HomeMy WebLinkAboutCSS 2021-10-04 Item 1B - Contract - Tukwila Park Gazebo with Northwest PlaygroundCity of Tukwila
Allan Ekberg, Mayor
INFORMATIONAL MEMORANDUM
TO: Community Services and Safety
FROM: Tracy Gallaway - Parks and Recreation Director
BY: Matthew Austin - Parks Maintenance Supervisor
CC: Mayor Ekberg
DATE: 9/20/2021
SUBJECT: Tukwila Park Improvements
ISSUE
Replacement of the Tukwila Park gazebo.
BACKGROUND
On July 19, 2020, the gazebo at Tukwila Park was destroyed by a fire. Throughout the past 14
months, parks maintenance staff have been working on replacing the structure.
DISCUSSION
Staff worked with Public Works and the Washington Cities Insurance Authority (WCIA) to
confirm that the replacement of the gazebo would be covered by insurance. Once confirmed,
staff selected a contractor and a replacement structure. The new gazebo will be fire resistant,
with a metal frame and roof and will have similar amenities such as integrated wiring, lighting,
and electrical outlets for potential rentals. Attachment A is a contract to address the gazebo
replacement.
FINANCIAL IMPACT
The gazebo replacement described in Attachment A will be reimbursed through WCIA with initial
funding through the Parks and Recreation capital improvement budget utilizing a combination of
King County Levy funds, Park Impact Fees and REET funds.
Attachment A: Contract with Northwest Playgrounds for Tukwila Park
Gazebo replacement
Total
$80,000
$80,000
RECOMMENDATION
Staff recommends the City Council authorize the Mayor to sign the contract (Attachment A) with
Northwest Playgrounds for $80,000 for installation of a new gazebo.
ATTACHMENTS
Attachment A: Northwest Playground Contract and Scope of Work.
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City of Tukwila
6200 Southcenter Boulevard, Tukwila WA 98188
CONTRACT FOR SERVICES
Contract Number.
This Agreement is entered into by and between the City of Tukwila, Washington, a non -charter
optional municipal code city hereinafter referred to as the City," and Northwest Playground Equipment,
lnc, hereinafter referred to as "the Contractor," whose principal office is
located at
PO Box 2410, Issaquah, WA 98027.
WHEREAS, the City has determined the need to have certain services performed for its citizens
but does not have the manpower or expertise to perform such services; and
WHEREAS, the City desires to have the Contractor perform such services pursuant to certain terms
and conditions; now therefore.
IN CONSIDERATION OF the mutual benefits and conditions hereinafter contained, the parties
hereto agree as follows
1. Scope and Schedule of Services to be Performed by Contractor. The Contractor shall perform
those services described on Exhibit A attached hereto and incorporated herein by this reference as if
fully set forth. In performing such services, the Contractor shall at all times comply with all Federal.
State. and local statutes, rules and ordinances applicable to the performance of such services and the
handling of any funds used in connection therewith. The Contractor shall request and obtain prior
written approval from the City if the scope or schedule is to be modified in any way.
2. Compensation and Method of Payment. The City shall pay the Contractor for services rendered
according to the rate and method set forth on Exhibit B attached hereto and incorporated herein by this
reference The total amount to be paid shall not exceed S80.000.
3. Contractor Budget. The Contractor shall apply the funds received under this Agreement within the
maximum limits set forth in this Agreement. The Contractor shall request prior approval from the City
whenever the Contractor desires to amend its budget in any way
4. Duration of Acareement. This Agreement shall be in full force and effect for a period commencing
October 1st. 2021, and ending March , 2021, unless sooner terminated under the provisions 4Y
hereinafter specified. 20 7
5. Independent Contractor. Contractor and City agree that Contractor is an independent contractor with
respect to the services provided pursuant to this Agreement Nothing in this Agreement shall be
considered to create the relationship of employer and employee between the parties hereto. Neither
Contractor nor any employee of Contractor shall be entitled to any benefits accorded City employees
by virtue of the services provided under this Agreement. The City shall not be responsible for
withholding or otherwise deducting federal income tax or social security or contributing to the State
Industrial Insurance Program, or otherwise assuming the duties of an employer with respect to the
Contractor, or any employee of the Contractor.
6. indemnification. The Contractor shall defend, indemnify, and hold the Public Entity, its officers,
officials, employees and volunteers harmless from any and all claims, injuries, damages losses or
suits including attorney fees, arising out of or in connection with the performance of this Agreement,
except for injuries and damages caused by the sole negligence of the Public Entity.
CA Revised May 2020 Page 1 of 4
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Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115.
then, in the event of liability for damages arising out of bodily injury to persons or damages to property
caused by or resulting from the concurrent negligence of the Contractor and the Public Entity, its
officers, officials, employees, and volunteers, the Contractor's liability hereunder shall be only to the
extent of the Contractor's negligence. It is further specifically and expressly understood that the
indemnification provided herein constitutes the Contractor's waiver of immunity under Industrial
Insurance, Title 51 RCW. solely for the purposes of this indemnification. This waiver has been mutually
negotiated by the parties The provisions of this section shall survive the expiration or termination of
this Agreement.
7. Insurance. The Contractor shall procure and maintain for the duration of the Agreement. insurance
against claims for injuries to persons or damage to property which may arise from or in connection with
the performance of the work hereunder by the Contractor, their agents. representatives, employees or
subcontractors. Contractor's maintenance of insurance, its scope of coverage and limits as required
herein shall riot be construed to limit the liability of the Contractor to the coverage provided by such
insurance, or otherwise limit the City's recourse to any remedy available at law or in equity.
A Minimum Scope of Insurance. Contractor shall obtain insurance of the types and with the limits
described below:
1. Automobile Liability insurance with a minimum combined single limit for bodily injury and
property damage of $1.000,000 per accident. Automobile liability insurance shall cover all
owned, non -owned hired and leased vehicles. Coverage shall be written on Insurance Services
Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If
necessary. the policy shall be endorsed to provide contractual liability coverage.
2. Commercial General Liability insurance with limits no less than $2.000,000 each occurrence.
$2,000,000 general aggregate and $2.000,000 products -completed operations aggregate
limit. Commercial General Liability insurance shall be as least at broad as ISO occurrence
form CG 00 01 and shall cover liability arising from premises, operations, independent
contractors, products -completed operations. stop gap liability. personal injury and advertising
injury, and liability assumed under an insured contract. The Commercial General Liability
insurance shall be endorsed to provide a per project general aggregate limit using ISO form
CG 25 03 05 09 or an equivalent endorsement. There shall be no exclusion for liability
arising from explosion, collapse or underground property damage. The City shall be named
as an additional insured under the Contractor's Commercial General Liability insurance policy
with respect to the work performed for the City using ISO Additional Insured endorsement CG
20 10 10 01 and Additional Insured -Completed Operations endorsement CG 20 37 10 01 or
substitute endorsements providing at least as broad coverage.
3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of
Washington.
B Public Entity Full Availability of Contractor Limits. If the Contractor maintains higher insurance
limits than the minimums shown above, the Public Entity shall be insured for the full available limits
of Commercial General and Excess or Umbrella liability maintained by the Contractor, irrespective
of whether such limits maintained by the Contractor are greater than those required by this Contract
or whether any certificate of insurance furnished to the Public Entity evidences limits of liability
lower than those maintained by the Contractor.
C. Other Insurance Provision. The Contractor's Automobile Liability and Commercial General
Liability insurance policies are to contain, or be endorsed to contain that they shall be primary
insurance with respect to the City. Any insurance, self-insurance, or insurance pool coverage
maintained by the City shall be excess of the Contractor's insurance and shall not contribute with
it.
D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M Best rating
i 1 Revised May 2020 Faze 2 of .1
of not less than A. VH.
E. Verification of Coverage. Contractor shall furnish the City with original certificates and a copy of
the amendatory endorsements, including but not necessarily limited to the additional insured
endorsement, evidencing the insurance requirements of the Contractor before commencement of
the work. Upon request by the City, the Contractor shall furnish certified copies of all required
insurance policies, including endorsements, required in this Agreement and evidence of all
subcontractors' coverage.
F Subcontractors. The Contractor shall cause each and every Subcontractor to provide insurance
coverage that complies with all applicable requirements of the Contractor -provided insurance as
set forth herein, except the Contractor shall have sole responsibility for determining the limits of
coverage required to be obtained by Subcontractors. The Contractor shall ensure that the Public
Entity is an additional insured on each and every Subcontractor's Commercial General Liability
insurance policy using an endorsement as least as broad as ISO CG 20 10 10 01 for ongoing
operations and CG 20 37 10 01 for completed operations.
G. Notice of Cancellation. The Contractor shall provide the City and all Additional Insureds for this
work with written notice of any policy cancellation, within two business days of their receipt of such
notice.
H. Failure to Maintain Insurance. Failure on the part of the Contractor to maintain the insurance as
required shall constitute a material breach of contract, upon which the City may, after giving five
business days notice to the Contractor to correct the breach, immediately terminate the contract
or, at its discretion, procure or renew such insurance and pay any and all premiums in connection
therewith, with any sums so expended to be repaid to the City on demand or at the sole discretion
of the City, offset against funds due the Contractor from the City
8. Record Keeping and Reporting.
A The Contractor shall maintain accounts and records. including personnel, property, financial and
programmatic records which sufficiently and properly reflect all direct and indirect costs of any
nature expended and services performed in the performance of this Agreement and other such
records as may be deemed necessary by the City to ensure the performance of this Agreement.
B. These records shall be maintained for a period of seven (7) years after termination hereof unless
permission to destroy them is granted by the office of the archivist in accordance with RCW Chapter
40.14 and by the City.
9. Audits and lnsnection§. The records and documents with respect to all matters covered by this
Agreement shall be subject at all times to inspection, review or audit by law during the performance of
this Agreement.
10. Termination. This Agreement may at any time be terminated by the City giving to the Contractor thirty
(30) days written notice of the City's intention to terminate the same Failure to provide products on
schedule may result in contract termination If the Contractor's insurance coverage is canceled for any
reason. the City shall have the right to terminate this Agreement immediately.
11. Discrimination Prohibited. The Consultant, with regard to the work performed by it under this
Agreement, will not discriminate on the grounds of racereligion, creed, color, national origin, age,
veteran status, sex. sexual orientation, gender identity. marital status. political affiliation, the
presence of any disability. or any other protected class status under state or federal law, in the
selection and retention of employees or procurement of materials or supplies.
12. Assignment and Subcontract. The Contractor shall not assign or subcontract any portion of the
services contemplated by this Agreement without the written consent of the City.
13. Entire Agreement. Modification. This Agreement, together with attachments or addenda, represents
the entire and integrated Agreement between the City and the Contractor and supersedes all prior
negotiations. representations, or agreements written or oral. No amendment or modification of this
Agreement shall be of any force or effect unless it is in writing and signed by the parties.
CA Revised May 202() Page 3 of 4
11
14. Severability and Survival. If any term, condition or provision of this Agreement is declared void or
unenforceable or limited in its application or effect, such event shall not affect any other provisions
hereof and all other provisions shall remain fully enforceable. The provisions of this Agreement, which
by their sense and context are reasonably intended to survive the completion, expiration or cancellation
of this Agreement. shall survive termination of this Agreement.
15. Notices. Notices to the City of Tukwila shall be sent to the following address:
City Clerk, City of Tukwila
6200 Southcenter Blvd.
Tukwila. Washington 98188
Notices to the Contractor shall be sent to the address provided by the Contractor upon the
signature line below,
16. Aoolicable Law: Venue: Attorney's Fees. This Agreement shall be governed by and construed in
accordance with the laws of the State of Washington. In the event any suit, arbitration, or other
proceeding is instituted to enforce any term of this Agreement, the parties specifically understand and
agree that venue shall be properly laid in King County. Washington. The prevailing party in any such
action shall be entitled to its attorney's fees and costs of suit.
DATED this day of , 20
CITY OF TUKWILA CONTRACTOR
By
/m
Allan Ekberg, Mayor
ATTEST/AUTHENTICATED
City Clerk. Christy O'Flaherty
APPROVED AS TO FORM:
Office of the City Attorney
Printed Name and Title
3a .6 14 6 r -
Address: rets 2 Li IC
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CA Revised May 2020 Page 4 of 4
12
Price Total Price a
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Northwest Playground Equipment, Inc.
PO Box 2410, Issaquah, WA 98027-0109
Phone (425) 313-9161 FAX (425) 313-9194
Email: sales(lnwplayground.com
QUOTE
This quote is only valid for 30 days.
To: Tukwila Parks & Rec
Re: Tukwila Park Pagoda
15460 65th Ave S
Tukwila, WA 98188
Contact Name: Matthew Austin
Email: matthew.austint57tukwilawa.gov
Phone:
Cell/Fax:
Quote # 083121RR-01
Date: 8/31/2021
206-445-2245
Item # Oty Description
EQUIPMENT
Poligon
OTC 20SS Shelter with Primary SS, IBC 2015 Building Code, Wind Speed
148655 1 110, Ground Snow Load 20, Min Clearance Height 7'5", Upper Roof Slope 6/12
and Anchor Bolts. NOTE: Carmel/Handrail - 7 Side / 0 Ends (Bays), MCH of
7.5, Electrical Access with 2 Cutouts & Frame Finish/Color - Galvanizing
148655 1 Sealed and Stamped Engineered Drawings with Calculations
$ 41,170.00 $ 41,170.00
$ 1,000.00
Equipment Subtotal $ 42,170.00
Northwest Playground Equipment Discount: NPEI 20.00% $ (8,234.00)
Poligon Freight. $ 6,000.00_
Equipment Total (less tax) $ 39,936.00
CERTIFIED INSTALLATION
1 Installation of Poligon Shelter Which Includes: Shelter Assembly, Unloading $ 29,400.00
Onsite, Disposal of Packaging and Did from Holes Offsite. Footings included
with Excavation thru Existing Concrete, Disposal of Dirt from Holes, plus all
Forming with Rebar and Concrete. Electrical set up will also be an additional
cost
Bond or CC Convenience Fee:
Location Code: 1729
Prevailing Wage Job Installation Total: $ 29,400.00
Performance Bond (If Required): 3.0% $
Resale Certificate Required for Tax Exemption: Tax: 10.1% $ 7,002.94
ORDER TOTAL: $ 76,338.94
All quotes are subject to material and fuel surcharges.
Acceptance of Proposal:
(Please be sure you have read, signed, initialed and understand the Terms and Conditions on Page 2 of this Quote)
The items, prices and conditions listed herein are satisfactory and are hereby accepted.
TITLE
Customer Signature Date
Thank you for considering Northwest Playground Equipment, Inc. for your
Park, Playground, Shelter and Sports Equipment requirements.
PAGE 1 of 3 Revised 8111/2017
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Northwest Playground Equipment, Inc.
PO Box 2410, Issaquah, WA 98027-0109
Phone (425) 313-9161 FAX (425) 313-9194
Email: sales@nwplayground.com
Project Name: Tukwila Park Pagoda Quote # 083121RR-01
TERMS AND CONDITIONS
QUOTE CONDITIONS AND ACCEPTANCE:
This quote is only valid for 30 days.
Orders placed or requested for delivery after 30 days are subject to price increases.
(PIs Initial) It is the Buyer's responsibility to verify quantities and description of items quoted.
Once your order has been placed, any changes including additions, deletions or color changes, will delay your shipment.
EXCLUSIONS: Unless specified, this quote specifically excludes all of the following:
Required Permits; Davis Bacon, Certified Payroll or Prevailing Wage fees
Performance/Payment Bonds
Site work and landscaping
Removal of existing equipment
Unloading; Receiving of inventory or equipment; Storage of equipment
Equipment assembly and/or installation
Safety surfacing; Borders or drainage requirements
Landscaping Repairs DUE to poor access or in climatic weather
FREIGHT AND DELIVERY:
Shipping is FOB Origin. A 24 -hr Call Ahead is available at additional cost.
Delivery is currently 5+ weeks after order submittal. Unless otherwise noted, all equipment is delivered unassembled.
"' (PIs Initial)Buyer Is responsible to meet and provide a minimum of 2 ADULTS to unload truck
A Check List, detailing all items shipped, will be mailed to you and a copy will be included with the shipment.
Buyer is responsible for ensuring the Sales Order and Item Numbers on all boxes and pieces match the Check List.
(PIs Initial)Shortages or damages must be noted on the driver's delivery receipt. Shortages or damages not noted become
the buyers financial responsibility.
Damaged Freight must be refused. Please notify Northwest Playground Equipment immediately of any damages.
Shortages and Concealed Damage must be reported to Northwest Playground Equipment within 10 days of delivery.
A reconsignment fee will be charged for any changes made to delivery address after order has been placed.
TAXES:
All orders delivering in Washington are subject to applicable sales tax unless a tax exemption or Reseller Permit is on file
at the time the order is placed.
PAYMENT TERMS: An approved Credit Application is required for new customers. 50% down payment is due at time of order
with balance due upon delivery, unless other credit terms have been approved. Interest may be charged on past due
balances at an annual rate of 18%. A 3% charge will be added to all credit card orders.
RESTOCKING: Items canceled, returned or refused will be subject to a minimum 25% restocking fee. All return freight
charges are the responsibility of the Buyer.
MAINTENANCE/WARRANTY:
Manufacturer's standard product warranties apply and cover equipment replacement and freight costs only; labor is not included,
Northwest Playground Equipment offers no additional warranties.
Maintenance of the equipment and safety surfacing is the responsibility of the customer.
Any unauthorized alterations or modifications to the equipment (including layout) will void your warranty.
INSTALLATION: (if applicable)
A private locate service for underground utilities must be completed before your scheduled installation.
Site must be level and free of loose debris (this includes ground cover/chips).
A minimum 6 foot opening with good access must be available to the site for delivery trucks and tractor.
An onsite dumpster must be provided for disposal of packaging materials.
Arrangements must be made in advance for the disposal of dirt/rocks from within the installation area.
Arrangements must be made in advance for the removal/disposal of existing equipment.
Additional charges may apply if large rocks or concrete are found beneath the surface.
Access to power and water must be available.
Site supervision is quoted in 8 -hour days.
Acceptance of Terms & Conditions
Acceptance of this proposal, made by an authorized agent of your company, indicates agreement to the above terms and conditions.
TITLE Customer Signature Date
Thank you for choosing Northwest Playground Equipment
PAGE 2 of 3 Revised 8/11/2017
14
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PAGE 3 of 3
Revised 8/11/2017
15
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pciigon
FRAME COLOR: GALV
ROOF COLOR: EVERGREEN
COLORS MAY VARY SLIGHTLY FROM RENDERED IMAGE
TUKWILA PARK
SEATTLE, WA
OTC 20
PROJECT: TUKWILA PARK
LOCATION: SEATTLE, WA
BUILDING TYPE: OTC 20
ROOF TYPE: STANDING SEAM
BUILDING NUMBER: P12616
ORDER NUMBER: 69669
DRAWING LIST:
SKEET NUMBER
DRAWING DESCRIPTION
CS
COVER SHEET
I
ARCHITECTURAL ELEVATIONS
2
STRUCTURAL FRAMING PLAN
3
COLUMN LAYOUT
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USE FOR PRELIMINARY
PLANNING AND ESTIMATING
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FABRICATOR APPROVALS:
CITY OF PHOENIX, A2 APPROVED FABRICATOR .CO8-2010
CITY OF LOS ANGELES. CA APPROVED FABRICATOR 41596
CITY OF RIVERSIDE. CA APPROVED FABRICATOR /SPO6-0033
CITY OF HOUSTON, TX APPROVED FABRICATOR 0470
CLARK COUNTY, NV APPROVED FABRICATOR 0284
STATE OF UTAH APPROVED FABRICATOR 02008-14
CERTIFICATES;
COUNTY CERTIFICATE OF COMPETENCY NO. 19 -OBOE.
PCI (POWDER COATING INSTITUTE) 4000 CERTIFIED
MATERIALS'
pEgCglpT(QN
SCHEDULE PIPE
RMT PIPE
LIGHT GAGE COLD FORMED
STRUCTURAL STEEL PLATE
ROOF PANELS (STEEL)
ASOOGRAOE BITION
553 ARADE
A519
A1503 (GRADE 501
A38
A653
GENERAL NOTES:
UNLESS NO ED OTHERWISE, THIS STRUCTURE WAS DESIGNED TO
ONLY SUPPORT WHAT IS SHOWN ON THESE DRAWINGS. THE
MANUFACTURER MUST BE CONTACTED IF ANYTHING ELSE IS TO SE
ATTACHED TO THIS STRUCTURE (WALLS, COLUMN WRAPS, RAILINGS,
ETC.) SO THE DESIGN OF THIS STRUCTURE CAN BE REVIEWED AND
POSSIBLY REVISED.
UNLESS NOTED OTHERWISE, THIS STRUCTURE WAS DESIGNED
05 ASSUMING A 20' SEPARATION BETWEEN ANY ADJACENT STRUCTURE
WITH AN EAVE HEIGHT EQUAL TO OR GREATER THAN THE EAVE
HEIGHT OF THIS STRUCTURE IF THAT SEPARATION DOES NOT EXIST,
THE MANUFACTURER MUST BE CONTACTED SO THE DESIGN OF THIS
STRUCTURE CAN BE REVIEWED AND POSSIBLY REVISED.
STRUCTURAL STEEL SHALL BE DETAILED. FABRICATED. AND ERECTED
IN ACCORDANCE WITH THE LATEST EDITION OF THE AMERICAN
INSTITUTE OF STEEL CONSTRUCTION (AISC) SPECIFICATION MANUAL
ALL WELDING IS PERFORMED BY AMERICAN WELDING SOCIETY
O(AWS) CERTIFIED WELDERS AND CONFORMS TO THE LATEST EDITION
f AWS 01.1 OR D1.3 AS REQUIRED.
PARTS SHOWN MAY BE UPGRADED DUE TO STANDARDIZED
FABRICATION. REFER TO THE SHIPPING BILL OF MATERIALS FOR
POSSIBLE SUBSTITUTIONS.
FOR PROPER FIELD INSTALLATION OF THE BUILDING IT IS
RECOMMENDED THAT THE PRIMARY FRAME INSTALLER AND THE
ROOF INSTALLER HAVE A MINIMUM FIVE (5) YEARS DOCUMENTED
EXPERIENCE INSTALLING THIS TYPE OF PRODUCT.
FOR PROPER FIELD INSTALLATION OF THE BUILDING IT IS
RECOMMENDED THAT ELECTRIC WIRING, IF REQUIRED, BE RUN
THROUGH THE STRUCTURAL MEMBERS BEFORE THE BUILDING IS
ERECTED.
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TOP VIEW
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FRONT VIEW
FINISH GRADE
]ASSUMED AT CONSTANT
ELEvAi)ON UNLESS
OTHERWISE NOTED]
GENERAL ROOF NOTES:
METAL ROOFING:
• 24 GAUGE
• GALVALUME COATED
• KYNAR 500 PAINTED
2. TRIM COLOR MATCHES ROOF
3. SEE POUGON_COM FOR
COLOR OPTIONS
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ISOMETRIC VIEW
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BASEPLATE NOTES:
1. POUGON ENGINEERING WILL DETERMINE REQUIRED BASEPLATE
DESIGN AFTER ENGINEERING PACKAGE IS ORDERED.
2. CUSTOMER MAY SUGGEST PREFERRED BASEPLATE DESIGN.
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22
Policy No.CPP1037280 COMMERICAL GENERAL LIABILITY
WN GL 39 08 18
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
The Commercial General Liability Enhancement Endorsement is an optional endorsement that provides coverage
enhancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is.
provided by this summary, refer to following endorsement for changes in your policy.
SUMMARY OF COVERAGES PAGE
Bodily Injury And Property Damage Liability
• Non Owned Watercraft Up To 50 Feet 2
Property Damage Liability
• Elevators 3
• Fire. Lightning, Explosion Or Sprinkler Leakage Exception 3
• Borrowed Equipment ($25,000 Per Occurrence, $50.000 Aggregate.
$2,500 Deductible Per Occurrence 3
Supplementary Payments — Amended
• Bail Bonds Up To $5,000 3
• Loss of Earnings Up To $500/Day 3
Who Is An Insured Amendments
• Employee Bodily Injury To A Co -Employee 4
• Newly Formed Or Acquired Organizations For Up To 180 Days 4
• Blanket Additional Insured — Vendors — As Required By Contract 4
• Blanket Additional Insured — Lessor Of Leased Equipment 6
• Blanket Additional Insured — Managers Or Lessors Of Premises 6
• Blanket Additional Insured — State Or Governmental Agency Or Subdivision
Or Political Subdivision — Permits Or Authorizations 7
• Blanket Additional Insured — State Or Governmental Agency Or Subdivision
Or Political Subdivision — Permits Or Authorizations Relating To Premises 8
Damage To Premises Rented To You — $300,000 9
Medical Payments Increased Limit — $10,000 Or Amount Shown on Declarations 9
Conditions
• Knowledge of Occurrence. Offense, Claim Or Suit Amended 9
• Unintentional Failure To Disclose Hazards 9
• Waiver of Subrogation 10
Insured Contract Amended 10
Personal And Advertising Injury Redefined
• Televised, Videotaped Or Electronic Publication 10
WN GL 39 08 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Page 1 of 10
23
COMMERCIAL GENERAL LIABILITY
WN GL 39 08 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
This endorsement modifies the insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement. The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement
will be amended as shown below.
SECTION I — COVERAGES AMENDMENTS
COVERAGE A — BODILY INJURY AND PROPERTY
DAMAGE LIABILITY
A. Non Owned Aircraft Or Watercraft
Item 2. Exclusions, Paragraph g. is replaced by the
following:
g.
Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising out
of the ownership, maintenance, use or
entrustment to others of any aircraft, "auto" or
watercraft owned or operated by or rented or
loaned to any insured. Use includes operation
and "loading or unloading".
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" involved
in the ownership, maintenance, use or
entrustment to others of any aircraft" "auto" or
watercraft that is owned or operated by or
rented or loaned to any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises you
own or rent;
(2) A watercraft you do not own that is:
(a) Less than 50 feet long; and
(b) Not being used to carry persons or
property for a charge:
This Subparagraph (2) applies to any
person, who with your expressed or implied
consent, either uses or is responsible for the
use of the watercraft;
(3) Parking an "auto" on, or on the ways next to,
premises you own or rent, provided the
"auto" is not owned by or rented or loaned to
you or the insured;
(4) Liability assumed under any "insured
contract" for the ownership, maintenance or
use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage" arising
out of:
(a) The operation of machinery or
equipment that is attached to, or part of,
a land vehicle that would qualify under
the definition of "mobile equipment" if it
were not subject to a compulsory or
financial responsibility law or other
motor vehicle insurance law where it is
licensed or principally garaged; or
(b) The operation of any of the machinery
or equipment listed in Paragraph f. (2)
or f. (3) of the definition of "mobile
equipment".
B. Damage To Property Coverage Extensions
Item 2. Exclusions, Paragraph j. is replaced by the
following:
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy, including
any costs or expenses incurred by you, or
any other person, organization or entity, for
repair, replacement, enhancement,
restoration or maintenance of such property
for any reason, including prevention of injury
to a person or damage to another's
property;
(2) Premises you sell, give away or abandon, if
the "property damage" arises out of any part
of those premises;
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24
Page 2 of 10
(3) Property loaned to you;
(4) Personal property in the care, custody or
control of the insured;
(5) 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; or
(6) That particular part of any property that must
be restored, repaired or replaced because
"your work" was incorrectly performed on it.
Paragraphs (1), (3) and (4) of this exclusion do not
apply to "property damage" (other than damage by
fire, lightning, explosion or sprinkler leakage) to
premises, including the contents of such premises,
rented to you for a period of seven or fewer
consecutive days. A separate limit of insurance
applies to Damage To Premises Rented To You as
described in SECTION III — LIMITS OF INSURANCE.
However, the provisions of this paragraph do not apply
if coverage for Damage To Premises Rented To You
is excluded by endorsement.
Paragraph (2) of this exclusion does not apply if the
premises are "your work" and were never occupied,
rented or held for rental by you.
Paragraphs (3) and (4) of this exclusion do not apply
to the use of elevators.
Paragraphs (3), (4), (5) and (6) of this exclusion do not
apply to liability assumed under a sidetrack
agreement.
Paragraph (4) of this exclusion does not apply to
"property damage" to borrowed equipment while not
being used to perform operations at the jobsite.
Subject to Paragraph 2. of SECTION III — LIMITS OF
INSURANCE, the rules below fix the most we will pay
for "property damage" under this provision;
(1) $25,000 any one "occurrence", regardless of the
number of persons or organizations who sustain
damages because of that "occurrence";
(2) $50,000 annual aggregate; and
(3) We will pay only for damages in excess of $2,500
as a result of any one "occurrence", regardless of
the number of persons or organizations who
sustain damages because of that "occurrence".
We may, or if required by law, pay all or any part
of any deductible amount, if applicable, to effect
settlement of any claim or "suit". Upon notice of
our payment of a deductible amount, you shall
promptly reimburse us for the part of the
deductible amount we paid.
Paragraph (6) of this exclusion does not apply to
"property damage" included in the
"products -completed operations hazard".
The insurance provided for "property damage" from
the use of elevators and for "property damage" to
borrowed equipment is excess over any other valid
and collectible property insurance (including any
deductible portion thereof) available to the insured
whether primary, excess, contingent or on any other
basis.
C. Damage To Premises Rented To You
Item 2. Exclusions, the last paragraph is replaced by
the following:
Exclusions c. through n. do not apply to damage by
fire, lightning, explosion or sprinkler leakage to
premises while rented to you or temporarily occupied
by you with permission of the owner. A separate limit
of insurance applies to this coverage as described in
Paragraph 6. of SECTION III — LIMITS OF
INSURANCE.
COVERAGE B — PERSONAL AND ADVERTISING
INJURY LIABILITY
D. Personal And Advertising Injury
Item 2. Exclusions is amended by replacing
Sub -paragraphs b. and c. with the following:
b. Material Published With Knowledge Of Falsity
"Personal and advertising injury" arising out of
oral, written, televised, videotaped or electronic
publication, in any manner, of material, if done by
or at the direction of the insured with knowledge of
its falsity.
c. Material Published Prior To Policy Period
"Personal and advertising injury" arising out of
oral, written, televised, videotaped or electronic
publication, in any manner, of material whose first
publication took place before the beginning of the
policy period.
SUPPLEMENTARY PAYMENTS — COVERAGES A
AND B
E. Supplementary Payments — Coverages A and B
Item 1. is amended by replacing Subparagraphs b.
and d. 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 the
Bodily Injury Liability Coverage applies. We do
not have to furnish these bonds.
d. All reasonable expenses incurred by the insured at
our request to assist us in the investigation or
defense of the claim or "suit", including actual loss
of earnings up to $500 a day because of time off
from work.
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25
SECTION II — WHO IS AN INSURED AMENDMENTS
A. Employee Bodily Injury To A Co -Employee
Paragraph 2. a. (1) is replaced by the following:
However, none of these "employees"' or "volunteer
workers" are insureds for "bodily injury" or "personal
and advertising injury":
(a) To you, to your partners or members (if you are
a partnership or joint venture), to your members
(if you are a limited liability company). to a
co -'employee" while in the course of his or her
employment or performing duties related to the
conduct of your business, or to your other
"volunteer workers" while performing duties
related to the conduct of your business;
(b) To the spouse, child, parent, brother or sister of
the co -"employee" or "volunteer worker' as a
consequence of Paragraph (1)(a) above;.
(c) 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) or (b) above; or
(d) Arising out of his or her providing or failing to
provide professional health care services.
However, if a suit seeking damages for "bodily
injury" or "personal and advertising injury' to any
co -"employee" or other "volunteer worker' arising out
of and in the course of the co -"employee's" or
"volunteer worker's" employment or while performing
duties related to the conduct of your business, or a
suit seeking damages brought by the spouse, child,
parent, brother or sister of the co -'employee" or
other "volunteer worker', is brought against you or a
co -"employee" or a "volunteer worker', we will
reimburse the reasonable costs that you incur in
providing a defense to the co -"employee" or
'Vo'lunteer worker" against such matters, Any
reimbursement made pursuant to this sub -section
will be in addition to the limits of liability set forth in
the Declarations.
B. Newly Acquired Organizations
Paragraph 3. a. is replaced by the following:
a. Coverage under this provision is afforded only
until the 180th day after you acquire or farm the
organization or the end of the policy period,
whichever is earlier;
The following are added:
C. Blanket Additional Insured — Vendors — As
Required By Contract
1. Section II — Who Is An Insured is amended to
include as an additional insured any person(s) or
organization(s) (referred to throughout this
endorsement as vendor) with whom you have
agreed in a written contract, executed prior to
loss, to name as an additional insured, but 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,
a. The insurance afforded to such vendor only
applies to the extent permitted by law; and
b. 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.
2. With respect to the insurance afforded to these
vendors, the following additional exclusions
apply:
a. The insurance afforded the vendor does not
apply to:
(1) "Bodily injury" or "property damage" for
which the vendor is obligated to pay
damages by reason of the assumption
of liability in a contract or agreement.
This exclusion does not apply to liability
for damages that the vendor would have
in the absence of the contract or
agreement;
(2) Any express warranty unauthorized by
you;
(3) Any physical or chemical change in the
product made intentionally by the
vendor;
(4) 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;
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26
Page 4 of 10
(5) 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 the products;
(6) Demonstration, installation, servicing or
repair operations, except such
operations performed at the vendor's
premises in connection with the sale of
the product;
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: or
(8) "Bodily injury" or "property damage"
arising out of the sole negligence of the
vendor for its own acts or omissions or
those of its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(7)
(i) The exceptions
Subparagraphs (4) or
(ii) Such inspections,
tests or servicing as
agreed to make
undertakes to make
course of business,
with the distribution
products.
3. This Provision C. does not apply:
a. 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:
b. To any vendor for which coverage as an
additional insured specifically is scheduled
by endorsement: or
c. When liability included within the
"products -completed operations hazard" has
been excluded for such product either by the
provisions of the coverage part or by
endorsement.
contained in
(6); or
adjustments.
the vendor has
or normally
in the usual
in connection
or sale of the
4. With respect to the insurance afforded to these
vendors, the following is added to Section III —
Limits Of Insurance:
if coverage provided to the vendor is required by
a contract or agreement, the most we will pay on
behalf of the vendor is:
a. The minimum amount required by the
contract or agreement; or
b. The Limits of Insurance shown in the
Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
5. With respect to the insurance afforded to these
additional insureds. the following additional
exclusion applies:
This insurance does not apply to:
a. "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:
(1) The preparing, approving, or failing to
prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against an additional 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 failure to render any
professional services by you with
respect to your providing engineering,
architectural or surveying services in
your capacity as an engineer, architect
or surveyor.
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27
D. Blanket Additional Insured — Lessor Of Leased
Equipment
1. Section II — Who Is An Insured is amended to
include as an additional insured 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, executed prior to loss, that such
person(s) or organization(s) be added as an
additional insured on your policy. Such
person(s) or organization(s) is an insured only
with respect to liability for "bodily injury",
"property damage" 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(s) or
organization(s).
However, the insurance afforded to such
additional insured:
a. Only applies to the extent permitted by law:
and
b. 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.
2. 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.
3. 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:
a. The minimum amount required by the
contract or agreement; or
b. The Limits of Insurance shown in
Declarations;
whichever is less.
This endorsement shall not increase
applicable Limits of Insurance shown in
Declarations.
the
the
the
4. With respect to the insurance afforded to these
additional insureds, the following additional
exclusion applies:
This insurance does not apply to:
a. "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:
(1) The preparing, approving, or failing to
prepare or approve. maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against an additional 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 failure to
render any professional services by you with
respect to your providing engineering,
architectural or surveying services in your
capacity as an engineer, architect or
surveyor.
E, Blanket Additional Insured -- Managers Or
Lessors Of Premises
1. Section II — Who Is An Insured is amended to
include as an additional insured any person(s) or
organization(s) with whom you have agreed in a
written contract, executed prior to loss, to name
as an additional insured, but only with respect to
liability arising out of the ownership,
maintenance or use of that part of the premises
leased to you, subject to the following additional
exclusions:
This insurance does not apply to:
a. Any "occurrence" which takes place after
you cease to be a tenant in that premises.
b. Structural alterations, new construction or
demolition operations performed by or on
behalf of such additional insured.
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28
However:
a. The insurance afforded to such additional
insured only applies to the extent permitted
by law: and
b. 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.
2. 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:
a. The minimum amount required by the
contract or agreement; or
b. The Limits of Insurance shown in the
Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
3. With respect to the insurance afforded to these
additional insureds, the following additional
exclusion applies:
This insurance does not apply to:
a. "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:
(1) The preparing, approving, or failing to
prepare or approve. maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against an additional 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 failure to
render any professional services by you with
respect to your providing engineering,
architectural or surveying services in your
capacity as an engineer, architect or
surveyor.
F. Blanket Additional Insured — State Or
Governmental Agency Or Subdivision Or
Political Subdivision — Permits Or Authorizations
Section II — Who Is An Insured is amended to
include as an additional insured any state or
governmental agency or subdivision or political
subdivision with whom you have agreed in a written
contract, executed prior to loss, to name as an
additional insured, subject to the following
provisions:
1. This insurance applies only with respect to
operations performed by you or on your behalf
for which the state or governmental agency or
subdivision or political subdivision has issued a
permit or authorization.
However:
a. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
b. 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.
2. This insurance does not apply to:
a. "Bodily injury". "property damage" or
"personal and advertising injury" arising out
of operations performed for the federal
government. state or municipality: or
b. "Bodily injury" or "property damage"
included within the "products -completed
operations hazard".
3. 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:
a. The minimum amount required by the
contract or agreement; or
b. The Limits of Insurance shown in the
Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
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29
30
4. With respect to the insurance afforded to these
additional insureds, the following additional
exclusion applies:
This insurance does not apply to:
a. "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:
(1) The preparing, approving, or failing to
prepare or approve, maps, shop
drawings, opinions, reports, surveys.
field orders, change orders or drawings
and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against an additional 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 failure to
render any professional services by you with
respect to your providing engineering,
architectural or surveying services in your
capacity as an engineer, architect or
surveyor.
G. Blanket Additional Insured — State Or
Governmental Agency Or Subdivision Or
Political Subdivision — Permits Or Authorizations
Relating To Premises
Section II — Who Is An Insured is amended to
include as an additional insured any state or
governmental agency or subdivision or political
subdivision with whom you have agreed in a written
contract, executed prior to loss, to name as an
additional insured, subject to the following provision:
1. This insurance applies only with respect to the
following hazards for which the state or
governmental agency or subdivision or political
subdivision has issued a permit or authorization
in connection with premises you own, rent or
control and to which this insurance applies:
a. The existence, maintenance, repair,
construction, erection or removal of
advertising signs, awnings, canopies, cellar
entrances, coal holes, driveways, manholes,
marquees, hoist away openings, sidewalk
vaults, street banners or decorations and
similar exposures; or
b. The construction, erection or removal of
elevators; or
c. The ownership, maintenance or use of any
elevators covered by this insurance.
However,
a. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
b. 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.
2. 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:
a. The minimum amount required by the
contract or agreement: or
b. The Limits of Insurance shown in the
Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
3. With respect to the insurance afforded to these
additional insureds, the following additional
exclusion applies:
This insurance does not apply to:
a. "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:
(1) The preparing, approving, or failing to
prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
WN GL 39 08 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 10
This exclusion applies even if the claims
against an additional 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 failure to
render any professional services by you with
respect to your providing engineering.
architectural or surveying services in your
capacity as an engineer, architect or
surveyor.
SECTION III — LIMITS OF INSURANCE
AMENDMENTS
A. Damage To Premises Rented To You
Paragraph 6. is replaced by the following:
6. Subject to Paragraph 5. 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 by fire,
lightning, explosion or sprinkler leakage, while
rented to you or temporarily occupied by you
with permission of the owner is the greater of;
a. $300,000, or
b. The amount shown next to the Damage To
Premises Rented To You Limit in the
Declarations.
However, the provisions of this paragraph do not
apply if Damage To Premises Rented To You
Coverage is excluded by endorsement.
B. Medical Expense Limit
Paragraph 7. is replaced with the following:
7. Subject to Paragraph 5. above, the most we will
pay under Coverage C for all medical expenses
because of "bodily injury" sustained by any one
person is the greater of:
a. $10,000: or
b. The amount shown next to the Medical
Expense Limit in the Declarations.
This insurance does not apply if coverage for
Medical Expenses is excluded either by the
provisions of the coverage part or by
endorsement.
SECTION IV — COMMERCIAL GENERAL LIABILITY
CONDITIONS AMENDMENTS
A. Knowledge Of Occurrence
Item 2. Duties In The Event Of Occurrence,
Offense, Claim or Suit is amended by adding the
following:
e. You must give us or our authorized
representative prompt notice of an "occurrence",
claim or loss only when the "occurrence", claim
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: or
(4) A member or manager, if you are a limited
liability company.
B. Other Insurance
Item 4. Other Insurance, b. Excess Insurance (1)
(a) (ii) is replaced by the following:
(ii) That is fire, lightning, explosion or sprinkler
leakage insurance for premises rented to you or
temporarily occupied by you with permission of
the owner:
C. Unintentional Failure To Disclose Hazards
Item 6. Representations is replaced by the
following:
6. Representations And Unintentional Failure
To Disclose Hazards
a. By accepting this policy, you agree:
(1) The statements in the Declarations are
accurate and complete;
(2) Those statements are based upon
representations you made to us: and
(3) We have issued this policy in reliance
upon your representations.
b. If you unintentionally fail to disclose any
hazards existing 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.
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31
D. Waiver of Subrogation
Item 8. Transfer of Rights of Recovery Against
Others to Us is hereby amended by the addition of
the following:
We waive any right of recovery we may have
because of payments we make for injury or damage
arising out of your ongoing operations or "your work"
done under a written contract, executed prior to loss.
requiring such waiver with that person or
organization and included in the
"products -completed operations hazard". However,
our rights may only be waived prior to the
"occurrence" giving rise to the injury or damage for
which we make payment under this Coverage Part.
The insured must do nothing after a loss to impair
our rights. At our request, the insured will bring
"suit" or transfer those rights to us and help us
enforce those rights.
SECTION V — DEFINITIONS AMENDMENTS
A. Insured Contract Amended
Paragraph 9. a. is replaced by 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,
explosion or sprinkler leakage to premises while
rented to you or temporarily occupied by you
with permission of the owner is not an "insured
contract":
B. Personal And Advertising Injury Redefined
Paragraph 14. d. and e, are replaced by the
following:
d. Oral, written, televised, videotaped or electronic
publication of material that slanders or libels a
person or organization or disparages a person's
or organization's goods, products or service;
e. Oral, written, televised, videotaped or electronic
publication of material that violates a person's
right of privacy;
WN GL 39 08 18 Includes copyrighted material of Insurance Services office, Inc., with its permission. Page 10 of 10
32
Policy No.CPP1037280
COMMERCIAL GENERAL LIABILITY
WN GL 49 07 15
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
PRIMARY AND NONCONTRIBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended to
include as an additional insured any person or or-
ganization for whom you are performing opera-
tions 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. Such person or
organization is an additional insured only with re-
spect to liability for "bodily injury', "property dam-
age" 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.
A person's or organization's status as an additional
insured under this endorsement ends when your
operations for that additional insured are complet-
ed.
However:
1. The insurance afforded to such additional in-
sured 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 in-
surance afforded to such additional insured
will not be broader than that which you are re-
quired by the contract or agreement to provide
for such additional insured.
WN GL 49 07 15
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sion applies:
This insurance does not apply to:
1. "Bodily injury", "property damage" or "personal
and advertising injury" arising out of the ren-
dering of, or the failure to render, any profes-
sional architectural, engineering or surveying
services, including:
a. The preparing, approving, or failing to pre-
pare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,
change orders or drawings and specifica-
tions; or
b. Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against an additional insured allege negli-
gence 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 failure to render any profes-
sional services by you with respect to your
providing engineering, architectural or survey-
ing services in your capacity as an engineer,
architect or surveyor.
Includes copyrighted material of Insurance Services Office, inc., with its permission.
Page 1 of 2
33
2. "Bodily injury" or "property damage" occurring
after:
a. All work, including materials, parts or
equipment furnished in connection with
such work, on the project (other than ser-
vice, maintenance or repairs) to be per-
formed by or on behalf of the additional in-
sured(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 or-
ganization other than another contractor or
subcontractor engaged in performing op-
erations for a principal as a part of the
same project.
C. With respect to the insurance afforded to these
additional insureds, the following is added to Sec-
tion 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:
1. The minimum amount required by the contract
or agreement; or
2. The Limits of Insurance shown in the Declara-
tions;
whichever is less.
This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
WNGL490715
34
D. The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
any contribution from any other insurance
available to an additional insured under your
policy provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
(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.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 2 of 2
POLICY NUMBER: CPP 1037280 COMMERCIAL GENERAL LIABILITY
WN GL 50 07 15
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
PRIMARY AND NONCONTRIBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s):
Location And Description Of Completed Operations
PER WRITTEN CONTRACT OR AGREEMENT
WHERE YOU AGREE TO NAME A PARTY OR
PARTIES AS ADDTTIONAL INSURED (S)
PER WRITTEN CONTRACT OR AGREEMENT
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" or "prop-
erty damage" caused, in whole or in part, by
"your work" at the location designated and de-
scribed in the schedule of this endorsement per-
formed for that additional insured and included in
the "products -completed operations hazard".
However:
1. The insurance afforded to such additional in-
sured 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 pro-
vide for such additional insured.
WN GL500715
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sion applies:
This insurance does not apply to:
1. "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,
including:
a. The preparing, approving, or failing to pre-
pare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,
change orders or drawings and specifica-
tions; or
b. Supervisory, inspection, architectural or en-
gineering activities.
includes copyrighted material of Insurance Services Office Inc. with its permission.
Page 1 of 2
35
This exclusion applies even if the claims
against an additional insured allege negli-
gence or other wrongdoing in the supervi-
sion, hiring, employment, training or monitor-
ing 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 failure to render
any professional services by you with respect
to your providing engineering, architectural or
surveying services in your capacity as an en-
gineer, architect or surveyor.
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:
1. The minimum amount required by the con-
tract or agreement; or
2. The Limits of Insurance shown in the Decla-
rations;
whichever is less.
This endorsement shall not increase the applica-
ble Limits of Insurance shown in the Declara-
tions.
D. The following is added to the Other Insurance
Condition and supersedes any provision to the con-
trary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek con-
tribution from any other insurance available to an
additional insured under your policy provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be pri-
mary and would not seek contribution from
any other insurance available to the additional
insured.
WN GL 50 07 15 Page 2 of 2
Includes copyrighted material of Insurance Services Office Inc. with its permission.
36
POLICY NUMBER: CPP 1037280 COMMERCIAL GENERAL LIABILITY
CG 25 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Projectls}:
PER WRITTEN CONTRACT OR AGREE-
MENT WHERE YOU AGREED TO PRO-
VIDE A SEPARATE GENERAL AGGRE-
ATE LIMIT FOR EACH PROJECT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. For all sums which the insured becomes le-
gally obligated to pay as damages caused by
"occurrences" under Section I - Coverage A,
and for all medical expenses caused by acci-
dents under Section I - Coverage C, which
can be attributed only to ongoing operations
at a single designated construction project
shown in the Schedule above:
1. A separate Designated Construction Proj-
ect General Aggregate Limit applies to
each designated construction project, and
that limit is equal to the amount of the
General Aggregate Limit shown in the
Declarations.
2. The Designated Construction Project Gen-
eral Aggregate Limit is the most we will
pay for the sum of all damages under
Coverage A, except damages because of
"bodily injury" or "property damage"
included in the "products -completed oper-
ations hazard", and for medical expenses
under Coverage C regardless of the
number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making
claims or bringing "suits".
3. Any payments made under Coverage A
for damages or under Coverage C for
medical expenses shall reduce the Desig-
nated Construction Project General Aggre-
CG 25 03 05 09
gate Limit for that designated construction
project. Such payments shall not reduce
the General Aggregate Limit shown in the
Declarations nor shall they reduce any
other Designated Construction Project
General Aggregate Limit for any other
designated construction project shown in
the Schedule above.
4. The limits shown in the Declarations for
Each Occurrence, Damage To Premises
Rented To You and Medical Expense
continue to apply. However, instead of
being subject to the General Aggregate
Limit shown in the Declarations, such
limits will be subject to the applicable
Designated Construction Project General
Aggregate Limit.
B. For all sums which the insured becomes
legally obligated to pay as damages caused by
"occurrences" under Section I - Coverage A,
and for all medical expenses caused by
accidents under Section I - Coverage C,
which cannot be attributed only to ongoing
operations at a single designated construction
project shown in the Schedule above:
1. Any payments made under Coverage A
for damages or under Coverage C for
medical expenses shall reduce the amount
available under the General Aggregate
Limit or the Products -completed Opera-
tions Aggregate Limit, whichever is ap-
plicable; and
' Insurance Services Office, Inc., 2008 Page 1 of 2
37
2. Such payments shall not reduce any Des-
ignated Construction Project General
Aggregate Limit.
C. When coverage for liability arising out of the
"products -completed operations hazard" is
provided, any payments for damages because
of "bodily injury" or "property damage" in-
cluded in the "products -completed operations
hazard" will reduce the Products -completed
Operations Aggregate Limit, and not reduce
the General Aggregate Limit nor the Desig-
nated Construction Project General Aggregate
Limit.
Page 2 of 2
38
D. If the applicable designated construction proj-
ect has been abandoned, delayed, or aban-
doned and then restarted, or if the authorized
contracting parties deviate from plans, blue-
prints, designs, specifications or timetables,
the project will still be deemed to be the same
construction project.
E. The provisions of Section III - Limits Of In-
surance not otherwise modified by this
endorsement shall continue to apply as
stipulated.
Insurance Services Office, Inc., 2008 CG 25 03 05 09
COVERAGES
CERTIFICATE NUMBER: Cert ID 20819
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.
(NSR
LTR
TYPEOF INSURANCE
AOOL
INSO
SUBR
MAID
POLICY NUMBER
POLICY EFF
IMMIDOIYYYY1
POLICY EXP
(MM/DDIYYYY)
_. LIMITS
A
X
COMMERCLALGENERALLIABILITY
INSURED 1425) 313-9161
Northwest Playground Equipment Inc
Play Safe Construction, Inc.
PO Box 2410
Issaquah WA 98027
INSURERS:
INSURERC:
EACHOCCURRENCE
$ 1,000,000
INSURER E:
INSURER F:
CLAIMS -MADE 1 X J OCCUR
Y
Y
CPP1037280
03/01/202103/01/2022
PREMISES EaENTECoccurrence)
$ 100,000
MED EXP (Any one person)
6 5,000
_
PERSONALBADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 2,000,000
POLICY
X
EC ' LOC
PRODUCTS-COMPIOPAGG
$ 2,000 000
OTHER:
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
A
X
ANY AUTO
-
CPP1037051
03/01/2021
03/01/2022
BODILY INJURY (Per person)
S
OWNED
AUTOS ONLY
."
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
S
X
HIRED
AUTOS ONLY
X
NON -OWNED
AUTOS ONLY
PROPERTY DAMAGE
(Per accident)
$
S
A
X
UMBRELLALIAB
X
OCCUR
UW31006108
03/01/2021
03/01/2022
EACH OCCURRENCE
$ 5,000,000
EXCESS LIAR
CLAIMS -MADE
AGGREGATE
$ 5,000,000
DED X RETENT ON S 10,000
$
A
WORKERS COMPENSATION
ANDEMPLOYERS'LIABILMY
CPP1037260
03/01/2021
03/01/2022
PER OTH-
STATUTE X ER
ANYPROPRIETOR/PARTNERJEXECUTIVE
YIN
NIA
WA State Stop Gap
E.L. EACH ACCIDENT
S 1,000,000
OFFICE RIMEMBEREXCLUDED7
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1, 000,000
5
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Seheduls, may be attached II more apace Is required)
RE: Pagoda Project.
City of Tukwila is included as Additional Insured with respect to work performed by or on behalf of
the Named Insured and coverage is Primary i Nan -Contributory per Endorsement WNGL49. Waiver of
Subrogation included per Endorsement WNGL39. Completed operations wording included per Endorsement
WNGL50. Additional Insured shall apply by written contract and/or agreement.
ACC)REr CERTIFICATE OF LIABILITY INSURANCE
kr.-f
DATE(MMIDDMYYY)
09/15/2021
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 policyfies) must have ADDITIONAL INSURED provisions or 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
CHOICE Insurance, LLC 8
1715 Market Street STE 100
Kirkland WA 98033
CONTACT
NAME: Nick Ghaffari
PHONE Ext). (425) 739-6565 {� , No): (425) 739-9955
ADDRESS: Serviceechoiceineurance.net
INSURERS) AFFORDING COVERAGE
NAM*
INSURER A : Western National Mutual Insure
15377
INSURED 1425) 313-9161
Northwest Playground Equipment Inc
Play Safe Construction, Inc.
PO Box 2410
Issaquah WA 98027
INSURERS:
INSURERC:
INSURER D
INSURER E:
INSURER F:
CERTIFICATE HOLDER
CANCELLATION
City of Tukwila
6200 Southcenter Blvd
Tukwila WA 98188
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
r,. /1s df/6Ci
ACORD 25 (2016103)
Q 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Page 1 of 1
39