HomeMy WebLinkAboutRolfe Construction - 2014 Agreement - Change Order No. 01Citp of Of[rop
Public Works Department - Engineering Division
7351 Rosanna St., Gilroy, CA 95020
Phone (408) 846 -0451; Fax (408) 846 -0429
CONTINGENCY CHANGE ORDER NO. 1
To contract for: Gilroy- Morgan Hill Joint Trunk Sewer Main City Project No.: 14 -PW -208
Contractor: Rolfe Construction, Inc. Contract Date: August, 2014
This order shall become effective when it has been signed by the City Administrator, City Engineer, Project Engineer, and
Contractor. All copies forwarded to Contractor for signature shall be returned to the City of Gilroy properly filled out. Upon
acceptance by the City, the Contractor's copy will be returned to him as his authority to proceed with the work.
Description of Work
Extra Work at Agreed Upon Lump Sum Compenstation Price: Modifications to the contract to include additional
replacement of in -kind fencing to segregate the existing right of way and easement. This additional item of work was
deemed necessary per the Project Manager and Resident Engineer's recommendations. This work includes the provision
of both a 6 -ft. high chain -fink fence and also 3 ft. high non -climb fencing (w /appurtenances). (See attached Rolfe
Construction estimate for additional information).
All requirements of the original Contract Documents shall apply to the above work except as specifically modified by this
Change Order. The contract time shall not extend unless expressly provided for in this Change Order.
By signing this Change Order, Contractor acknowledges and agrees that the adjustments to cost and time contained herein
are in full satisfaction and accord, and are accepted as payment in full, for any and all costs and expenses associated with
this Change Order, (the "Extra Work "), including but not limited to labor, materials, overhead and profit, delay, disruption,
loss of efficiency and any and all other direct and /or indirect costs or expenses associated with the Extra Work and hereby
waives any right to claim any further cost and time impacts at any time during and after completion of the Contract
associated with the Extra Work.
Change in working time granted by this change order:
► All Extra Work authorized under this Change Order
must be billed separately from the original contract. All
bills for work done under this Change Order shall
reference this Change Order No. 1.
I (We) agree to make the above change subject to the
terms of this Change Orderjofa NET INCREASE not
to exceed $20,210.00.
CONTRACTOR
By: 2,l;t Cokt 5T12vcal a.J
RECOMMENDED BY:
ACCEPTED BY:
2 Working Days
Cost Percentage
Contingency Amount
$239,643.00 8.4% used
Original Contract Price
$3,423,467.00
Previous Change Orders
$0.00 N/A
Total to Date
$3,423,467.00
This Change Order
$20,210.00
Total Change Orders to Date
$20,210.00 0.59% of bid
Revised Contract Price $3,443,677.00
Manager
Date: 4 1 is ILJ
Date
L1 /l�l i5
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NGjlund, C4� ndrn•nis +ynfv - Dc,
M"I,FE
CONSTRUCTION
Rolfe Construction
3573 Southern Pacific Ave.
Atwater, Ca. 95301
Ph: 209 358 -5548
Fax: 209.357.2916
rolfeconstruction@comcast.net
CHANGE ORDER
REQUEST
Date: 2/18/2015
Change Order # TBD
City of Gilroy
c/o CALTROP
3ames Schaaf
Office -(925) 548 -0895
Cell -(510) 299 -3789
Cc, a 1
t4^ fw -2x
Payment
Job Number Job Due Date j--
Terms W
1410 Gilroy — Fence Replacement Change Order Upon Approval
Quantity Des criptio n Unit Price Line Total
Furnish and install 6' high chain link fence in one straight
line. Specifications: 11 gauge, 6' high chain link fabric, 7
710 LF gauge top and bottom tension wire, 2 7/8 structural ;14.83 -If $10,529.30
terminal posts, 1 7/8 structural line posts, 4 point barbed
wire. All posts to be set in concrete
Furnish and install 3' high non climb fence with two strands
barbed wire. Specifications: 3' non climb wire, 2 7/8
1,450 LF structural terminal posts @ 96' on center, 1.33 t -posts 0 10' $6.68 -If $9,680.70
max on center, 1 5/8 sch. 40 braces. All terminal posts and
braces to be set in concrete.
*Allowable 15% markup has been added to unit costs.
Unit price is based on one mobilization per type offence.
Additional mobilizations will be charged at $1000 per
mobilization.
Fence install to be completed by Stockton Fence & Material
Co.
Total $20,210.00
Thank you for your business!
Approved by: Date:
Printed Name: �hmS VU. Sr� CA, Rolfe Approval:
G(o L't) Cq �lwa,
TAM T R 13 P.
MEMORANDUM (CC01)
To: Ian King,
City of Gilroy
From: Mike Schaaf, PE JMS
Date: April 15, 2015
Subject: City of Gilroy— Joint Trunk Sewer Replacement
Project 14 -PW -208
Contract Change Order No
to. ? _ i
14 -PW -208
-61a
Attached for your review and routing approval is the Contract Change Order No. 1 and
corresponding PCO estimate. As noted, the Project's Bid Items 1 through 27 did not
address or include the removal and replacement of the requested CCO 1 itemwork which
is to replace the removed fencing in -kind. This change order work is respectfully
requested to subsequently provide the replacement of the existing fencing in -kind and add
and additional item of work to the contract.
Original contract bid amount: $ 3,423,467.00
CCO No. 1 (approx. 0.59% of bid): $ 20,210.00
Revised Contract amount: $ 3,443,677.00
Upon final concurrence by the City, please process the CCO No. 1 accordingly and let
me know so that we may direct the contractor to diligently proceed with the prescribed
work. Should you have any immediate questions or wish to discuss further, please do not
hesitate to call me at (510) 299 -3789.
Attach: CCO No. 1
w/Rolfe PCO estimate
Cc: Project Inspector
Project Manager, City
CCOI.doc
ROLFE -2 OP ID: RL2
CERTIFICATE OF LIABILITY INSURANCE
02!00331 °A'�`!220,5 015'
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 pol(cy(les) 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 Sou of such endorsement s
Pao°ucER
Leap /Carppenter/Kemps insurance
3187 Collins Dr.
Merced, CA 95348
Michael J. Carpenter
NAME: Michael J. Carpenter
No E :209 -384 -0727 No): 209- 384 -0401
A
ADDRESS.
INSURER(S) AFFORDING COVERAGE
NAIC 0
INSURERA:WeSCo Insurance Company
25011
INSURED Rolfe Construction
3573 Southern Pacific Avenue
Atwater, CA 95301
INSURER B: Great American Alliance Ins Co
26832
INSURER C:
INSURER D:
MSLIPER E
EACH OCCURRENCE
INSURER F :
PREMISES Ea occurrence
CAVEROCES CERTIRCATE 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.,
_
I
TYPE OF INSURANCE
POLICY NUMBER
MMID
1%MfDD1YYYY
LOMrr3
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,0
PREMISES Ea occurrence
$ 300,00
A
X COMMERCIAL GENERAL LIABILITY
X
X
WPP1235560 00
01/31/2015
01/31/2016
CLAIMS-MADE Fx_] OCCUR
MED EXP (Any one person)
$ 5,0
PERSONAL & ADV INJURY
$ 1,000,0
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS- COMP/OP AGG
$ 2,000,0
mp Ben
$ 1,000,0
POLICY X PRO LoC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident)
1,000,000
$
BODILY INJURY (Per person)
$
A
X ANY AUTO
X
X
PP1235560 00
01/31/2015
01/31/2016
ALL'OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY' DAMAGE
PER ACCIDENT
$
$
X
UMaREL-A LIAR
X
OCCUR
EACH OCCURRENCE
$ 5,000,OOC
AGGREGATE
$ 5,000,00
B
EXCESS LIAR
CLAIMS -MADE
5.9717663
01131/2015
01/31/2016
DIED _ X I RETENTION $ 10000
$
WORKERS COMPENSATION
WC STATU- 0TH =.
LIMTS
EEL
AND EMPLOYERS' LIABILITY . YIN
ANY PROPRIETOR/PARTNER /EXECUTIVE ❑,
OFFICER/MEMBER EXCLUDED?
N! A
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT !
$
A
Rented/Leased
PP1235560 00
01131/2015
01/31/2016
100,00
Equipment
D 1,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
City of Gilroy, Its Officers, Elected or Appointed Officials, Employees,
Agents and Volunteers are named as Additional Insured with respects to
General & Auto Liability per attached forms. Waiver of Subrogation applies
to General and Auto Liability.
Project: City of Gilroy Joint Trunk Sewer
GILR0-3
City of Gilroy
Public Works Division
7351 Rosanna St.
Gilroy, CA 95020
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
riahts reserved
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: WPP1235560 00
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Blanket as required by written contract.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations. �
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV — Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products -
completed operations hazard ". This waiver applies
only to the person or organization shown in the
Schedule above.
CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number:WPP1235560 00
COMMERICAL AUTOMOBILE BROADENED COVERAGE ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. SUBSIDIARIES AND NEWLY ACQUIRED OR FORMED ORGANIZATIONS
Paragraph A.I. WHO IS AN INSURED of SECTION II — LIABILITY COVERAGE is amended as follows:
The Named Insured shown in the Declarations is amended to include:
1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective
date of the Coverage Form. However, the Named Insured does not include any subsidiary that Is an
"insured" under any other automobile policy or would bean "insured" under such a policy but for its
termination or the exhaustion of its Limit of Insurance.
2. Any organization that is acquired or formed by you and over which you maintain majority ownership.
However, the Named Insured does not include any newly formed or acquired organization:
a. That is a partnership, joint venture or limited liability company
b. That is an "insured" under any other policy,
C. That has exhausted its Limit of Insurance under any other policy, or
d. 180 days or more after its acquisition or formation by you, unless you have given us notice of the
acquisition or formation.
Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred
before you formed or acquired the organization
B. EMPLOYEES AS INSUREDS
Paragraph A. 1. WHO IS AN INSURED of SECTION II — LIABILTY COVERAGE is amended to add:
Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your
personal affairs.
C. LESSORS AS INSUREDS
Paragraph A.I. WHO IS AN INSURED of SECTION 11— LIABILITY COVERAGE is amended to add:
1. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if:
a. The agreement requires you to provide direct primary insurance for the lessor; and
b. The "auto" is leased without a driver.
CA990143 Page 1 of 7 Ed. 0912
Such a leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire.
D. ADDITIONAL INSURED IF REQUIRED BY CONTRACT
Paragraph 1L. WHO IS AN INSURED of A. Coverage under SECTION II — LIABILITY COVERAGE is amended to add:
1. Any person or organization with whom or with which you have agreed in writing in a contract or
agreement that such person(s) or organization(s) shall be included as an additional insured on your
business auto policy. Such person or organization is an "insured", but only to the extent such person or
organization is liable for "bodily injury" or "property damage" caused by the conduct of an insured"
under paragraphs la. or lb. of Who Is An Insured with regard to the ownership, maintenance or use of a
"covered" auto.
The insurance afforded to any such additional insured applies only if the "bodily injury" or "property damage"
occurs:
a. During the policy period, and
b. Subsequent to the execution of such written contract, and
C. Prior to the expiration of the period of time that the written contract requires such insurance be
provided to the additional insured.
2. How Limits Apply
If you have agreed in a written contract or written agreement that another person or organization be added as
an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of:
a. The limits of insurance specified in the written contract or written agreement; or
b. The Limits of Insurance shown in the Declarations.
Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and
described in this Section.
3. Additional Insureds Other Insurance
If we cover a claim or "suit" under this Coverage Part that may also be covered by other insurance available to
an additional insured, such additional insured must submit such claim or "suit" to the other insurer for
defense and indemnity.
Such insurance as is afforded by this policy or the benefit of the additional insured(s) shall be excess and non-
contributory as respect to any claim, loss or liability allegedly arising out of the operations of the Named
Insured; however, this insurance will not apply to any claim, loss or liability which is determined to be solely
the result of the additional insured's negligence or solely the additional insureds responsibility.
4. Duties In The Event Of Accident, Claim, Suitor Loss
If you agreed in a written contract or written agreement that another person or organization be added as an
additional insured on your policy, the additional insured shall.be required to comply with the provisions in
LOSS CONDITIONS 2. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV BUSINESS AUTO
CONDITIONS, in the samemanner as the Named Insured.
E. AMENDED FELLOW EMPLOYEE EXCLUSION
CA990143 Page 2 of 7 Ed. 0912
Paragraph S. Fellow Employee of SECTION 11— LIABILITY COVERAGE does not apply if you have workers'
compensation insurance in -force covering all of your "employees ". Coverage is excess over any other collectible
insurance.
F. HIRED AUTO PHYSICAL DAMAGE COVERAGE
The following is added to Paragraph G, Limit of Insurance of SECTION III PHYSICAL DAMAGE COVERAGE:
If hired "autos" are covered "autos" for Liability Coverage and if Comprehensive, Specified Causes of Loss, or
Collision coverages are provided under this Coverage Forms for any "auto" you own, then the Physical
Damage Coverages provided are extended to "autos" you hire or borrow, subject to the following limit.
The most we will pay for "loss" to any hired "auto" is:
a. $100,000;
b. The actual cash value of the damaged or stolen property at the time of the "loss "; or
C. The cost of repairing or replacing the damaged or stolen property,
whichever is less, minus a deductible. The deductible will be equal to the largest deductible applicable to any
owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning. Hired Auto
Physical Damage coverage is excess over any other collectible insurance. Subject to the above limit, deductible
and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered
"auto" you own.
We will also cover loss of use of the hired "auto" if it results from an "accident", you are legally liable and the
lessor incurs an actual financial loss, subject to a maximum of $1,000 per "accident".
This extension of coverage does not apply to any "auto" you hire or borrow from any of your "employees ",
partners (if you are a partnership), members (if you are a limited liability company), or members of their
households.
G. PHYSICAL DAMAGE — ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE
Paragraph a. Transportation Expenses of 4. Coverage Extensions under A. Coverage., SECTION III PHYSICAL
DAMAGE COVERAGE is amended to provide a limit of $50 per day and a maximum limit of $1,000.
H. LOAN /LEASE GAP COVERAGE
Under SECTION III PHYSICAL DAMAGE COVERAGE, in the event of a total "loss" to a covered "auto ", we will
pay your additional legal obligation for any difference between the actual cash value of the "auto" at the time
of the "loss" and the "outstanding balance" of the loan /lease.
"Outstanding balance" means the amount you owe on the loan /lease at the time of "loss" less any amounts
representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments;
additional mileage charges; excess wear and tear charges; lease termination fees; security deposits not
returned by the lessor; costs for extended warranties, credit life insurance, health, accident or disability
insurance purchased with the loan or lease; and carry-over balances from previous loans or leases.
I. AIRBAG COVERAGE
Under paragraph B. EXCLUSIONS of SECTION III PHYSICAL DAMAGE COVERAGE, the following is added:
CA990143 Page 3 of 7 Ed. 0912
The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag.
J. ELECTRONIC EQUIPMENT— BROADENED COVERAGE
Paragraph B. Exclusions of SECTION III PHYSICAL DAMAGE COVERAGE is amended as follows:
1. Subparagraph S. of Paragraph B. Exclusions of SECTION III PHYSICAL DAMAGE COVERAGE is replaced by
the following:
Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by use of the power
from the "auto's" electrical system that, at the time of "loss ", is:
(1) Permanently installed in or upon the covered "auto ";
(2) Removable from a housing unit which is permanently installed in or upon the covered "auto";
(3) An integral part of the same unit housing any electronic equipment described in Paragraphs a.
and b. above; or
(4) Necessary for the normal operation of the covered "auto" or the monitoring of the covered
"auto's" operating system.
2. Paragraph 2. of C. Limit Of Insurance, under SECTION III —PHYSICAL DAMAGE COVEAGE is replaced with
the following:
$1,500 is the most we will pay for "loss" in any one "accident" to all electronic equipment that
reproduces, receives or transmits audio, visual or data signals which, at the time of "loss ", is:
1. Permanently installed in or upon the covered "auto" in a housing, opening or other location that
is not normally used by the "auto" manufacturer for the installation of such equipment;
2. Removable from a permanently installed housing unit as described in Paragraph b.(1) above or is
an integral part of that equipment; or
3. An integral part of such equipment.
3. The following is added to Paragraph D. Deductible of SECTION III —PHYSICAL DAMAGE COVEAGE:
For each covered "auto ", should loss be limited to electronic equipment only, our obligation to pay for,
repair, return or replace damaged or stolen electronic equipment will be reduced by the applicable
deductible shown in the Declarations, or $250, whichever deductible is less.
K. GLASS REPAIR — WAIVER OF DEDUCTIBLE
Under Paragraph D. DEDUCTIBLE of SECTION 111 PHYSICAL DAMAGE COVERAGE, the following is added:
No deductible applies to glass damage if the glass is repaired rather than replaced.
L. EXTRA EXPENSE — BROADENED COVERAGE
Under paragraph A. Coverage of SECTION III PHYSICAL DAMAGE COVERAGE, we will pay for the expense of
returning a stolen covered "auto" to you.
CA990143 Page 4 of 7 Ed. 0912
M. PRIMARY AND NON CONTRIBUTORY IF REQUIRED BY CONTRACT
The following is added to Paragraph 6.5, Other Insurance, in SECTION IV— BUSINESS AUTO CONDITIONS
Only with respect to insurance provided to an additional insured of this endorsement, and required by
contract, the following provisions apply:
a. Primary Insurance When Required by Contract
This insurance is primary if you have agreed in a written contract or written agreement that this insurance
be primary. If other insurance is also primary, we will share with all that other insurance by the method
described in SA, Other Insurance under B. General Conditions of SECTION IV — BUSINESS AUTO
CONDTIONS
b. Primary And Non- Contributory To Other Insurance When Required By Contract
If you have agreed in a written contract or written agreement that this insurance is primary and non-
contributory with the additional insured's own insurance, this insurance is primary and we will not seek
contribution from that other insurance.
Paragraphs a. and b. above do not apply to other insurance, to which the additional insured has been
added as an additional insured.
When this insurance is excess, we will have no duty to defend the insured against any "suit" if any other
insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake
to do so, but we will be entitled to the insured's rights against all those other insurers. When this
insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that
exceeds the sum of:
1. The total amount that all such other insurance would pay for the loss in the absence of this
insurance; and
2. The total of all deductible and self - insured amounts under all that other insurance. We will share
the remaining loss, if any, by the method described in 5.d. Other Insurance of B. General
Conditions under SECTION IV— BUSINESS AUTO CONDITIONS.
N. AUTOS RENTED BY EMPLOYEES
Paragraph S. Other Insurance of B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is
amended as follows:
If an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by
your "employee" on your behalf and at your direction, this insurance will be primary to the "employee's"
personal insurance.
O. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
The requirement in A. Loss Conditions, 2. Duties In The Event Of Accident Claim, Suit Or Loss, sub- paragraph
a. of SECTION IV BUSINESS AUTO CONDITIONS that you must notify us of an "accident" applies only when the
"accident' is known to:
CA990143 Page 5 of 7 Ed. 0912
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. A member, if you are a limited liability company; or
4. An executive officer or insurance manager, if you are a corporation.
P. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
Section B. General Conditions of SECTION IV BUSINESS AUTO CONDITIONS is amended as follows:
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.
Q. HIRED AUTO — COVERAGE TERRITORY
Sub - section 7. Policy Period, Coverage Territory of B. General Conditions, under SECTION IV BUSINESS AUTO
CONDITIONS is replaced by the following:
a. For short-term hired "autos ", the coverage territory with respect to Liability Coverage is
anywhere in the world provided that if the "insured's" responsibility to pay damages for "bodily
injury" or "property damage" is determined in a "suit", the "suit" is brought in the United States
of America, the territories and possessions of the United States of America, Puerto Rico or
Canada or in a settlement we agree to.
R. WAIVER OF SUBROGATION
Sub - section S. Transfer Of Rights Of Recovery Against Others To Us of A. Loss Conditions under SECTION IV
BUSINESS AUTO CONDITIONS is amended by adding the following:
We waive any right of recovery we may have against any person or organization with whom you have a
written contract that requires such waiver because of payments we make for damages under this Coverage
Form.
S. EXTENDED CANCELLATION CONDITION
Paragraph Lb. of the COMMON POLICY CONDITIONS (IL 00 17) cancellation applies except as follows:
If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first Named
Insured written notice of cancellation at least 60 days before the effective date of cancellation.
T. TWO OR MORE DEDUCTIBLES
The following is added to Paragraph D., Deductible, of SECTION III, PHYSICAL DAMAGE COVERAGE
If any another policy or policies issued by us provides coverage for the same accident the following applies:
a. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible,
it will be waived;
CA990143 Page 6 of 7 Ed. 0912
If the deductible under this Business Auto Coverage Form is not the smaller (or smallest)
deductible, it will be reduced by the amount of the smaller (or smallest) deductible.
U. HYBRID PAYMENT COVERAGE
The following is added to Paragraph C, Limits of Insurance, of SECTION III, PHYSICAL DAMAGE COVERAGE
1. In the event of a total loss to a "non- hybrid" auto for which Comprehensive, Specified. Causes of Loss, or
Collision coverages are provided under this Coverage Form, then such Physical Damage Coverages are
amended as follows:
a. If the auto is replaced with a "hybrid" auto, we will pay an additional 10 %, to a maximum of
$2,500, of the "non - hybrid" auto's actual cash value or replacement cost, whichever is less.
b. The auto must be replaced and a copy of a bill of sale or new lease agreement received by us
within 60 calendar days of the date of "loss,"
C. Regardless of the number of autos damaged in any one "loss", the most we will pay under this
Hybrid Payment Coverage provision for any one 'loss" is $10,000.
2. For the purposes of this HYBRID PAYMENT COVERAGE provision the following definitions apply:
"Non- hybrid" auto is defined as an auto that uses only an internal combustion engine to move the auto.
"Hybrid" auto is defined as an auto with an internal combustion engine and one or more electric motors;
and that uses the internal combustion engine and one or more electric motors to move the auto, or the
internal combustion engine to charge one or more electric motors, which move the auto.
V. RESULTANT MENTAL ANGUISH INCLUDED
The definition of "bodily injury" in SECTION V— DEFINITIONS is replaced with the following:
"Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or
death resulting from any of these.
W. HIRED "AUTO" REDEFINED
The following is added to the Description of Covered Auto Designation Symbols for Symbol 8, Hired "Autos" Only:
Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an
"auto" you hire.
CA990143 Page 7 of 7 Ed. 0912
POLICY NUMBER:WPP1235560 00
COMMERCIAL GENERAL LIABILITY
CG 2010 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modes insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Locations Of Covered Operations
Blanket as required by written contract.
Blanket as required by written contract.
It is agreed that such insurance as is afforded by this
policy for the benefit of the additional insured shown
shall be primary insurance, and any other insurance
maintained by the additional insured(s) shall be
excess and noncontributory as respects to any claim,
loss or liability, allegedly arising out of the operations
of the named insured, provided however that this
insurance will not apply to any claim loss or liability
which is determined to be solely the additional
insured's responsibility
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 liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
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(s) at the location(s)
designated above.
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.
CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 3
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. 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
2. 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.
Page 2 of 3 0 Insurance Services Office, Inc., 2012 CG 2010 0413
C. With respect to the insurance afforded to these .
additional insureds, the following is added to
Section Ili — 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
CG 20 10 04 13
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.
0 Insurance Services Office, Inc., 2012
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