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Improvement Contract_Bond_Drew Cook, Hike-Bike Trail Phase 4 & 5 SECTION 00600 Page 1 of 4 PERFORMANCE, PAYMENT AND MAINTENANCE BOND SECTION 00600 KNOW ALL BY THESE PRESENTS: That we, Drew Cook & Sons Excavating, Ing. as Principal (hereinafter the "Contractor" or "Principal") and IMT Insurance Company as Surety are held and firmly bound unto the City of Dubuque, Iowa, as Obligee (hereinafter referred to as "Owner"), and to all persons who may be injured by any breach of any of the conditions of this Bond in the penal sum of Two Hundred Seventy-Three Thousand Four Htmdrpd Sixty-Fi STP anal 10/1001'-°-' dollars ($273,465.10 ), lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, legal representatives and assigns, jointly or severally, firmly by these presents. The conditions of the above obligations are such that whereas said Contractor entered into a contract with the Owner, bearing date the 18th day of Au ust, 2015, (hereinafter the "Contract") wherein said Contractor undertakes and agrees to construct the following project in accordance with the Contract Documents, and to faithfully perform all the terms and requirements of said Contract within the time therein specified, in a good and workmanlike manner, and in accordance with the Contract Documents. The Contract Documents for IA 32 HIKE-BIKE TRAIL PHASE 4 & 5 PROJECT Project detail the following described improvements: IA 32 Hike-Bike Trail Phase 4 and 5 Project CIP # 3502430 This project will include the construction of a 4400 foot long asphalt trail which is 10 feet wide between Holliday Drive and Chavanelle Drive along the west side of IA 32. The trail will be constructed in Iowa DOT ROW. The construction will include 4" thick HMA pavement with 8" thick granular stone base. 3" breaker stone has been estimated for 25% of the trail to be used for additional stability. a The trail will be graded to a width of 12' wide to allow for the stone base and paving operations. Additionally, 66 bike sharrows will be painted on Chavanelle Road from the trail at IA 32 to the bike trail east of Bergfeld Pond. A small 250 SF Versalok or approved equal retaining wall will be constructed at Bergfeld pond to allow for construction of ADA accessible sidewalk to the east u side of the bridge. It is expressly understood and agreed by the Contractor and Surety in this Bond that the following provisions are a part of this Bond and are binding upon said Contractor and Surety, to-wit: 1. PERFORMANCE: The Contractor shall well and faithfully observe, perform, fulfill, and abide by each and every covenant, condition, and part of said Contract and Contract Documents, by reference made a part hereof, for the project, and shall indemnify and save SECTION 00600 Page 2 of 4 harmless the Owner from all outlay and expense incurred by the Owner by reason of the Contractor's default of failure to perform as required. The Contractor shall also be responsible for the default or failure to perform as required under the Contract and Contract Documents by all its subcontractors, suppliers, agents, or employees furnishing materials or providing labor in the performance of the Contract. 2. PAYMENT: The Contractor and the Surety on this Bond hereby agreed to pay all just claims submitted by persons, firms, subcontractors, and corporations furnishing materials for or performing labor in the performance of the Contract on account of which this Bond is given, including but not limited to claims for all amounts due for labor, materials, lubricants, oil, gasoline, repairs on machinery, equipment, and tools, consumed or used by the Contractor or any subcontractor, wherein the same are not satisfied out of the portion of the contract price the Owner is required to retain until completion of the improvement, but the Contractor and Surety shall not be liable to said persons, firms, or corporations unless the claims of said claimants against said portion of the contract price shall have been established as provided by law. The Contractor and Surety hereby bind themselves to the obligations and conditions set forth in Chapter 573 of the Iowa Code, which by this reference is made a part hereof as though fully set out herein. 3. MAINTENANCE: The Contractor and the Surety on this Bond hereby agree, at their own expense: A. To remedy any and all defects that may develop in or result from work to be performed under the Contract Documents within the period of two (2) year(s) from the date of acceptance f p ce o the work under the Contract, by reason of defects in workmanship, equipment installed, or materials used in construction of said work; B. To keep all work in continuous good repair; and ii C. To pay the Owner's reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the Owner all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. Contractor's and Surety's Contract herein made extends to defects in workmanship p or materials not discovered or known to the Owner at the time such work was accepted. u f 4. GENERAL: Every Surety on this Bond shall be deemed and held bound, any contract to the 4 contrary notwithstanding, to the following provisions: A. To consent without notice to any extension of time authorized in approved change orders to the Contractor in which to perform the Contract; B. To consent without notice to any change in the Contract or Contract Documents, authorized in approved change orders which thereby increases the total contract price and the penal sum of this Bond, provided that all such changes do not, in the fi SECTION 00600 Page 3of4 aggregate, involve an increase of more than twenty percent(20%) of the total contract price, and that this Bond shall then be released as to such excess increase; C. To consent without notice that this Bond shall remain in full force and effect until the Contract is completed, whether completed within the specified contract period, within an extension thereof, or within a period of time after the contract period has elapsed and the liquidated damage penalty is being charged against the Contractor. The Contractor and every Surety on the Bond shall be deemed and held bound, any contract to the contrary notwithstanding, to the following provisions: D. That no provision of this Bond or of any other contract shall be valid that limits to less than five (5) years after the acceptance of the work under the Contract the right to sue on this Bond. E. That as used herein, the phrase "all outlay and expense" is not to be limited in any way, but shall include the actual and reasonable costs and expenses incurred by the Owner including interest, benefits, and overhead where applicable. Accordingly, "all outlay and expense" would include but not be limited to all contract or employee expense, all equipment usage or rental, materials, testing, outside experts, attorney's fees (including overhead expenses of the Owner's staff attorneys), and all costs and expenses of litigation as they are incurred by the Owner. It is intended the Contractor and Surety will defend and indemnify the Owner on all claims made against the Owner on account of Contractor's failure to perform as required in the Contract and Contract Documents, that all agreements and promises set forth in the Contract and Contract Documents, in approved change orders, and in this Bond will be fulfilled, and that the Owner will be fully indemnified so that it will be put into the position it would i have been in had the Contract been performed in the first instance as required. a In the event the Owner incurs any "outlay and expense" in defending itself against any claim as to which the Contractor or Surety should have provided the defense, or in the enforcement of the promises given by the Contractor in the Contract, Contract Documents, or approved change orders, or in the enforcement of the promises given by the Contractor and Surety in this Bond, the Contractor and Surety agree that they will make the Owner whole for all such outlay and expense, provided that the Surety's obligation under this Bond shall not exceed one hundred twenty-five percent(125%) of the penal sum of this Bond. In the event that any actions or proceedings are initiated regarding this Bond, the parties agree that the venue thereof shall be Dubuque County, State of Iowa. If legal action is required by the Owner to enforce the provisions of this Bond or to collect the monetary obligation incurring to the benefit of a the Owner, the Contractor and the Surety agree, jointly, and severally, to pay the Owner all outlay and expense incurred therefor by the Owner. All rights, powers, and remedies of the Owner hereunder shall be cumulative and not alternative and shall be in addition to all rights, powers, and 1 a t i t SECTION 00600 Page 4of4 remedies given to the Owner, by law. The Owner may proceed against surety for any amount guaranteed hereunder whether action is brought against the Contractor or whether Contractor is joined in any such action(s) or not. NOW THEREFORE, the condition of this obligation is such that if said Principal shall faithfully perform all the promises of the Principal, as set forth and provided in the Contract, in the Contract Documents, and in this Bond, then this obligation shall be null and void, otherwise it shall remain in full force and effect. When a work, term, or phrase is used in this Bond; it shall be interpreted or construed first as defined in this Bond, the Contract, or the Contract Documents; second, if not defined in the Bond, Contract, or Contract Documents, it shall be interpreted or construed as defined in applicable provisions of the Iowa Code; third, if not defined in the Iowa Code, it shall be interpreted or construed according to its generally accepted meaning in the construction industry; and fourth, if it has no generally accepted meaning in the construction industry, it shall be interpreted or construed according to its common or customary usage. Failure to specify or particularize shall not exclude terms or provisions not mentioned and shall not limit liability hereunder. The Contract and Contract Documents are hereby made a part of this Bond. Project No. 1002273 i Witness our hands, in triplicate, this 31st day of August , 2015. SURETY C I-TERSIGNED BY: Title nt• of Agent FORM APPROVED BY: John E. Goodmann Representa ive for Owner Printed Name of Agent I 2774 University Ave SURETY: Company Address IMT Insuranc mpany Dubuque, IA 52001 SuretyCariy - City,State,Zip Code By' ,, j 563-556-3232 ignatu Attorney-in-Fact Officer Company Telephone Number John E. Goodmann Printed Name of Attorney-in-Fact Officer PRINCIPAL: IMT Insurance Company #' �a Company Name ..�..„JJJ P 0 Box 1336 B : Company Address g re Des Moines, IA 50306-1336 City, State,Zip Code Printed Name 1-800-274-3531 Company Telephone Number i I SECTION 00600 Page 5 of 4 1 NOTE: �J 1. All signatures on this performance, payment, and maintenance Bond must be original signatures in ink; copies, facsimile, or electronic signatures will not be accepted. 2. This Bond must be sealed with the Surety's raised, embossing seal. 3. The name and signature of the Surety's Attorney-in-Fact/Officer entered on this Bond must be exactly as listed on the Certificate or Power of Attorney accompanying this Bond. END OF SECTION 00600 I' li i 4, f u V 5 5 5 5 5 IMT - INSURANCE 5 5 5 5 POWER OF ATTORNEY No. 464 5 SNotice: The warning found elsewhere in this Power of Attorney affects the validity thereof.Please review carefully. 5 SKnow All Persons By These Presents,that IMT Insurance Company a corporation duly organized under the laws of the State of Iowa,and having S 5 its principal office in the City of West Des Moines,County of Polk,State of Iowa,hath made,constituted and appointed,and does by these presents �5 C� make,constitute and appoint 5 5 John E.Goodmann and Barton P.Brown 5 5 of Dubuque and State of Iowa its true and lawful Attorney-in-Fact,with full power and 5 5 authority hereby conferred in its name,place and stead,to sign,execute,acknowledge and deliver in its behalf as surety any and all bonds,under- 5 5 takings,recognizances or other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the 5 Samount of: One Million Five Hundred Thousand and No/100($1,500,000.00)Dollars 5 Sand to bind IMT Insurance Company thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized S 5 officers of IMT Insurance Company,and all such acts of said Attorney-in-Fact,pursuant to the authority herein given,are hereby ratified and 5 Sconfirmed. 5 5 This Power-of-Attorney is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of 5 5 Directors of IMT Insurance Company on December 18, 1998. 5 ARTICLE VIII,SECTION 4.-The President or any Vice President or Secretary shall have the authority to appoint Attorneys In Fact and 5 5 to authorize them to execute on behalf of the Company,and attach thereto the Corporate Seal,bonds,undertakings,recognizances,con- 5 5 tracts of indemnity or other obligatory writings,excluding insurance policies and endorsements. 5 5 ARTICLE VIII,SECTION 5.-The signature of any authorized officer and the Corporate Seal may be affixed by facsimile to any Power 5 5 of Attorney authorizing the execution and delivery of any of the instruments described in Article VIII,Section 4 of the By-Laws. Such 5 5 facsimile signature and seal shall have the same force and effect as though manually affixed. 5 S 5 In Witness Whereof, IMT Insurance Company has caused these presents its President and its corporate seal to 5� � 5 be hereto affixed,this 20th day of May 2015 rj IMV4ns4farice Cotrlpan 5 Rich atl Kgtlhf Presic(ent,b`� 5 5 WARNING: THIS POWER IS INVALID IF NOT PRINTED WITH RD' `ORDER AND RED LOGO. 5 5 STATE OF IOWAss 1 5 �j COUNTY OF POLK J 5 SOn this 20th day of May 2015 before me appeared Richard Keith,to me personally known, 5 5 who being by me duly sworn did say that he is President of the IMT Insurance Company,the corporation described in the foregoing instrument, 5 C55 and that the Seal affixed to the said instrument is the Corporate Seal of the said Corporation and that the said instrument was signed and sealed in 5 behalf of said Corporation by authority of its Board of Directors. 5 5 In Testimony Whereof,I have hereunto set my hand and affixed my Official Seal at the City of West Des Moines,Iowa,the day and year S rj first above written. 5 5 ' A d DEE COMMISSION NO.742311 5 5 5 MYCOMM/SS/ONEXAIRES NotaryPublic,Polk Count Iowa IOWA 8-16-2015 y' S CS CERTIFICATE 5 I,Dalene Holland,Secretary of the IMT Insurance Company do hereby certify that the above and foregoing is a true and correct copy of 5 5 the POWER-OF-ATTORNEY,executed by said the IMT Insurance Company,which is still pLfor,%and effect. 5 5In Witness Whereof, I have hereunto set my hand and affixed the Seal q:(*' i$,Cobpanrr�on 31st day of 5 5 August 2015 SDalen Hollatd'fSeclelary SY 06 06(01/07) 5 --01004111 DREWC-2 OP ID: KN ,a►coRLY ATE CERTIFICATE OF LIABILITY INSURANCE 0813112 YYYY) 08/31/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Goodmann Insurance Services NAME: John E Goodmann 2774 University Ave A/CNNo. Ext:563-556-3232 A/c No): 563-556-2246 Dubuque,IA 52001 EMAIL John E Goodmann ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:United Fire&Casualty Co* 13021 INSURED Drew Cook and Sons INSURER B: II Excavating Inc INsuRERc: 10782 Timber Ridge Dubuque, IA 52001 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR 60432947 06/10/2015 06/10/2016 DAMAGE ( RENTED PREMISES Ea occurrence) $ 100,000 !: A Primary& MED EXP(Any one person) $ 5,000 Non-contributing PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY® PEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ l AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO 60432947 06/10/2015 06/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ p AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS MADE 60432947 06/10/2015 06/10/2016 AGGREGATE $ 3,000,000 Ili DED RETENTION$ $ WORKERS COMPENSATION X IPER STATUTE OR H AND EMPLOYERS'LIABILITY �! A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 60432947 06/10/2015 06/10/2016 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Dubuque, including all its elected and appointed officials,all its employees and volunteers,all its boards,commissions and/or authorities and their board members,employees and volunteers included as Addl Insured Project: 1002273 IA 32 Hike-Bike Trail Phase 4&5 CERTIFICATE HOLDER CANCELLATION CITYDU1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Dubuque ACCORDANCE WITH THE POLICY PROVISIONS. 50 W 13th Street I Dubuque, IA 52001 AUTHORIZED REPRESENTATIVE R ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD I ENDORSEMENT 604`32947 SPEC END (00041) G� '.I !i I� TIJE r'QLLO-WINGI'S HOW TRE C071.71 RDDITIONA.L INSURED FQR THE CITY OF° DUBUQUE SHOULD READ: it T14-E: CITY, OF DUBUQUE, INCLUDING ALL ITS ELECT'E;D AND APP'b 'NTED 01?FZCIA'LS, ALL ITS EMPLOYEE`S ,AND QLU d 'E R-' QLD 1 BO 7�S;r CQ MizS'lONS SND/OR RUTH--? T.TT''8$ A E ` ..HEIR HQARD' XI ER19 EXPLOYEEs AND, VOLUNTEERS. F J �I I II J l i 1 I r. f� Ali other teras, conditions, ilrnitations,and agreements of'the faollcy remain unchanged SPEC ENb, (0000) S r S r E gNo 7 01,01 06.»x.0;- Zol5 [PC ICY NUMBER; 60432947 CiOMMEROA OEN'EML LLA i ITY UPPLEMENTAL DE01,,ARATI,ONS •AbDITI! NAL WtURED'S' $.Chod6l6-of Rddi£i`4010W fd s;.. Prohlium li W, S4:E.-,5"$EE$ -0R C, ZAU.I, CQIS SCHIDIuD' PERSON5;D f (�,'; 7 0 8~5.; l o b A, Owners, Lersees -o.r ontr,actors Looat.ion of Covered bveratlon j Npl't H ROCK', 4E ;_ T ; x'723 W; Y1R RP; STE X08. it CS3,N7� 7C?12 -.;Ct)IZ]. �] 1 [ '± X130 56 .l JTA 5 1 1'BUS U I.P 510101 ba.4�1;0 and 3esc i lw,ion a completed ope:rationls VARIOUS LCCAT1,0 5, T °13 kIEL 8 OROIJP IRC' 31 AtJ,SAO i P I� ii IIIS' �i I U� �J U i 1 CG 716401 07 „__ i CG 71 31 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART N PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE 'S Name of Additional Insured Person(s) or Organization(s) Location And Description Of Completed Operations i ill Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to your liability for "bodily injury" or "property damage"which may be imputed to that person(s) or organization(s) directly arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and only for that liability included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and i 2. If coverage provided to the additional insured is required by a contractor agreement, the insurance afforded to such additional insured will not be broader than that which you are required By the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "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, field orders, change orders or drawings or specifications; or V r, b. Supervisory, inspection, architectural or engineering activities. (' C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 71 31 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 f 04 3 5 4 1 L 70 84 01 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IOWA-GOVERNMENTAL IMMUNITIES,ENDORSEMENT This endorsement modifies insuranceprovided o Rder the following; Ij CQMM�RdAI_.GENERAL I LIA'B'1L1TY:Q.OV,ERAOE "ART" BUSINES86MERS bb' VERAGE FORM SCHEDULE :Na of Qr4anizatiott:- I 1 0',F DvB,jQ­,Uk b, 14 - i 3 TH: DU' U,Q:IM 14 520,01 I Non-wgiVOr of !rnmgntJmm-u_nfty. The insurance carrier-expros8ly agrees and statesthat the purchlasd Of this- policy and the including of the organizationas an Additibnal Insured does not waive any of the defenses.of.governmentAtimmunity available to the organization:.shown in'the Schedule under Code of Iowa;Section 670,4 as itnow exists and,asjt.maybe amended from time to time, 2. Claims.Covera,The insurance agrees that,th is,pol�icy V"Insurance shall.-cover only those,claims not 10� of Section rid as it object rite defense gOvernMental'Immurtity:under,the Code of loyva S tioo ,670,4 as it now exists a May be amended frorn-time to,time, 3, Assertion.of,0-4yernmentjmmui� .The orga*atJOnshown.jn the Schedule shall beresporisible-for,asserting any defeEtso of gpyern(nent4rHmMvqity, and May do$Q at anytir>te-and..sitall do SO L pOijthe:t1melV written reuestofthe -q insurance carrier. Nothing contained in, this ondorserritnt 8.haIj --rovep nt the carrier from assorting the defense of gbve�mmental immunity on behalf of the organi atiarr shown in the .SQhedUle, 4. NOO-Qenial of C !0 ij)§wa1, hoil nut deity coverage unde!'this'p-plipy a,f d (1,10 Insurai ice,paj 0er OvO(aqo. T1 1W ca,fr�er :5, strait nOt,d:0ny_ary6f_L'­ the-rights.arid beriefits accruing to the Organization shown in the';Schedule uhderthis policy 1or reasons of g6vbattmental immunity unless and until: a court of competent jurisdiction has ruled 'in favor of t:he defbrise(s)of;governmental-I Mm unity asserted by the organization shown ih:the.-Schedule ii, 5. No:Other Cha6gq:jn Policy `Cheinsurance carrier and the,org a-rilzation'shown in the Schedule agree that the above preservation of govqrqmental immunities sh-611 not othqrwisecban coverage available--und'erthe policy, IL 74 64 0110 3 IL 71 05 10 14 i. i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION { I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART COMMERCIAL UMBRELLA COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance j This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1 (1) The additional insured is a Named Insured under such other insurance; a (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured; (3) The additional insured gives us prompt written notice of any "occurrence" which may result in a claim and prompt written notice of"suit"; (4) The additional insured immediately forwards all legal papers to us, cooperates in the investigation or settlement of j the claim or defense against the "suit", and otherwise complies with policy conditions. j (5) The additional insured must tender the defense and indemnity of any claim or "suit' to any other insurer which also insures against a loss we cover under this policy. This includes, but is not limited to, any insurer which has issued a policy of insurance in which the additional insured qualifies as an insured. For the purpose of this requirement, the term "insures against' refers to any self-insurance and to any insurer which issued a policy of insurance that may provide coverage for the loss, regardless of whether the additional insured has actually requested that the insurer j provide the additional insured with a defense and/or indemnity under that policy of insurance. i (6) The additional insured agrees to make available any other insurance that the additional insured has for a loss we cover under this policy. �h IIS i� IL 71 05 10 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 I k k CG 71 85 02 15 � LAND IMPROVEMENT CONTRACTORS ASSOCIATION (LICA)- ULTRA LIABILITY PLUS ENDORSEMENT l COMMERCIAL GENERAL LIABILITY EXTENSION ENDORSEMENT SUMMARY OF COVERAGES This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. II * Extended Property Damage * Expanded Fire Legal Liability to include Explosion, Lightning and Sprinkler Leakage * Coverage for non-owned watercraft is extended to 51 feet in length * Property Damage - Borrowed Equipment * Property Damage Liability - Elevators • Coverage D -Voluntary Property Damage Coverage $10,000 Occurrence with a $20,000 Aggregate * Coverage E - Care, Custody and Control Property Damage Coverage $10,000 Occurrence with a $20,000 Aggregate - $500 Deductible *Coverage F - Electronic Data Liability Coverage -$50,000 *Coverage H -Water Damage Legal Liability -$25,000 * For newly formed or acquired organizations - extend the reporting requirement to 180 days * Broadened Named Insured *Automatic Additional Insured - Owners, Lessees or Contractors -Automatic Status When Required in Construction Agreement With You *Automatic Additional Insured -Vendors *Automatic Additional Insured - Lessor of Leased Equipment Automatic Status When Required in Lease Agreement With You *Automatic Additional Insured - Managers or Lessor of Premises •Additional Insured - Engineers, Architects or Surveyors Not Engaged by the Named Insured *Additional Insured - Employee Injury to Another Employee *Automatically included -Aggregate Limits of Insurance (per location) *Automatically included -Aggregate Limits of Insurance (per project) *Knowledge of occurrence - Knowledge of an "occurrence", "claim or suit" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee * Blanket Waiver of Subrogation * Liberalization Condition *Unintentional failure to disclose all hazards. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. * Mobile equipment to include snow removal, road maintenance and street cleaning equipment less than 1,000 lbs GVW * Bodily Injury Redefined N Y REFER TO THE ACTUAL ENDORSEMENT FOLLOWING ON PAGES 2 THROUGH 9 FOR CHANGES AFFECTING YOUR INSURANCE PROTECTION Y CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9 l i I " !I CG 71 85 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. u I LAND IMPROVEMENT CONTRACTORS ASSOCIATION (LICA) l ULTRA LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I - COVERAGES A. The following changes are made at COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Extended Properly Damage At 2. Exclusions exclusion a. Expected or Intended Injury is replaced with the following: "Bodily injury" or"property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2. Expanded Fire Legal Liability At 2. Exclusions the last paragraph is deleted and replaced by the following: Exclusions c. through n. do not apply to damage by fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of this owner. A separate limit of insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. 3. Non-Owned Watercraft At 2. Exclusions exclusion g. Aircraft, Auto Or Watercraft (2) (a) is deleted and replaced by the following: (a) Less than 51 feet long; 4. Property Damage — Borrowed Equipment At 2. Exclusions the following is added to paragraph (4) of exclusion j. Damage To Property: This exclusion does not apply to "property damage" to borrowed equipment while at a jobsite and while not being used to perform operations. The most we will pay for "property damage" to any one piece of borrowed equipment under this coverage is $25,000 per occurrence. The insurance afforded under this provision is excess over any r valid and collectible property insurance (including deductible) available to the insured, whether primary, excess, contingent or on any other basis. 5. Property Damage Liability — Elevators At 2. Exclusions the following is added to paragraphs (3), (4) and (6) of exclusion j. Damage To Property: This exclusion does not apply to "property damage" resulting from the use of elevators. However, any insurance provided for such "property damage" is excess over any valid and collectible property insurance(including deductible) available to the insured, whether primary, excess, contingent or on any other basis. h B. The following coverages are added 1. COVERAGE D -VOLUNTARY PROPERTY DAMAGE COVERAGE "Property damage" to property of others caused by the insured: a. While in your possession; or b. Arising out of"your work". Coverage applies at the request of the insured, whether or not the insured is legally obligated to pay. For the purposes of this Voluntary Property Damage Coverage only: k s t a CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 9 { E i E pip 9p' W 9 • 7 CG 71 85 02 15 Exclusion j. Damage to Property is deleted and replaced by the following: j. Damage to Property "Property damage" to: (1) Property held by the insured for servicing, repair, storage or sale at premises you own, rent, lease, i operate or use; (2) Property transported by or damage caused by any "automobile", "watercraft" or "aircraft" you own, hire or j lease; (3) Property you own, rent, lease, borrow or use. The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for this coverage. 2. COVERAGE E -CARE, CUSTODY AND CONTROL PROPERTY DAMAGE COVERAGE For the purpose of this Care, Custody and Control Property Damage Coverage only: a. Item (4) of Exclusion j. does not apply. The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE I For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for this coverage. 3. COVERAGE F - ELECTRONIC DATA LIABILITY COVERAGE For the purposes of this Electronic Data Liability Coverage only: a. Exclusion p. of Coverage A — Bodily Injury And Property Damage Liability in Section I —Coverages is replaced by the following: 2. Exclusions This insurance does not apply to: p. Electronic Data a Damages arising out of 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. However, this exclusion does not apply to liability for damages because of"bodily injury" b. "Property Damage" means: (1) Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or (2) Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or (3) Loss of, loss of use of, damage to, corruption of, inability to access or inability to properly manipulate I "electronic data", resulting from physical injury to tangible property. All such loss of"electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this Electronic Data Liability Coverage, "electronic data" is not tangible property. The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE 4. COVERAGE H -WATER DAMAGE LEGAL LIABILITY The Insurance provided under Coverage W (Section 1) applies to "property damage" arising out of water damage to premises that are both rented to and occupied by you. The Limit under this coverage shall not be in addition to the Damage To Premises Rented To You Limit. The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE a CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 9 CG 71 85 02 15 C. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B is amended: The following language is added to Item 1. However, we shall have none of the duties set forth above when this insurance applies only for Voluntary Property Damage Coverage and/or Care, Custody or Control Property Damage Coverage and we have paid the Limit of Liability or the Aggregate Limit for these coverages. SECTION II- WHO IS AN INSURED A. The following change is made: Extended Reporting Requirements a Item 3.a. is deleted and replaced by the following a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or 1 the end of the policy period, whichever is earlier. B. The following provisions are added: j i 4. BROAD FORM NAMED INSURED l Item 1.f. is added as follows: f. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period only if there is no other similar insurance available to that entity. However: (1) Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired { more than 50 percent of the voting stock; and (2) Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired more than 50 percent of the voting stock. 5. Additional Insured - Owners, Lessees or Contractors-Automatic Status When Required in Construction or Service Agreement With You a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy is an insured. Such person or organization is an additional insured only with respect to your liability for "bodily injury", "property damage" or "personal and advertising injury" which may be imputed to that person or organization directly arising out of: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "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, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. 1 CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 9 i I j I CG 71 85 02 15 I 2. "Bodily injury" or"property damage" occurring after: y 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 location of the covered operations has been completed; or b. That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. i 6. Additional Insured -Vendors a. Any person(s) or organization(s) (referred to throughout this additional coverage as vendor), but only with d respect to "bodily injury" or "property damage", which may be imputed to that person(s) or organization(s) j arising out of "your products" shown with the Schedule which are distributed or sold in the regular course of the vendor's business is an insured. I' However: (1) The insurance afforded to such vendor only applies to the extent permitted by law; and (2) If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. !i b. With respect to the insurance afforded to these vendors, the following additional exclusions apply: (1) This insurance afforded the vendor does 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. 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; V (d) Repackaging, except when 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. I (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 distribution or sale of products. (f) Demonstration, installation, servicing or repair operations, except such operations performed at the it vendor's premises in connection with the sale of the product. (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor. (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts 1 or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: I. The exceptions contained in Sub-paragraphs d. or f.; or ^I ii. Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally I undertakes to make in the usual course of business, in connection with the distribution or sale of , the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. i CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 0 i 3 i CG 71 85 02 15 7. Additional Insured — Lessor of Leased Equipment — Automatic Status When Required in Lease Agreement With You a. Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be 1 added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with j respect to your liability for "bodily injury", "property damage" or "personal and advertising injury" directly arising out of the maintenance, operation or use of equipment leased to you, which may be imputed to such a person or organization as the lessor of equipment. However, the insurance afforded to such additional insured: j (1) Only applies to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. (I b. 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. �V 8. Additional Insured —Managers or Lessors of Premises a. Any person(s) or organization(s), but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. j (2) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) afforded coverage by this additional coverage. However: (1) The insurance afforded to such additional insured only applies to the extent permitted by law; and (2) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. I 9. Additional Insured - Engineers, Architects or Surveyors Not Engaged by the Named Insured a. Any architects, engineers or surveyors who are not engaged by you are insureds, but only with respect to liability for "bodily injury" or"property damage" or "personal and advertising injury" which may be imputed to 4 that architect, engineer or surveyor arising out of: (1) Your acts or omissions; or (2) Your acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed by you or on your behalf. But only if such architects, engineers or surveyors, while not engaged by you, are contractually required to be added as an additional insured to your policy. However, the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law; and i (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. b. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: f This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services, including: (1) The preparing, approving, or failing to prepare or approve, maps, drawings, opinions, reports, surveys, j change orders, designs or specifications; or I CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9 j j CG 71 85 02 15 (2) Supervisory, inspection or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the !,I supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services. i 10. Additional Insured - Employee Injury to Another Employee With respect to your "employees" who occupy positions which are supervisory in nature: Paragraph 2.a.(1) of SECTION II —WHO IS A NAMED INSURED is amended to read: i a. "Bodily injury" or"personal and advertising injury" (1) To you, to your partners or members (if you are a partnership or joint venture), or to your members (if you are a limited liability company); (2) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraph (1)(a) above; or II (3) Arising out of his or her providing or failing to provide professional healthcare services. Paragraph 3.a. is deleted. For the purpose of this Item 10 only, a position is deemed to be supervisory in nature if that person performs j principle work which is substantially different from that of his or her subordinates and has authority to hire, direct, discipline or discharge. I SECTION III - LIMITS OF INSURANCE A. The following Items are deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: i a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and c. Damages under Coverage B; and d. Damages under Coverage H. 6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning or sprinkler leakage while rented to you or temporarily occupied by you with permission of the owner. B. The following are added: 8. Subject to Paragraph 5. of SECTION III — LIMITS OF INSURANCE $25,000 is the most we will pay under Coverage H for Water Damage Legal Liability. 9. Aggregate Limits of Insurance (Per Location) The General Aggregate Limit applies separately to each of your 'locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. P, i "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 10. Aggregate Limits of Insurance (Per Project) The General Aggregate Limit applies separately to each of your projects away from premises owned by or rented to you. 1, I i CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 9 s i a i 1 I CG 71 85 02 15 y 11. With respects to the insurance afforded to additional insureds afforded coverage by items 5 through 10 of SECTION II —WHO IS AN INSURED above, the following is added: The most we will pay on behalf of the additional insured is the amount of insurance: 4 a. Required by the contract or agreement; J b. Available under the applicable Limits of Insurance shown in the Declarations; i Whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 12. Subject to 5. of SECTION III — LIMITS OF INSURANCE, a $10,000 "occurrence" limit and a $20,000 1111 aggregate" limit is the most we will pay under Coverage A for damages because of "property damage" covered under Coverage D -Voluntary Property Damage Coverage. For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for this coverage. 13. Subject to 5. of SECTION III — LIMITS OF INSURANCE, a $10,000 "occurrence" limit and a $20,000 "aggregate" limit is the most we will pay under Coverage E -Care, Custody and Control Coverage regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". Deductible -Our obligation to pay damages on your behalf applies only to the amount of damages in excess of$500. This deductible applies to all damages because of "property damage" as the result of any one "occurrence" regardless of the number of persons or organizations who sustain damages because of that "occurrence". We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. As respects this coverage "Aggregate" is the maximum amount we will pay for all covered "occurrences" during one policy period. For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for this coverage. I' 15. Subject to 5. of SECTION III — LIMITS OF INSURANCE, the most we will pay for "property damage" under Coverage F - Electronic Data Liability Coverage for loss of "electronic data" is $50,000 without regard to the number of"occurrences". I r k SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS A. The following conditions are amended: 1. Knowledge of Occurrence 4 a. Condition 2., Items a. and b. are deleted and replaced by the following: F (1) Duties In The Event Of Occurrence, Offense, Claim Or Suit (a) You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which k may result in a claim. Knowledge of an "occurrence" by your agent, servant or employee shall not in i itself constitute knowledge of the named insured unless an officer of the named insured has received i such notice from the agent, servant or employee. To the extent possible, notice should include: i. How, when and where the "occurrence" took place; i ii. The names and addresses of any injured persons and witnesses, and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 9 { 3 B CG 71 85 02 15 (b) If a claim is made or"suit" is brought against any insured, you must: I. Immediately record the specifics of the claim or"suit" and the date received; and ii. Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. Knowledge of a claim or "suit" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee. 1 2. Where Broad Form Named Insured is added in SECTION II — WHO IS AN INSURED of this endorsement, Condition 4. Other Insurance b. Excess Insurance (1).(a) is replaced by the following: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to an insured solely by reason of ownership by you of more than 50 percent of the voting stock, and not withstanding any other language in any other policy. This provision does not apply to a policy written to apply specifically in excess of this policy. 1 B. The following are added: 1. Condition (5) of 2.c. i (5) Upon our request, replace or repair the property covered under Voluntary Property Damage Coverage at your actual cost, excluding profit or overhead. I' 10. Blanket Waiver Of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: premises owned or occupied by or rented or loaned to you, ongoing operations performed by you or on your behalf, done under a contract with that person or organization, "your work", or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you before the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed. i 11. Liberalization If a revision to this Coverage Part, which would provide more coverage with no additional premium becomes effective during the policy period in the state designated for the first Named Insured shown in the Declarations, j your policy will automatically provide this additional coverage on the effective date of the revision. 12. Unintentional Failure to Disclose All Hazards Based on our reliance on your representations as to existing hazards, if you unintentionally should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. SECTION V - DEFINITIONS A. At item 12. Mobile Equipment the wording at f.(1) is deleted and replaced by the following: f.(1)Equipment designed primarily for: (a) Snow removal; 1 i (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; except for such vehicles that have a gross vehicle weight less than 1,000 lbs which are not designed for highway use. B. Item 3. "bodily injury" is deleted and replaced with the following: a 3 3. "bodily injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sickness or disease. I CG 71 85 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 9 0101 07-� -201"5' POLICY N(. MBEk: 6043.2947 r WORKERS COMPENSATION AND EMPLOYERS LIABILITY SUPPLEMENTAL DECLARATIONS. j Premium Basis: Rate Per Pstimated Tq�aj Estimated, $'[.Ut)of Annual a Aorival Remuneration Remuneration Premium CCT�'T IN:UE�3 4. T,HE PREMIUM FOR THIS POLICY WILL BE DETER9I34E'b" BYOUR 'xAN'tjALS OF RUL')'S, RATES- AND ATIN-G PLAYS,, ,ALL INFOPATIaN REQUIRED BELQW', 3C S. S[TBi11 HQT TO. V I7ICATIQN: RNID C ,&VXgE BY AUDIT: Vor:m WC000313: ap.pl-ies Lo : j ICON SMITH & 50NS CONST UQTT.0 16140 JUSTI LN; DU'8U'QU8IA CITY OF D1181tQ,ITE 5:0 W 13TH "SI DUBUQUE I'A 52001; I t A Lot* £71 52.00 WOLF" ,RP DUBUQUE, 1A 52002-250.5 5217 EXCAVAtA6N &, DRIVERS' 294,$9' 7.220 21,291 I 6306 SEWER CONSTRUCTION-ALIO OPERATION IF ANY 6. 90 0 �r I?RI�ERS' 6319 WAT,2"R MAIN OR CONNECTION ONSTRU'QTIQN IF Y 4.3901: b &; BR I VER S 8i 1LT CLERICALOF�"ICE EMPLQY4ES OC £39,2.2'4 .300 268 I LQC## O�1 DEPT. 02 T`NE" S NUEI S GROUP INC: 5,2,0,0 WOLF' R DU:,BUQ'UE, IA 5200-2-2505 617 E.NCAVATION & DR,1,?ERS 1,,F ANY' 7.229: 0 u 0930 ADUITIO A.L PRE SITM— .WAIVER OF 9UBR:OUA'TIQN 2.00 p IA LOCA 0 OF ,pTr# 03" tON a I.TH & SONS Cfl STR13,C`I IC'N 5--�00 WOL-F? RTS DtSVQUE,, IA 52'002-250 r 6217 EXCAVATION rx "DRIVER IF ANY 7.220 0 V 0930 ADRTTibNAL PREMIUM— WAfv,'ER Off" SUSR()CsATICN 1OQ g IA LOC-4 01 DEPT# ;04 C;ITY OF D-USUQUE 5200 wblvF' RD QQ, TIKUE"D ON WC-2S WC-ZS (01 95)' I I� WC 00 03 13 (4-84) i WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of (DATE) Policy No. of the (NAME OF INSURANCE COMPANY) issued to h Premium $ Authorized Representative 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 l only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. � This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule J jl �i i I,I I i i p WC 00 03 13 (4-84) Copyright 1982, 1983 National Council on Compensation Insurance. r