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CORRESPONDENCE - BID - 9267 PRESSURE WASHING FOR DOWNTOWN AREA 2021
December 20, 2021 Top Gun Pressure Washing INC Attn: Kristina Redstone 500 West 67th St. Loveland, CO 80538 RE: Contract Renewal, 9267 - Pressure Washing for Downtown Area 2021 Dear Ms. Redstone: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: 1) The term will be extended for one (1) additional year, February 28, 2022 through February 27, 2023. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of insurance certificate naming the City as an additional insured for General and Automotive Liability within the next fifteen (15) days. If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non-renewal. Please contact Jake Rector, Senior Buyer at (970) 221-6776 or jrector@fcgov.com if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew 9267 by signing this letter and returning it to Purchasing Division within the next fifteen days.) GSP:kr Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 12/23/2021 CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSR ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Olson &Olson Ltd 5655 S.Yosemite St.#200 Greenwood Village CO 80111 303-867-2055 303-867-2074 Certificates@olsonandolson.com Union Insurance Company 25844 TOPGU-1 RSUI Indemnity Company 22314TopGunPressureWashing,LLC 500 W.67th St. Loveland CO 80538 Pinnacol Assurance 41190 87272725 A X 1,000,000 500,000 X 1,000,000 2,000,000 2,000,000 CPA3235676 3/4/2021 3/4/2022 X 10,000 A 1,000,000 X X X CPA3235676 3/4/2021 3/4/2022 A X X 10,000,000 X 10,000,000 N/A CPA3235676 3/4/2021 3/4/2022 C N 4031609 7/1/2021 7/1/2022 1,000,000 1,000,000 1,000,000 B Excess Liability 12/21/2021 X NHA093319 3/4/2021 3/4/2022 Each Occurrence Aggregate 5,000,000 5,000,000 See Attached... City of Fort Collins Purchasing Department;Attn:John Stevens P.O.Box 580 Fort Collins CO 80522-0580 DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: TOPGU-1 1 2 Olson &Olson Ltd Top Gun Pressure Washing,LLC 500 W.67th St. Loveland CO 80538 25 CERTIFICATE OF LIABILITY INSURANCE CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS A WRAP EXCLUSION APPLIES PER POLICY TERMS AND CONDITIONS Other Coverages: LEASED/RENTED EQUIPMENT POLICY Policy Number:8B845589 Policy Effective Date:7-1-2021 to 7-1-2022 Insurer:Travelers Prop Cas Co of Amer (NAIC #25674) Limit:$100,000 Deductible:$1,000 CRIME POLICY Policy Number:CPA3235676 Policy Effective Date:3-4-2021 to 3-4-2022 Insurer:Union Insurance Company (NAIC #25844) Theft of Client’s Property Limit:$100,000 Deductible:$1,000 GENERAL LIABILITY: CG2040 Form Attached Includes: Blanket Additional Insured –Competed Operations status when required by written contract. CG2001 Form Attached Includes: Blanket Primary &Non-Contributory status to Additional insured applies when required by a written contract. CLCG0492 Form Attached Includes: Blanket Additional Insured –Ongoing Operations status when required by written contract. Blanket Additional Insured for Various Relationships when required by written contract or written agreement. Blanket Waiver of Subrogation applies when required by written contract. AUTO LIABILITY: CLCA2093 Form Attached Includes: Blanket Additional Insured status applies when required by written contract. Blanket Waiver of Subrogation applies when required by written contract. Blanket Primary &Non-Contributory status to Additional insured applies when required by a written contract. WORKERS COMPENSATION WC000313B Form Attached Includes: Blanket Waiver of Subrogation applies when required by written contract. UMBRELLA LIABILITY Umbrella Liability policy is on a follow form basis for the following underlying insurance coverages:General Liability,Automobile Liability and Employers Liability. CW1054U Form Attached Includes: Additional Insured status including Primary and Non-Contributory status,will follow form when required by written contract. POLLUTION LIABILITY: Policy Number:6049865555 Policy Effective Date:7-1-2021 to 7-1-2022 Insurer:Columbia Casualty Company (NAIC #31127) Per Claim Limit:$1,000,000 Aggregate Limit:$1,000,000 Self-Insured Retention:$10,000 CNA90038XX Form Attached Includes: Blanket Additional Insured status when required by written contract or written agreement. Blanket Primary &Non-Contributory status to Additional insured applies when required by a written contract or written agreement. CNA83662XX Form Attached Includes: Blanket Waiver of Subrogation applies when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only.To obtain copies,please send your request with the email address to Certificates@olsonandolson.com DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: TOPGU-1 2 2 Olson &Olson Ltd Top Gun Pressure Washing,LLC 500 W.67th St. Loveland CO 80538 25 CERTIFICATE OF LIABILITY INSURANCE Contract Work.Additional Insured(s):The City of Fort Collins,its officers,agents and employees. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 COMMERCIAL GENERAL LIABILITY CL CG 04 92 10 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CL CG 04 92 10 18 Page 1 of 8 GENERAL LIABILITY ULTRA PLUS ENDORSEMENT SUMMARY OF COVERAGE EXTENSIONS Provision Name Of Coverage Extension Included or Limit of Insurance A. B C. D. E F. G. H. I. J. 1. 2. K. L. M. N. A. MISCELLANEOUS ADDITIONAL INSUREDS 1. Section II – Who Is An Insured A.1.c.(1)A.1.c.(9) a. (1) (2) DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 2 of 8 b. c. (1) Persons or Organizations For Whom Operations Are Performed (a) (b) (a) (c) (i) (ii) (d) (i) (1.1) (1.2) (ii) (1.1) (1.2) (2) Managers Or Lessors Of Premises DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 3 of 8 (a) (b) (3) Mortgagee, Assignee Or Receiver (4) Owners Or Other Interests From Whom Land Has Been Leased (a) (b) (5) Lessor Of Leased Equipment (6) State, Municipality, Governmental Agency Or Subdivision Or Other Political Subdivision – Permits Or Authorizations Relating To Premises (a) (i) (1.1) (1.2) (1.3) (ii) DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 4 of 8 (b) (7) Controlling Interest (a) (b) (8) Co-Owner Of Insured Premises (9) Vendors (a) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (1.1) (iv) (vi) (1.2) DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 5 of 8 (b) 2. A. Miscellaneous Additional Insureds a. A.1.c.(1)A.1.c.(8) (1) (2) b. c. 3. A. Miscellaneous Additional Insureds Section III – Limits Of Insurance a. b. B. EXPECTED OR INTENDED INJURY OR DAMAGE 2.a. Expected Or Intended Injury Section I – Coverage A – Bodily Injury And Property Damage Liability a. Expected Or Intended Injury Or Damage C. KNOWLEDGE OF OCCURRENCE 2.a. Duties In The Event Of Occurrence, Offense, Claim Or Suit Section IV – Commercial General Liability Conditions a. (1) (2) (3) (4) (i) (ii) (iii) D. LEGAL LIABILITY – DAMAGE TO PREMISES RENTED TO YOU (Fire, Lightning, Explosion, Smoke, Or Leakage From Automatic Fire Protective Systems) 1.Section I – Coverage A – Bodily Injury And Property Damage Liability DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 6 of 8 c.n. Section III – Limits Of Insurance 2. j.(6)2. Exclusions Section I – Coverage A – Bodily Injury And Property Damage Liability (1)(3)(4) Section III – Limits Of Insurance. 3.6.Section III – Limits Of Insurance 6.5. a. b. Coverage A 4.b.(1)(a)(ii)4. Other Insurance Section IV – Commercial General Liability Conditions (ii) 5.a.9. Section V – Definitions a. 6.D. Legal Liability – Damage To Premises Rented To You E. MEDICAL PAYMENTS Section III – Limits Of Insurance F. MOBILE EQUIPMENT REDEFINED f.(1)12. Section V – Definitions (1) (a) (b) (c) G. NEWLY FORMED OR ACQUIRED ORGANIZATION, PARTNERSHIP OR LIMITED LIABILITY COMPANY AND EXTENDED PERIOD OF COVERAGE 3.Section II – Who Is An Insured 3. a. b. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 7 of 8 c. (i) (ii) Section I – Coverage A – Bodily Injury And Property Damage Liability (iii) Section I – Coverage B – Personal And Advertising Injury Liability (iv) (v) (vi) H. WHO IS AN INSURED – AMENDMENT Section II – Who Is An Insured a. 3.Section II – Who Is An Insured b. c. I. NON-OWNED WATERCRAFT (2)Exclusion 2.g. Aircraft, Auto Or Watercraft Section I – Coverage A – Bodily Injury And Property Damage Liability (2) (a) (b) J. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS Section I – Supplementary Payments – Coverages A And B 1.1.b. 2.1.d. K. UNINTENTIONAL OMISSION OR UNINTENTIONAL ERROR IN DISCLOSURE 6. Representations Section IV – Commercial General Liability Conditions L. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS 8. Transfer Of Rights Of Recovery Against Others To Us Section IV – Commercial General Liability Conditions DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CG 04 92 10 18 Page 8 of 8 M. LIBERALIZATION CLAUSE Section IV – Commercial General Liability Conditions: N. INCIDENTAL MEDICAL MALPRACTICE 1.2.a.(1)(d)Section II – Who Is An Insured 2. 4.b.Section IV – Commercial General Liability Conditions DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 &200(5&,$/*(1(5$//,$%,/,7< &* 7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< &* ,QVXUDQFH6HUYLFHV2IILFH,QF3DJHRI $'',7,21$/,1685('±2:1(56/(66((625&2175$&7256±$8720$7,&67$786)2527+(53$57,(6:+(15(48,5(',1:5,77(1&216758&7,21$*5((0(17 &203/(7('23(5$7,216 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 352'8&76&203/(7('23(5$7,216/,$%,/,7<&29(5$*(3$57 $ 6HFWLRQ,,±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olicy number: CPA3235676 DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 3DJHRI,QVXUDQFH6HUYLFHV2IILFH,QF&* & :LWK UHVSHFW WR WKH LQVXUDQFH DIIRUGHG WR WKHVH DGGLWLRQDO LQVXUHGV WKH IROORZLQJ LV DGGHG WR6HFWLRQ,,,±/LPLWV2I,QVXUDQFH 7KHPRVWZHZLOOSD\RQEHKDOIRIWKHDGGLWLRQDO LQVXUHGLVWKHDPRXQWRILQVXUDQFH 5HTXLUHG E\ WKH FRQWUDFW RU DJUHHPHQW GHVFULEHGLQ3DUDJUDSK$ RU $YDLODEOH XQGHU WKH DSSOLFDEOH OLPLWV RI LQVXUDQFH ZKLFKHYHULVOHVV 7KLV HQGRUVHPHQW VKDOO QRW LQFUHDVH WKH DSSOLFDEOHOLPLWVRILQVXUDQFH DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 &200(5&,$/*(1(5$//,$%,/,7< &* 7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< &* ,QVXUDQFH6HUYLFHV2IILFH,QF3DJHRI 35,0$5<$1'121&2175,%8725<±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olicy number: CPA3235676 DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 COMMERCIAL AUTO CL CA 20 93 03 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CL CA 20 93 03 19 Includes copyrighted material of Insurance Services Page 1 of 8 Offices, Inc. with its permission BUSINESS AUTO ENHANCEMENT – PLATINUM PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGE EXTENSIONS Paragraph No. Name Of Extension Limit or Included A. Additional Insured by Contract Or Agreement Including Primary and Noncontributory Other Insurance Condition Included B. Airbags - Extended Coverage Included C. Telematics & GPS Equipment Coverage $2,500 D. Electronic Equipment – Increased Coverage $2,500 E. Auto Loan/Lease Gap Coverage Unlimited F. Autos Rented by Employees Included G. Bail Bonds - Extended Coverage $5,000 H. Broad Form Named Insured Including Newly Acquired or Formed Organizations Included I. Custom Signs & Decorations Included J. Employees as Insureds Included K. Family Emergency Travel Reimbursement $2,500 L. Fellow Employee Coverage Included M Fire Extinguisher Recharge Included N. Glass Repair – No Deductible Included O. Hired Auto Physical Damage and Increased Loss of Use Expenses Loss of use (Per Day / Maximum) $100,000 $500 / $3,500 P Hybrid Auto Payment Coverage (per auto / per loss) $2,500/ $5,000 Q. Knowledge Of An Accident, Claim, Suit Or Loss Included R. Limited Worldwide Hired & Non Owned Auto Coverage Included S. Loss Of Earnings - Extended Coverage $1,000 T. New Vehicle Replacement Cost Included U. Rental Reimbursement Coverage Maximum Rental Expenses Per Day $75 Maximum Rental Expenses Because Of Loss To Any One Covered "Auto" $3,375 Maximum Rental Expenses Because Of Loss To All Covered "Autos" In Any One Policy Period $15,000 DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 Page 2 of 8 Includes copyrighted material of Insurance Services CL CA 20 93 03 19 Offices, Inc. with its permission V. Personal Effects Coverage $500 W. Resultant Mental Anguish Included X. Towing And Labor Coverage Extension Private Passenger Type Other than Private Passenger Type $200 $250 Y. Transportation Expenses - Coverage Extension ( Per Day / Maximum) $75 / $2,500 Z. Unintentional Failure To Disclose Hazards Included AA. Waiver Of Collision Deductible – Attached Autos Included BB. Waiver Of Subrogation By Contract Or Agreement Included A. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT INCLUDING PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION The following is added to Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage: When you have agreed in a written contract or agreement to include a person or organization as an additional insured, such person or organization is included as an "insured" subject to the following: 1. Such person or organization is an additional insured only to the extent such person or organization is liable for "bodily injury" or "property damage" because of the conduct of an "insured" under Paragraphs a. or b. under Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto". 2. The written contract or agreement described above must have been executed prior to the "accident" that caused the "bodily injury" or "property damage" and be in effect at the time of such "accident". 3. The insurance afforded to any such additional insured does not apply to any "accident" beyond the period of time required by the written contract or agreement described above. 4. The most we will pay on behalf of such additional insured(s) is the lesser of: a. The Limits of Insurance specified in the written contract or agreement described above; or b. The Limits of Insurance shown in the Declarations. This provision shall not increase the Limit of Insurance shown in the Declarations in this policy or coverage part. 5. The following changes are made to Paragraph 5. Other Insurance of B. General Conditions under Section IV – Business Auto Conditions: a. The following is added to Paragraph 5.a.: If required by the written contract or agreement described above, the insurance afforded to the additional insured under this provision will be primary to, and will not seek contribution from, the additional insured’s own insurance. b. Paragraph 5.c. is deleted in its entirety. 6. Paragraph A.1.c. under Section II - Covered Autos Liability Coverage is deleted in its entirety. 7. The definition of "insured contract" under Section V – Definitions is amended to add the following: An "insured contract" does not include that part of any contract or agreement: That pertains to the ownership, maintenance or use of an "auto" and which indemnifies a person or organization for other than the vicarious liability of such person or organization for "bodily injury" or "property damage" caused by your operation or use of a covered "auto". However, a person or organization is an additional "insured" under this provision only to the extent such person or organization is not named as an "insured" by separate endorsement to this policy. B. AIRBAGS- EXTENDED COVERAGE Section III – Physical Damage Coverage, Paragraph B.3.a. does not apply to the unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide coverage. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CA 20 93 03 19 Includes copyrighted material of Insurance Services Page 3 of 8 Offices, Inc. with its permission C. TELEMATICS & GPS EQUIPMENT COVERAGE Physical Damage Coverage is amended as follows: 1. In Section III – Physical Damage Coverage, Paragraphs B.4.c. and B.4.d. do not apply to: a. Global positioning systems; or b. “Telematics devices”; which are not: (1) Permanently installed in or upon the covered "auto"; (2) Removable from a housing unit which is permanently installed in or upon the covered "auto"; (3) An integral part of the same unit housing any electronic equipment described in Paragraphs a. and b. above; or; (4) Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's" operating system. 2. In the event of a “loss” to a covered “auto”, the most we will pay for “loss” to global positioning systems and “telematics devices” in any one covered “auto” is the lesser of: a. The actual cash value of the damaged or stolen property at the time of loss; b. The cost of repairing or replacing damaged or stolen property with other property of like kind and quality; or c. $2,500 3. For each covered “loss”, a deductible of $100 shall apply. “Telematics Devices” include devices that are not installed by the vehicle manufacturer and that are designed for the collection and dissemination of data for the purpose of monitoring vehicle and/or driver performance. This includes global positioning systems and wireless safety communication devices. Cellular, mobile and smart phones are not considered global positioning systems or “telematics devices” for purposes of this coverage provision. D. ELECTRONIC EQUIPMENT – INCREASED COVERAGE The $1,000 limit indicated in Paragraph C.1.b. under Section III – Physical Damage Coverage is increased to $2,500. E. AUTO LOAN/LEASE GAP COVERAGE The following is added to Section III – Physical Damage Coverage, Paragraph C.: In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less: The amount paid under the Physical Damage Coverage section of the policy; and any: 1. Overdue lease/loan payments at the time of the "loss"; 2. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; 3. Security deposits not returned by the lessor; 4. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and 5. Carry-over balances from previous loans or leases. However, this provision does not apply to the extent loan/lease gap coverage has been provided by separate endorsement to this policy. F. AUTOS RENTED BY EMPLOYEES The following is added to Section II – Covered Autos Liability Coverage, Paragraph A.1.: The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business G. BAIL BONDS - EXTENDED COVERAGE Section II – Covered Autos Liability Coverage, Paragraph A.2.a.(2) is deleted and replaced by the following: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 Page 4 of 8 Includes copyrighted material of Insurance Services CL CA 20 93 03 19 Offices, Inc. with its permission H. BROAD FORM NAMED INSURED INCLUDING NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following is added to sub paragraph A1. Who Is An Insured of Section II – Covered Autos Liability Coverage: For any covered “auto”; Any organization, other than a partnership, joint venture or limited liability company, over which you maintain ownership or majority interest of more than 50 percent on the effective date of this endorsement and for which you are obligated prior to the loss to provide insurance, unless that organization is an “insured” under any other automobile policy or would be an “insured” under such a policy but for the exhaustion of its Limit of Insurance. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company or any organization excluded either by this Coverage Part or by endorsement, and over which you maintain ownership or majority interest of more than 50 percent will qualify as a Named Insured. However: 1. This insurance does not apply to any newly acquired or formed organization that is an "insured" under any other automobile policy or would be an "insured" under such policy but for its termination or the exhaustion of its Limit of Insurance. 2. Coverage under this provision does not apply to "bodily injury", "property damage", expense or "loss" that occurred before you acquired or formed the organization. 3. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. I. CUSTOM SIGNS & DECORATIONS Physical Damage coverage on a covered “auto” extends to “loss” to custom signs and decorations including custom murals, paintings or other decals or graphics. Our limit of liability for each “loss” to custom signs and decorations shall be the least of: (1) Actual cash value of the stolen or damaged property; or (2) Amount necessary to repair or replace the property; This coverage does not apply to Hired Auto Physical Damage Coverage. J. EMPLOYEES AS INSUREDS Section II- Covered Autos Liability Coverage, Paragraph A.1.b.(2) is deleted and replaced by the following: (2) Any “employee” of yours is an “insured” while using a covered “auto” you don’t own, hire or borrow in your business or your personal affairs. However, the insurance provided by this provision, I. EMPOYEES AS INSUREDS, does not apply if separate Employee as Insured coverage (or any similar or equivalent coverage) has been provided by a separate endorsement issued by us and made a part of this policy or coverage part. K. FAMILY EMERGENCY TRAVEL REIMBURSEMENT SECTION II - LIABILITY COVERAGE, A. 2. Coverage Extensions is amended to include the following: In addition to the Limit of Insurance, we will pay reasonable "travel reimbursement expenses" incurred by a “family member” or “designated representatives”, of an "insured" or passenger for travel to visit that "insured" or passenger who was injured in an "accident" involving a covered "auto", subject to the following conditions: 1. Regardless of the number of traveling “family members” or “designated representatives”, injured "insureds" or passengers, claims made or vehicles involved in the "accident", the most we will pay for all “travel reimbursement expenses" resulting from any one "accident" is $ 2,500. 2. Travel must be to visit the injured party at the hospital to which such “insured” has been admitted and has received medical or surgical treatment for a period of 72 hours or more from the time of first admittance to such hospital, or in the event of death, to the location necessary to handle the immediate affairs of the deceased. 3. Subject to the $2,500 per accident limit, the most we will pay for the combined total of expenses for room accommodations, meals, and parking for each “family member” or “designated representatives” is $200 per day. 4. We will reimburse ground transportation using a personal vehicle at a rate of 40 cents DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CA 20 93 03 19 Includes copyrighted material of Insurance Services Page 5 of 8 Offices, Inc. with its permission per mile for the actual miles driven. 5. AII ''travel reimbursement expenses" must be supported by written receipts submitted to us no later than 120 days from the date such “travel reimbursement expenses” were incurred. "Travel reimbursement expenses" include reasonable ground, rail, or air (coach class) transportation, room accommodations, meals, and parking expenses only. “Designated representative” is an individual identified by the “insured” as a close personal friend or as having decision making authority pertaining to the insured’s care in the event of incapacity or death. “Family member” means a person related to the injured “insured” by blood, marriage, state- recognized civil union, or adoption, including a ward or foster child. L. FELLOW EMPLOYEE COVERAGE Exclusion B. 5. of Section II - Covered Autos Liability Coverage is deleted and replaced with the following: 5. Fellow Employee a. "Bodily injury" to any fellow "employee" of an "insured" arising out of and in the course of the fellow "employee’s" employment or while performing duties related to the conduct of your business; or b. The spouse, child, parent, brother or sister of that fellow "employee" as a consequence of Paragraph a. above. However, this exclusion does not apply to liability incurred by your “employees” that are “executive officers”. No "employee" is an "insured" for "bodily injury" to a co-employee if such co- employee's exclusive remedy is provided under a workers compensation law or any similar law. For the purpose of Fellow Employee Coverage only, paragraph B.5. of Business Auto Conditions is changed as follows: This FELLOW EMPLOYEE COVERAGE is excess over any other collectible insurance. As used in this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document. M. FIRE EXTINGUISHER RECHARGE The following is added to Paragraph A.4. Coverage Extensions of Section III – Physical Damage Coverage: When fire extinguishers are kept in your covered "auto" and are discharged in an attempt to extinguish a fire, we will pay the lesser of the actual cost of recharging or replacing such fire extinguisher(s). No deductible applies to this coverage. N. GLASS REPAIR – NO DEDUCTIBLE Section III – Physical Damage Coverage, Paragraph D. is deleted and replaced by the following: D. DEDUCTIBLE For each covered “auto” our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to: 1. “Loss” caused by fire or lightning; or 2. “Loss” when you elect to patch or repair glass rather than replace. O. HIRED AUTO PHYSICAL DAMAGE COVERAGE AND INCREASED LOSS OF USE EXPENSES Section III – Physical Damage Coverage, A. 4 Coverage Extensions is amended to include the following: If hired "autos" are covered "autos" for Liability Coverage under this policy and if Physical Damage Comprehensive Coverage, Physical Damage Specified Causes Of Loss Coverage, or Physical Damage Collision Coverage is provided under this policy for any "auto" you own, then such Physical Damage Coverages are extended to apply to "autos" you lease, hire, rent or borrow without a driver, subject to the following provisions: 1. This extension is only available for “autos” you lease, hire, rent or borrow for less than 30 consecutive days. 2. The most we will pay in any one “loss” is the least of $100,000, the actual cash value of the “auto” or the cost to repair or replace the “auto”, except that such amount will be reduced by a deductible to be determined as follows: a. The deductible shall be equal to the DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 Page 6 of 8 Includes copyrighted material of Insurance Services CL CA 20 93 03 19 Offices, Inc. with its permission amount of the highest deductible shown for any owned “auto” of the same classification for that coverage. In the event there is no owned “auto” of the same classification, the highest deductible for any owned “auto” will apply for that coverage. b. No deductible will apply to “loss” caused by fire or lightning. 3. Coverage provided under this extension will be excess over any other collectible insurance you have. Paragraphs 1 through 3 above do not apply if separate Hired Auto Physical Damage is indicated in the declarations. 4. For “autos” you lease, hire, rent or borrow covered under this Hired Auto Physical Damage Coverage extension or under separate coverage provided in the declarations, the limits in subparagraph b. Loss Of Use Expenses under paragraph 4. Coverage Extensions as found in paragraph A. Coverage of SECTION III – PHYSICAL DAMAGE COVERAGE, are increased to $500 per day, to a maximum of $3,500. P. HYBRID AUTO PAYMENT COVERAGE Section III – Physical Damage Coverage, A. 4 Coverage Extensions is amended to include the following: 1. In the event of a total “loss” to a non-“hybrid auto” for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under the Business Auto Coverage form, then Physical Damage Coverages are amended as follows: a. If a non-“hybrid auto” is replaced with a “hybrid auto” or “electric auto” we will pay an additional 10% of the non-“hybrid auto’s” actual cash value or replacement cost, to a maximum of $2,500, whichever is less; b. The non-“hybrid autos” must be replaced and a copy of a bill of sale or lease agreement must be received by us within 60 calendar days of the date of “loss”; and c. If more than one non-“hybrid auto” is damaged in any one “loss”, the most we will pay under this Coverage for any one “loss” is $5,000. 2. For the purpose of this coverage provision the following Definitions are added: a. “Hybrid auto” is defined as an “auto”, including a hybrid “electric auto” that is powered by two sources, an internal combustion engine, and an electric motor. b. “Electric auto” is an “auto” that is powered by an electric motor instead of an internal combustion engine. The “electric auto” uses energy stored in its rechargeable batteries, which are recharged by common household electricity. Q. KNOWLEDGE OF AN ACCIDENT, CLAIM, SUIT OR LOSS The following is added to Section IV – Business Auto Conditions, Paragraph A.2.: Notice of an "accident" or "loss" will be considered knowledge of yours only if reported to you, if you are an individual, a partner, an executive officer or an employee designated by you to give us such notice. Notice of an "accident" or "loss" to your Workers’ Compensation insurer, for an event which later develops into a claim for which there is coverage under this policy, shall be considered notice to us, but only if we are notified as soon as you know that the claim should be addressed by this policy, rather than your Workers’ Compensation policy. R. LIMITED WORLDWIDE HIRED & NON OWNED AUTO COVERAGE In Section IV - Business Auto Conditions, Condition B.7., paragraph b.(5) is replaced by the following: (5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed without a driver for a period of 30 days or less, S. LOSS OF EARNINGS - EXTENDED COVERAGE Section II – Covered Autos Liability Coverage, Paragraph A.2.a.(4) is deleted and replaced by the following: (4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $1,000 a day because of time off from work. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 CL CA 20 93 03 19 Includes copyrighted material of Insurance Services Page 7 of 8 Offices, Inc. with its permission T. NEW VEHICLE REPLACEMENT COST The following is added to the Paragraph C. Limit of Insurance provision of Section III – Physical Damage Coverage: In the event of a total “loss” to your “new vehicle” to which this coverage applies, we will pay at your option: a. The cost to replace the covered “auto” with a new “auto” of like make, model and year; or b. An amount equal to the original purchase price you paid to acquire the vehicle, including taxes, but excluding any extended warranties and licensing fees. This coverage applies only to a covered “auto” of the private passenger, light truck or medium truck type (20,000 lbs. or less gross vehicle weight). As used in this endorsement, a “new vehicle” means an “auto” of which you are the original owner that has not been previously titled and which you purchased less than 180 days before the date of the “loss”. U. RENTAL REIMBURSEMENT COVERAGE 1. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductible applies to this coverage. This coverage is only available to those covered “autos” involved in a “loss” and Physical Damage is provided to the covered “auto”. 2. We will pay only for those expenses incurred during the policy period, beginning 24 hours after the "loss" and ending, regardless of the expiration date of the policy, with the lesser of the following; 1. The number of days reasonably required to repair or replace the covered "auto". If “loss” is caused by theft, this number of days is added to the number of days it takes to locate the covered “auto” and return it to you; or 2. 45 days. 3. Our payment is limited to the lesser of the following amounts: 1. Necessary and actual expenses incurred. 2. The maximum rental expenses indicated below: (1) Not more than $75 per day; (2) The maximum rental expenses shown below: (a) $3,375 because of "loss" to any one covered "auto"; (b) $15,000 because of all "loss" to all covered "autos" in any one policy period. 4. We will pay up to an additional $300 for the reasonable and necessary expenses you incur to remove your materials and equipment from the covered "auto" and replace such materials and equipment on the rental "auto". 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. V. PERSONAL EFFECTS COVERAGE The following is added to Section III – Physical Damage Coverage, Paragraph A.4.: Physical Damage Coverage on a covered “auto” is extended to “loss” to your personal property and, if you are an individual, the personal property of a family member, that is in the covered “auto” at the time of “loss”; and caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto". The most we will pay for any one "loss" under this coverage extension is $500. However, our payment for "loss" to personal property will only be for the account of the owner of the property. Under this provision personal property does not include and we will not pay for "loss" of: 1. Currency, coins, securities or 2. Property that under federal or state law is a. An illegal controlled substance b. Property in the course of illegal transportation or trade. No deductible applies to this coverage extension. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 Page 8 of 8 Includes copyrighted material of Insurance Services CL CA 20 93 03 19 Offices, Inc. with its permission W. RESULTANT MENTAL ANGUISH Section V - Definitions, Paragraph C. is deleted and replaced by the following: C. "Bodily injury" means bodily injury, disability, sickness, or disease sustained by a person, including death resulting from any of these at any time. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury". X. TOWING AND LABOR COVERAGE EXTENSION The following is added to Section III – Physical Damage Coverage, paragraph A.2.: 1. We will pay up to: a. $200 for a covered "auto" of the private passenger type or b. $250 for a covered "auto" that is not of the private passenger type, for towing and labor costs incurred each time the covered "auto" is disabled. However, the labor must be performed at the place of disablement. 2. This coverage applies only for an "auto" covered on this policy for Comprehensive or Specified Causes of Loss Coverage and Collision Coverages. 3. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". Y. TRANSPORTATION EXPENSES - COVERAGE EXTENSION Paragraph A.4.a. Transportation Expenses of Section III – Physical Damage Coverage is amended as follows: 7. The Limits of Insurance are increased to $75 per day to a maximum of $2,500. 8. We will also pay reasonable and necessary expenses to facilitate the return of the stolen "auto" to you. Z. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following is added to Section IV - Business Auto Conditions, Paragraph B.2.: If you unintentionally fail to disclose any hazards existing at the inception of this policy, such failure will not prejudice the coverage provided to you. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. AA. WAIVER OF COLLISION DEDUCTIBLE – ATTACHED AUTOS The following is added to paragraph D. under SECTION III - PHYSICAL DAMAGE COVERAGE of the Business Auto Coverage Form: If a “trailer” is connected to an “auto” that is not a “trailer” and both “autos”: 1. Are covered “autos” for Collision Coverage that applies to that “accident”, and 2. Sustain damage in a single “accident”. we will waive the lowest of the applicable Collision deductibles. BB. WAIVER OF SUBROGATION BY CONTRACT OR AGREEMENT The following is added to Section IV - Business Auto Conditions, Paragraph A.5.: We waive any right of recovery we may have against any “insured” provided coverage under this endorsement under A. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT INCLUDING PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION, but only as respects “loss” arising out of the operation, maintenance or use of a covered “auto” pursuant to the provisions or conditions of the written contract or agreement. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 COMMERCIAL LIABILITY UMBRELLA CW 10 54 U 01 90 MANUSCRIPT ENDORSEMENT_CW 10 54 U_01/90 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CW 10 54 U 01 90 Page 1 of 1 MANUSCRIPT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART BUSINESSOWNERS INLAND MARINE CRIME COVERAGE PART COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART 7 COMMERCIAL EXCESS POLICY WORKERS' COMPENSATION POLICY Name of Additional Insured Person or Organization: "Any person or organization as agreed in writing in a contract or agreement" The following Replaces: A. SECTION II - WHO IS AN INSURED Paragraph 3. Any additional insured under any policy of "underlying insurance" will automatically be an insured under this insurance.Subject to Section III - Limits Of Insurance, if coverage provided to the additional insured is required by a contract oragreement, the most we will pay on behalf of the additional insured is the amount of insurance:a. Required in a written contract on a non-contributory basis for such additional insured, less any amounts payableby any "underlying insurance", orb. The limits of insurance available after the payment of "ultimate net loss" on any insured's behalf from any claimor "suit"; whichever is less.This provision is included within and does not act to increase the Limit of Insurance stated in the Declarations.Additional insured coverage provided by this insurance will not be broader than coverage provided by the "underlyinginsurance".The following is added toB. SECTION IV - CONDITIONS, Paragraph 5. Other Insurance.5. Other InsurancePrimary And Noncontributory InsuranceThis insurance is primary to and will not seek contribution from any other insurance available to an additionalinsured under your policy provided that;a. The additional insured is a Named Insured under such other insurance; andb. You have agreed in writing in a contract or agreement that this insurance would be primary and would notseek contribution from any other insurance available to the additional insured. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com Top Gun Pressure Washing LLC 500 W 67th St Loveland, CO 80538 Olson and Olson Insurance Services, 5655 S. Yosemite St. Suite 200 Greenwood Village, CO 80111 (303) 867-2055 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P BULLARDN - Underwriter 06/21/2021 11:26:43 4031609 58043114 359-B NCCI #: WC000313B Policy #: 4031609 ENDORSEMENT:Blanket Waiver of Subrogation Effective Date:July 1, 2021 Expires on: July 1, 2022 Pinnacol Assurance has issued this endorsement June 21, 2021 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. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408 DocuSign Envelope ID: 7F042C1C-9990-4733-A110-0E26B99DD408