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Contract 50906-FP1
FORTWORTH® CSC No.50906-FP1 TRANSPORTATION AND PUBLIC WORKS NOTICE OF PROJECT COMPLETION City Project Ns: 02552 Regarding contract 50906 for Wilbarger Street&Miller Avenue Pedestrian,Signal,and Lighting Improvementsis required by the Department of Transportation&Public Works as approved by City Council on 06/05/2018 through M&C C-28716 the director of the Department of Transportation&Public Works upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $1,135,497.95 Amount of Approved Change Orders: $28,413.20 Ns 1 & 2 Revised Contract Amount: $1,163,911.15 Total Cost Work Completed: $1,098,135.50 Less Deductions: Liquidated Damages: 0 Days @$1,250.00/Day Pavement Deficiencies: Total Deduction Amount: $0.00 Total Cost Work Completed: $1,098,135.50 Less Previous Payments: $1,098,135.50 Final Payment Due $0.00 Lauren Prieur Dec 31, 2020 Lauren Prieur(Dec 31,202012:06 CST) Recommended for Acceptance Date Asst. Director, TPW - Capital Delivery 1-)k-n-L. Jan 4 2021 William Johnso (Jan 4,202109:01 CST) Accepted Date Director, Department of Transportation & Public Works Client Department 1?71a-vl� SG� � Jan 4, 2021 Dana Burghdoff(Jan 4,202 6:26 CST) Asst. City Manager Date Comments: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX TPW Construction Invoice Contract: CS50906 P.O.# FW020-1487 Payment Date: 9/21/2020 TO:BEAN ELECTRICAL INC INV•# CS50906-14-FINAL Estimate No. 14 DOE: PO BOX 40016 ProjManager Wilma Smith EVERMAN TX 76140 FOR: Intersection Improvements at Miller/Wilbarger Contract Amount: $1,163,911.15 Completed Ret Pen Adj Pay Total to Date: $1,098,135.50 $0.00 $0.00 $0.00 $1,098,135.50 Previous Estimate: $1,098,135.50 $0.00 $0.00 $0.00 $1,098,135.50 Earned to Date: $0.00 $0.00 $0.00 $0.00 $0.00 Payments: 31001-0200410-5740010-0O2552-003980 $1,000,000.00 Total to Date: $953,642.30 $0.00 $0.00 $0.00 $953,642.30 Previous Estimate: $953,642.30 $0.00 $0.00 $0.00 $953,642.30 Earned to Date: $0.00 $0.00 $0.00 $0.00 $0.00 34014-0200431-5740010-0O2552-003980-9999-14010204 $163,911.15 CO#1:$0 CO#2:$28,413.20 Total to Date: $144,493.20 $0.00 $0.00 $0.00 $144,493.20 Previous Estimate: $144,493.20 $0.00 $0.00 $0.00 $144,493.20 Earned to Date: $0.00 $0.00 $0.00 $0.00 $0.00 Friday,December 18,2020 Page 1 of 1 m cu m C _m N Cq U w r N .ti N h h b O Vi M 00 00 00 h N 1� [� ^' ry `\�I V] b9 fli to Vf f--1 A a � F U a a d m o E0./ �j 2 Q' O ; ^ } 'cT 4: Q O L ,Z + C O c� F a Q a H o G W F 72 a Q > - w U O` 2 F Q w" S a m `- F x x a acn v) L w Co U F. a 0 o U o 0 C� > Sr Z a U U Z pa, Z U F v m O o z U C O w w U > a �_ O c/ ° c ° Em w o .0 r.0 a3FOUF of o Z o o m'O � °�D w F o � m o 0 40 �r" o a vs o a _ NOO wa� P2� a o > tO 3 c'S - Cq E O O Ll 0 U u = ac ° p\O c c RS o I v b 5 c c N n m (i m vi "w c m E :.ay m 0 O C1r VJ E y ^ = C `L vvtltl� y C C}N to V O O O M M O O y C N O O n P.y n C L O 0 U ° z w �yg- 3 O F > z V n o U c =a'� c o ° o 0 v O N Q O O N C J O N O N � m H 10 � v O C C. 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FOLDERS REVIEWS TRANSMITTALS ISSUES Management - Reviews > Review detail OPEN #37 - Final Review Time left: 1day Construction Final Invoice Payment Start review Void entire review Export Report Name Description PROGRESS Final Pay App.pdf »» <bwebb@beanelectrical.com> Submitted to Reviewer 1 13 Final Pay App.xlsm -- Reviewer 1 Initial Review 1 NK Neal Kime Dec 15,2:25 PM <nkime@tnpinc.com> Submitted to Reviewer 2 Reviewer 2 Initial Review 2 n SR Shweta Rao Dec 15,2:35 PM <shweta.rao@fortworthtexas.gov> Submitted to Reviewer 3 Reviewer 3 Initial Review 3 LA Lissette Acevedo Dec 15,4:43 PM <lissette.acevedo@fortworthtexas.go\ Submitted to Reviewer 4 approved Reviewer 4 Initial Review 4 LA Lissette Acevedo Dec 15,4:44 PM <lissette.acevedo@fortworthtexas.go\ Submitted to Approver approved https://docs.b360.autodesk.com/projects/ae85894e-Oa4f-4b99-al67-ed3e0428a7f9/reviews/7567660a-23cc-4e53-b697-5e4799a29548 1/1 FORTWORTH, TRANSPORTATION AND PUBLIC WORKS October 27,2020 Bean Electrical,Inc. 821 E Enon Eve rman,TX 76140 RE: Acceptance Letter Project Name:WilbargerSt. &Miller Ave. Project Type: Pedestrian,Signal &Lighting Improvements City Project No.: 02552 To Whom It May Concern: On August 14, 2020 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on August 14,2020, which is the date of the final inspection and will extend of two(2)years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance,please feel free to contact meat 817- 392-8022. Sincerely, Shweta Rao, P.E.,Project Manager Cc: Neal Kime,Inspector Mark Owen, Inspection Supervisor Edwin Rodriguez,Senior Inspector Lissette Acevedo, P.E.,Program Manager HalffAssociates, Inc., Consultant Bean Electrical,Inc.,Contractor City of Fort Worth&TxDOT, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.08/20/19 JEAN' ELECTRUCALL--, INC-t 821 E. I iioii Aventie P 817-561-7400 B I Fort Worth,Texas 76140 F 817-561-7403 t�tzt•.beanelectrical.com 10/27/2020 City of Fort Worth CFA Administration 200 Texas St. Fort Worth, TX 76102 RE: Wilbarger Street & Miller Avenue DOE#: N/A City Project# 50906 The purpose of this letter is to acknowledge that Bean Electrical, Inc., have been paid in full by City of Fort Worth for the public improvements constructed to serve Wilbarger Street& Miller Avenue in Fort Worth, Texas. As a result, we hereby waive, release and relinquish all rights to assert any claim or demand for lien in connection with this project. Please feel fr e to contact me with any questions you may have. Since , Roy E. Bean II President Bean Electrical, Inc. TECL17979 Regulated by The Texas Department of Licensing and Regulations,P.O.Box 12157,Austin,Texas 78711,1 800 803 9202,512 463 6599,website www.license.state.tx.us/complaints CONSENT OF OWNER x SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ AIA DOCUMENT G707 SURETY ❑ OTHER ❑ Bond 44418349 PROJECT: Wilbarger Street&Miller Avenue-Pedestrian,Signal,&Lighting Improvements 2552,Wilbarger Street&Miller Avenue (name, address) TO(Owner)City of Fort Worth ARCHITECT'S PROJECT NO: 1000 Throckmorton CONTRACT FOR: FT. Worth,TX CONTRACT DATE: 6/5/2018 76102 CONTRACTOR: Bean Electrical,Inc. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (here insert name and address of Surety Company) SureTec Insurance Company 2103 CityWest Blvd.,Suite 1300 Houston,TX 77042 ,SURETY COMPANY, on bond of (here insert name and address of Contractor) Bean Electrical,Inc. 821 E Enon Fort Worth,TX 76140 CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety company of any of its obligations to (here insert name and address of Owner) City of Fort Worth 1000 Throckmorton,FT.Worth,TX 76102 ,OWNER, as set forth in the said Surety Company's bond IN WITNESS WHEROF, The Surety Company has hereunto set its hand this 26th day of October, 2020. SureTec Insurance ompany Surety Company r /Z r� SignaturZst uthorized Re esentative Attest (seal): Johnny Attorney-in-Fact Title NOTE:This form is to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBT AND CLAIMS, Current Edition AIA DOCUMENT G707*CONSENT OF SURETY COMPANY TO FINAL PAYMENT*APRIL 1970 EDITION*AIA 1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.NW WASHINGTON,D.C.2006 WARNING: Unlicensed photocopying violates U.S.copyright laws and is subject to legal prosecution. POO 4221049 JOINT LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That SureTec Insurance Company,a Corporation duly organized and existing under the laws of the State of Texas and having Its principal office in the County of Harris,Texas and Markel Insurance Company(the"Company"),a corporation duly organized and existing under the laws of the state of Illinois,and having its principal administrative office in Glen Allen,Virginia,does by these presents make,constitute and appoint: Tony Fierro,Jay Jordan,Johnny Moss,Steven W.Searcey,Robert J.Shuya,Mistie Beck, Jeremy Barnett,Robert G.Kanulh,Jade Porter,Jennifer Cisneros,Jarrett Willson,Jack Nottingham Their true and lawful agent(s)and attorney(s)-in-fact,each in their separate capacity if more than one is named above,to make,execute,seal and deliver for and on their own behalf,individually as a surety or jointly,as co-sureties,and as their act and deed any and all bonds and other undertaking in suretyship provided;however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: Five Million and 00/100 Dollars($5,000,000.00) This Power of Attorney Is granted and is signed and sealed under and by the authority of the following Resolutions adopted by the Board of Directors of 5ureTec Insurance Company and Markel Insurance Company: "RESOLVED,That the President,Senior Vice President,Vice President,Assistant Vice President,Secretary,Treasurer and each of them hereby is authorized to execute powers of attorney,and such authority can be executed by use of facsimile signature,which may be attested or acknowledged by any officer or attorney,of the company,qualifying the attorney or attorneys named in the given power of attorney,to execute in behalf of,and acknowledge as the act and deed of the SureTec Insurance Company and Markel Insurance Company,as the case may be,all bond undertakings and contracts of suretyship,and to affix the corporate seal thereto." IN WITNESS WHEREOF,Markel Insurance Company and SureTec Insurance Company have caused their official seal to be hereunto affixed and these presents to be signed by their duly authorized officers on the 24th day 0f March 2020 SureTec Insurance Company pntuurr+ Mar Insurance Company �SPANL' `���SJRANp1+�� i ""I �� Rpp . B : Lu W =Y' SEAL J,, ,4 }'� _ Michael C.Keimig,President s`•,,1 f "!;v Rdbin Russo,Senior Vice President Commonwealth of Virginia County of Henrico SS: on this 241h day of Much . 2020 A.D.,before me,a Notary Public of the Commonwealth of Virginia,in and for the County of Henrico,duly commissioned and qualified,came THE ABOVE OFFICERS OF THE COMPANIES,to me personally known to be the Indivldualsand officers described In,who executed the preceding instrument,and they acknowledged the execution of same,and being by me duly sworn,disposed and said that they are the officers of the said companies aforesaid, and that the seals affixed to the proceeding instrument are the Corporate Seals of said Companies,and the said Corporate Seals and their signatures as officers were duly affixed and subscribed to the said Instrument by the authority and direction of the said companies,and that Resolutions adopted by the Board of Directors of said Companies referred to in the preceding Instrument Is now In force. �s10011011,r1 IN TESTIMONY WHEREOF,I have hereunto set my hand,and affixed In \aF t e Cot{of Henrico,the day and year first above written. 2 MY i✓e��?� COMMISSION _ BY; ^, NUh IBF_R Donna Donavant,Notary Public 7083968 My commission expires 1/31/2023 We,the undersigned Officers of SureTec Insurance Company and MarkeYk)sUf iy��( O'iy Aerby certify that the original POWER OF ATTORNEY of which the foregoing Is-a full,true and correct copy Is still in full force and effect and hattlgtrljgefq rpyai4sd. IN WITNESS WHEREOF,we have hereunto set our hands,and affixed the Seals of said Companies,on the 7F;Ih day of October 2020 Vecce C pan Markel Insurance Company By i �`, V`"',Assistant Secrete Richard R.Grinnan,Vice President ann!Sers aryy^r' Any Instrument Issued In excess orthe penalty stated above is totally void and without any validity.4221049 For verificatlon of the authority of this Power you may call(713)812.0800 on any business day between 8:30 AM and 5:00 PM CST. POLICY NUMBER:TB2-Z91-471905-020 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole part, by required by a contract or agreement,the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement performed for that additional insured and included amount of insurance: in the"products-completed operations hazard". 1. Required by the contract or agreement;or However: 2. Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown in the Declarations; insured only applies to the extent permitted by whichever is less. law;and This endorsement shall not increase the applicable 2. If coverage provided to the additional insured is Limits of Insurance shown in the Declarations, 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. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement, prior to an agreement entered into prior to an "occurrence"or "occurrence"or offense,to provide additional insured offense. status. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 20 37 0413 0 Insurance Services Office,Inc.,2012 Page 1 of 1 POLICY NUMBER:TB2-Z91-471905-020 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 modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s)shown in the Schedule,but only with work, on the project (other than service, respect to liability for "bodily injury", "property maintenance or repairs)to be performed by or damage" or "personal and advertising injury" on behalf of the additional insured(s) at the caused, inwhole or in part, by: location of the covered operations has been 1. Your acts or omissions:or completed; or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf: injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. principal as a part ofthe same project. However: C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III—Limits Of Insurance: law: and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement,the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contract or agreement;or by the contractor agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the "property damage"occurring after: Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement, prior to an agreement entered into prior to an "occurrence"or "occurrence"or offense,to provide additional insured offense. status. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. CG 2010 0413 0 Insurance Services Office. Inc., 2012 Page 1 of 1 Policy Number: TB2-Z91-471905-020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY ADDITIONAL INSURED ENHANCEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Index of modified items: Item 1. Blanket Additional Insured Where Required By Written Agreement Lessors of Leased Equipment Managers or Lessors of Premises Mortgagees, Assignees or Receivers Owners, Lessees or Contractors Architects, Engineers or Surveyors Any Person or Organization Item 2. Blanket Additional Insured—Grantor Of Permits Item 3. Other Insurance Amendment Item 1. Blanket Additional Insured Where Required By Written Agreement Paragraph 2. of Section II—Who Is An Insured is amended to add the following: Additional Insured By Written Agreement The following are insureds under the Policy when you have agreed in a written agreement to provide them coverage as additional insureds under your policy: 1. Lessors of Leased Equipment: The person(s) or organization(s)from whom you lease equipment, but 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). This insurance does not apply to any"occurrence"which takes place after the equipment lease expires. 2. Managers or Lessors of Premises:Any manager(s)or lessor(s)of premises leased to you in which the written lease agreement obligates you to procure additional insured coverage. The coverage afforded to the additional insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent act(s)or omission(s) of you, your "employees", your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out of the additional insured's sole negligence. LC 20 5811 18 ©2018 Liberty Mutual Insurance Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. This insurance does not apply to: a. Any"occurrence"which takes place after you cease to be a tenant in that premises or to lease that land; b. Structural alterations, new construction or demolition operations performed by or on behalf of that manager or lessor; or c. Any premises for which coverage is excluded by endorsement. 3. Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of your ownership, maintenance or use of the premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or on behalf of such person(s)or organization(s). 4. Owners, Lessees or Contractors: Any person(s) or organization(s) to whom you are obligated to procure additional insured coverage, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury" caused, in whole or in part, by your act(s) or omission(s) or the act(s)or omission(s)of your"employees", your agents, or your subcontractors, in the performance of your ongoing operations. This insurance does not apply to"bodily injury", "property damage", or"personal and advertising injury"arising out of"your work" included in the "products-completed operations hazard" unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for liability caused, in whole or in part, by your act(s) or omission(s) or the act(s)or omission(s)of your"employees", your agents, or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's sole negligence. This insurance does not apply to "bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: a. The preparing,approving,or failing to prepare or approve, maps,shop drawings,opinions, reports,surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services. 5. Architects, Engineers or Surveyors: Any architect, engineer, or surveyor engaged by you but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your act(s)or omission(s)or the act(s)or omission(s)of those acting on your behalf: a. In connection with your premises; or b. In the performance of your ongoing operations. This insurance does not apply to "bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of or failure to render any professional services by or for you, including: LC 20 5811 18 ©2018 Liberty Mutual Insurance Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. a. The preparing,approving,or failing to prepare or approve, maps,shop drawings,opinions, reports,surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by or for you. 6. Any Person or Organization Other Than a Joint Venture:Any person(s)or organization(s)(other than a joint venture of which you are a member) for whom you are obligated to procure additional insured coverage, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your act(s)or omission(s)or the act(s)or omission(s)of those acting on your behalf: a. In the performance of your ongoing operations; or b. In connection with premises owned by or rented to you. This insurance does not apply to: a. Any person(s)or organization(s) more specifically covered in Paragraphs 1. through 5. above; b. Any construction,renovation,demolition or installation operations performed by or on behalf of you,or those operating on your behalf; or c. Any person(s)or organization(s)whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving or failing to prepare or approve, maps, drawings, opinions, reports, surveys, field orders, change orders, designs and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by or on behalf of you, or those operating on your behalf. The insurance afforded to any person(s)or organization(s)as an insured under this Item 1.: 1. Applies to the extent permitted by law; 2. Applies only to the scope of coverage and the minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the limits of insurance provided by this Policy; 3. Does not apply to any person(s) or organization(s)for any"bodily injury", "property damage" or"personal and advertising injury" if any other additional insured endorsement attached to this Policy applies to such person(s) or organization(s)with regard to the "bodily injury", "property damage"or"personal and advertising injury'; 4. Applies only if the "bodily injury" or"property damage" occurs, or the offense giving rise to the "personal and advertising injury" is committed, subsequent to the execution of the written agreement; and 5. Applies only if the written agreement is in effect at the time the "bodily injury" or"property damage" occurs, or at the time the offense giving rise to the"personal and advertising injury" is committed. LC 20 5811 18 ©2018 Liberty Mutual Insurance Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Policy Number TB2—Z91-471905-020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY ADDITIONAL INSURED ENHANCEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Index of modified items: Item 1, Blanket Additional Insured Where Required By Written Agreement Lessors of Leased Equipment Managers or Lessors of Premises Mortgagees,Assignees or Receivers Owners, Lessees or Contractors Architects, Engineers or Surveyors Any Person or Organization Item 2. Blanket Additional Insured—Grantor Of Permits Item 3. Other Insurance Amendment Item 1. Blanket Additional Insured Where Required By Written Agreement Paragraph 2. of Section If—Who Is An Insured is amended to add the following: Additional Insured By Written Agreement The following are insureds under the Policy when you have agreed in a written agreement to provide them coverage as additional insureds under your policy: 1. Lessors of Leased Equipment: The person(s)or organization(s)from whom you lease equipment, but 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). This insurance does not apply to any"occurrence"which takes place after the equipment lease expires. 2. Managers or Lessors of Premises:Any manager(s)or lessor(s)of premises leased to you in which the written lease agreement obligates you to procure additional insured coverage. The coverage afforded to the additional insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent act(s)or omission(s) of you, your "employees", your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured,except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out of the additional insured's sole negligence. LC 20 58 11 18 ©2018 Liberty Mutual Insurance Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. This insurance does not apply to: a. Any"occurrence"which takes place after you cease to be a tenant in that premises or to lease that land; b. Structural alterations, new construction or demolition operations performed by or on behalf of that manager or lessor; or c. Any premises for which coverage is excluded by endorsement. 3. Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of your ownership, maintenance or use of the premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or on behalf of such person(s)or organization(s). 4. Owners, Lessees or Contractors: Any person(s) or organization(s) to whom you are obligated to procure additional insured coverage, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your act(s)or omission(s)or the act(s)or omission(s)of your"employees", your agents, or your subcontractors, in the performance of your ongoing operations. This insurance does not apply to"bodily injury", "property damage", or"personal and advertising injury"arising out of"your work" included in the "products-completed operations hazard" unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for liability caused, in whole or in part, by your act(s)or omission(s)or the act(s)or omission(s)of your"employees", your agents, or your subcontractors, There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's sole negligence. This insurance does not apply to"bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: a. The preparing,approving,or failing to prepare or approve,maps,shop drawings,opinions,reports,surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection,architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services. 5. Architects, Engineers or Surveyors: Any architect, engineer, or surveyor engaged by you but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your act(s)or omission(s)or the act(s)or omission(s)of those acting on your behalf: a. In connection with your premises; or b. In the performance of your ongoing operations. This insurance does not apply to"bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering of or failure to render any professional services by or for you, including: LC 20 58 11 18 O 2018 Liberty Mutual Insurance Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. a. The preparing,approving,or failing to prepare or approve,maps,shop drawings,opinions,reports,surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection,architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by or for you. 6. Any Person or Organization Other Than a Joint Venture:Any person(s)or organization(s)(other than a joint venture of which you are a member) for whom you are obligated to procure additional insured coverage, but only with respect to liability for"bodily injury","property damage"or"personal and advertising injury"caused, in whole or in part, by your act(s)or omission(s)or the act(s)or omission(s)of those acting on your behalf: a. In the performance of your ongoing operations; or b. In connection with premises owned by or rented to you. This insurance does not apply to: a. Any person(s)or organization(s)more specifically covered in Paragraphs 1.through 5.above; b. Any construction,renovation,demolition or installation operations performed by or on behalf of you,or those operating on your behalf;or c. Any person(s)or organization(s)whose profession, business or occupation is that of an architect,surveyor or engineer with respect to liability arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving or failing to prepare or approve, maps, drawings, opinions, reports, surveys, field orders, change orders, designs and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by or on behalf of you, or those operating on your behalf. The insurance afforded to any person(s)or organization(s)as an insured under this Item 1.: 1. Applies to the extent permitted by law; 2. Applies only to the scope of coverage and the minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the limits of insurance provided by this Policy; 3. Does not apply to any person(s)or organization(s)for any"bodily injury", "property damage"or"personal and advertising injury"if any other additional insured endorsement attached to this Policy applies to such person(s) or organization(s)with regard to the"bodily injury", "property damage"or"personal and advertising injury'; 4. Applies only if the "bodily injury" or"property damage"occurs, or the offense giving rise to the "personal and advertising injury"is committed, subsequent to the execution of the written agreement; and 5. Applies only if the written agreement is in effect at the time the"bodily injury"or"property damage"occurs, or at the time the offense giving rise to the"personal and advertising injury"is committed. LC 20 58 11 18 ©2018 Liberty Mutual Insurance Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Item 2. Blanket Additional Insured Grantor Of Permits Paragraph 2. of Section II—Who Is An Insured is amended to add the following: Any state, municipality or political subdivision that has issued you a permit in connection with any operations performed by you or on your behalf, or in connection with premises you own, rent or control, and to which this insurance applies, but only to the extent that you are required to provide additional insured status to the state, municipality or political subdivision as a condition of receiving and maintaining the permit. Such state, municipality or political subdivision that has issued you a permit is an insured only with respect to their liability as grantor of such permit to you. However,with respect to the state, municipality or political subdivision: 1. Coverage will be no broader than required; and 2. Limits of insurance will not exceed the minimum limits of insurance required as a condition for receiving or maintaining the permit; but neither the scope of coverage nor the limits of insurance will exceed those provided by this Policy. This insurance does not apply to: 1. 'Bodily injury", "property damage" or"personal and advertising injury" arising out of operations performed for the state, municipality or political subdivision; 2. Any "bodily injury" or "property damage" included within the "products-completed operations hazard", except when required by written agreement initiated prior to loss; or 3. 'Bodily injury", "property damage"or"personal and advertising injury", unless negligently caused, in whole or in part, by you or those acting on your behalf. Item 3. Other Insurance Amendment If you are obligated under a written agreement to provide liability insurance on a primary,excess,contingent,or any other basis for any person(s)or organization(s)that qualifies as an additional insured on this Policy, this Policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV— Commercial General Liability Conditions will not apply.Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV— Commercial General Liability Conditions will apply. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured for the same 'occurrence", claim or"suit". LC 20 58 11 18 ©2018 Liberty Mutual Insurance Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Item 2. Blanket Additional Insured—Grantor Of Permits Paragraph 2. of Section II—Who Is An Insured is amended to add the following: Any state, municipality or political subdivision that has issued you a permit in connection with any operations performed by you or on your behalf, or in connection with premises you own, rent or control, and to which this insurance applies, but only to the extent that you are required to provide additional insured status to the state, municipality or political subdivision as a condition of receiving and maintaining the permit. Such state, municipality or political subdivision that has issued you a permit is an insured only with respect to their liability as grantor of such permit to you. However, with respect to the state, municipality or political subdivision: 1. Coverage will be no broader than required; and 2. Limits of insurance will not exceed the minimum limits of insurance required as a condition for receiving or maintaining the permit; but neither the scope of coverage nor the limits of insurance will exceed those provided by this Policy. This insurance does not apply to: 1. 'Bodily injury", "property damage" or"personal and advertising injury" arising out of operations performed for the state, municipality or political subdivision; 2. Any "bodily injury" or "property damage" included within the "products-completed operations hazard", except when required by written agreement initiated prior to loss; or 3. 'Bodily injury", "property damage" or"personal and advertising injury", unless negligently caused, in whole or in part, by you or those acting on your behalf. Item 3. Other Insurance Amendment If you are obligated under a written agreement to provide liability insurance on a primary, excess,contingent, or any other basis for any person(s)or organization(s)that qualifies as an additional insured on this Policy, this Policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV— Commercial General Liability Conditions will not apply.Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV— Commercial General Liability Conditions will apply. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured for the same 'occurrence", claim or"suit". LC 20 5811 18 ©2018 Liberty Mutual Insurance Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Policy Number:AS2-Z91-471905-030 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. Newly Acquired or Formed Organizations II. Employees as Insureds III. Lessor-Additional Insured and Loss Payee IV. Supplementary Payments- Increased Limits V. Fellow Employee Coverage VI. Personal Property of Others VII. Additional Transportation Expense and Cost to Recover Stolen Auto VIII. Airbag Coverage IX. Tapes, Records and Discs Coverage X. Physical Damage Deductible-Single Deductible XI. Physical Damage Deductible-Glass XI I. Physical Damage Deductible-Vehicle Tracking System XIII. Duties in Event of Accident, Claim, Suit or Loss XIV. Unintentional Failure to Disclose Hazards XV. Worldwide Liability Coverage- Hired and Nonowned Autos XVI. Hired Auto Physical Damage XVII. Auto Medical Payments Coverage Increased Limits XVIII. Drive Other Car Coverage- Broadened Coverage for Designated Individuals XIX. Rental Reimbursement Coverage XX. Notice of Cancellation or Nonrenewal XXI. Loan/Lease Payoff Coverage XXII. Limited Mexico Coverage XXIII. Waiver of Subrogation I. NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words "you" and "your" also refer to any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership of more than 50 percent interest, provided: A. There is no similar insurance available to that organization; B. Unless you notify us to add coverage to your policy,the coverage under this provision is afforded only until: 1. The 90th day after you acquire or form the organization; or 2. The end of the policy period, whichever is earlier; and C. The coverage does not apply to an "accident" which occurred before you acquired or formed the organization. AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 1 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. II. EMPLOYEES AS INSUREDS Paragraph A.1.Who Is An Insured of SECTION II -COVERED AUTOS LIABILITY COVERAGE is amended to add the following: Your "employee" is an "insured" while using with your permission a covered "auto" you do not own, hire or borrow in your business or your personal affairs. III. LESSOR-ADDITIONAL INSURED AND LOSS PAYEE A. Any"leased auto"will be considered an"auto"you own and not an"auto"you hire or borrow.The coverages provided under this section apply to any 'leased auto" until the expiration date of this policy or until the lessor or his or her agent takes possession of the'leased auto"whichever occurs first. B. For any 'leased auto" that is a covered "auto" under SECTION II - COVERED AUTOS LIABILITY COVERAGE, Paragraph A.I.Who Is An Insured provision is changed to include as an"insured"the lessor of the 'leased auto". However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You. 2. Any of your"employees"or agents; or 3. Any person, except the lessor or any"employee"or agent of the lessor, operating a'leased auto"with the permission of any of the above. C. Loss Payee Clause 1. We will pay, as interests may appear, you and the lessor of the 'leased auto"for"loss"to the covered "leased auto". 2. The insurance covers the interest of the lessor of the 'leased auto" unless the 'loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor of a 'leased auto", we will obtain his or her rights against any other party. D. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. E. The lessor is not liable for payment of your premiums. F. For purposes of this endorsement, the following definitions apply: "Leased auto"means an"auto"which you lease for a period of six months or longer for use in your business, including any"temporary substitute"of such 'leased auto". "Temporary substitute" means an "auto" that is furnished as a substitute for a covered "auto" when the covered "auto" is out of service because of its breakdown, repair, servicing, 'loss" or destruction. AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 2 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. IV. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS Subparagraphs A.2.a.(2) and A.2.a.(4) of SECTION II - COVERED AUTOS LIABILITY COVERAGE are deleted and replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. V. FELLOW EMPLOYEE COVERAGE A. Exclusion B.5. of SECTION II -COVERED AUTOS LIABILITY COVERAGE does not apply. B. For the purpose of Fellow Employee Coverage only, Paragraph B.5. of SECTION IV - BUSINESS AUTO CONDITIONS is changed as follows: This Fellow Employee Coverage is excess over any other collectible insurance. VI. PERSONAL PROPERTY OF OTHERS Exclusion 6. in SECTION II -COVERED AUTOS LIABILITY COVERAGE for a covered "auto" is amended to add the following: This exclusion does not apply to "property damage"or"covered pollution cost or expense" involving "personal property" of your "employees" or others while such property is carried by the covered "auto". The Limit of Insurance for this coverage is$5,000 per"accident". Payment under this coverage does not increase the Limit of Insurance. For the purpose of this section of this endorsement, "personal property" is defined as any property that is not used in the individual's trade or business or held for the production or collection of income. VII. ADDITIONAL TRANSPORTATION EXPENSE AND COST TO RECOVER STOLEN AUTO A. Paragraph AA.a. of SECTION III -PHYSICAL DAMAGE COVERAGE is amended as follows: The amount we will pay is increased to$50 per day and to a maximum limit of$1,000. B. Paragraph AA.a. of SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add the following: If your business is shown in the Declarations as something other than an auto dealership, we will also pay up to$1,000 for reasonable and necessary costs incurred by you to return a stolen covered "auto"from the place where it is recovered to its usual garaging location. VIII. AIRBAG COVERAGE Exclusion B.3.a. in SECTION III - PHYSICAL DAMAGE COVERAGE is amended to add the following: This exclusion does not apply to the accidental discharge of an airbag. IX. TAPES, RECORDS AND DISCS COVERAGE Exclusion B.4.a.of SECTION III -PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: a. Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment except when the tapes, records, discs or other similar audio, visual or data electronic devices: AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 3 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. (1) Are your property or that of a family member; and (2) Are in a covered "auto" at the time of"loss". The most we will pay for"loss" is$200. No Physical Damage Coverage deductible applies to this coverage. X. PHYSICAL DAMAGE DEDUCTIBLE -SINGLE DEDUCTIBLE Paragraph D. in SECTION III -PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: D. Deductible For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss"caused by fire or lightning. When two or more covered "autos" sustain "loss" in the same collision, the total of all the "loss"for all the involved covered "autos" will be reduced by a single deductible, which will be the largest of all the deductibles applying to all such covered "autos". XI. PHYSICAL DAMAGE DEDUCTIBLE—GLASS Paragraph D. in SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add the following: No deductible applies to"loss"to glass if you elect to patch or repair it rather than replace it. XII. PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM Paragraph D. in SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add: Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global positioning device and that device was the method of recovery of the vehicle. XIII. DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Subparagraphs A.2.a. and A.2.b. of SECTION IV- BUSINESS AUTO CONDITIONS are changed to: a. In the event of"accident", claim, "suit"or"loss", your insurance manager or any other person you designate must notify us as soon as reasonably possible of such "accident", claim, "suit" or"loss". Such notice must include: (1) How, when and where the"accident"or"loss"occurred; (2) The"insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. Knowledge of an "accident", claim, "suit" or "loss" by your agent, servant or "employee" shall not be considered knowledge by you unless you, your insurance manager or any other person you designate has received notice of the "accident", claim, "suit"or"loss"from your agent, servant or"employee". b. Additionally, you and any other involved "insured" must: (1) Assume no obligation, make no payment or incur no expense without our consent, except at the "insured's"own cost. AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 4 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. (2) Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or"suit". (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit". (4) Authorize us to obtain medical records or other pertinent information. (5) Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require. XIV. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. in SECTION IV- BUSINESS AUTO CONDITIONS is amended to add the following: Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business Auto Coverage Form or at any time during the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. XV. WORLDWIDE LIABILITY COVERAGE -HIRED AND NONOWNED AUTOS Condition B.7. in SECTION IV-BUSINESS AUTO CONDITIONS is amended to add the following: For "accidents" resulting from the use or operation of covered "autos" you do not own, the coverage territory means all parts of the world subject to the following provisions: a. If claim is made or"suit"is brought against an"insured"outside of the United States of America, its territories and possessions, Puerto Rico and Canada, we shall have the right, but not the duty to investigate, negotiate, and settle or defend such claim or"suit". If we do not exercise that right, the "insured" shall have the duty to investigate, negotiate, and settle or defend the claim or "suit" and we will reimburse the "insured" for the expenses reasonably incurred in connection with the investigation, settlement or defense. Reimbursement will be paid in the currency of the United States of America at the rate of exchange prevailing on the date of reimbursement. The "insured" shall provide us with such information we shall reasonably request regarding such claim or "suit"and its investigation, negotiation, and settlement or defense. The "insured" shall not agree to any settlement of the claim or "suit" without our consent. We shall not unreasonably withhold consent. b. We are not licensed to write insurance outside of the United States of America, its territories or possessions, Puerto Rico and Canada. We will not furnish certificates of insurance or other evidence of insurance you may need for the purpose of complying with the laws of other countries relating to auto insurance. Failure to comply with the auto insurance laws of other countries may result in fines or penalties. This insurance does not apply to such fines or penalties. XVI. HIRED AUTO PHYSICAL DAMAGE If no deductibles are shown in the Declarations for Physical Damage Coverage for Hired or Borrowed Autos, the following will apply: A. We will pay for 'loss" under Comprehensive and Collision coverages to a covered "auto" of the private passenger type hired without an operator for use in your business: AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 5 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 1. The most we will pay for coverage afforded by this endorsement is the lesser of: a. The actual cost to repair or replace such covered "auto"with other property of like kind and quality; or b. The actual cash value of such covered "auto" at the time of the"loss". 2. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". 3. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. B. For each covered "auto", our obligation to pay for, repair, return or replace the covered "auto" will be reduced by any deductible shown in the Declarations that applies to private passenger "autos" that you own. If no applicable deductible is shown in the Declarations, the deductible will be$250. If the Declarations show other deductibles for Physical Damage Coverages for Hired or Borrowed Autos, this Section XVI of this endorsement does not apply. C. Paragraph AA.b. of SECTION III -PHYSICAL DAMAGE COVERAGE is replaced by the following: b. Loss of Use Expenses For Hired Auto Physical Damage provided by this endorsement, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a private passenger vehicle rented or hired without a driver, under a written rental contract or agreement.We will pay for loss of use expenses caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto'; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered"auto". However, the most we will pay under this coverage is $30 per day, subject to a maximum of$900. XVII. AUTO MEDICAL PAYMENTS COVERAGE -INCREASED LIMITS For any covered "loss", the Limit of Insurance for Auto Medical Payments will be double the limit shown in the Declarations if the"insured"was wearing a seat belt at the time of the"accident". This is the maximum amount we will pay for all covered medical expenses, regardless of the number of covered "autos", "insureds", premiums paid, claims made, or vehicles involved in the"accident". If no limit of insurance for Auto Medical Payments is shown on the Declarations, this paragraph Section XVII of this endorsement does not apply. XVIII. DRIVE OTHER CAR COVERAGE -BROADENED COVERAGE FOR DESIGNATED INDIVIDUALS A. This endorsement amends only those coverages indicated with an "X"in the Drive Other Car section of the Schedule to this endorsement. B. SECTION II -COVERED AUTOS LIABILITY COVERAGE is amended as follows: 1. Any"auto"you don't own, hire or borrow is a covered "auto"for Liability Coverage while being used by any individual named in the Drive Other Car section of the Schedule to this endorsement or by his or her spouse while a resident of the same household except: AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 6 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. a. Any"auto"owned by that individual or by any member of his or her household; or b. Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos". 2. The following is added to Who Is An Insured: Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her spouse, while a resident of the same household, are "insureds" while using any covered "auto" described in Paragraph B.I. of this endorsement. C. Auto Medical Payments, Uninsured Motorist, and Underinsured Motorist Coverages are amended as follows: The following is added to Who Is An Insured: Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her "family members"are"insured"while"occupying"or while a pedestrian when struck by any"auto"you don't own except: Any"auto"owned by that individual or by any"family member". D. SECTION III - PHYSICAL DAMAGE COVERAGE is changed as follows: Any private passenger type "auto" you don't own, hire or borrow is a covered "auto" while in the care, custody or control of any individual named in the Drive Other Car section of the Schedule to this endorsement or his or her spouse while a resident of the same household except: 1. Any"auto"owned by that individual or by any member of his or her household; or 2. Any"auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos". E. For purposes of this endorsement, SECTION V-DEFINITIONS is amended to add the following: "Family member" means a person related to the individual named in the Drive Other Car section of the Schedule to this endorsement by blood, marriage or adoption who is a resident of the individual's household, including a ward or foster child. XIX. RENTAL REIMBURSEMENT COVERAGE A. For any owned covered "auto"for which Collision and Comprehensive Coverages are provided,we will pay for rental reimbursement expenses incurred by you for the rental of an"auto"because of a covered physical damage "loss" to an owned covered "auto". Such payment applies in addition to the otherwise applicable amount of physical damage coverage you have on a covered"auto". No deductibles apply to this coverage. B. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending with the earlier of the return or repair of the covered "auto", or the exhaustion of the coverage limit. C. Our payment is limited to the lesser of the following amounts: 1. Necessary and actual expenses incurred; or 2. $30 per day with a maximum of$900 in any one period. AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 7 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. D. This coverage does not apply: 1. While there are spare or reserve"autos"available to you for your operations; or 2. If coverage is provided by another endorsement attached to this policy. E. If a covered 'loss" results from the total theft of a covered "auto"of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE of the Business Auto Coverage Form or Section VII of this endorsement. XX.NOTICE OF CANCELLATION OR NONRENEWAL A. Paragraph A.2. of the COMMON POLICY CONDITIONS is changed to: 2. We may cancel or non-renew this policy by mailing written notice of cancellation or non-renewal to the Named Insured, and to any name(s) and address(es) shown in the Cancellation and Non-renewal Schedule: a. For reasons of non-payment, the greater of: (1) 10 days; or (2) The number of days specified in any other Cancellation Condition attached to this policy; or b. For reasons other than non-payment, the greater of: (1) 60 days; (2) The number of days shown in the Cancellation and Non-renewal Schedule; or (3) The number of days specified in any other Cancellation Condition attached to this policy, prior to the effective date of the cancellation or non-renewal. B. All other terms of Paragraph A. of the COMMON POLICY CONDITIONS, and any amendments thereto, remain in full force and effect. XXI. LOAN/LEASE PAYOFF COVERAGE The following is added to Paragraph C. Limits Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE: In the event of a total 'loss" to a covered "auto" of the private passenger type shown in the schedule or declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto", less: 1. The amount paid under the PHYSICAL DAMAGE COVERAGE SECTION of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the'loss'; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor; d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 8 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. e. Carry-over balances from previous loans or leases. This coverage is limited to a maximum of$1,500 for each covered "auto". XXII.LIMITED MEXICO COVERAGE WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY- NOT THE LAWS OF THE UNITED STATES OF AMERICA.THE REPUBLIC OF MEXICO CONSIDERS ANYAUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR BEYOND 25 MILES FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA. A. Coverage 1. Paragraph B.7. of SECTION IV- BUSINESS AUTO CONDITIONS is amended by the addition of the following: The coverage territory is extended to include Mexico but only if all of the following criteria are met: a. The"accidents"or"loss"occurs within 25 miles of the United States border; and b. While on a trip into Mexico for 10 days or less. 2. For coverage provided by this section of the endorsement, Paragraph B.5. Other Insurance in SECTION IV- BUSINESS AUTO CONDITIONS is replaced by the following: The insurance provided by this endorsement will be excess over any other collectible insurance. B. Physical Damage Coverage is amended by the addition of the following: If a 'loss" to a covered "auto" occurs in Mexico, we will pay for such 'loss" in the United States. If the covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash value of such 'loss"at the nearest United States point where the repairs can be made. C. Additional Exclusions The following additional exclusions are added: This insurance does not apply: 1. If the covered "auto" is not principally garaged and principally used in the United States. 2. To any"insured"who is not a resident of the United States. XXIII.WAIVER OF SUBROGATION Paragraph A.5.in SECTION IV-BUSINESS AUTO CONDITIONS does not apply to any person or organization where the Named Insured has agreed, by written contract executed prior to the date of "accident", to waive rights of recovery against such person or organization. AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 9 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Schedule Premium Liability Physical Damage Total Premium XVIII. Drive Other Car LIAB MP UM UIM COMP COLL Name of Individual XX. Notice of Cancellation or Nonrenewal Name and Address Number of Days AC 84 07 11 17 ©2017 Liberty Mutual Insurance Page 10 of 10 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. () Specific Waiver Name of person or organization (X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: All Texas operations 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: Issued by Liberty Mutual Fire Insurance Company16586 For attachment to Policy No.WC2-Z91-471905-010 Effective Date Premium$ Issued to Bean Electrical,Inc. WC 42 03 04 B C Copyright 2014 National Council on Compensation Insurance,Inc. Page 1 of 1 Ed, 06/01/2014 All Rights Reserved. DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCEF O6112/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CONTACT Natasha Felts NAME: P E -7256 (FZ, (972)771-4695K&S Insurance Agency AONNo (972)772 No): 2255 Ridge Road,Ste.333 E-MAIL nfelts@kandsins.com ADDRESS: P.O.Box 277 INSURER(S)AFFORDING COVERAGE NAIC# Rockwall TX 75087 INSURERA: Liberty Mutual Fire Ins.Co. 23035 INSURED INSURER B: Travelers Prop Cas Co of Amer 25674 Bean Electrical,Inc INSURER C: Travelers Lloyds Ins.Co. 41564 P.O.Box 40016 INSURER D: INSURER E: Fort Worth TX 76140 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I O LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD POLICY D EXP Y EFF LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU--_7 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 100,000 X Deductible$1,000 PD MED EXP(Any one person) $ 10,000 A TB2-Z91-471905-020 06/15/2020 06/15/2021 PERSONAL&ADV INJURY $ 1,000,000 70THER: LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Es accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED AS2-Z91-471905-030 06/15/2020 06/15/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 B EXCESS LIAB CLAIMS-MADE ZUP-51N31433-20-NF 06/15/2020 06/15/2021 AGGREGATE $ 9,000,000 DIED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER PER H AND EMPLOYERS'LIABILITY YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ A OFFICER/MEMBER EXCLUDED? N/A WC2-Z91�71905-010 O6/15/2020 O6/15/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractor's Equipment C QT6602F259406 06/15/2020 06/15/2021 Leased/Rented $200,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:#CO2552 Wilabarger Street&Miller Avenue Pedestrian,Signal&Lighting Improvements. See Attached forAdditional Information. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Fort Worth ACCORDANCE WITH THE POLICY PROVISIONS. 200 Texas Street AUTHORIZED REPRESENTATIVE Fort Worth TX 76102 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED K&S Insurance Agency Bean Electrical,Inc POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes The General Liability and Auto Liability policies include a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.The endorsements wording include both the insured's ongoing and completed operations. The General Liability policy contains an endorsement with'Primary and Noncontributory"wording. The General Liability,Auto Liability and Workers'Compensation policies include a blanket automatic waiver of subgrogation endorsement that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it. *ALWAYS REFER TO THE ATTACHED POLICY FORMS FOR SPECIFIC WORDING OF SUCH COVERAGE,LIMITS,CONDITIONS AND EXCLUSIONS. ACORD 101 (2008101) © 2008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD