Loading...
HomeMy WebLinkAboutContract 57058-R1CSC No. 57058-R1 CITY OF FORT WORTH CONTRACT RENEWAL NOTICE January 26, 2023 CLS Sewer Equipment Company, Inc. Attn: Jerry Sonnier, President 726 S. Sherman Street Richardson, TX 75081 Re: Contract Renewal Notice— 131 Renewal Original Equipment Manufacturer (OEM) Cues CCTV Sewer Inspection Equipment Parts and Repair Contract CSC No. 57058 Original Contract Amount: $300,000.00 The above referenced contract with the City of Fort Worth, as renewed, expires with the expenditure of funds. The funds for the contract have been expended or programmed. This letter is to inform you that the City has appropriated funding and is exercising its right to renew the contract in the original contract amount, which will be effective upon execution by the designated Assistant City Manager. All other terms and conditions of the contract remain unchanged. Please sign in the space indicated below and return this document, along with a copy of your current insurance certificate, to the undersigned. Please log onto PeopleSoft Purchasing at httna/fortworthtexas.,-,ov/Furchasina to ensure that your company information is correct and up-to-date. If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number listed below. Sincerely, Patty Jean Wilson Contract Services Administrator (817) 392-841 I OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Renewal (ver. 8.19.22 updated 10.28.22) Pagel of2 ACCEPTED AND AGREED: CITY OF FORT WORTH J 'y� auk-aaa 4- CST) _ Name: Dana Burghdoff Title: Assistant City Manager Date: APPROVAL RECOMMENDED: (AV/ 17�del- By fhri't 315:48 CST) Name: Christopher Harder, P.E. Title: Water Department Director bp44lpIlnT' ATTEST: p9A, °f° �000 oRro�°o 0. 1 ° 4 d Pvo o=0 opQ,� °°° °e *�d b A aaa� nezp5aaa By: Name: Jannette S. Goodall Title: City Secretary Sewer By: Title: CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. By: Name: Patty J ilson Title: Contract ices Administrator APPROVED AS TO FORM AND LEGALITY: By: Name: Taylor Paris Title: Assistant City Attorney AUTHORIZATION: M&C: 22-0040 Date Approved: 1/11/2022 1295 Form: 2021-822929 Inc. OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Renewal (ver. 8.19.22 updated 10.29 22) Page 2 of 2 M&C Review CITY COUNCIL AGENDA Create New From This 8C DATE: 1/11/2022 REFERENCE NO.. CODE: SUBJECT: Page 1 of 2 MIA Site of the City of fort Worth, TeKas Ft�I'111 T **M&C 22- 60CLS SEWER 0040 LOG NAME: EQUIPMENT CO. INC. G TYPE: CONSENT PUBLIC NO HEARING: Amount Up to $300,000.00 for the First Year, for Original Equipment Manuf(ALL) Authorize an Agreement with CLS Sewer Equipment Company, Inc., foracturer (OEM) a Total Cues CCTV Sewer Inspection Equipment Parts and Repair for the Water Department and Property Management Department RECOMMENDATION: It is recommended that the City Council authorize an agreement with CLS Sewer Equipment Company, Inc., for a total amount up to $300,000.00 for the first year, for the original equipment manufacturer cues closed circuit television video sewer inspection equipment parts and repair for the Water Department and Property Management Department. DISCUSSION: The Water Department and Property Management Department/Fleet Division will use this agreement with CLS Sewer Equipment Company, Inc., to purchase Original Equipment Manufacturer (OEM) Cues Closed Circuit Television Video (CCTV) sewer inspection equipment, repair parts and repair service on cameras and vehicles used for wastewater line and storm water pipeline inspection throughout the City of Fort Worth (City). CLS Sewer Equipment Company, Inc. is the documented sole source provider for OEM Cues CCTV sewer inspection equipment, parts and repair service in the Texas region. The agreement includes detailed specifications describing the OEM Cues CCTV sewer inspection equipment, parts and repair service required. No guarantee was made that a specific amount of goods will be purchased. Items will be ordered on an as needed -basis. The Water Department and Property Management DepartmentlFleet Division anticipates spending $300,000.00 during this agreement period. AGREEMENT TERMS — Upon City Council's approval, this agreement shall begin on March 8, 2022 and expire March 7, 2023. RENEWAL OPTIONS - This agreement may be renewed for up to four (4) additional one-year terms at the City's option. This action does not require specific City Council approval provided that the City Council has appropriated sufficient funds to satisfy the City's obligation during this renewal term. BID ADVERTISEMENT: This procurement is exempt from the competitive bidding requirements as provided under Section 252.022(7)(A) of the Texas Local Government Code because CLS Sewer Equipment Company, Inc. is the sole provider and distributor of Original Equipment Manufacturer (OEM) Replacement Parts, Equipment, Repairs and Maintenance Services the Cues CCTV equipment, parts and repair services. ADMININSTRATIVE CHANGE ORDER: An administrative increase or change order may be made by the City Manager up to the amount allowed by relevant law and the Fort Worth City Code and does not require specific City Council approval as long as sufficient funds have been appropriated. DVIN — A waiver of the goal for Business Equity subcontracting requirements was requested, and approved by the DVIN, in accordance with the applicable Ordinance, because the waiver request is based on the sole source information provided. http:/lapps.cfwnet.orglcouncil_packetlmc—review.asp?ID=29S92&councildate=l /11 /2022 1 /12/2022 M&C Review Page 2 of 2 FISCAL INFORMATI ;ER 1CAT10N: The Director of Finance certifies that funds are available in the current operating budget, as Previously appropriated, in the Water & Sewer Fund and Fleet and E u' th e approval of the above recommendation and execution of the purchase agreement. Prior to any expenditure being incurred, the Water Department and Property Management Department have the responsibility to validate the availability of funds. TO -T Fund Department Account Project Program [Act1V-1t'-y—j--&dgej-[Reference # Amount ID - I Year I (Chartfleid 2) f FRO Fund Department Account Project I Program Activity Budget Reference # Amount ID f — 1 - ID _. _ __ Year__[ _ (Chartfletd,2) Subrni for Ci Mana er`s Office Originating Deoartm, W Head: Additionallnforma C n A- TTACHMENTS Dana Burghdoff (8018) Chris Harder (5020) Patty Wilson (8411) 1295 Form - CLS ewer E ui m n Co.. df (CFW Internal) 60CLS SEWER EQUIPMENT CO. INC. funds availabilit .docx (CFW Internal) 60CLS SEWER EQUIPMENT CO. INC. U dated FID table.xlsx (CFW Internal) Cha ter 252 Exem tion Form - Sewer Ins ection E ui .. df (Public) CLS Sewer ui menk o - Sam Search. df (CFW Intemal) Conflict of Interest Form - CLS-.Sewer E ui ment Co.. df (Public) Del2artmental Waiver - -11,SourceCUES Equipment 11152021 WN. d. df (CFW Internal) Notarized Sole S urce Le er - CLS Sewer E luiQmeat - 01- 7-21. df (CFW Internal) http://apps.cfwtiet.org/councij_packet/mc xtview.asp?IU=29592&councildate=l/11/2022 1/12/2022 CERTIFI TE OF INTERESTED PARTIES I trampiete Nos - C No§. and a it there are interested Parties. 3. 5, and 5 if there are no interesW parties. i Name of basin of S. a� tine GLY, state and country of the rw --. CLS Sewer ut ent co. inc Richardson. sited States E 2 Name being filed. i or° �e"tY at a party m the mntract for which tt City of Fort W Texas ; 3 Provide the i FORM 1295 l or l OFFICE USE ONLY CERTIFICATION OF HUNG t PMce Certificate Number. 2021-822929 Date Filed: rm a 11/11M21 Date Acknowledged: description of n number used by the governmental entity or state ages to GM goods, or other ProPerty to be provided under the fib. or 'den" the c0ntrept, and provide a WaterlPMD CUES Sewer CCTV Water/PMD 2 21 CUES Sewer CCTV Irtspecbon Equipment Pans & Repairs 4 Of �� ��ittlNatun bhterxated Party City, State. Country (place of business) (check CLS Sewer Egul Co. Inc II Controning Richardson. TX United States X S Check only it NO Interested patty, ❑ s LNSWORN DrbpN My name is r end my date of birth is; My address is 7VtWtt ' I i declare under of p L1fY that the foreoNrC is true and ctxrecL Executed in County, State of _�. an the day i (month) (Yeaci 71 re of auftdiedi Of contracting business entity Forms provided by Ethics Commission etltics.state.tx.us Version VL1.191b5u _ i A` oRo CERTIFICATE OF LI, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIT REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, thi If SUBROGATION IS WAIVED, subject to the terms and conditions o this certificate does not confer rights to the certificate holder in lieu of s PRODUCER Weatherby-Eisenrich Insurance 211 W. Broadway Andrews, TX 79714 INSURED CLS Sewer Equipment Co., Inc. 726 S. Sherman Street Richardson, TX 75081 CLSEQUI-01 kBILITY INSURANCE DATE(MMlDDIYYYY) 1/27/2023 ILY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ITE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. the policy, certain policies may require an endorsement A statement on ich endorsement(s). C ACT PHONE ac, No, Ext : (432) 218-4195 FAX, No :(432) 218-4195 ceft@weinsure4you.com INSURE S AFFORDING COVERAGE NAIC 0 INSURER A: Travelers Indemnitv Co Of America 25666 INSURER B: Travelers Property Casualty Co Of America 25674 INSURERC:Texas Mutual Insurance Company 22W INSURER D: Hanover Insurance Company 22292 INSURER E : INSURER F : THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRII EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM: EL R TYPE OFlNSURANCE ADOLSUBR POLICYEFF POLICYE%P POLICY NUMBER Ju L X I COMMERCIAL GENERAL LIABILITY cLAW"ADE ❑X OCCUR 6301S784836 SM 112022 5/1112023 GEN1 AGGREGATE LIMIT APPLIES PER. X POLICY JECT ❑ LOC OTHER AUTOMOBILE LIABILITY X ANY AUTO BAIS793673 6/11/2022 5111/2023 OWNED SCHEDULED AUTOS ONLY AUUTyOSy�,�Ep AUTOS ONLY AUTO ONLY UMBRELLA LIAR A OCCUR EXCESSL1Aa CLAIMS -MADE CUPIS797371 5/11/2022 5/11/2023 Drn I X I arT1=NTrnN c 10.000 C WORKERS COMPENSATION AND EMPLOYERS' LUIBILRY ANY PRDPRIIETBOERIPARTNERIEXECVTIVE Y f N 0001252402 611112D22 5111/2023 0IWindatory In NHj EXCLUDED? N ! A It yes. dedcnbe under DESCRIPTION OF OPERATIONS below D Equipment Floater IHDH60926901 511112022 5/1112023 iESCRIPTION OF OPERATION 51 LOCATIONS 1 VEHICLES ACORD 101, Additional Remarks Schedule, may be attached If more space Is requii arageKeepers Liability: BA1S793673 - Richardson Location: $2,000,000 Limit with $3,000 Deductible for Compr 30-day Notice of Cancellation except 10-day Notice for Non Payment in Premium General Liability and Business Auto Policies include blanket automatic additional insured endorsement that ficate holder only when there is a written contract between the named insured and the certificate holder that iness Auto, and Workers Compensation policies include blanket automatic waiver of subrogation status to tl ATTACHED ACORD 101 REVISION NLIMRFR- RED NAMED ABOVE FOR THE POLICY PERIOD 4 DOCUMENT WITH RESPECT TO WHICH THIS SED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE S 1,000,000 DAMAPREMGE TO RENTED 5 300,000 MED EXP (Any one S 5,000 PERSONALB,ADVINJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 S COMBINED SINGLE LIMIT 1,000,000 S BODILY INJURY Perperson)S BODILY INJURY JPar arooeni S PP,?P111 DAMAGE e S S EACH OCCURRENCE S 1,000,000 AGGREGATE 5 1,000,000 S X 1PER OTH- E.L EACH ACCIDENT S 1,000,000 E.LDISEASE- EAEMPLOYE S 1,000,000 E.L. DISEASE -POLICY LIMIT S 1,000,000 Rented/Leased Equip 250,000 ad) thensive 8 Collision for Theft, Vandalism. provides additional insured status to the requires such status. The General Liability, le certificate holder only when there is a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Worth AUTHORI I D REPRESENTATIVE Fort. Worth Water Department - Field Operations 1608 11th Avenues 2Y)� IFQrt Worth- TX 1 02 ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CLSEQUI-01 KBERRY ACORU' �4� I110101Iq ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Weatherby-Eisenrich Insurance izs S 3nermani�n� Co., Inc. Richardson, TX 75081 Dallas POLICY NUMBER EE PAGE 1 CARRIER NAIL CODE EE PAGE 1 SEE P 1 EFFECTIYEDATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 26 FORM TITLE: certificate of Liability insurance Description of Operations/LocationsNehicies: written contract between the named insured and the certificate holder that requires such status. Umbrella is follow form to General Liablity, Business Auto, and Workers Compensation General Liability Policy includes Primary & Non -Contributory wording ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR MANUFACTURERS AND WHOLESALERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries B. Who Is An insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees And Co -Volunteer Workers C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies D. Blanket Additional Insured — Broad Form Vendors H. Blanket Additional Insured -- Governmental Entities — Permits Or Authorizations Relating To Operations I. Blanket Additional Insured — Grantors Of Franchises J. Incidental Medical Malpractice K. E. Blanket Additional Insured —Controlling Interest L. F. Blanket Additional Insured — Mortgagees, M Assignees, Successors Or Receivers G. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II —WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: Medical Payments — Increased Limit Blanket Waiver Of Subrogation Contractual Liability — Railroads a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. CG D4 58 02 19 0 2017 The Travelers indemnity Company. AM rights reserved. Page 1 of 5 Includes copyrighted material of Insurance services Office, Inc. with its penrission COMMERCIAL GENERAL LIABILITY B. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the co -"employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct o f your business. C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION II — WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization, other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. D. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. Occurs subsequent to the signing of that contract or agreement; and b. Arises out of "your products" that are distributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you or any distribution or sale for a purpose not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (4) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products": Page 2 of 5 0 2017 The Travelers Indemnity Company. All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission (5) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your products": or (6) "Your products" that, 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 on behalf of such vendor. Coverage under thi s provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such products; or b. Any vendor for which coverage as an additional insured specifically is scheduled by endorsement. E. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" that arises out of: a. Such financial control; or b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4. of SECTION 11 —WHO IS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. F. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to its COMMERCIAL GENERAL LIABILITY liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" that: a. Is "bodily injury' or "property damage" that occurs, or is "personal and advertising injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee. successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury' or "property damage" that occurs, or any "personal and advertising injury' caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury', "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. G. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that govemmental entity has CG D4 58 02 19 ® 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission COMMERCIAL GENERAL LIABILITY issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. H BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPER- ATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to, a. Any "bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". I. BLANKET ADDITIONAL INSURED — GRANTORS OF FRANCHISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that grants a franchise to you is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of your operations in the franchise granted by that person or organization. If a written contract or agreement exists between you and such additional insured, the limits of insurance provided to such insured will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. J. INCIDENTAL MEDICAL MALPRACTICE services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech - language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services". first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: 1. The fallowing replaces Paragraph b. of the Sale Of Pharmaceuticals definition of "occurrence" in the 'Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or b. An act or omission committed in providing ordinance relating to the sale of pharmaceuticals committed by, or with the or failing to provide "incidental medical knowledge or consent of, the insured. Page 4 of 5 ® 2017 The Travelers Indemnity Company. All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1 ) of Section II — Who Is An Insured. K. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph 5, above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: COMMERCIAL GENERAL LIABILITY a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. M. CONTRACTUAL LIABILITY— RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. CG D4 58 02 19 ® 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 5 Includes copyrighted material of insurance Services Office. Inc. with its permission