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HomeMy WebLinkAboutContract 56416-A1 CSC No. 56416-A1 AMENDMENT No. 1 TO CITY SECRETARY CONTRACT No. 56416 WHEREAS, the City of Fort Worth (CITY) and Shield Engineering Group, PLLC, (ENGINEER) made and entered into City Secretary Contract No. 56416, (the CONTRACT) which was authorized by M&C 21-0508 on the 22nd day of June, 2021 in the amount of $ 456, 150 . 00; and WHEREAS, the CONTRACT involves engineering services for the following project: Trinity River Vision-Central City Flood Control Drainage Projects, CPNs (103260, 103261, 103262, 103263, 103264) ; and WHEREAS, it has become necessary to execute Amendment No. 1 to the CONTRACT to include an increased scope of work and revised fee. NOW THEREFORE, CITY and ENGINEER, acting herein by and through their duly authorized representatives, enter into the following agreement, which amends the CONTRACT: 1 . Article I of the CONTRACT is amended to include the additional engineering services specified in proposal attached hereto and incorporated herein. The cost to City for the additional design services to be performed by Engineer totals $94, 690. 00. (See Attached Funding Breakdown Sheet, Page -4-) 2 . Article II of the CONTRACT is amended to provide for an increase in the fee to be paid to Engineer for all work and services performed under the Contract, as amended, so that the total fee paid by the City for all work and services shall be an amount of $550,840. 00. 3 . All other provisions of the Contract, which are not expressly amended herein, shall remain in full force and effect. EXECUTED and EFFECTIVE as of the date subscribed by the City' s designated Assistant City Manager. OFFICIAL RECORD APPROVED: CITY SECRETARY City of Fort Worth, Texas Trinity River Vision-Central City Flood Coi FT.WORTH, TX Prof Services Agreement Amendment Template 103260, 103261, Revision Date: November 23, 2021 Page 1 of 4 City of Fort Worth Consultant /f Shield Engineering Group, PLLC Dana Burg hdoff(Afn 27,20 12:27 CDT) Jean&arierxan er(Jun 20,2022 09:49 CDT) Dana Burghdoff Jean Marie Alexander Assistant City Manager COO DATE: Jun 27, 2022 DATE: Jun 20, 2022 APPROVAL RECOMMENDED: Wj(Jun 21,202218: CDT) William Johnson Director, Transportation and Public Works Department 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 . Linda Young Engineering Manager OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX City of Fort Worth, Texas Trinity River Vision-Central City Flood Control Drainage Projects Prof Services Agreement Amendment Template 103260, 103261, 103262, 103263, 103264 Revision Date: November 23, 2021 Page 2 of 4 APPROVED AS TO FORM AND LEGALITY: Form 1295 N/A M&C: N/A WI Date : N/A DBlack(Jun 24,202216:17 CDT) Douglas W. Black Sr. Assistant City Attorney ATTEST: a� OR �a Goodall �ddG�' t c` T J ette S. (Jun 28,202213� CDT) A3 O`01000pOo ��(�j� O Y Jannette Goodall P� �O�4d City Secretary �vo =d o ���nEXAS.oAp OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX City of Fort Worth, Texas Trinity River Vision-Central City Flood Control Drainage Projects Prof Services Agreement Amendment Template 103260, 103261, 103262, 103263, 103264 Revision Date: November 23, 2021 Page 3 of 4 FUNDING BREAKDOWN SHEET City Secretary No. 56416 Amendment No. 1 Department Fund-Account-Center Amount TPW 52002 0200431 5330500 $94, 690 . 00 Total : $94, 690 . 00 City of Fort Worth, Texas Trinity River Vision-Central City Flood Control Drainage Projects Prof Services Agreement Amendment Template 103260, 103261, 103262, 103263, 103264 Revision Date: November 23, 2021 Page 4 of 4 REVISED ATTACHMENT "A" Scope for Engineerinq Design Related Services for Storm Water Improvements Projects The scope set forth herein defines the work to be performed by the ENGINEER in completing the project. Both the CITY and ENGINEER have attempted to clearly define the work to be performed and address the needs of the Project. Under this scope, "ENGINEER" is expanded to include any sub-consultant, including surveyor, employed or contracted by the ENGINEER. OBJECTIVE The objective is to provide storm water capital project management and administrative support, from design through construction, as an extension to City staff. The tasks outlined below are examples of duties that may or may not be required to assist the City depending on the complexity and completeness of the projects that are assigned. WORK TO BE PERFORMED Task 1. Manage Project Design Process Task 2. Manage Right of Way Acquisition Process Task 3. Manage Utility Relocation Process Task 4. Manage Project Construction Process Task 5. Close Project Basic Assumptions • The City will make available needed information on existing and proposed projects in a timely manner. • The presence or duties of Consultant's personnel at the construction site, whether as onsite representatives or otherwise, do not make CONSULTANT or Consultant's personnel in any way responsible for those duties that belong to OWNER's inspection staff and/or the construction contractors or other entities. And do not relieve the construction contractors or any other entity of their obligations, duties, and responsibilities, including, but not limited to, all construction methods, job site safety, means, techniques, sequences, and procedures necessary for coordinating and completing all portions of the construction work in accordance with the construction Contract Documents and any health or safety precautions required by such construction work. • The Task effort and deliverables outlined under the Scope are subject to change based on City needs and processes. The effort and deliverables are not limited to the items listed for each Task. City of Fort Worth,Texas Trinity River Vision-Central City Flood Control Drainage Projects Attachment 103260, 103261, 103262, 103263, 103264 PMO Release Date:07/23/2012 Page 1 of 22 TASK 1. Manage Project Design Process Description of Work: • Act as the City's primary point of contact • Work with City staff to develop project charters, communication plans, stakeholder registers, and total project budget estimates (TPBE) • Coordinate with the consultant and City project control staff to develop a baseline schedule • Charter the project team • Schedule meetings as needed with City staff from all departments • Attend weekly staff meeting with the program manager, City PMs, CPMs and administrative staff • Obtain and review monthly consultant project status reports (PSR), risk registers (RR) and schedules. Report project status the program manager • Track projects' progress in the City's PM/Program Manager dashboard • Update the City's overall project schedule as needed • Review invoices for reasonableness, accuracy, and appropriate charges • Review consultant submittals at 30%, 60%, 90%, and 100% design phases for completeness, constructability, conformance with the Storm Water Management Design Manual, and other City design standards • Schedule and lead review meetings of the consultant design submittals with the City's storm water technical review team. Coordinate reviews as needed with other City departments • Coordinate and conduct a public meeting at the 60% design stage • Schedule project site visits as necessary • Coordinate a construability review at the 60% design stage • Proactively manage change on the project. Deliverables: • Monthly status reports (PSR, RR) • Charters, Communication Plans, Stakeholder Registers, TPBE • Recommendation of invoice payment • Design review comments • Budget reviews and updates • Schedule updates • Recommendation of amendment scope and fee city of Fort Worth,Texas Trinity River Vision-Central City Flood Control Drainage Projects Attachment 103260, 103261, 103262, 103263, 103264 PMO Release Date:07/23/2012 Page 2 of 6 • Documentation of the above and other project activities, decisions and milestones TASK 2. Manage Right of Way Acquisition Process Description of Work: • Act as task manager for the City's Real Property group staff and acquisition consultants, if used. Be the primary point of contact with Real Property for the consultant and acquisition consultants • Review easement/ ROW and property acquisition documents against the requirements of the design for appropriateness and accuracy • Coordinate with Real Property so appraisals are completed in a timely manner. Review appraisals for completeness • Review acquisition M&Cs and update budget • Coordinate with the City's Legal Department on Eminent Domain issues • Review Real Property project tracking spreadsheet with estimated easement/ROW costs Deliverables: • Easement/ROW/property acquisition review comments • Appraisal review comments • Acquisition M&C review comments • Budget reviews and updates • Documentation of the above and other project activities, decisions and milestones maintained in hard copy form and electronic form on the City's BIM 360 site TASK 3. Manage Utility Relocation Process Description of Work: • Ensure appropriate Level of Subsurface Utility Engineering (SUE) is being conducted by the consultant • Review consultant SUE plan sheets for conformance to the SUE Quality Level scoped • Coordinate with the consultant to identify options that minimize utility conflicts • Submit plans to the City's Utility Coordinator • Coordinate with the City's Utility Coordinator for utility relocations City of Fort Worth,Texas Trinity River Vision-Central City Flood Control Drainage Projects Attachment 103260, 103261, 103262, 103263, 103264 PMO Release Date:07/23/2012 Page 3 of 6 • Prepare M&Cs if necessary to fund utility relocations and update the budget Deliverables: • SUE plan sheet review comments • M&C for utility relocation costs • Budget reviews and updates • Documentation of the above and other project activities, decisions and milestones maintained in hard copy form and electronic form on the City's BIM 360 site TASK 4. Manage Project Construction Process Description of Work: • Obtain M/WBE or SBE construction project goal • Review consultant prepared Notice to Bidders and Comprehensive Notice to Bidders for accuracy and advertise the project • Lead pre-bid meeting, if one is required • Attend Bid Opening • Review consultants bid tab summary for completeness and accuracy • Review contractor's bid package for conformance with the contract requirements • Recommend successful bidder for contract award • Prepare M&C for authorization to award contract • Coordinate routing of contract books with contract coordinator • Coordinate Storm Water Pollution Prevention Plan with Environmental Department • Issue the Notice to Proceed • Act as the point of contact between the contractor, inspector and consultant • Coordinate and conduct a public meeting at the start of construction • Coordinate with the design consultant on responses to Request for Information and submittal reviews. Maintain hard copies of these documents and ensure consultant is tracking them • Coordinate site visits with the inspector and consultant as appropriate • Ensure contractor and inspector are maintaining as-built mark-ups City of Fort Worth,Texas Trinity River Vision-Central City Flood Control Drainage Projects Attachment 103260, 103261, 103262, 103263, 103264 PMO Release Date:07/23/2012 Page 4 of 6 • Review contractor and consultant invoices for reasonableness, accuracy, and appropriate charges • Proactively manage change on the project Deliverables: • Advertisement • Recommendation to award contract • M&C for construction contract • Notice to proceed • Budget reviews and updates • Recommendation for change order approval • M&C for change order • Documentation of the above and other project activities, decisions and milestones maintained in hard copy form and electronic form on the City's BIM 360 site. TASK 5. Close Project Description of Work: • Once the storm drainage system is functional and construction is deemed complete, initiate the project close out process and coordinate with the inspector and consultant • Coordinate and attend a final walk through with the consultant, inspector, and contractor • Verify final punch list is completed by the consultant • If part of the consultant's scope, coordinate completion of Record Drawings and deliver to the City's record storage (the "vault") in electronic form and in hard copy mylar drawings • Review consultant and contractor final invoices for reasonableness, accuracy and appropriate charges • Prepare and route reconciliation change order • Recommend final project closure and complete the City's "green" sheet • Purge the files of any unnecessary documents and archive the project Deliverables: City of Fort Worth,Texas Trinity River Vision-Central City Flood Control Drainage Projects Attachment 103260, 103261, 103262, 103263, 103264 PMO Release Date:07/23/2012 Page 5 of 6 • Final punch list • Record drawings • Recommendation of final invoice payment • Expenditure and budget reconciliation • Final closure recommendation "green sheet" • Documentation of the above and other project activities, decisions and milestones maintained in hard copy form and electronic form on the City's BIM 360 site City of Fort Worth,Texas Trinity River Vision-Central City Flood Control Drainage Projects Attachment 103260, 103261, 103262, 103263, 103264 PMO Release Date:07/23/2012 Page 6 of 6 SHIELD ENGINEERING GROUP April 21, 2022 Linda S. Young, PE, PMP Program Manager, TPW Capital Delivery City of Fort Worth 200 Texas Street Fort Worth, TX 76102 RE: Trinity River Vision-Central City Flood Control Drainage Projects —Amendment 1 CS N 103260, 103261, 103262, 103263, 103264 Dear Ms. Young, Shield Engineering Group, PLLC is pleased to submit the following services to amend the contract shown above per the attached Level of Effort Spreadsheet. The new contract will be amended in the amount of$94,690 for a revised contract amount of$550,840. Shield plans to provide a Project Manager and EIT2 services. Original contract $456,150 Amendment 1 $94,690 Revised contract $550,840 Additionally, the contract Attachment "A" will be replaced with the attached Revised Attachment "A" to provide project management for the following additional services: • Task 4. Project Construction Process • Task 5. Close Project. Management of the following projects will be added to this contract: • 103644 FWCC Grand Ave Ph2 Pt2 • 103665 FWCC Grand Ave Ph2 Pt3 • 103666 TRVA New Main St Outfall & 8 • 103667 FWCC Cemetery Outfall & Houstn 1600 West 7th Street, Suite 200, Fort Worth, TX 76102 - 817.810.0696 info@segpllc.com - www.SHIELDENGINEERINGGROUP.com TBPE FIRM #F-1 1039 - TBPLS FIRM #10193890 SHIELD ENGINEERING GROUP Please see the attached Level of Effort spreadsheet which includes the assumptions and estimations for the hourly efforts and Revised Attachment "A". Please feel free to contact me with any questions or comments. Sincerely, Jean-Marie Alexander, P.E. COO Shield Engineering Group, PLLC Attachments: Attachment B LOE and Revised Attachment"A"for CPM amendment 1 1600 West 7th Street, Suite 200, Fort Worth, TX 76102 - 817.810.0696 info@segpllc.com - www.SHIELDENGINEERINGGROUP.com TBPE FIRM #F-1 1039 - TBPLS FIRM #10193890 O O O O O O O O O O O � O�EA EA EA EA EA M M M EA O� t0 O W W t0 N A N M M A Vi EA EA EA Vi N H O O O O O O O O O O O i9 U3 U3 U3 U3 U3 U3 U3 U3 U3 i9 O H O O O � � U U O fl. d K ON ON V m�ON- ON- ON- 0 O O O O V O� —N rn m A F � O O O O O O O O O O O M H3 H3 H3 H3 H3 H3 H3 H3 H3 M N _ C N O N H C C % O W � o 0 o E fq W E. Y W U m N a` o o a r S ++ c o a ,d a o0 o mmo 3 o Nc '" � N Z Y Q 0 0 0 0 0 0 0 0 0 O N G7 Q co R D m00000000 0 m Q.W V Z cl) 0� m K W O � m O 2 N c o 0 G7 N ++ Q c w JF •� V V W d m m O o 0 0 0 M N 0 0 N N W N N N W O n O O W Qi O y O M N O C 0 0 0 0 0 O y N N 'C N y O C y o_� N N � O H U C C O y 6 N N U Q_ N N C� 0 N L E m F C N a E N N N m > > w m m o_co Qm L o > m m axi a3i m U O O ~a>i-o K o 0 3m � z r 0 O o w 3 m Or �NMV� r� 6� U¢H LL AGENCY CUSTOMER ID: SHIEENG-02 LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Frost Insurance-Fort Worth Shield Engineering Group, PLLC P O Box 470636 POLICY NUMBER Fort Worth TX 76147 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 the certificate holder requiring the Waiver subject to policy terms and conditions.The General Liability,Automobile Liability,and Umbrella Liaiblity policies include a blanket notice of cancellation to certificate holders endorsement providing [30]day advance notice if policy is cancelled by the company other than for non-payment of premium, 10 days notice after the policy is cancelled for non-payment of premium.The endorsement does not provide for notice of cancellation if the named insured requests cancellation. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BA-9P888871-21-47-G ISSUE DATE: 01-21-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: 1 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS B. If we do not renew this policy for any legally A. If we cancel this policy for any legally permitted permitted reason other than nonpayment of reason other than nonpayment of premium, and a premium, and a number of days is shown for number of days is shown for Cancellation in the When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of Schedule above, we will mail notice of cancellation to the person or organization shown nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the in such Schedule. We will mail such notice to the address shown in the Schedule above at least the address shown in the Schedule above at least the number of days shown for Cancellation in such number of days shown for When We Do Not Schedule before the effective date of cancellation. Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T4 00 05 19 ©2019 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM 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 the 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 cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C. EMPLOYEES AS INSURED I. WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY LIMITS K. AIRBAGS E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1., Who Is your business. An Insured, of SECTION II —COVERED AUTOS 2. The following replaces Paragraph b. in B.S., LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who is required under NESS AUTO CONDITIONS: a written contract or agreement between you and b. For Hired Auto Physical Damage Cover- that person or organization, that is signed and age, the following are deemed to be cov- executed by you before the "bodily injury" or ered "autos"you own: "property damage" occurs and that is in effect during the policy period, to be named as an addi- (1) Any covered "auto" you lease, hire, tional insured is an "insured" for Covered Autos rent or borrow; and Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by this insurance applies and only to the extent that your "employee" under a contract in person or organization qualifies as an "insured" an "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties in Section II. related to the conduct of your busi- B. EMPLOYEE HIRED AUTO ness. 1. The following is added to Paragraph A.1., However, any "auto" that is leased, hired, Who Is An Insured, of SECTION II — COV- rented or borrowed with a driver is not a covered "auto". ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is under a contract or agreement in an "em- An Insured, of SECTION II —COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- (2) An adjustment for depreciation and physical ing a covered "auto" you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs. cash value in the event of a total "loss". D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better LIMITS than like kind or quality, we will not pay for the 1. The following replaces Paragraph A.2.a.(2) of amount of betterment. SECTION II —COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of bail bonds (in- covered "auto". cluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to: tions) required because of an "accident" (a) Any "auto" that is hired, rented or bor- we cover. We do not have to furnish rowed with a driver; or these bonds. (b) Any "auto" that is hired, rented or bor- 2. The following replaces Paragraph A.2.a.(4) of SECTION II —COVERED AUTOS LIABILITY rowed from your"employee". COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT (4) All reasonable expenses incurred by the The following replaces the first sentence in Para- "insured" at our request, including actual graph A.4.a., Transportation Expenses, of loss of earnings up to $500 a day be- SECTION III — PHYSICAL DAMAGE COVER- cause of time off from work. AGE: E. TRAILERS—INCREASED LOAD CAPACITY We will pay up to $50 per day to a maximum of The following replaces Paragraph C.1. of SEC- $1,500 for temporary transportation expense in- TION I —COVERED AUTOS: curred by you because of the total theft of a cov- 1. "Trailers" with a load capacity of 3,000 ered "auto" of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT—INCREASED LIMIT F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.1.b. of SECTION III — PHYSICAL The following is added to Paragraph AA., Cover- DAMAGE COVERAGE is deleted. age Extensions, of SECTION III — PHYSICAL I. WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: The following is added to Paragraph D., Deducti- Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than also provides Physical Damage Coverage for an replaced. owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY age is extended to "autos" that you hire, rent or The following is added to Paragraph AA., Cover- borrow subject to the following: age Extensions, of SECTION III — PHYSICAL (1) The most we will pay for "loss" to any one DAMAGE COVERAGE: "auto" that you hire, rent or borrow is the Personal Property Coverage lesser of: We will pay up to $400 for "loss" to wearing ap- (a) $50,000; parel and other personal property which is: (b) The actual cash value of the damaged or (1) Owned by an "insured"; and stolen property as of the time of the (2) In or on your covered "auto". "loss"; or This coverage only applies in the event of a total (c) The cost of repairing or replacing the theft of your covered "auto". damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age. Page 2 of 3 ©2015 The Travelers Indemnity Company.All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO K. AIRBAGS (2) Any: The following is added to Paragraph B.3., Exclu- (a) Overdue lease or loan payments at the sions, of SECTION III — PHYSICAL DAMAGE time of the "loss"; COVERAGE: Exclusion 3.a. does not apply to "loss" to one or (b) Financial penalties imposed under a pp y lease for excessive use, abnormal wear more airbags in a covered "auto" you own that in- and tear or high mileage; flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto" is a covered "auto" for Compre- (d) Costs for extended warranties, Credit Life hensive Coverage under this policy; Insurance, Health, Accident or Disability b. The airbags are not covered under any war- Insurance purchased with the loan or ranty; and lease; and c. The airbags were not intentionally inflated. (e) Carry-over balances from previous loans We will pay up to a maximum of $1,000 for any or leases. one "loss". M. BLANKET WAIVER OF SUBROGATION L. AUTO LOAN LEASE GAP The following replaces Paragraph A.5., Transfer The following is added to Paragraph AA., Cover- Of Rights Of Recovery Against Others To Us, age Extensions, of SECTION III — PHYSICAL of SECTION IV — BUSINESS AUTO CONDI- DAMAGE COVERAGE: TIONS: Auto Loan Lease Gap Coverage for Private 5. Transfer Of Rights Of Recovery Against Passenger Type Vehicles Others To Us In the event of a total "loss" to a covered "auto" of We waive any right of recovery we may have the private passenger type shown in the Schedule against any person or organization to the ex- or Declarations for which Physical Damage Cov- tent required of you by a written contract exe- erage is provided, we will pay any unpaid amount cuted prior to any "accident" or "loss", pro- due on the lease or loan for such covered "auto" vided that the "accident" or"loss" arises out of less the following: the operations contemplated by such con- (1) The amount paid under the Physical Damage tract. The waiver applies only to the person or Coverage Section of the policy for that "auto"; organization designated in such contract. and CA T4 20 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION II — COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part S. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory. conduct of another"insured". CA T4 74 02 16 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. POLICY NUMBER: 680-9P888766-21-47 ISSUE DATE: 01/21/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS B. If we do not renew this policy for any legally A. If we cancel this policy for any legally permitted permitted reason other than nonpayment of reason other than nonpayment of premium, and a premium, and a number of days is shown for number of days is shown for Cancellation in the When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of Schedule above, we will mail notice of cancellation to the person or organization shown nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the in such Schedule. We will mail such notice to the address shown in the Schedule above at least the address shown in the Schedule above at least the number of days shown for Cancellation in such number of days shown for When We Do Not Schedule before the effective date of cancellation. Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T4 00 05 19 ©2019 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II —WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by 'your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance" to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or"personal injury"; and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of 'your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily injury", "property damage" or is excess over any valid and collectible other "personal injury" for which such person or insurance, whether primary, excess, contingent or organization has assumed liability in a on any other basis, that is available to the contract or agreement. additional insured for a loss we cover. However, if you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part must apply on a primary basis or a primary and e. This insurance does not apply on any basis to non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this as a named insured for such loss, and we will not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs; and "professional services". g (2) The "personal injury" for which coverage is g. In the event that the Limits of Insurance of the sought arises out of an offense committed; Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III — person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 09 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV — COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of 'your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused by an offense committed: under a written contract requiring insurance with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the "personal injury" offense is committed. Page 2 of 2 ©2015 The Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS 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. Non-Owned Watercraft—75 Feet Long Or Less H. Blanket Additional Insured — Governmental B. Who Is An Insured—Unnamed Subsidiaries Entities — Permits Or Authorizations Relating To Premises C. Who Is An Insured — Retired Partners, Members, Directors And Employees I. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To D. Who Is An Insured — Employees And Volunteer Operations Workers — Bodily Injury To Co-Employees, Co- Volunteer Workers And Retired Partners, J. Incidental Medical Malpractice Members, Directors And Employees K. Medical Payments— Increased Limit E. Who Is An Insured — Newly Acquired Or Formed L. Amendment Of Excess Insurance Condition — Limited Liability Companies Professional Liability F. Blanket Additional Insured—Controlling Interest M. Blanket Waiver Of Subrogation —When Required G. Blanket Additional Insured — Mortgagees, By Written Contract Or Agreement Assignees, Successors Or Receivers N. Contractual Liability—Railroads PROVISIONS uses or is responsible for the use of a A. NON-OWNED WATERCRAFT — 75 FEET watercraft that you do not own that is: LONG OR LESS (1) 75 feet long or less; and 1. The following replaces Paragraph (2) of (2) Not being used to carry any person Exclusion g., Aircraft, Auto Or Watercraft, or property for a charge; in Paragraph 2. of SECTION I — B. WHO IS AN INSURED — UNNAMED COVERAGES — COVERAGE A — BODILY SUBSIDIARIES INJURY AND PROPERTY DAMAGE The following is added to SECTION II —WHO IS LIABILITY: AN INSURED: (2) A watercraft you do not own that is: Any of your subsidiaries, other than a partnership (a) 75 feet long or less; and or joint venture, that is not shown as a Named (b) Not being used to carry any person Insured in the Declarations is a Named Insured or property for a charge; if: 2. The following replaces Paragraph 2.e. of a. You are the sole owner of, or maintain an SECTION II —WHO IS AN INSURED: ownership interest of more than 50% in, such e. Any person or organization that, with subsidiary on the first day of the policy your express or implied consent, either period; and CG D3 79 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under Unless you are in the business or occupation similar other insurance. of providing professional health care No such subsidiary is an insured for "bodily services, Paragraphs (1)(a), (b), (c) and (d) injury" or "property damage" that occurred, or above do not apply to "bodily injury" arising "personal and advertising injury" caused by an out of providing or failing to provide first aid offense committed: or "Good Samaritan services" by any of your retired partners, members, directors or a. Before you maintained an ownership interest "employees", other than a doctor. Any such of more than 50% in such subsidiary; or retired partners, members, directors or b. After the date, if any, during the policy period "employees" providing or failing to provide that you no longer maintain an ownership first aid or "Good Samaritan services" during interest of more than 50% in such subsidiary. their work hours for you will be deemed to be acting within the scope of their employment For purposes of Paragraph 1. of Section II —Who by you or performing duties related to the Is An Insured, each such subsidiary will be conduct of your business. deemed to be designated in the Declarations as: a. A limited liability company; (2) "Personal injury": b. An organization other than a partnership, (a) you, to your current or retired pa joint venture or limited liability company; or partners or members (if you are a partnership or joint venture), to your c. A trust; current or retired members (if you are a as indicated in its name or the documents that limited liability company), to your other govern its structure. current or retired directors or "employees" while in the course of his or C. WHO IS AN INSURED — RETIRED PARTNERS, her employment or performing duties MEMBERS, DIRECTORS AND EMPLOYEES related to the conduct of your business, The following is added to Paragraph 2. of or to your other "volunteer workers" SECTION II —WHO IS AN INSURED: while performing duties related to the Any person who is your retired partner, member, conduct of your business; director or "employee"that is performing services (b) To the spouse, child, parent, brother or for you under your direct supervision, but only for sister of that current or retired partner, acts within the scope of their employment by you member, director, "employee" or or while performing duties related to the conduct "volunteer worker" as a consequence of of your business. However, no such retired Paragraph (2)(a) above; partner, member, director or "employee" is an insured for: (c) For which there is any obligation to share damages with or repay someone (1) "Bodily injury": else who must pay damages because of (a) To you, to your current partners or the injury described in Paragraph (2)(a) members (if you are a partnership or or(b) above; or joint venture), to your current members (d) Arising out of his or her providing or (if you are a limited liability company) or failing to provide professional health care to your current directors; services. (b) To the spouse, child, parent, brother or (3) "Property damage" to property: sister of that current partner, member or director as a consequence of Paragraph (a) Owned, occupied or used by; or (1)(a) above; (b) Rented to, in the care, custody or control (c) For which there is any obligation to of, or over which physical control is share damages with or repay someone being exercised for any purpose by; else who must pay damages because of you, any of your retired partners, members the injury described in Paragraph (1)(a) or directors, your current or retired or(b) above; or "employees" or "volunteer workers", any current partner or member (if you are a (d) Arising out of his or her providing or partnership or joint venture), or any current failing to provide professional health care member (if you are a limited liability services. company) or current director. Page 2 of 6 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY D. WHO IS AN INSURED — EMPLOYEES AND organization will be deemed to be VOLUNTEER WORKERS — BODILY INJURY designated in the Declarations as: TO CO-EMPLOYEES, CO-VOLUNTEER a. A limited liability company; WORKERS AND RETIRED PARTNERS, b. An organization other than a partnership, MEMBERS, DIRECTORS AND EMPLOYEES joint venture or limited liability company; The following is added to Paragraph 2.a.(1) of or SECTION II —WHO IS AN INSURED: c. A trust; Paragraphs (1)(a), (b) and (c) above do not as indicated in its name or the documents apply to "bodily injury" to a current or retired co- that govern its structure. "employee" while in the course of the co- "employee's" employment by you or performing F. BLANKET ADDITIONAL INSURED — duties related to the conduct of your business, or CONTROLLING INTEREST to "bodily injury" to your other "volunteer 1. The following is added to SECTION II — workers" or retired partners, members or WHO IS AN INSURED: directors while performing duties related to the conduct of your business. Any person or organization that has financial control of you is an insured with respect to E. WHO IS AN INSURED—NEWLY ACQUIRED liability for "bodily injury", "property damage" OR FORMED LIMITED LIABILITY COMPANIES or "personal and advertising injury" that The following replaces Paragraph 3. of arises out of: SECTION II —WHO IS AN INSURED: a. Such financial control; or 3. Any organization you newly acquire or form, b. Such person's or organization's other than a partnership or joint venture, and ownership, maintenance or use of of which you are the sole owner or in which premises leased to or occupied by you. you maintain an ownership interest of more than 50%, will qualify as a Named Insured if The insurance provided to such person or there is no other similar insurance available organization does not apply to structural to that organization. However: alterations, new construction or demolition operations performed by or on behalf of such a. Coverage under this provision is person or organization. afforded only: 2. The following is added to Paragraph 4. of (1) Until the 180th day after you acquire SECTIO N II —WHO IS AN INSURED: or form the organization or the end of This paragraph does not apply to any the policy period, whichever is premises owner, manager or lessor that has earlier, if you do not report such financial control of you. organization in writing to us within 180 days after you acquire or form it; G. BLANKET ADDITIONAL INSURED — or MORTGAGEES, ASSIGNEES, SUCCESSORS (2) Until the end of the policy period, OR RECEIVERS when that date is later than 180 days The following is added to SECTION II —WHO IS after you acquire or form such AN INSURED: organization, if you report such Any person or organization that is a mortgagee, organization in writing to us within assignee, successor or receiver and that you 180 days after you acquire or form it; have agreed in a written contract or agreement b. Coverage A does not apply to "bodily to include as an additional insured on this injury" or "property damage" that Coverage Part is an insured, but only with occurred before you acquired or formed respect to its liability as mortgagee, assignee, the organization; and successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" c. Coverage B does not apply to "personal that: and advertising injury arising out of an offense committed before you acquired a. Is "bodily injury" or "property damage" that or formed the organization. occurs, or is "personal and advertising injury" For the purposes of Paragraph 1. of Section caused by an offense that is committed, II — Who Is An Insured, each such CG D3 79 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or openings, sidewalk vaults, elevators, street agreement; and banners or decorations. b. Arises out of the ownership, maintenance or I. BLANKET ADDITIONAL INSURED — use of the premises for which that GOVERNMENTAL ENTITIES — PERMITS mortgagee, assignee, successor or receiver OR AUTHORIZATIONS RELATING TO is required under that contract or agreement OPERATIONS to be included as an additional insured on The following is added to SECTION II —WHO IS this Coverage Part. AN INSURED: The insurance provided to such mortgagee, Any governmental entity that has issued a permit assignee, successor or receiver is subject to the or authorization with respect to operations following provisions: performed by you or on your behalf and that you a. The limits of insurance provided to such are required by any ordinance, law, building code mortgagee, assignee, successor or receiver or written contract or agreement to include as an will be the minimum limits that you agreed to additional insured on this Coverage Part is an provide in the written contract or agreement, insured, but only with respect to liability for or the limits shown in the Declarations, "bodily injury", "property damage" or "personal whichever are less. and advertising injury" arising out of such b. The insurance provided to such person or operations. organization does not apply to: The insurance provided to such governmental 1 An "bodily injury" or "property dama e" entity does not apply to: ( ) Y Y g that occurs, or any "personal and a. Any "bodily injury", "property damage" or advertising injury" caused by an offense "personal and advertising injury" arising out that is committed, after such contract or of operations performed for the agreement is no longer in effect; or governmental entity; or (2) Any "bodily injury", "property damage" or b. Any "bodily injury" or "property damage" "personal and advertising injury" arising included in the "products-completed out of any structural alterations, new operations hazard". construction or demolition operations J. INCIDENTAL MEDICAL MALPRACTICE performed by or on behalf of such mortgagee, assignee, successor or 1. The following replaces Paragraph b. of the receiver. definition of "occurrence" in the H. BLANKET ADDITIONAL INSURED — DEFINITIONS Section: GOVERNMENTAL ENTITIES — PERMITS OR b. An act or omission committed in AUTHORIZATIONS RELATING TO PREMISES providing or failing to provide "incidental medical services", first aid or "Good The following is added to SECTION II —WHO IS Samaritan services" to a person, unless AN INSURED: you are in the business or occupation of Any governmental entity that has issued a permit providing professional health care or authorization with respect to premises owned services. or occupied by, or rented or loaned to, you and 2. The following replaces the last paragraph of that you are required by any ordinance, law, Paragraph 2.a.(1) of SECTION II — WHO IS building code or written contract or agreement to include as an additional insured on this AN INSURED: Coverage Part is an insured, but only with Unless you are in the business or occupation respect to liability for "bodily injury", "property of providing professional health care damage" or "personal and advertising injury" services, Paragraphs (1)(a), (b), (c) and (d) arising out of the existence, ownership, use, above do not apply to "bodily injury" arising maintenance, repair, construction, erection or out of providing or failing to provide: removal of any of the following for which that (a) "Incidental medical services" by any of governmental entity has issued such permit or your "employees" who is a nurse, authorization: advertising signs, awnings, nurse assistant, emergency medical canopies, cellar entrances, coal holes, technician, paramedic, athletic trainer, driveways, manholes, marquees, hoist away audiologist, dietician, nutritionist, Page 4 of 6 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY occupational therapist or occupational that is available to any of your "employees" therapy assistant, physical therapist or for "bodily injury" that arises out of providing speech-language pathologist; or or failing to provide "incidental medical (b) First aid or "Good Samaritan services" services" to any person to the extent not by any of your "employees" or "volunteer subject to Paragraph 2.a.(1) of Section II — workers", other than an employed or Who Is An Insured. volunteer doctor. Any such "employees" K. MEDICAL PAYMENTS—INCREASED LIMIT or "volunteer workers" providing or failing to provide first aid or "Good Samaritan The following replaces Paragraph 7. of services" during their work hours for you SECTION III —LIMITS OF INSURANCE: will be deemed to be acting within the 7. Subject to Paragraph S. above, the Medical scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business. because of "bodily injury" sustained by any 3. The following replaces the last sentence of one person, and will be the higher of: Paragraph S. of SECTION III — LIMITS OF a. $10,000; or INSURANCE: For the purposes of determining the b. The amount shown in the Declarations of applicable Each Occurrence Limit, all related this Coverage Part for Medical Expense acts or omissions committed in providing or Limit. failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION—PROFESSIONAL LIABILITY services" to any one person will be deemed to be one "occurrence". The following is added to Paragraph 4.b., 4. The following exclusion is added to Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY Paragraph 2., Exclusions, of SECTION I — CONDITIONS: COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE This insurance is excess over any of the other LIABILITY: insurance, whether primary, excess, contingent or on any other basis, that is Professional Sale Of Pharmaceuticals Liability or similar coverage, to the extent the "Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B. ordinance relating to the sale of pharmaceuticals committed by, or with the M. BLANKET WAIVER OF SUBROGATION — knowledge or consent of the insured. WHEN REQUIRED BY WRITTEN CONTRACT S. The following is added to the DEFINITIONS OR AGREEMENT Section: The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, "Incidental medical services" means: of SECTION IV — COMMERCIAL GENERAL a. Medical, surgical, dental, laboratory, x- LIABILITY CONDITIONS: ray or nursing service or treatment, If the insured has agreed in a written contract or advice or instruction, or the related agreement to waive that insured's right of furnishing of food or beverages; or recovery against any person or organization, we b. The furnishing or dispensing of drugs or waive our right of recovery against such person medical, dental, or surgical supplies or or organization, but only for payments we make appliances. because of: 6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV — occurs; or COMMERCIAL GENERAL LIABILITY CONDITIONS: b. "Personal and advertising injury" caused by This insurance is excess over any valid and an offense that is committed; collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, agreement. CG D3 79 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY N. 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. Page 6 of 6 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDATORY ENDORSEMENT - PRODUCTS- COMPLETED OPERATIONS HAZARD This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following replaces Paragraph b.(3) of the definition of "products-completed operations hazard" in the DEFINITIONS Section: (3) Products or operations for which the classification, listed in the Declarations, in a policy Schedule or in our manual of rules, states that the products-completed operations are subject to the General Aggregate Limit. CG D3 09 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: 46 WBC AH9367 Endorsement Number: Effective Date: 04/09/21 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: SHIELD ENGINEERING GROUP, PLLC 1600 W 7TH ST STE 200 FORT WORTH TX 76102 This endorsement applies only to the insurance provided respect to bodily injury arising out of the operations by the policy because Texas is shown in Item 3.A. of the described in the Schedule where you are required by a Information Page. written contract to obtain this waiver from us. We have the right to recover our payments from anyone This endorsement shall not operate directly or indirectly liable for an injury covered by this policy. We will not to benefit anyone not named in the Schedule. enforce our right against the person or organization The premium for this endorsement is shown in the named in the Schedule, but this waiver applies only with Schedule. Schedule 1. ( ) Special 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 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: Form WC 42 03 04 B Printed in U.S.A. Process Date: 02/28/21 Policy Expiration Date: 04/09/22