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HomeMy WebLinkAboutContract 48155-R2 V; �,o 10% CSC No. �Q�P� CITY OF FORT WORTH G� S CONTRACT RENEWAL NOTICE July 27,2018 Aqua Metric Sales Company A Thirkettle Company 6700 Guada Coma Dr. Schertz,TX 78154 Re: REQUEST TO EXERCISE RENEWAL OPTION Water Services Meters,Appurtenances and Related Services Contract No.CSC No.48155(the"Contract") Renewal Term No.2: October 1,2018 to September 30,2018 The above referenced Contract will expire on August 30,2018.Pursuant to the Contract,contract renewals are at the sole option of the City.This letter is to inform you that the City is exercising its right to renew CSC No.48155 for an additional one year period,which will begin immediately upon the expiration of the current term and will end on September 30,2019.All other terms and conditions of CSC No.48155 remain unchanged. Please return this signed acknowledgement letter,along with a copy of your current insurance certificate,to the address set forth below,acknowledging receipt of the Notice of Contract Renewal. Please log onto Bu}Speed Online at hap:H-fortw-orthtexas.gQylpurchmigg to insure 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 yours, FMS,Purchasing Division 817-392-8355—Direct 817-392-8440—Fax I hereby acknowledge receipt of the Contract Renewal Notice for CSC No.48155 for a one year period ending on September 30,2019 By: Mike Cartwright. Qnerations Date: 08/06/2018 Printed Name znd Title RT Signature CITY OF FORT WORTH: AT S Jesus"Jay"Chapa,Assistant City Manager ar J.Kayser,City Secreta Date: �r �� M&C No NA . C I A5• 0V OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX CSC No. RECOMMENDED BY: CI`-. h;stopher Harder,Interim Water Director Date: Q/g/I' APPROVED AS TO FORM AND LEGALITY: By: Lqi%k) t Christa R. opez-Reyn s Sr. Assistant City Atto y 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. b�(� Ed a arc titer Systems Superintendent Date: f' 7- It —Q OFFICIAL RECORD CITY SECRETARY FT 'WORTMI TX THIRK-1 OP ID:JP CERTIFICATE OF LIABILITY INSURANCE DA08/06/2018Y) o8/os/2o18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT R.T.Beers&Co.Ins.Services NAME: Lejani Sarian 100 Oceangate,Suite 850 ac.o Ell:562-901-4605 ac No):562-901-4601 Long Beach,CA 908024653 E-MAIL Lejani Sarian ADDRESS:lsarian@rtbeers.COm INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Hanover American INSURED Thirkettle Corporation INSURERB:Allmerica Financial Benefit 41840 DBA:Aqua Metric Sales Company 6700 Guada Coma Drive INSURER C:Hanover Insurance Company 22292 Schertz,TX 78154 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR L U POLICY EFF POLICY LTR TYPE OF INSURANCE POLICY NUMBER IMMIF MD � LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X X ZH3 A664940 03 07/01/2018 07/01/2019 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $ 10,00 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY CEa OMaBcciINEDdentSINGLE LIMIT $ 1,000 00 B X ANY AUTO X AW3 A665023 03 07/01/2018 07/01/2019 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ATOS AUTOS X HIR D AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 C EXCESS LIAB CLAIMS-MADE UH3 A664942 03 07/01/2018 07/01/2019 AGGREGATE $ 10,000,00 DED RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY IT R A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/NN f A X WH3 A652982 03 07/01/2018 07/01/2019 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,0 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Prof Liabrrech E&O LH3 A665809 03 07/01/2018 07/01/2019 Ea.Claim 2,000,00 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Notice to Proceed Date: October 25, 2017 *See Notepad* CERTIFICATE HOLDER CANCELLATION FORTWOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Fort worth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Throckmorton Street Fort worth,TX 76102 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE FORTWOR THIRK-1 PAGE 2 INSURED'S NAME Thirkettle Corporation OP ID:JP Date 08/06/2018 The City of Fort Worth its employees, officers, officials agents and volunteers are named as additional insured for the General Liability 6 Auto Liability per attached form #421-2915 6 form #461-0155. Waiver of Subrogation applies for the benefit of the City of Fort Worth. The term City shall include its employees, officers, officials, agent, and volunteers in respect to the contracted services. Insurance is Primary and Non-Contributory. 30 days notice of cancellation. 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 0■ Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: TEXAS (TX) 3. Premium: The premium charge for this endorsement shall be - ercent 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: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07/01/2018 Policy No .WH3 A652982 03 Endorsement No. Insured Thirkettle Corporation Premium Insurance Company Hanover American Countersigned by Page 1 of 1 WC 42 03 04 B(Ed.6.14)0 Copyright 2014 National Council on Compensation Insurance,Inc.A I Rights Reserved. 1 Insured: Thirkettle Corporation Policy Number: AW3 A665023 03 Policy Period: 07/01/2018 to 07/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1 CANCELLATION EXTENSION d. Any business entity for which you have a financial interest greater Paragraph A. CANCELLATION 2. b. of the than 50%of the voting stock or COMMON POLICY CONDITIONS is otherwise have a controlling replaced with the following: interest after the effective date of b. 60 days before the effective date this policy or that is newly of cancellation if we cancel for acquired or formed by you during any other reason. the term of this policy. SECTION I-COVERED AUTOS The coverage provided by this provision is afforded until 2. EMPLOYEE HIRED"AUTOS" expiration or termination of this Description Of Covered Auto policy, whichever occurs earlier. Designation Symbols; Symbol 8 is replaced by the following: The coverage provided by this provision does not apply to any 8= Hired"Autos"Only - Only those"autos" business entity described in d. you lease, hire, rent or borrow; including above that qualifies as an "autos"your employee hires at your insured under any other direction, for the purpose of conducting your automobile liability policy issued business. This does not include any"auto" to that business entity as a you lease, hire, rent, or borrow from any of named insured or would have your"employees"or partners or members of been an insured except for the their households. exhaustion of the policy limits or the insolvency of the insurer. SECTION II -LIABILITY COVERAGE The coverage provided by this 3. BROADENED NAMED INSURED provision does not apply to "bodily injury"nor"property The following is added to the SECTION II - damage"arising from an LIABILITY COVERAGE, Paragraph 1.Who accident that occurred prior to Is An Insured provision: your acquiring or forming the business entity described in d. above. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) 4. EMPLOYEES AS INSUREDS SECTION III -PHYSICAL DAMAGE COVERAGE. The following is added to the SECTION II - LIABILITY COVERAGE, Paragraph 1. Who 7. EXPENSE OF RETURNING A STOLEN Is An Insured provision: "AUTO"and SIGN COVERAGE e. Any employee of yours is an The following is added to SECTION III - "insured"while using a covered PHYSICAL DAMAGE COVERAGE, A.I. "auto" you do not own, hire or COVERAGE: borrow in your business or your personal affairs. d. Expense Of Returning A Stolen "Auto" 5. SUPPLEMENTARY PAYMENTS We will pay for the expense of The following amends SECTION II - returning a covered "auto"to you. LIABILITY COVERAGE, Paragraph 2. Coverage Extensions provision: e. Sign Coverage Paragraph (2) is replaced by the following: We will pay for loss to signs, (2) Up to$2500 for cost of bail bonds murals, paintings or graphics, (including bonds for related traffic as part of equipment, which are law violations) required because displayed on a covered "auto". of an "accident"we cover. We do not have to furnish these bonds. The most we will pay for"loss" in Paragraph (4) is replaced by the following: any one"accident"is the lesser of: (4) All reasonable expenses incurred 1. The actual cash value of by the"insured"at our request, the property as of the including actual loss of earnings time of the"loss"; or up to $500 a day because of time 2. The cost of repairing or off from work. replacing the damaged or stolen property with other 6. AMENDED FELLOW EMPLOYEE EXCLUSION property of like kind and quality; or 3. $2,000. The following is added to the SECTION II - LIABILITY COVERAGE, B. Exclusions 8. GLASS BREAKAGE DEDUCTIBLE Paragraph 5. Fellow Employee exclusion: The following is added to SECTION III- This exclusion does not apply if the PHYSICAL DAMAGE COVERAGE A. "bodily injury"arises from the use of a COVERAGE paragraph 3. Glass covered "auto" you own or hire. This Breakage- Hitting a Bird or Animal- coverage is excess over any other Falling Objects or Missiles: collectible insurance Any deductible shown in the Declarations as applicable to the Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) covered"auto"will not apply to glass direction, for the purpose of breakage if such glass is repaired, conducting your business, for a rather than replaced. period of 30 days or less, of like kind and use as the"autos"you 9. TRANSPORTATION EXPENSE own, subject to the following: Paragraph 4. Coverage Extension. of The most we will pay for any one SECTION III - PHYSICAL DAMAGE loss is the lesser of the following: COVERAGE, A. COVERAGE is replaced with the following: a. $50,000 per accident, or b. cash value, or 4. Coverage Extension c. the cost of repair, We will pay up to$50 per day to a minus the deductible equal to the maximum of$1500 for temporary lowest deductible applicable to any transportation expense incurred by owned"auto"for that coverage. you because of the total theft of a Any deductible shown in the covered"auto"of the private Declarations does not apply to passenger type. We will pay only "loss"caused by fire or lightning. for those covered"autos"for which Subject to the limit and deductible you carry either Comprehensive or stated above, we will provide Specified Causes of Loss coverage equal to the broadest Coverage. We will pay for coverage provided to any covered temporary transportation expenses "auto"you own, that is applicable to incurred during the period beginning the loss. 24 hours after the theft and ending, regardless of the policy's expiration, If the loss arises from an accident when the covered"auto" is returned for which you are legally liable and to use or we pay for its"loss". the lessor incurs an actual financial loss from that accident,we will 10. HIRED AUTO PHYSICAL DAMAGE cover the lessor's actual financial loss of use of the hired"auto"for a The following is added to SECTION III - period of up to seven consecutive PHYSICAL DAMAGE COVERAGE,A. days from the date of the accident, COVERAGE: subject to a limit of$1,000 per accident. 5. Hired Auto Physical Damage 11. AUDIO,VISUAL AND DATA If hired"autos"are covered"autos" ELECTRONIC EQUIPMENT for Liability Coverage and if Physical COVERAGE Damage Coverage of Comprehensive, Specified Causes The following is added to SECTION III - of Loss, or Collision is provided PHYSICAL DAMAGE COVERAGE,A. under this Coverage Form for any COVERAGE: "auto"you own,then the Physical Damage Coverage(s)provided is 6. Audio, Visual and Data Electronic extended to"autos"you hire without Equipment Coverage a driver or your employee hires, without a driver, at your We will pay for"loss"to any electronic equipment that receives Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) or transmits audio, visual or data signals and that is not designed b. Permanently installed solely for the reproduction of sound. in the opening of the dash This coverage applies only if the or console normally used equipment is permanently installed by the manufacturer for the in the covered"auto"at the time of installation of a radio. the"loss"or the equipment is removable from a housing unit With respect to coverage herein, the which is permanently installed in the LIMIT OF INSURANCE provision of covered"auto' at the time of the PHYSICAL DAMAGE COVERAGE "loss", and such equipment is is replaced by the following: designed to be solely operated by use of the power from the"auto's" 1. The most we will pay for all electrical system, in or upon the "loss"to audio, visual or data covered"auto", including its electronic equipment and any antennas and other accessories. accessories used with this However, this does not include equipment as a result of any tapes, records or discs. one"accident" is the lesser of The exclusions that apply to a. The actual cash value of PHYSICAL DAMAGE COVERAGE, the damaged or stolen except for the exclusion relating to property as of the time of Audio, Visual and Data Electronic the"loss"; or Equipment, also apply to coverage b. The cost of repairing or provided herein. In addition,the replacing the damaged or following exclusions apply: stolen property with other property of like kind and We will not pay , under this quality; or coverage, for either any electronic c. $500. equipment or accessories used with such electronic equipment that is: 2. An adjustment for depreciation and physical 1. Necessary for the normal condition will be made in operation of the covered determining actual cash value "auto"or the monitoring of at the time of the"loss". the covered "auto's" operating system;or 3. Deductibles applicable to PHYSICAL DAMAGE 2. Both: COVERAGE, do not apply to this Audio, Visual and Data a. An integral part of the Electronic Equipment same unit housing any Coverage. sound reproducing equipment designed If there is other coverage provided solely for the by this policy for audio, visual and reproduction of sound if the data electronic equipment, the sound reproducing coverage provided herein is equipment is permanently installed in the covered "auto", and Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) excess. However, you may elect to covered "auto". If"loss" is apply the limit or any portion thereof caused by theft, this of coverage provided herein to pay number of days is added any deductible that is applicable to the number of days it under the provisions of the other takes to locate the covered coverage. "auto"and transport it to a repair shop. 12. RENTAL REIMBURSEMENT and MATERIAL TRANSFER EXPENSE 2. 60 days. The following is added to SECTION III - Our payment is limited to the lesser PHYSICAL DAMAGE COVERAGE,A. of the following amounts: COVERAGE: 1. Necessary and actual 7. Rental Reimbursement and expenses incurred, Material Transfer Expense including loss of use. This coverage provides only those 2. $3000. Physical Damage Coverages where a premium is shown in the This auto rental expense coverage Declarations. It applies only to a does not apply while there are covered "auto"described or spare or reserve"autos"available to designated to which the Physical you for your operations. Damage Coverages apply. If"loss"results from the total theft of We will pay for auto rental expenses a covered"auto"of the private and the expenses, incurred by you passenger type, we will pay under because of"loss"to a covered this coverage only that amount of "auto",to remove and transfer your your rental reimbursement materials and equipment from the expenses which is not already covered"auto" . Payment applies in provided for under the SECTION addition to the otherwise applicable III-PHYSICAL DAMAGE amount of each coverage you have COVERAGE,A.4. Coverage on a covered "auto". No Extension. deductibles apply to this coverage. 13. AIRBAG COVERAGE We will pay only for those auto rental expenses incurred during the The following is added to SECTION III - policy period beginning 24 hours PHYSICAL DAMAGE COVERAGE, B. after the"loss"and ending, Exclusions, paragraph 3. regardless of the policy's expiration, with the lesser of the following The portion of this exclusion relating to number of days: mechanical or electrical breakdown does not apply to the accidental discharge of an 1. The number of days airbag. This coverage is excess of other reasonably required to collectible insurance or warranty. No repair or replace the deductible applies to this Airbag Coverage. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) 14. AUTO LOAN PHYSICAL DAMAGE imposed under a lease for excessive use, EXTENSION abnormal wear and tear or high mileage; security deposits not refunded by the lessor; The following is added to SECTION III - cost for extended warranties, Credit Life PHYSICAL DAMAGE COVERAGE,C. Insurance, Health,Accident or Disability Limit Of Insurance provision: Insurance purchased with the loan; and carry over balances from previous leases. When a"loss" results in a total loss to a covered auto you own for which a Loss This coverage applies only to the initial Payee is designated in this policy, the most lease for the covered"auto"which has not we will pay for"loss" in any one"accident'is previously been leased. This coverage is the greater of: excess over all other collectible insurance. 1. The actual cash value of the SECTION IV-CONDITIONS damaged or stolen property as of the time of the"loss"; or 16. DUTIES IN THE EVENT OF ACCIDENT,CLAIM,SUIT OR LOSS 2. The outstanding balance of the initial loan, less any amounts for The following is added to SECTION IV- taxes, overdue payments, overdue BUSINESS AUTO CONDITIONS, A. Loss payment charges, penalties, Conditions, 2. Duties In The Event Of interest, any charges for early Accident,Claim, Suit Or Loss: termination of the loan, costs for Credit Life Insurance, Health, d. Knowledge of any"accident', Accident or Disability Insurance claim, "suit'or"loss"will be purchased with the loan, and deemed knowledge by you when carry-over balances from previous notice of such"accident', loans. claim, "suit'or"loss"has been received by: 15. AUTO LEASE PHYSICAL DAMAGE EXTENSION (1) You, if you are an individual; (2) Any partner or insurance The following is added to SECTION III - manager if you are a PHYSICAL DAMAGE COVERAGE, C. partnership; or Limit Of Insurance provision: (3) An executive officer or insurance manager if you are If, because of damage, destruction or theft a corporation. of a covered"auto",which is a long-term leased"auto", the lease agreement between 17 BLANKET WAIVER OF you and the lessor is terminated, "we"will SUBROGATION pay the difference between the amount paid under paragraph C. LIMIT OF INSURANCE Paragraph 5.Transfer Of Rights Of 1. or 2. and the amount due at the time of Recovery Against Others To Us, "loss"under the terms of the lease SECTION IV-BUSINESS AUTO agreement applicable to the leased"auto" CONDITIONS,A. Loss Conditions is which you are required to pay: less any fees replaced by the following: to dispose of the auto; any overdue payments; financial penalties Includes copyrighted material of Insurance Services Office, Inc.with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) 5. Transfer Of Rights Of Recovery 19. HIRED AUTO—WORLDWIDE Against Others To Us COVERAGE If any person or organization to or The following is added to SECTION IV- for whom we make payment under Business Auto Conditions, B. General this Coverage Form has rights to Conditions, paragraph 7. Policy Period, recover damages from another, Coverage Territory provision: which have not been waived through the execution of an"insured e. Outside the coverage territory contract',written agreement, or described in a., b., c., and d. permit, prior to the"accident'or above for an "accident'or"loss" "loss"giving rise to the payment, resulting from the use of a those rights to recover damages covered "auto"you hire, without a from another are transferred to us. driver, or your employee hires That person or organization must do without a driver, at your direction, everything necessary to secure our for the purpose of conducting your rights and must do nothing after the business,for a period of 30 days "accident"or"loss" to impair them. or less, provided the suit is brought within The United States 18. UNINTENTIONAL FAILURE TO of America or its territories or DISCLOSE INFORMATION possessions. The following is added to SECTION IV SECTION V-DEFINITIONS BUSINESS AUTO CONDITIONS. B. General Conditions, paragraph 2. 20. MENTAL ANGUISH Concealment, Misrepresentation Or Fraud: Paragraph C.'Bodily injury", SECTION V- DEFINITIONS is replaced by the following: Your unintentional error in disclosing, or failure to disclose, any material fact C. 'Bodily injury"means bodily injury, existing after the effective date of this sickness or disease sustained by a Coverage Form shall not prejudice your person including death or mental rights under this Coverage Form. anguish resulting from any of these. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Insured: Thirkettle Corporation Policy Number:ZH3 A664940 03 Policy Period: 07/01/2018 to 07/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit Included 2. Additional Insured—Primary and Non-Contributory Included 3. Blanket Waiver of Subrogation Included 4. Bodily Injury Redefined Included 5. Broad Form Property Damage—Borrowed Equipment, Customers Goods& Use of Elevators Included 6. Knowledge of Occurrence Included 7. Liberalization Clause Included 8. Medical Payments—Extended Reporting Period Included 9. Newly Acquired or Formed Organizations-Covered until end of policy period Included 10. Non-owned Watercraft 51 ft. 11. Supplementary Payments Increased Limits - Bail Bonds $2,500 - Loss of Earnings $1000 12. Unintentional Failure to Disclose Hazards Included 13. Unintentional Failure to Notify Included This endorsement amends coverages provided under the Commercial General Liability Coverage Part through new coverages, higher limits and broader coverage grants. 1. Additional Insured by Contract, Agreement or (1) "Your work" for the additional insured(s) Permit designated in the contract, agreement or The following is added to SECTION II — WHO IS permit; AN INSURED: (2) Premises you own, rent, lease or occupy; Additional Insured by Contract, Agreement or or Permit (3) Your maintenance, operation or use of a. Any person or organization with whom you equipment leased to you. agreed in a written contract, written agreement b. The insurance afforded to such additional or permit that such person or organization to insured described above: add an additional insured on your policy is an (1) Only applies to the extent permitted by additional insured only with respect to liability law; and for "bodily injury", "property damage", or `personal and advertising injury" caused, in 2) Will not be broader than the insurance whole or in part, by your acts or omissions, or which you are required by the contract, the acts or omissions of those acting on your agreement or permit to provide for such behalf, but only with respect to: additional insured. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 4 (3) Applies on a primary basis if that is advertising injury" involved the rendering required by the written contract, written of or failure to render any professional agreement or permit. services by or for you. (4) Will not be broader than coverage d. With respect to the insurance afforded to provided to any other insured. these additional insureds, the following is (5) Does not apply if the "bodily injury", added to SECTION III — LIMITS OF "property damage" or "personal and INSURANCE: advertising injury" is otherwise excluded The most we will pay on behalf of the from coverage under this Coverage Part, additional insured for a covered claim is the including any endorsements thereto. lesser of the amount of insurance: c. This provision does not apply: 1. Required by the contract, agreement or (1) Unless the written contract or written permit described in Paragraph a.; or agreement was executed or permit was 2. Available under the applicable Limits of issued prior to the"bodily injury", "property Insurance shown in the Declarations. damage", or "personal injury and This endorsement shall not increase the advertising injury". applicable Limits of Insurance shown in the (2) To any person or organization included as Declarations. an insured by another endorsement 2. Additional Insured — Primary and Non- issued by us and made part of this Contributory Coverage Part. The following is added to SECTION IV — (3) To any lessor of equipment: COMMERCIAL GENERAL LIABILITY (a) After the equipment lease expires; or CONDITIONS, Paragraph 4. Other insurance: (b) If the "bodily injury", "property Additional Insured — Primary and Non- damage", "personal and advertising Contributory injury" arises out of sole negligence of If you agree in a written contract, written the lessor agreement or permit that the insurance provided to (4) To any: any person or organization included as an (a) Owners or other interests from. whom Additional Insured under SECTION II — WHO IS land has been leased which takes AN INSURED, is primary and non-contributory, place after the lease for the land ex- the following applies: pires; or If other valid and collectible insurance is available (b) Managers or lessors of premises if: to the Additional Insured for a loss covered under Coverages A or B of this Coverage Part, our (i) The occurrence takes place after obligations are limited as follows: you cease to be a tenant in that a. Primary Insurance premises; or (ii) The "bodily injury", "property This insurance is primary to other insurance damage", "personal injury" or that is available to the Additional Insured "advertising injury" arises out of which covers the structural alterations, new con- Additional Insured as a Named Insured. We struction or demolition operations will not seek contribution from any other performed by or on behalf of the insurance available to the Additional Insured manager or lessor. except: (5) To "bodily injury", "property damage" or (1) For the sole negligence of the Additional "personal and advertising injury" arising Insured; out of the rendering of or the failure to (2) When the Additional Insured is an render any professional services. Additional Insured under another primary This exclusion applies even if the claims liability policy; or against any insured allege negligence or (3) when b. below applies. other wrongdoing in the supervision, hiring, employment, training or monitoring If this insurance is primary, our obligations are of others by that insured, if the not affected unless any of the other insurance "occurrence" which caused the "bodily is also primary. Then, we will share with all injury'or"property damage" or the offense that other insurance by the method described which caused the "personal and in c. below. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 4 b. Excess Insurance insurer contributes equal amounts until it has (1) This insurance is excess over any of the paid its applicable limit of insurance or none of other insurance, whether primary, excess, the loss remains, whichever comes first. If any contingent or on any other basis: of the other insurance does not permit contribution by equal shares,we will contribute (a) That is Fire, Extended Coverage, by limits. Under this method, each insurer's Builder's Risk, Installation Risk or share is based on the ratio of its applicable similar coverage for"your work"; limit of insurance to the total applicable limits (b) That is Fire insurance for premises of insurance of all insurers rented to the Additional Insured or 3. Blanket Waiver of Subrogation temporarily occupied by the Additional Insured with permission of the owner; The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY (c) That is insurance purchased by the CONDITIONS, Paragraph 8. Transfer Of Rights Additional Insured to cover the Of Recovery Against Others To Us: Additional Insured's liability as a tenant for "property damage" to We waive any right of recovery we may have premises rented to the Additional against any person or organization with whom you Insured or temporarily occupied by the have a written contract that requires such waiver Additional with permission of the because of payments we make for damage under owner: or this coverage form. The damage must arise out of (d) If the loss arises out of the your activities under a written contract with that person or organization. This waiver applies only to maintenance or use of aircraft, "autos" the extent that subrogation is waived under a or watercraft to the extent not subject written contract executed prior to the "occurrence" to Exclusion g. of SECTION I — or offense giving rise to such payments. COVERAGE A — BODILY INURY AND PROPERTY DAMAGE 4. Bodily Injury Redefined LIABILITY. SECTION V — DEFINITIONS, Definition 3. "bodily (2) When this insurance is excess, we will injury" is replaced by the following: have no duty under Coverages A or B to 3. "Bodily injury" means bodily injury, sickness or defend the insured against any"suit"if any disease sustained by a person including death other insurer has a duty to defend the resulting from any of these at any time. "Bodily insured against that "suit". If no other injury" includes mental anguish or other insurer defends, we will undertake to do mental injury resulting from "bodily injury". so, but we will be entitled to the insured's 5. Broad Form Property Damage — Borrowed rights against all those other insurers. Equipment, Customers Goods, Use of (3) When this insurance is excess over other Elevators Insurance, we will pay only our share of a. SECTION I—COVERAGES, COVERAGE A— the amount of the loss, if any, that BODILIY INJURY AND PROPERTY exceeds the sum of: DAMAGE LIABILITY, Paragraph 2. (a) The total amount that all such other Exclusions subparagraph j. is amended as insurance would pay for the loss in the follows: absence of this insurance; and Paragraph (4) does not apply to "property (b) The total of all deductible and self damage" to borrowed equipment while at a insured amounts under all that other jobsite and not being used to perform insurance. operations. We will share the remaining loss, if any, Paragraphs (3), (4) and (6) do not apply to with any other insurance that is not "property damage"to"customers goods"while described in this Excess Insurance on your premises nor do they apply to the use provision and was not bought specifically of elevators at premises you own, rent, lease to apply in excess of the Limits of or occupy. Insurance shown in the Declarations of b. The following is added to SECTION V — this Coverage Part. DEFINTIONS: c. Method Of Sharing 24. "Customers goods" means property of If all of the other insurance permits your customer on your premises for the contribution by equal shares,we will follow this purpose of being: method also. Under this approach each 421-2916 06 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 4 a. worked on; or 10. Non-Owned Watercraft b. used in your manufacturing process. SECTION I — COVERAGES, COVERAGE A c. The insurance afforded under this provision is BODILY INJURY AND PROPERTY DAMAGE excess over any other valid and collectible LIABILITY, Paragraph 2. Exclusions, property insurance (including deductible) subparagraph g.(2) is replaced by the following: available to the insured whether primary, g. Aircraft,Auto Or Watercraft excess, contingent (2) A watercraft you do not own that is: 6. Knowledge of Occurrence (a) Less than 51 feet long; and The following is added to SECTION IV — (b) Not being used to carry persons or COMMERCIAL GENERAL LIABILITY property for a charge; CONDITIONS, Paragraph 2. Duties in the Event of Occurrence,Offense, Claim or Suit: This provision applies to any person who, e. Notice of an 'occurrence", offense, claim or with your consent, either uses or is "suit" will be considered knowledge of the responsible for the use of a watercraft. insured if reported to an individual named 11. Supplementary Payments Increased Limits insured, partner, executive officer or an SECTION I — SUPPLEMENTARY PAYMENTS "employee" designated by you to give us such COVERAGES A AND B, Paragraphs 1.b. and a notice. 1.d.are replaced by the following: 7. Liberalization Clause 1.b.Up to $2,500 for cost of bail bonds required The following is added to SECTION IV — because of accidents or traffic law violations COMMERCIAL GENERAL LIABILITY arising out of the use of any vehicle to which CONDITIONS: the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Liberalization Clause If we adopt an revision that would broaden the 1.d.All reasonable expenses incurred by the p y insured at our request to assist us in the coverage under this Coverage Form without investigation or defense of the claim or "suit', additional premium, within 45 days prior to or including actual loss of earnings up to$1000 a during the policy period, the broadened coverage day because of time off from work. will immediately apply to this Coverage Part. 12. Unintentional Failure to Disclose Hazards 8. Medical Payments — Extended Reporting Period The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY a. SECTION I—COVERAGES, COVERAGE C— CONDITIONS, Paragraph 6. Representations: MEDICAL PAYMENTS, Paragraph 1. Insuring Agreement, subparagraph a.(3)(b) We will not disclaim coverage under this Coverage is replaced by the following: Part if you fail to disclose all hazards existing as of (b) The expenses are incurred and reported the inception date of the policy provided such failure is not intentional. to us within three years of the date of the accident; and 13. Unintentional Failure to Notify b. This coverage does not apply if COVERAGE The following is added to SECTION IV — C — MEDICAL PAYMENTS is excluded either COMMERCIAL GENERAL LIABILITY by the provisions of the Coverage Part or by CONDITIONS, Paragraph 2. Duties in the Event endorsement. of Occurrence, Offense, Claim or Suit: 9. Newly Acquired Or Formed Organizations Your rights afforded under this policy shall not be SECTION II — WHO IS AN INSURED, Paragraph prejudiced if you fail to give us notice of an SE SEis replaced by the following: "occurrence", offense, claim or"suit', solely due to your reasonable and documented belief that the a. Coverage under this provision is afforded until "bodily injury" or"property damage" is not covered the end of the policy period. under this policy. ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 4 CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2018-388370 Aqua-Metric Sales Company Schertz,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is08/06/2018 being filed. City of Fort Worth Texas Date Ackno dged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a description of the services,goods,or other property to be provided under the contract. 48155 Water Service Meters and Appurtenances for the City of Fort Worth Nature of interest 4 Name of Interested Pa City,State,Count lace of business Party Country(p ) (check applicable) Controlling I Intermediary Aqua Metric Sales Company Schertz,TX United States X Arnold, Clint Schertz,TX United States X Cartwright, Michael Schertz,TX United States X Kristy,Segarra Schertz,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Michael Cartwright and my date of birth is 05/14/1955 Myaddressis 6700 Guada Coma Drive Schertz TX 78154 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Guadalupe County, State of Texas on the 6th day of August 20 18 (irnonth) (year) Signature of authorized agen of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711