 2.2 Owner has declared a Contractor Default and formally terminated Contractor's right to complete the Contract. Such Contractor Default shall not be declared earlier than 2Q days after Contractor and Surety have received notice as provided in Paragraph 2.1; and 2.3 Owner has agreed to pay the Balance of the Contract Price lo: 1. Surety in accordance with the terms of the Contract; or 2. Another contractor selected pursuant to Paragraph 3.3 to perform the Contract. �� EJCOC C•610 Periormanco Sond Proparod by lho Englnoers Joint Gontract t)ocuments Committee. 3. When Owner has satisfied the conditions of Paragraph 2, Surety shall promptly, and at Surety's expense, take one of the following actions, 3A Arrange for Contractor, with consent of Owner, to perform and compiete the Contract; or 3.2 Undertake to perform and complete the Contract itself, through its agents or through Independent contractors, or 3.3 Obtain bids or negotiated proposals from qualified contractars acceptable to Owner for a contract for performance and completion of the Contract, arrange for a contract to be prepared for execution by Owner and contractor selected with Owner's concurrence, to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Contract and pay to Owner the amount of damages as described in Paragraph 5 in excess of the Balance of the Contract Price incurred by Owner resulting from Contractor Default, or 3.4 Waive its right to perform and compiete, arrange for completion or obtain a new contractor, and with reasonable promptness under the circumstances, 1. After investigation, determine the amount for which it may be liable to Owner and, as soon as practicable after the amount is determined, tender payment therefore to Owner; or 2. Deny liability in whole or in part and notify Owner citing reasons therefore. 4. !f Surety does not proceed as provided in Paragraph 3 with reasonable promptness, Surety shall be deemed to be in default on this Band 15 days after receipt of an additional written notice from Owner to Surety demanding that Surety perform its obligations under this Bond, and Owner shall be entitled to enforce any remedy available to Owner. If Surety proceeds as provided in Paragraph 3.4, and Owner refuses the payment tendered or Surety has denied liability, in whole or in part, without further notice Owner shall be entitled to enforce any remedy available to Owner. 5. After Owner has terminated Contractor's right to complete the Contract, and if Surely elects to act under Paragraph 3.11 3.2 or 3.3 above, then the responsibilities of Surety to Owner shall not be greater than those of Contractor under the Contract, and the responsibilities of Owner to Surety shall not be greater than those of Owner under the Contract. To the limit of the amount of this Bond, but subject to commitment by Owner of the Balance of the Contract Price to mitigation of costs and damages on the Contract, Surety Is obligated without duplication fore. 5.1 The responsibilities of Contractor for correction of defective Work and completion of the Contract; 5.2 Additional legal, design professional and delay costs resulting from Contractor's Default, and resulting from the actions of or facture to act of Surety under Paragraph 3; and 5.3 Liquidated damages, or if no liquidated damages are specified in the Contract, actual damages caused by delayed performance or non-performance of Contractor. 6. Surety shall not be liable to Owner or others for obligations of Contractor that are unrelated to the Contract, and the Balance of the Contract Price shall not be reduced ar set off on account of any such unrelated obligations. No right of action shall accrue on this Bond to any person or entity other than Owner or Its heirs, executors, administrators or successors. 7. Surety hereby waive notice of any change, including changes of time, to Contract or to related EJCDC C-610 Performance Bond Prepared tty the Engineers Joint Contract Documents Commlltee. subcontracts, purchase orders and other obligatians. 8. Any proceeding, legal or equitable, under this Bond may be instituted in any court of competent jurisdiction in the location in which the Work or par# of the Work is located, and shall be instituted within two years after Contractor Default or within two years after Contractor ceased working or within two years after Surety refuses or fails perform its obligations under this Bond, whichever occurs first. if the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. 9. Notice to Surety, Owner or Contractor shall be mailed or delivered to the address shown an the signature page. 10. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory band and not as a common law bond. 11.Oefinitions. 11.1 Balance of the Contract Price: The total amount payable by Owner to Contractor under the Contract after ail proper adjustments have been made, including allowance to Contractor of any amounts received or to be received by Owner in settlement of insurance or other Claims for damages to which Contractor is entitled, reduced by ail valid and proper payments made to ar on behalf of Contractor under the Contract. 11.2 Contract: The agreement between Owner and Contractor identified on the signature page, including all Contract Documents and changes thereto. 11.3 Contractor Default: Failure of Cantractor, which has neither been remedied nor waived, to perform ar otherwise to comply with the terms of the Contract. 11.4 Owner Default: Failure of Owner, which has neither been remedied nor waived, to pay Cantractor as required by the Contract or to perform and complete or otherwise comply with the other terms thereof. FOR INFORMATION ON<rY -- (Name, Address and Telephone) Surety Agency or Broker: Moody Insurance Agency, Inc., 8055 E. Tufts Avenue, #1000, penver, CO 80237 - 303-82A-660D EJCDC C-610 Perrormance Eond Prepared sy the Engineers Joint contraai Documents Committee. PAYMENT BAND Any singular reference to Contractor, Surely, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): SURETY (Name, and Address of Principal Place of Business): A-i Chipsea! Company 2505 E. 74th Avenue Denver, CO 80229 OWNER (Name and Address}: Town of Firestone 151 Grant Avenue (P.O. Box 100} Firestone, Colorado 80520 Western Surety Company 151 N. Franklin Street Chicago, Il. 60606 CONTRACT Effective pate of Agreement: Date the Agreement is signed by Firestone June Sth, 2022 Amount: Seven Hundred Thousand and 56/100��-($700,000.56) Description {Name and Location): 2022 Chipseai Program (S2022-9229j Firestone, CO goND Bond Number: 30159576 Date (Nof earlier than Effective Date of Agreement}: June 8th, 2022 Amount; Seven Hundred Thousand and S6/100••-($700,000.56) Modifications to this Bond Form; None �F_.�� EJCgG G•S15 Payment bond Prepared by the Engineers Joint Contract Documents Committee. Surety and Contractor, intending to cause this Payment Bond io be �'rG�;�,t' �fi;1r�; �,� .a e �" � ��` %• 9 •� � � ;N3r.. �,;,1...,, . 1110g11992 (sego a P ' �10•, CQNTRACTQR AS PRINCIP. A•1 Chlpseal Company Contractor's a and By: - _m � r Signature Atte rnrn rvdnro rp� ro�~t � __._ . . Title 1"� � ay: ound hereby, subject to the terms set forth below, do each ��n authorized officer, agent or representative. RETY (Seal Western Surety Company � Surety's Name and Corporate Seal Attest: _ c... Sign ture (Att ch Po er of Attorney) ]ody t.. Anderson Print Name Attorney-In•Fact ___ _ _ _ Title Signature Witness __ _____ Title Note: Provide execution by additional parties, such as joint venturers, if necessary. 1. Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to Owner to pay for labor, materials and equipment furnished by Claimants for use in the performance of the Contract, which is incorporated herein by reference. 2. With respect to Owner, this obligation shall be null and void if Contractor: 2.1 Promptly makes payment, directly or indirectly, for all sums due Claimants, and 2.2 Defends, indemnifies and holds harmless Owner from all claims, demands, liens or suits alleging non-payment by Contractor by any person or entity who furnished labor, materials or equipment for use in the performance of the Contract, provided Owner has promptly notified Contractor and Surety (at the addresses described in Paragraph 12) of any claims, demands, liens or suits and tendered defense of such claims, demands, liens or suits to Contractor and Surety, and provided there is no Owner Default. 3. With respect to Claimants, this obligation shall be null and void if Contractor promptly makes payment, directly or indirectly, far all sums due. 4. Surety shall have no obligation to Claimants under this Bond until: 4.1 Claimants who are employed by or have a direct contract with Contractor have given notice to Surety (at the address described in Paragraph 12) and sent a copy, or notice thereof, to Owner, stating that a claim is being made under this Bond and, with substantial accuracy, the amount of the claim. 4.2 Claimants who do not have a direct contract with Contractor: EJCdC C•815 Payment Bond Prnnarad by the Enainaers Joint Contract bocumonts Committee. 1. Have furnished written notice to Contractor and sent a copy, or notice thereof, to Owner, within 90 days after having last performed labor or last furnished materials or equipment included In the claim stating, with substantial accuracy, the amount of the claim and the name of the party to whom the materials or equipment were furnished or supplied, or for whom the labor was done or performed, and 2. Have either received a rejection in whole or in part from Contractor, or not received within 30 days of furnishing the above notice any communication from Contractor by which Contractor had indicated the claim will be paid directly or indirectly, and 3. Not having been paid within the above 30 days, have sent a written notice to Surety (at the address described in Paragraph 12) and sent a copy, or notice thereof, to Owner, stating that a claim is being made under this Bond and enclosing a copy of the previous written notice furnished to Contractor. 5. If a notice. by a Claimant required by Paragraph 4 is provided by Owner to Contractor or to Surety, that is sufficient compliance. 6. When a Claimant has satisfied the conditions Surety's expense take the following actions. of Paragraph 4, the Surety shall promptly and at 6.1 Send an answer to that Claimant, with a copy #o Owner, within 45 days after receipt of the claim, stating the amounts that are undisputed and the basis for challenging any amounts that are disputed. 6.2 Pay or arrange for payment of any undisputed amounts. 7. Surety's total obligation shall not exceed the amount of this Bond, and the amount of this Bond shall be credited for any payments made in good faith by Surety. 8. Amounts owed by Owner to Contractor under the Contract shah be used for the performance of the Contract and to satisfy claims, if any, under any performance bond. By Contractor furnishing and Owner accepting this Bond, they agree that all funds earned by Contractor in the performance of the Contract are dedicated to satisfy obligations of Contractor and Surety under this Bond, subject to Owner's priority to use the funds for the completion of the Work. 9. Surety shall not be liable to Owner, Claimants or others for obligations of Contractor that are unrelated to the Contract. Owner shall not be liable far payment of any costs or expenses of any Claimant under this Bond, and shalt have under this Bond no obligations to make payments to, give notices on behalf of or otherwise have obligations to Claimants under this Bond. 10. Surety hereby waives notice of any change, including changes of time, to the Contract or to related subcontracts, purchase orders and other obligations. 11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the Work or part of the Work is located or after the expiration of one year from the date (1) on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph 4.2.3, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Contract, whichever of (1) or (2) first occurs. If the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit snail be applicable. EJCDC C•615 Payment Bond Prepared by the Engineers Joint Contract Documents Committee. 12. Notice to Surety, Owner or Contractor. shall be mailed or delivered to the addresses shown on the signature page. Actual receipt of notice by Surety, Owner ar Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown an the signature page. 13. When this Bond has been furnished to comply with a statutory requirement in the location where the Contract was to be performed, any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed .incorporated herein. The intent is that this Bond shall be construed as a statutory Bond and not as a common law bond, 14. Upon request of any person ar entity appearing to be a potential beneficiary of this Band, Cantractor shall promptly furnish a copy of this Bond or shall permit a copy to be made. 15. Definitions 15.1 Claimant: An individual or entity having a direct contract with Contractor, or with afirst-tier subcontractor of Contractor, to furnish tabor, materials or equipment for use in the pertarmance of the Contract. The intent of this Band shaii be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, ail, gasoline, telephone SENICe or rental equipment used in the Contract, architectural and engineering services required for performance of the Work of Cantractor and Contractor's subcontractors and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials or equipment were furnished. 15.2 Contract: The agreement between Owner and Contractor identified an the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of Owner, which has neither been remedied nor waived, fo pay Cantractor as required by the Contract, or to perform and complete ar otherwise comply with the other terms thereof. FOR INFORMATION ONLY — (Name, Address, and %lephane) Surety Agency or Broker; Moody Insurance Agency, Inc., 8fl5S �. Tufts Avenue, #1000, Denver, CO 80237 - 303-824-6600 Owner's Representative (Engineer or other}: �µ EJCpC C-61S i�ayment Band Prepared by the Engineers Joint Contraot Documents Committee. n. �► ♦ � � i POWER OF ATTORNEY APPOINTING INnIVIVUA>✓ A'1"CURNEX-IN-t�AC'1' Knorr Alf. dlen By These Presents, That 1VESTERN SUk�'fY CQMCANY..r South Dakota curpurntiou, is a du{}• organizad and existing corporation having its principal o(tice in the City ofSioux Falls, and State of South Dakota, and that it does by virtue of tha signautra and scat herein affixed hereby make. cuustturo and appoint Jody L Anderson, Evan E Moody, Karen A C�'eggestad, Tina Marie Post, Bradley J Moody, Andrew J Waterbury, Elizabeth Ostblom, individually of Dcnvcr, CO, its true and la+vfitl Auomcy(s)-imFact +vith lid! po+ver and authority hereby conferred to sign, scat and execute for and vn its behalf bonds, undcnakings and other obligotory instruments of similar nnwre - in Unlimited Amounts - and to bind it !hereby as fully and to the some extent as if such instruments were signed by a duly authuriacd officer �rf the corporation and ull the nets of said Mtorncy, pursuant to the nulhority hereby given, arc hereby ratified and tonfinncd. This bower of Attomoy is made and executed pursuant to and by authority of the 13y-t �+v pritHcd on the reverse hcrcof, duly adopted, as indicated, by the sharchotdars of the corporation. In Witness �Vherenf, WESTERN SURLrTY COMPANY has caused these presents to be signed by its Vicc president find its corporue seal to be hereto aff xcd on this 22nd day of December, 2021. WESTERN SURETY COMPANY State nCSoodt Dakota ss Couuty otMinncha#ta On this 22nd day of December, 2021, before me persona{ly came haul T. [iru0a4 to me knu+nt, who, being by me duly sworn, did depose and say:.. that he resides in the City of Sioux F:olls, Slate of South Dnkota; that he is the Vicc President of WLSTCRN SURETY COMPANY described in and +vhich csccutcd the above instrumcm: that he knv++s the scat of>;aid corporation; that t{te sea) affixed to the said iustromerrt is such corporate scat; that it a•as so affixed pursuant to authority liven by the [ioard of Directors of said corporation and drat he signed his name th4roto pursuant to {ikr authority, and acknowtcdgcs same to be dtc act and dead of said cnrpuratian. My cmnmissimt expires �� M. GENT \\.\\\ March 2, 2026 �jj::rr//iGYTN pA}(CiA��SE'��'�5.,!! •\Nw\\wM\\\w1\w\\M\4w M. I3cnt. Notary Publ CF,RTIFICATF 1, L. Netson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Po+ver of AUomcy {tercittabave set forth is still in force, and fiathcr cerufy that the T3yl.aw of tha corporation printed on the reverse hcrcof is still iu force. In testimony wher+•of I have hereunto subscribed my name and affixed the scat of the said corporation this Ath day of Juna, 2022. WESTERN SURETY COMPANY farm tazAo.7.zotz Go to tHww.cnasuretv.com > Owner /Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. Autharizing I3yl,mi ADOPTED BY THE SHAREHOLDERS Vr WESTERN SURETY COMPANY This Power of Attorney is mnde and executed pursuant to and by authority of the following i3y),aa duly adopted by the shareholders of the Connpany. Section 7. All bands, palici+ , uindcriakings, Powers of Attorney, or other ohligniions of the corporation shall be executed in the corporate name of the Company by the President, Secretary, and Assistant Sceretnry, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shaft have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attomcy or other obligations of the corporation. The signature of any such officer and the corporate scat maybe printed by facsimile. �Q � CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDnrYYY) 05J19/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the pDilcy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER Mocdy Insurance Agency, Inc. 8055 East Tufts Avenue Suite 1000 Denver INSURED RAGES CO 80237 A•1 Chipseal Company, OBA: Rocky Mountain Pavement, LLC 2505 E. 7Ath Ave Denver CO 80229 CERTIFICATE NUMBER• CONTACT Moody Insurance Agency NAME: PHONE (303) 824-8600 (AIC, No): (303j 370.0118 tetr. u.. a„t�• E• AIL ceArequest�moodyins.Com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA: Seteclive Insurance Co of America 12572 INsuRER a : Pinnacol Assurance 41190 INsuRER c : Evanston Insurance Company 35378 INSURER D INSURER E REVISION NUMBER: COVE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L15TE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIGATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERM5, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY NAVE BEEN REDUCED 8Y PAID CLAIMS. LTR TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY I p p POLICY NUMBER MM/DD(YYYY MMlDDlYYYY LIMIT9 EACH OCCURRENCE S 1,000,000 PREMISES Eaoocunence S 300,000 CLAIMS•MADE o OCCUR MED EXP (An one person) S 10,000 pERSDNALd,ADVINJURY S 1,000,000 A Y S2501487 02/01/2022 02/01l2023 GENERAL AGGREGATE S 2,000,000 C;EN"LAGGREGATELIMRAPPLIESPER: POLICY ❑X dECT � LOC PRODUCTS •COMP/OP AGO S 2,000,000 S OTHER: AUTOM091LE 1tA61LITY C e scd n SINGL 1 S 1,000,000 X ANY AUTO 90DiLY INJURY (Per person) S A OWNED SCHEDULED AVTOS ONLY AUTOS HIRED NON•OWNEO AVTOS ONLY AUTOS ONLY Y S2501487 02/0112022 02/OU2023 ao01LY1NJURY(Peracddent) S PROPER AMAG Per accident 3 S A x VMBRELtA LIAR ExcEas LU\a X OCCUR cLA1Ms•MADE S2501487 02/01/2022 02/01/2023 EACH OCCURRENCE S 10,000,000 AGGREGATE S 10�000,000 r B OED X RETENTION 5 O WORKER8 COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIVE oFFICERIMEMSEREXCLUDED9 � (Mandatory in NH) Ir yea, describe under DESCRIPTION OF OPERATIONS below NIA 4055760 02/01/2022 02/01I2023 X STATUTE ERH E E.L. EACHACCIDENT 500,000 S ___ E.L. DISEASE - EA EMPLOYEE S„ 500,000 E.L. DISEASE •POLICY LIMIT Each Occurrence Limit S 500,000 $5,000,000 C Pollution Liability CPLMOL105319 02/0112021 02/01/2023 Aggregate Limit $5,000,000 Deductible $10,000 DESCRIPTION OF OPERATION8 !LOCATIONS / VEHICLES {ACORD 101, Additional Remarks Schodule, may be attached If more apaco Is roquirod) Re: 2622 Chipseat S2022-9229- Various locations within Town Limits SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Firestone ACCORDANCE WITH THE POLICY PROVISIONS. 9950 Park Avenue AUTHORIZED REPRESENTATIVE Firestone CO 80504 �� ,,Q,�I/>(' ©1988-2015 ACORD CORPORATION. Ail rights reserved. AQENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Moody insurance Agency, Inc. POLICY NUMBER CARRIER ! NAtC CODE ennrTrntuer RFMARKR NAMEDIN8URE0 A-1 Chipseal Company, DBA: Rocky Mountain Pavement, LLC EFFECTIVE DATE: TNIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS Additional Named Insureds: AA Chipseal Company DBA Rocky Mountain Pavement, LLC Black Rock Material & Supply, LLC Location Schedule: 2505 E. 741h Avenue, Denver, CO 80229 7231 Cole VW, Colorado Springs, CO 80915 7620 & 7560 Space Village Avenue, Colorado Springs, CO 80929 1100 Harlem, Pueblo CO 81001 10800 Highway 90, Arvada CO 80007 Inland Marine Policy: Policy Number. 52501487 Policy Effective Dates: 2.1.2022 to 2A1 2023 Insurer: Selective insurance Company of America Total Combined Scheduled Contractor's Equipment Value: $6,893,372 Scheduled Contractor's Equipment Deductible: $10,000 Leased & Rented Equipment From Others Limit: $1,000,000 feral Liability Policy: Feral Liability Deductible: $2,000 73 00 01/19 From Attached Includes: Iket Additional Insured status applies only to the extent provided in form CG 79 88 01119. tket Waiver of Subrogation applies only to the extent provided in from CG 73 00 01/19. feral Liability Policy is Primary and Non•Contributory only to the extent provided in form CG 79 88 01/19. Auto Liability Policy: Physical Damage Deductibles: Comprehensive: $2,500, Collision: $2,500 CA 78 091 From Attached includes: Blanket Additional Insured status applies only to the extent provided in form CA 78 0911/17. Blanket Waiver of Subrogation applies only to the extent provided in from CA 78 0911117. Umbrella Policy: Umbrella Policy is on a followl) Corm basis for underlying insurance coverages: General Liability, Automobile Liability, and Employers Liability. Additional insured status will follow when required by v✓riflen contract, including primary end Non-contributory Status. Worker's Compensation Policy: 359.8 Form Attached Includes; Blanket Waiver of Subrogation status applies when required by written contract. se Note Hard Copies of Endorsement will not be sent out via mail. All Endorsements will only be sent electronically via email. Pieaso send your address to certrequest@moodylns.com for forms and future mailings" ►N111/1 ASSURANCE A-1 Chipseal Company dba Rocky Mounts Rocky Mountain Pavement LLC 2505E 74th Ave Denver, CO 80229 ENDORSEMENT: Blanket Waiver of Subrogation 7501 E. Lowry Bivd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com NCCI #: WC0003138 Policy #: 4055760 Moody Insurance Agency Inc 8055 E. Tufts Ave Ste 1000 Denver, C4 80237 (303) 824-6600 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date:February 1, 2022 Expires on: February 1, 2023 Pinnacoi Assurance has issued this endorsement January 26, 2022 7501 E. Lawry Blvd Denver, CO 80230.7006 �.rn.on AflGG7en s�n�nca� ��n_c'a Contractingg, Installation, Service and Repair General Liability Extended ElitePac® Endorsement COMMERCIAL. GENERAL_ t_IABIL.ITY CG79880119 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ I CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABiI_ITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Bt.ANKET ADDITIONAL INSUREDS a. Ongoing Operations SECTION 11 -- WHO IS AN INSURED is amended to include as an additional insured. 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above; Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed under that contract, agreement, or permit when that contract, agreement, or permit requires the additional insured be added with respect to lI ability arising out of your ongoing operations. If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of your ongoing operations, then such person or organization is an additional insured only with respect to "bodily injury", "property damage" or "personal and advertising injury" caused In whole or in part by your ongoing operations performed under that contract, agreement, or permit. b. Completed Operations SECTION II --- WHO IS AN INSURED is amended to include as an additional insured: 1. Any person or organization for whom you are performing or have performed operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above; Such person or organization is an additional insured only with respect to their liability arising out of "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard" when that contract, agreement, or permit requires the additional insured be added with respect to liability arising out of "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard". If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard", then such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by "your work" performed under that contract, agreement, or permit and included in the "products -completed operations hazard". c. The coverages provided in Paragraphs a. and b. do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the "bodily injury', "property damage" or "personal and advertising injury". d. Exclusions (1) With respect to the insurance afforded to additional insureds under a. Ongoing Operations the following is added to 2. Exclusions under SECTION 1 — COVER- AGE A— BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: This insurance does not apply to "bodily injury"property damage", or "personal and advertising injury' occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed, or (b) That portion of "your work" out of which the injury or damage arises has bean put to its intended use by any person or organization other than another contrac- tor or subcontractor engaged in perform- ing operations for a principal as a part of the same project. (2) With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations, the following is added to 2. Exclusions under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This insurance does not apply to: "Bodily injury"property damage", or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, held orders, change orders or drawings and specifications, or (b) Supervisory, inspection, architectural or engineering activities. e. Conditions With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations the following is added to Paragraph 4. Other Insurance, a. Primary Insurance under SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary and will not contribute with any other insurance available to an additional insured under this coverage part provided that: (1) The additional insured is a Named Insured under such other insurance. (2) You have agreed in a written contract, written agreement ar written permit to include that additional insured on your General Liability policy an a primary and/or non-contributory basis. 2. PROPERTY DAMAGE CARE, CUSTODY OR CONTROL The following is added to Exclusion J. under SECTION i — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) do not apply for the limited purpose of providing the coverage and sub -limits of liability as set forth below. We will pay those sums that the insured becomes legally obligated to pay as damages arising out of "property damage" to. (1) Personal property in the care, custody or control of the insured; and (2) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations. The most we will pay under (1) and (2) above in any one "occurrence" or for all damages during any one policy period is a sub -limit of $100,000, These limits are included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. Our right and duty to defend the insured against any "suit" for damages under (1) and (2) above ends when we have used up the applicable sub -limit of liability in the payment of judgments or settlements under it. 3. OTHER INSURANCE AMENDMENT — SUPPLE- MENTAL COVERAGE FOR INSURED'S INVOLVE- MENT IN A CONSOLIDATED (WRAP-UP) IN SUR- ANCE PROGRAM OR SIMILAR PROJECT The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDI- TIONS, Paragraph 4. Other insurance b. Excess Insurance (1)(a). (v) That is covered by a consolidated (wrap-up) or similar insurance program provided by the prime contractor/project manager or owner of the construction project in which you are involved for your ongoing operations or operations included within the "products -completed operations hazard", unless such consolidated (wrap-up) or similar program is specifically excluded from coverage on this policy. 4. FELLOW EMPLOYEE EXTENSION Under SECTION II —WHO IS AN INSURED Para- graphs 2.a. and 2.a. (1) are replaced by the following. a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture, or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. The Employers Liability exclusion (SECTION I -- COVERAGES; COVERAGE A, exclusion e.) does not apply to this provision. However, none of these "employees" or it workers" are insureds for. (1) "Bodily injury" or "personal and advertising injury . (aj Arising out of his or her providing or failing to provide professional health care services. 5. CONTRACTUAL LIABILITY (RAILROADS) Definition 9. insured Contract is amended as fol- IoWs. Paragraph c. is deleted in its entirety and replaced with the following. Any easement or license agreement; Paragraph f.(1) is deleted in its entirety. 6. CONTRACTUAL LIABILITY AMENDMENT — (PERSONAL AND ADVERTISING INJURY) If it is required in a written contract, written agreement or written permit with the insured that any contractual liability exclusion for Personal Injury be removed from the policy, then Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND ADVERTISING INJURY, 2. Excluslons is deleted in its entirety and replaced with the following. e. Contractual Liability "Personal and advertising Injury" for which the insured has assumed liability in a contract or agreement arising out of an "advertisement". This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement" 7. WAIVER OF GOVERNMENTAL IMMUNITY We will waive, both in the adjustment of claims and in the defense of "suits" against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of Immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. 8. DAMAGE TO PREMISES RENTED TO YOU The Limit of insurance far Damage To Premises Rented To You is increased to $1,000,000. ElitePac® Commercial Automobile Extension COMMERCIAL AUTO CA 78 49 11 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless modified by the endorsement. AMENDMENTS TO SECTION 11 - LIABILITY COVER- EMPLOYEE INDEMNIFICATION AND EMPLOY - AGE ER'S LIABILITY AMENDMENT A. if this policy provides Auto Liability coverage for Owned Autos, the following extensions are applica- ble accordingly: NEWLY ACQUIRED OR FORMED ORGANIZA- TIONS The following is added to SECTION II, A.1. Who Is An Insured: Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no similar insurance available to that organi- zation. However. 1. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; 2. Coverage does not apply to "bodily injury' or "property damage" resulting from an "accident" that occurred before you acquired or formed the organization. No person or organization is an "insured" with re- spect to the conduct of any current or past partner- ship, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. EXPENSES FOR BAIL BONDS AND LOSS OF EARNINGS Paragraphs (2) and (4) of SECTION II, A.2.a. - Supplementary Payments are deleted in their entirety and replaced with the following: (2) Up to the Limit of Insurance shown on the ElitePac Schedule for the cost of bail bonds (in- cluding bonds for related traffic law violations) required because of an "accident" covered under this policy. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request. This includes actual loss of earnings because of time off from work, which we will pay up to the Limit of Insurance shown on the ElitePac Schedule. The following is added to SECTION II, B.4. - Exclusions: This exclusion does not apply to a "volunteer work- er" who is not entitled to workers compensation, disability or unemployment compensation benefits. FELLOW EMPLOYEE COVERAGE The Fellow Employee Exclusion, SECTION 11, 8.5. - is deleted in its entirety. CARE, CUSTODY OR CONTROL AMENDMENT The following is added to SECTION 11, B.6. - Excluslons. This exclusion does not apply to property owned by anyone other than an "insured", subject to the follow- ing: 1. The most we will pay under this exception for anyone "accident" is the Limit of Insurance stat- ed in the ElitePac Schedule; and 2. A per "accident" deductible as stated in the ElitePac Schedule applies to this exception. B. If this policy provides Auto Liability coverage for Owned Autos or Non -Owned Autos, the following extension is applicable accordingly. LIMITED LIABILITY COMPANIES The following is added to SECTION II, A.1. Who is An {nsured: If you are a limited liability company, your members and managers are "insureds" while using a covered "auto" you don't own, hire or borrow during the course of their duties for you. BLANKET ADDITIONAL INSUREDS - As Required By Contract The following is added to SECTION 11, AA - Who Is An Insured. Any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional "Insured" on your policy. Such person or organization is an additional "insured" only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your owner- ship, maintenance or use of a covered "auto". This coverage shall be primary and non-contributory with respect to the additional "insured". This provision only applies if: 1e it is required in the written contract, written agreement or written permit identified in this sec- tion; 2. It is permitted by law; and 3. The written contract or written agreement has been executed (executed means signed by a named insured) or written permit issued prior to the "bodily injury" or "property damage". Co if this policy provides Auto Liability coverage for Non - Owned Autos, the following extension is applicable accordingly: EMPLOYEES AS INSUREDS If this policy provides Auto Liability coverage for Non -Owned Autos, the following is added to SECTION II, A.1. - Who Is An Insured: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. An "employee" of yours is an "insured" while operat- ing an "auto" hired or rented under a contract or agreement in that "employee's" name with your per- mission, while performing duties related to the con- duct of your business. AMENDMENTS TO SECTION 111 - PHYSICAL DAMAGE COVERAGE If this policy provides Comprehensive, Specified Causes of Loss or Collision coverage, the following extensions are applicable for those "autos" for which Comprehen- sive, Specified Causes of Loss or Collision coverage is purchased. TOWING AND LABOR SECTION III, A.2. -Towing is deleted in its entirety and replaced with the following: We will pay all reasonable towing and labor costs up to the maximum Limit of Insurance shown on the ElitePac Schedule per tow each time a covered "Private Passen- ger Auto", "Social Service Van or Bus" or "Light Truck" is disabled and up to the maximum Limit of Insurance per tow each time a covered "Medium Truck", "Heavy Truck" or "Extra Heavy Truck" is disabled. For labor charges to be eligible for reimbursement the or must be performed at the place of disablement. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. GLASS BREAKAGE DEDUCTIBLE The following is added to SECTION ill, A.3. - Glass Breakage - Hitting A Bird Or Animal - Failing Objects or Missiles: if damaged glass is repaired rather than replaced, no deductible will apply for such repair. This extension does not apply to Emergency Services Organizations and Governmental Entities. ADDIT{ONAL TRANSPQRTATION EXPENSES SEC- TION 111, A.4.a. - Transportation Expenses is deleted in its entirety and replaced with the following: We will pay up to the maximum Limit of Insurance shown on the ElitePac Schedule for temporary transportation expenses that you incur because of any "loss" to a cov- ered "auto", but only if the covered "auto" carries the coverages and meets the requirements described in 1. or 2. below: 1. We will pay temporary transportation expenses for total theft of a covered "auto". We will only pay for such expenses incurred during the period beginning 24 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is re- turned to use or we pay for its "loss". 2. For "loss" other than total theft of a covered "auto" under Comprehensive or Specified Causes of Loss Coverage, or for any "loss" under Collision Coverage to a covered "auto", we will only pay for those tem- porary transportation expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the number of days reasonably required to repair or replace the covered it or 30 days. Paragraph 2. of this extension does not apply while there are spare or reserve "autos" available to you for your operations. This coverage extension does not apply to Emergency Svi erces Organizations and Governmental Entities. HIRED AUTO PHYSICAL. DAMAGE COVERAGE The following is added to SECTION III, A.4. -Coverage Extensions: Physical Damage coverage is hereby extended to apply to Physical Damage "loss" to "autos" leased, hired, rent- ed or borrowed without a driver. We will provide cover- age equal to the broadest coverage available to any covered "auto" shown in the Declarations. But, the most we will pay for "loss" to each "auto" under this coverage extension is the lesser of: 1. The Limit of Insurance stated in the ElitePac Sched- ule; or 2. The actual cash value of the damaged or stolen property as of the time of the "loss", or 3. The actual cost of repairing or replacing the dam- aged or stolen property with other property of like kind and quality. A part is of like kind and quality when it is of equal or better condition than the pre - accident part. We will use the original equipment from the manufacturer when: (a) The operational safety of the vehicle might otherwise be impaired, (b) Reasonable and diligent efforts to locate the appropriate rebuilt, aftermarket or used part have been unsuccessful; or (c) A new original equipment part of like kind and quality is available and will result in the lowest overall repair cost. For each leased, hired, rented or borrowed "auto" our obligation to pay "losses" will be reduced by a deductible equal to the highest deductible applicable to any owned "auto" for that coverage. No deductible will be applied to "losses" caused by fire or lightning. SECTION IV, B.S. Other Insurance Condition, Para- graph 6.16. is deleted in its entirety and replaced by the following: For Hired Auto Physical Damage Coverage, the foilow- Ing are deemed to be covered "autos'" you own: 1. Any covered "auto" you lease, hire, rent, or borrow; and 2. Any covered "auto" hired or rented by your "em- ployee" under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. HIRED AUTO LOSS OF USE COVERAGE The following is added to SECTION III, A.4. - Coverage Extensions: We will pay expenses for which you are legally responsi- ble to pay up to the Limit of Insurance shown on the ElitePac Schedule per "accident" for loss of use of a leased, hired, rented or borrowed "auto" if it results from an "accident". This coverage extension does not apply to Emergency Services Organizations, Governmental Entities, and Schools. AUTO LOANILEASE GAP COVERAGE (Not Applica- ble In New York) The following is added to SECTION III, A.4. - Coverage Extensions: In the event of a total "loss" to a covered "auto" we will pay any unpaid amount due on the lease or loan for a covered "auto", less: 1. The amount paid under the Physical Damage Cover- age Section of the policy, and 2. Any: a. Overdue leaselloan payments at the time of "loss'; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear, high mileage or similar charges; c. Security deposits not refunded by the lessor or financial institution, d. Costs for extended warranties, credit life, health, accident, or disability insurance purchased with the loan or lease, and e. Carry-over balances from previous leases or loans. You are responsible for the deductible applicable to the "loss" for the covered "auto". PERSONAL EFFECTS The following is added to SECTION III, A.4. - Coverage Extensions: If this policy provides Comprehensive Coverage for a covered "auto" you own and that covered "auto" is stolen, we will pay up to the Limit of Insurance shown on the ElitePac Schedule, without application of a deducti- ble, for lost personal effects that were in the covered "auto" at the time of theft. Personal effects do not include jewelry, tools, money, or securities. This coverage is excess over any other collectible insurance. AIRBAG COVERAGE The following is added to SECTION Ili, B.3.a. - Exclu- sions; Mechanical breakdown does not include the accidental discharge of an airbag. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. EXPANDED AUDIO, VISUAL, AND DATA ELEC- TRONIC EQUIPMENT COVERAGE SECTION Ill, B.4. •Exclusions This exclusion does not apply to the following: 1. Global positioning systems, 2. "Telematic devices"; or 3. Electronic equipment that reproduces, receives or transmits visual or data signals and accessories used with such equipment, provided such equipment ISO a. Permanently installed in or upon the covered "auto" at the time of the "loss"; b. Removable from a hous!ng unit that is perma- nently installed in the covered "auto" at the time of the "loss' c. Designed to be solely operated by use of power from the "auto's" electrical system, or d. Designed to be used solely in or upon the covered "auto". For each covered "loss" to such equipment, a deductible of $50 shall apply, unless the deductible otherwise appli- cable to such equipment is less than $50, at which point the lower deductible, if any, will apply. COMPREHENSIVE DEDUCTIBLE - LOCATION TRACKING DEVICE The following is added to SECTION III, D. -Deductible: Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the covered "auto" is equipped with a location tracking device and that device was the sole method used to recover the "auto". PHYSICAL DAMAGE LIMIT OF INSURANCE SECTION III, C. •Limit Of Insurance is deleted in its entirety and replaced with the following: The most we will pay for a "loss" in any one "accident' is the lesser of, 1. The actual cash value of the damaged or stolen property as of the time of the "loss"; or 2. The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. AMENDMENTS TO SECTION IV - BUSINESS AUTO CONDITIONS DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The following is added to SECTION IV, A.2.a. - Duties In The Event Of Accident, Claim, Suit Or Loss: The notice requirements for reporting "accident" claim, "suit" or "loss" information to us, including provisions related to the subsequent investigation of such "acc!- dent", claim, "suit" or "loss" do not apply until the "accident", claim, "suit" or "loss" is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An executive officer or insurance manager, if you are a corporation, 4. Your members, managers or insurance manager, if you are a limited liability company, 5. Your elected or appointed officials, trustees, board members or your insurance manager, if you are an organization other than a partnership, joint venture or limited liability company. But, this section does not amend the provisions relating to notification of police or protection or examination of the property that was subject to the "loss". WAIVER OF SUBROGATION SECTION IV, A.S. -Transfer Of Rights Of Recovery Against Others To Us is deleted in its entirety and replaced with the following: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury" or "property damage" resulting from the ownership, maintenance or use of a covered "auto" but only when you have assumed liability for such "bodily injury" or "property damage" in an "insured con- tract". In all other circumstances, if a person or organiza- tion to or for whom we make payment under this Cover- age Form has rights to recover damages from another, those rights are transferred to us. MULTIPLE DEDUCTIBLES The following is added to SECTION IV, A. -Loss Conditions: If a "loss" from one event involves two or more covered "autos" and coverage under Comprehensive or Specified Causes of Loss applies, only the highest applicable deductible will be applied. CONCEALMENT, MISREPRESENTATION OR FRAUD The following is added to SECTION IV, B.2. - Conceal- ment, Misrepresentation Or Fraud: if you should unintentionally fail to disclose any existing hazards in your representations to us prior to the incep- tion date of the policy or during the policy period in connection with any newly discovered hazards, we will not deny coverage under this Coverage Form based upon such failure. POLICY PERIOD, COVERAGE TERRITORY SECTION IV, B.7. On Policy Period, Coverage Territory is deleted in its entirety and replaced with the following. Under this Coverage Form, we cover "accidents" and "losses" occurring: a. During the policy period shown in the Declarations; and b. Within the "Coverage Territory". We also cover "loss" to or "accidents" involving a cov- ered "auto" while being transported between any of these places. TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US - DEDUCTIBLES The following is added to SECTION IV, B.ti. -Two Or More Coverage Forms Or Policies Issued By Us. If a "loss" covered under this Coverage Form also in- volves a "loss" to other property resulting from the same "accident" that is covered under this policy or another policy issued by us or any member company of ours, only the highest applicable deductible will be applied. AMENDMENTS TO SECTION V - DEFINITIONS BODILY INJURY INCLUDING MENTAL ANGUISH (Not Applicable in New York) The definition of bodily injury is deleted in its entirety and replaced by the following. "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including death resulting from any of these. "Bodily injury" includes mental anguish resulting from bodily injury, sickness or disease sus- tained by a person. ADDITIONS TO SECTION V -DEFINITIONS COVERAGE TERRITORY "Coverage Territory" means: 1. The United States of America (including its territories and possessions), Canada and Puerto Rico; and 2. Anywhere in the world, except for any country or jurisdiction that Is subject to trade or other economic sanction or embargo by the United States of America, if a covered "auto" is leased, hired, rented, or borrowed without a driver for a period of 30 days or less, and the insured's responsibility to pay "dam- ages" is determined in a "suit" on the merits in and under the substantive law of the United States of America (including its territories and possessions), Puerto Rico, or Canada, or in a settlement we agree to. If we are prevented by law, or otherwise, from defending the "insured" in a "suit" brought in a location described in Paragraph 2. above, the insured will conduct a defense of that "suit". We will reimburse the "insured" for the rea- sonable and necessary expenses incurred for the de- fense of any such "suit" seeking damages to which this insurance applies, and that we would have paid had we been able to exercise our right and duty to defend. EXTRA HEAVY TRUCK "Extra Heavy Truck" means a truck with a gross vehicle weight rating of 45,001 pounds or more. HEAVY TRUCK "Heavy Truck" means a truck with a gross vehicle weight rating of 20,001 pounds to 45,000 pounds. LIGHT TRUCK ght Truck" means a truck with a gross vehicle weight ratV ng of 10,000 pounds or less. MEDIUM TRUCK "Medium Truck" means a truck with a gross vehicle weight rating of 10,001 pounds to 20,000 pounds. PRIVATE PASSENGER AUTO "Private Passenger Auto" means afour-wheel "auto" of the private passenger or station wagon type. A pickup, panel truck or van not used for business is included within the definition of a "private passenger auto". SOCIAL SERVICE VAN OR BUS "Social Service Van or Bus" means a van or bus used by a government entity, civic, charitable or social service organization to provide transportation to clients inci- dental to the social services sponsored by the organiza- tion, including special trips and outings. TELEMA7IC DEVICE "Telematic Device" includes devices designed for the collection and dissemination of data for the purpose of monitoring vehicle and/or driver performance. This in- cludes Global Positioning System technology, wireless safety communications and automatic driving assistance systems, all integrated with computers and mobile com- munications technology in automotive navigation sys- tems. VOLUNTEER WORKER "Volunteer worker" means a person who performs busi- ness duties for you, for no financial or other compensa- tion. General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY cG �3 00 01 19 SUMMARY OF COVERAGES (including index This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3-through-9} for changes affecting your insurance protection. DESCRIPTION Additional Insureds - Primary and Non -Contributory Provision Blanket Additional Insureds - As Required By Contract • Owners, Lessees or Contractors (includes Architects, Engineers or Surveyors • Lessors of Leased Equipment • Managers or Lessors of Premises • Mortgagees, Assignees and Receivers • Any Other person or organization other than a joint venture • Grantors of Permits Broad Form Vendors Coverage Damage To Premises Rented To You (including Fire, Lightning or Explosion} Electronic Data Liability ($100,000) Employee Definition Amended Employees As Insureds Modified Employer's Liability Exclusion Amended {Not applicable in New York) Incidental Malpractice Exclusion modified Knawledge of Occurrence, Claim, Suit or Loss Liberalization Clause Mental Anguish Amendment {Not applicable to New York) Newly Formed or Acquired Organizations Non -Owned Aircraft Non -Owned Watercraft {under 60 feet) Not -for -profit Members - as additional insureds � Personal And Advertising Injury -Discrimination Amendment (Not applicable in New York) � Products Amendment (Medical Payments) Supplementary Payments Amended -Bail Bonds ($5,000) and Loss of Earnings ($1,000) Two or More Coverage Parts or Policies Issued By Us Unintentional Failure to Disclose Hazards � Waiver of Transfer of Rights of Recovery (subrogation) ..� When Two or More Coverage Parts of this Policy Apply to a Loss Copyright, 201f3 Selective Insurance Company of America. Ail rights reserved. Includes copyrighted material of Insurance Services OFfice, Inc., with its permission. i7Tr1��•lT1�L�7 CG73000119 Page 1 of 9 THIS PAGE IS INTENTIONALLY LEFT BLANK. Copyright, 2018 Selective Insurance Company of America. Ali rights reserved. CG ?3 00 01 19 Includes coavriahted material of Insurance Services t7ffice, Inc., with its permission. Page 2 of 9 General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG i3 00 01 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the insurance provided under the following: GOMMERGIAt_ GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. However, if (a) two or more Coverage Parts of this policy, or (bj two or more forms or endorsements within the same Coverage Part apply to a toss, coverage provisions) with the broadest language will apply, unless specifically stated otherwise within the particular amendment covering that loss. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. COVERAGES -Amendments B. The following is added to Exclusion g. Aircraft, SECTION I - COVERAGE A BODILY INJURY AND Auto Or Watercraft under COVERAGE A BODft_Y PROPERTY DAMAGE LIABILITY 8►lJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions; EXCLUSIONS This exclusion does not apply to: Employer's Liability Amendment (g) Any aircraft, not owned or operated by any (This provision is not applicable in the State of New insured, which is hired, chartered or loaned York). with a paid crew. However, if the insured The following is added to Exclusion e. Employer's has any other valid and collectible insur- Uability under COVERAGE A BODILY INJURY AND ance for "bodily injury" or "property dam - PROPERTY DAMAGE LIABILITY, 2. Exdusions; age" that would be covered under this This exclusion also does not apply to any provision, or on any other basis, this cover- "temporaryworker". age is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance Non -Owned Aircraft, Auto or Watercraft under SECTION N - COMMERCIAL A. Paragraph (2) of Exclusion g. Aircraft, Auto Or GENERAL LIABILITY CONDfTIONS. Watercraft under COVERAGE A BODILY INJURY Damage To Premises Rented to You AND PROPERTY DAMAGE LIABILITY, 2. Exdus- A. The last paragraph of Paragraph 2. Exdusions ions is deleted in its entirety and replaced with under COVERAGE A BODILY INJURY AND the following; PROPERTY DAMAGE is deleted in its entirety (2) A watercraft you do not own that is: and replaced with the following: (a) Less than 26 feet long and not being Exclusions c. through n. do not apply to damage used to carry persons or property fora by fire, lightning or explosion to premises rented charge; or to you or temporarily occupied by you with the (b) At least 26 feet, but less than 60 feet permission of the owner. A separate limit of long. and not being used to carry per- insurance applies to this coverage as described sons or property for a charge. Any in SECTION III -LIMITS OF INSURANCE. person is an insured who uses or is responsible for the use of such water- craft with your expressed or implied consent. However, lithe insured has any other valid and collectible insurance for "bodily injury" or "property damage" that would be covered under this provi- sion, or on any other basis, this cover- age is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION N - COM- MERCIAL GENERAL LtAB�.tTY CONDI- TIONS. Copyright, 2018 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. B. Paragraph 6. under SECTION III -LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to Paragraph i3. above, the most we will pay under COVERAGE A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner, for all such damage caused by fire, lightning or explosion proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of the three, is the amount shown in the Declarations for the Damage To Premises Rented To You Limit. C. Paragraph a. of Definition 9. "Insured contract" under SECTION V • DEF�1tTIONS is deleted in its entirety and replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with the per- mission of the owner is not an "insured contract' ; Electronic Data Liability A. Exclusion p. Access or Disclosure Of Conftden- tial Or Personal Information And Data -related Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Access or Disdosure Of Confidential Or Personal Information And Data•related Liability Damages arising out of: (1) Any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial infor- motion, credit card information or any other type of nonpublic information; or (2} The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. This exclusion applies even if damages are claimed for notification costs, credit mon- itoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or {2) above. B. The following paragraph is added to SECTION Ili • LIMITS OF INSURANCE: Subject to 5. above, the most we will pay under COVERAGE A for "property damage" because of ail loss of "electronic data" arising out of any one "occurrence" is a sub -limit of $100,000. SECTION 1 • COVERAGE C MEDICAL PAYMENTS EXCLUSIONS Any Insured Amendment Exclusion a. Any insured under COVERAGE C MEDICAL PAYMENTS, 2. Exdusions is deleted in its entirety and replaced with the following: a. Any Insured To any insured. This exclusion does not apply to: (1) "Not -for -profit members'; (2) "Golfing facility" members who are not paid a fee, salary, or other compensation; or (3} "Volunteer workers". This exclusion exception does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Product Amendment Exclusion f. Products -Competed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: f. Products•Compteted Operations Hazard Included within the "products -completed opera- tions hazard". This exclusion does not apply to "your products" sold for use or consumption on your premises, while such products are stilt on your premises. This exclusion exception, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. SECTION 1 - SUPPLEMENTARY PAYMENTS - COVERAGES A AND B Expenses For Bail Bonds And Lass Of Earnings A. Subparagraph 1.b. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 9 B. Subparagraph 1.d. under SUPPLEMENTARY a. Coverage under this provision is afforded PAYMENTS • COVERAGES A AND B is deleted only until the 180th day after you acquire or in its entirety and replaced with the following: form the organization or the end of the d. Ali reasonable expenses incurred by the policy period, whichever is earlier. However, insured at our request to assist us in the COVERAGE A does not apply to "bodily investigation or defense of the claim or injury or property damage that occurred "suit", including actual loss of earnings up to before you acquired or formed the organi- $1,000 aday because of time off from work. zation. SECTION II •WHO IS AN INSURED -Amendments 8. The following paragraph is added to SECTION II - WHO IS AN INSURED, Not for-ProTit Organization Members paragraph 3: The following paragraph is added to SECTION II • if you are engaged in the business of con - WHO IS AN WSURED; struction of dwellings three stories ar less in If you are an organization other than a partnership, height, or other buildings three stories or joint venture, or a limited liability company, and you less in height and less than 25,000 square are anot-far-profit organization, the following are feet in area, you will also be an insured with included as additional insureds: respect to "your work" only, for the period of 1. Your officials; time described above, for your liability arising out of the conduct of any partnership 2. Your trustees; or joint venture of which you are or were a 3. Your members; member, even if that partnership or joint 4. Your board members; venture is not shown as a Named Insured. However, this provision only applies if you 5. Your commission members; maintain or maintained an interest of at 6. Your agency members; least fifty percent in that partnership or joint venture for the period of that partnership or 7. Your insurance managers; joint venture. 8. Your elective or appointed officers; and This provision does not apply to any partnership or 8. Your "not -for -profit members". joint venture that has been dissolved or otherwise However only with respect to their liability for your ceased to function for mare than thirty-six months. activities or activities they perform on your behalf. With respect to the insurance provided by this Employees As Insureds Modified provision, Newly Formed or Acquired Organizations, the following is added to SECTION N • COMMER- A. Subparagraph 2.a.(1)(a) under SECTION it CIAL GENERAL LIABILITY, Paragraph 4. Other WHO IS AN INSURED does not apply to "bodily Insurance, Subparagraph b. Excess Insurance: injury" to a "temporary worker" caused by a co- "empioyee" who is not a "temporary worker". The insurance provided by this provision, Newly Formed or Acquired Organizations, is excess over B. Subparagraph 2.a.(2) under SECTION 11 -WHO any other insurance available to the insured, tS AN INSURED does not apply to "property whether primary, excess, oantingent or on any other damage" to the property of a "temporary basis. worker" or "volunteer worker" caused by a,co- (Ail other provisions of this section remain employee who is not a temporary worker or unchanged) "volunteer worker". C. Subparagraph 2,a.{1xd) under SECTION it - Blanket Additional Insureds • As Required By WHO IS AN INSURED does not apply to "bodily Contract injury" caused by cardio-pulmonary resuscita- Subject to the Primary and Non -Contributory provi- tion or first aid services administered by a co- sion set forth in this endorsement, SECTION 11 - "employee ". WHO IS AN INSURED is amended to include as an With respect to this provision only, Subparagraph additional insured: (1) of Exclusion 2. e. Employer's Liability under A. Owners, Lessees or Contractors/Architects, SECTION I •COVERAGES, COVERAGE A BODILY Engineers and Surveyors INJURY AND PROPERTY DAMAGE LtABtI.ITY does 1, Any person ar organization for whom you not apply. are performing operations when you and Newly Formed Or Acquired Organizations such person or organization have agreed in A. Subparagraph 3.a. under SECTION II -WHO IS a written contract, written agreement or AN INSURED is deleted in its entirety and written permit that such person or organi- replaced with the following: zation be added as an additional insured on your commercial general liability policy; and Copyright, 2018 Selective Insurance Company of America. Ali rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG73444119 Page 5 of 9 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above: Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts of omissions of those acting on your behalf; in the performance of your ongoing operations performed for the additional insured in Para- graph 1., above. However, this insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury"' arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. Professional services do not include services within construction means, methods, tech- niques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor. A person or organization's status as an additional insured under this endorsement ends when your operations for the person or organi- zation described in Paragraph 1. above are completed. B. Other Additional Insureds Any of the following persons or organizations with whom you have agreed in a written contract, written agreement or written permit that such persons or organizations be added as an additional insured on your commercial general liability policy: 1. Lessors of Based Equipment Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organi- zation. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you. This insurance does not apply to any "occurrence" which takes place after you cease to be a tenant of that premises. Any person or organization with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to any "occurrence" which takes place after the mortgage is satisfied, or the assignment or receivership ends. a. Any Person or Organization Other Than A Joint Venture Any person or organization (other than a joint venture of which you are a member), but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts of omissions of those acting on your behalf in the performance of your ongoing operations or in connection with property owned by you. 5. State or Governmental Agency or Political Subdivision -Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, but only with respect to: a. Operations performed by you or on your behalf for which the state or govern- mental agency or subdivision or political subdivision has issued a permit or authorization; or b. The following hazards for which the state or governmental agency or sub- division or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: Copyright, 2018 Selective Insurance Company of America. Ail rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Qfflce, Inc., with its permission. Page 6 of 9 (1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, cano- pies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decora- tions and similar exposures; (2) The construction, erection or re- moval of elevators; or (3) The ownership, maintenance ar use of any elevators covered by this insurance. This insurance does not apply to: (a} "Bodily injury" or "property damage" arising out of opera- tions performed for the federal government, state or munici- pality; or (b) "Bodily injury" or "property damage" included within the "products -completed operations hazard". With respect to Paragraphs 2. through 4., this insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. The provisions of this coverage extension do not apply unless the written contract or written agree- ment has been signed by the Named Insured or written permit issued prior to the "bodily injury" or "property damage" or "personal and advertising injury". Broad Form Vendors Coverage Subject to the Primary and Non-contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) for whom you have agreed in a written contract or written agreement to provide coverage as an additional insured under your policy. Such person or organization is an additional insured only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. However, the insurance afforded the vendor doss not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or t. Products which, after distribution or sale by you, have been labeled or re -labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. The provisions of this coverage extension do not apply unless the written contract or written agree- ment has been signed by the Named Insured prior to the "bodily injury" or "property damage". inddental Malpractice Subparagraph 2.a.(1xd) under SECTION II -WHO IS AN INSURED is deleted in its entirety and replaced with the following: (d) Arising out of his or her providing or failing to provide professional health care services. This does not apply to nurses, emergency medical technicians or paramedics if you are not in the business or occupation of providing any such professional services. This also doss not apply to "bodily injury" caused by cardio-pulmonary resuscitation or first aid services administered by a co - "employee". This provision does not apply if you are a Social Service or Senior Living risk. SECTION IV -COMMERCIAL GENERAL, LIABILITY CONDITIONS •Amendments Knowledge Of Occurrence, Claim, Suit Or Loss The following is added to Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV •COMMERCIAL GENERAL LIABILITY CONDITIONS: The requirements under this paragraph do not apply until after the "occurrence" or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; Copyright, 2018 Selective Insurance Company of America. Ail rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 73 00 Q1 19 Page7of9 3. An "executive officer" or insurance manager, if you are a corporation; 4. Your members, managers or insurance manager, if you are a limited liability company; or 5. Your elected or appointed officials, officers, members, trustees, board members, commis- sion members, agency members, or your administrator or your insurance manager if you are an organization other than a partnership, joint venture, or limited liability company. Primary and Non -Contributory Provision The following is added to Paragraph 4. Other insur- ance, b. Excess insurance under SECTION N - COMMERCIAL GENERAL LIABILITY CONDRIONS: This insurance is primary to and we will not seek contribution from any other insurance available to an additional insured under this policy provided that: (1j The additional insured is a Named Insured under such other insurance; and (2) You have agreed in a written contract, written agreement or written permit that this insurance would be primary and would not seek contri- bution from any other insurance available to the additional insured. Untntentlonal Failure To Disclose Hazards The following is added to Paragraph 6. Representations under SECT�N N -COMMERCIAL GENERAL LIABILITY CONDITIONS: However, if you should unintentionally fail to disclose any existing hazards in your representa- tions to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under this Coverage Part based upon such failure to disclose hazards. Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION iV -COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of pay- ments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "products -completed operations hazard", if: 1. You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or 3. You have assumed the liability of that person or organization in that same contract, and it is an "insured contract". The section above only applies to that person or organization identified above, and only if the "bodily injury" or "property damage" occurs subsequent to the execution of the written contract or written agreement. Uberalization The following condition is added to SECTION N - COMMERCIAL GENERAL LIABILITY CONDtT10NS: if we revise this Coverage Part to provide more coverage without additional premium charge, sub- ject to our filed company rules, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. Two or More Coverage Parts or Polides Issued By Us (This provision is not Applicable in the state of New York or Wisconsin). The following condition is added to SECTION N - COMMERCIAL GENERAL LIABILITY CONDITIONS: It is our intention that the various coverage parts or policies issued to you by us, or any company affiliated with us, do not provide any duplication or overlap of coverage. We have exercised diligence to draft our coverage parts and policies to reflect this intention. However, if the facts and circumstances that will respond to any claim or "suit" give rise to actual or claimed duplication or overlap of coverage between the various coverage parts or policies issued to you by us or any company affiliated with us, the limit of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limit under this coverage, or any one of the other coverage forms or policies. This condition does not apply to any Excess or Umbrella policy issued by us specifically to apply as excess insurance over this coverage part or policy to which this coverage part is attached. SECTION V - DEFtNIT10NS Discrimination (This provision does not apply in New York). A. The following is added to Definition 14. "Per- sonal and advertising injury": "Personal and advertising injury" also means "discrimination" that results in injury to the feelings or reputation of a natural person, how- ever only if such "discrimination" or humiliation is: 1. Not done by or at the direction af: a. The insured; or Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copvri�hted material of Insurance Services Office, Inc., with its permission. Page $ of 9 b. Anyone considered an insured under b. Loss of, loss of use of, damage to, SECT�N it -WHO IS AN INSURED; corruption of, inability to access, or inability to properly manipulate electronic data", re- 2. Not done intentionally to cause harm to suiting from physical injury to tangible another person. property. All such loss of "electronic data" 3. Nat directly or indirectly related to the em- shall be deemed tv occur at the time of the ployment, prospective employment yr termi- "occurrence" that caused it. nation of employment of any person or For the purpose of the Electronic Data Liability persons by any insured. coverage provided by this endorsement, "electronic 4. Not arising out of any "advertisement" by data" is not tangible property. the insured. Employee Amendment B. The following definition is added to SECTION V - Definition 5. "Employee" under SECTION V - DEFINI- DEFINPfIONS: TiONS is deleted in its entirety and replaced by the "Discrimination" means: following: a. Any act or conduct that would be considered g, "Employee" includes a "leased worker", or a discrimination under any applicable federal, "temporary worker". If you are a School, state, ar local statute, ordinance or law; "Employee" also includes a student teacher. b. Any act or conduct that results in disparate Coifing Facility treatment of, or has disparate impact on, a The following definition is added to SECTION V - person, because of that person's race, pEFINRIONS: religion, gender, sexual orientation, age, "Golfing facility" means a golf course, golf club, disability or physical impairment; or driving range, or miniature golf course. c. Any act or conduct characterized or inter- Mental Anguish Amendment peeted as discrimination by a person based This provision does not apply in New York). on that person's race, religion, gender, sexual orientation, age, disability or physi- Definition 3. "Bodily injury" under SECTION V- cal impairment. DEFINtTtONS is deleted in its entirety and replaced It does not include acts or conduct character- with the following: fzed or interpreted as sexual intimidation or g, "godily injury" means bodily injury, sickness or sexual harassment, or intimidation or harass- disease sustained by a person, including death ment based on a person's gender. resulting from any of these at any time. This Electronic Data includes mental anguish resulting from any bodily injury, sickness or disease sustained by a The following definition is added to SECTION V - person. {In New York, mental anguish has been DEFINRtONS: determined to be "bodily injury"). "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cell, data pro- cessing devices or any other media which are used with electronically controlled equipment. For the purpose of the Electronic Data Liability coverage provided by this endorsement, Definition 17. "Prop- erty damage" is deleted In its entirety and replaced by the following. 17. "Property damage" means: a. Physical injury to tangible property, includ- ing all resulting loss of use of that property. All such loss of use shall be deemedto occur at the time of the physical injury h caused it; or Nat for -profit Member The following definition is added to SECTION V - DEFINRIONS: "Not -for -profit member" means a person who is a member of anot-for-profit organization, including clubs and churches, who receives no financial or other compensation. Copyright, 2018 Selective Insurance Company of America. Atl rights reserved. includes couvriohted material of Insurance Services Office, Inc., with its permission. CGT3000119 Page9of9