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HomeMy WebLinkAbout534235 APEX PAVEMENT SOLUTIONS - CONTRACT - BID - 9410 GARDENS ON SPRING CREEK DRIVEWAY REPLACEMENTS (2)Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 1 of 12 SERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and APEX PAVEMENT SOLUTIONS, LLC, hereinafter referred to as "Service Provider". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit A, consisting of two (2) pages and incorporated herein by this reference. 2. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated within thirty (30) days following execution of this Agreement. Services shall be completed no later than October 31, 2021. Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing signed by the parties. 3. Contract Period. This Agreement shall commence September 9, 2021, and shall continue in full force and effect until October 31, 2021, unless sooner terminated as herein provided. 4. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within ten (10) days from the onset of such condition. 5. Early Termination by City/Notice. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider. Such notice shall be delivered at least ten (10) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective immediately when emailed or three business days from the date of the notice when mailed to the following addresses: DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 2 of 12 Service Provider: City: Copy to: APEX PAVEMENT SOLUTIONS, LLC Attn: Quentin Larkin PO Box 597 Golden, CO 80402 qlarkin@apexpvmt.com City of Fort Collins Attn: Daniel Martinez PO Box 580 Fort Collins, CO 80522 dmartinez@fcgov.com City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 purchasing@fcgov.com In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Service Provider shall submit a final invoice within ten (10) days of the effective date of termination. Undisputed invoices shall be paid Net 30 days of the date of the invoice. Such payment shall be the Service Provider's sole right and remedy for such termination. 6. Compensation. The City shall pay the Service Provider for the performance of this Contract, subject to additions and deletions provided herein, Eighty Six Thousand Nine Hundred Eighty Nine Dollars and Twenty Nine Cents ($86,989.29) as per the attached Exhibit B, consisting of one (1) page, and incorporated herein by this reference. Invoices shall be emailed to invoices@fcgov.com with a copy to the Project Manager. The cost of the work completed shall be paid to the Service Provider following the submittal of a correct itemized invoice by the Service Provider. The City is exempt from sales and use tax. The City’s Certificate of Exemption license number is 09804502. A copy of the license is available upon written request. The City pays invoices on Net 30 days from the date of the invoice. 7. Appropriation. To the extent this Agreement or any provision in it constitutes a multiple fiscal year debt or financial obligation of the City, it shall be subject to annual appropriation by City Council as required in Article V, Section 8(b) of the City Charter, City Code Section 8-186, and Article X, Section 20 of the Colorado Constitution. The City shall have no obligation to continue this Agreement in any fiscal year for which no such supporting appropriation has been made. 8. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 9. Independent Service Provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 3 of 12 10. Subcontractors. Service Provider may not subcontract any of the Work set forth in the Exhibit A, Statement of Work without the prior written consent of the City, which shall not be unreasonably withheld. If any of the Work is subcontracted hereunder (with the consent of the City), then the following provisions shall apply: (a) the subcontractor must be a reputable, qualified firm with an established record of successful performance in its respective trade performing identical or substantially similar work, (b) the subcontractor will be required to comply with all applicable terms of this Agreement, (c) the subcontract will not create any contractual relationship between any such subcontractor and the City, nor will it obligate the City to pay or see to the payment of any subcontractor, and (d) the work of the subcontractor will be subject to inspection by the City to the same extent as the work of the Service Provider. Irrespective of any subcontractors named in Exhibit A, Service Provider shall be solely responsible for performance of all duties hereunder. 11. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City. 12. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the City under this Agreement or cause of action arising out of performance of this Agreement. 13. Warranty. a. Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. b. Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. c. Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City-furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period, the longer of; i) The original manufacturer’s warranty term; or ii). beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired, or replaced by Service Provider in a manner and at a time acceptable to City. 14. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refuse to perform according to the DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 4 of 12 terms of this agreement, such party may be declared in default thereof. 15. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non-defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non- defaulting party for the non-defaulting party's reasonable attorney fees and costs incurred because of the default. 16. Entire Agreement; Binding Effect; Order of Precedence; Authority to Execute. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties regarding this transaction and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. In the event of a conflict between terms of the Agreement and any exhibit or attachment, the terms of the Agreement shall prevail. Each person executing this Agreement affirms that they have the necessary authority to sign on behalf of their respective party and to bind such party to the terms of this Agreement. 17. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit C, consisting of one (1) page, attached hereto, and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Purchasing Director, purchasing@fcgov.com or P. O. Box 580, Fort Collins, Colorado 80522, one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. 18. Law/Severability. The laws of the State of Colorado shall govern the construction, interpretation, execution, and enforcement of this Agreement. The Parties further agree that Larimer County District Court is the proper venue for all disputes. If the City subsequently agrees in writing that the matter may be heard in federal court, venue will be in Denver District DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 5 of 12 Court. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement. 19. Prohibition Against Unlawful Discrimination. The City, in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 US.C. §§ 2000d to 2000d-4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that any contract entered into pursuant to this advertisement, disadvantaged business enterprises will be afforded full and fair opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, or national origin in consideration for an award. The City strictly prohibits unlawful discrimination based on an individual’s gender (regardless of gender identity or gender expression), race, color, religion, creed, national origin, ancestry, age 40 years or older, marital status, disability, sexual orientation, genetic information, or other characteristics protected by law. For the purpose of this policy “sexual orientation” means a person’s actual or perceived orientation toward heterosexuality, homosexuality, and bisexuality. The City also strictly prohibits unlawful harassment in the workplace, including sexual harassment. Further, the City strictly prohibits unlawful retaliation against a person who engages in protected activity. Protected activity includes an employee complaining that he or she has been discriminated against in violation of the above policy or participating in an employment discrimination proceeding. The City requires its vendors to comply with the City’s policy for equal employment opportunity and to prohibit unlawful discrimination, harassment and retaliation. This requirement applies to all third-party vendors and their subcontractors at every tier. 20. Governmental Immunity Act. No term or condition of this Agreement shall be construed or interpreted as a waiver, express or implied, of any of the notices, requirements, immunities, rights, benefits, protections, limitations of liability, and other provisions of the Colorado Governmental Immunity Act, C.R.S. § 24-10-101 et seq. and under any other applicable law. 21. Public Contracts for Services. Where applicable, the Service Provider verifies, warrants, and agrees that it is aware of, and shall comply with, C.R.S. Sec. 8-17.5-101 and -102 in its employment, contracting and subcontracting practices with respect to performing work under this Agreement. In the event the Service Provider fails to comply with any requirements of C.R.S. Sec. 8-17.5-101 and -102, the City may terminate this Agreement for breach and, if so terminated, the Service Provider shall be liable for actual and consequential damages. 22. Colorado Open Records Act. The City is subject to Sec. 24-72-201 et seq. of the Colorado Revised Statute (CORA). This Agreement is subject to public disclosure in whole pursuant to CORA. 23. Dust Control. The Service Provider shall abide by the City of Fort Collins “Dust Control and Prevention Manual,” which is available for public download at https://www.fcgov.com/ DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 6 of 12 airquality/pdf/dust-prevention-and-control-manual.pdf, and is incorporated herein by this reference. The City of Fort Collins has implemented this manual for all projects performed for the City of Fort Collins or located within the City of Fort Collins City limits. 24. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit D- Confidentiality, consisting of one (1) page, attached hereto, and incorporated herein by this reference. [Signature Page Follows] DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 7 of 12 THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul, Purchasing Director Date: ATTEST: APPROVED AS TO FORM: APEX PAVEMENT SOLUTIONS, LLC By: Printed: Title: Date: DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 9/16/2021 Sr. Project Manager Quinten Larkin Assistant City Attorney l 9/17/2021 Interim City Clerk Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 8 of 12 EXHIBIT A SCOPE OF SERVICES 1. Gardens on Spring Creek – Main Entrance -1 lane of access in and out of the Gardens on Spring Creek Main Entrance needs to be open at all times during construction. -Excavate entire area from red crosswalk to sidewalk on Center Ave to 6” depth. Compact, grade and replace with 6” of Compacted Grade S PG 64-22 Asphalt (9100 sq/ft) -Pricing to include all materials, labor, equipment and traffic control. -Pricing includes the disposal/recycle of removed material. -The City wants the project completed by October 31, 2021 – To be scheduled with site operations manager. DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 9 of 12 2. Gardens on Spring Creek – Rear Maintenance Driveway -Cut out and remove existing asphalt that encompasses the width of the driveway from sidewalk to north side of trash enclosure. Compact, grade and replace with 6” of 4,500 psi high-early concrete with fiber (1900 sq/ft). -Pricing includes all materials, labor and equipment. -Pricing includes the disposal/recycle of removed materials. -The City wants the project completed by Octobe r 31, 2021 – The removal of existing asphalt must occur on a Thursday. Installation of concrete on Friday so that the Gardens can open on a Saturday. DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 10 of 12 Exhibit B Compensation Schedule DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 11 of 12 EXHIBIT C INSURANCE REQUIREMENTS The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies. In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. Insurance certificates should show the certificate holder as follows: City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 The City, its officers, agents and employees shall be named as additional insureds on the Service Provider 's general liability and automobile liability insurance policies by marking the appropriate box or adding a statement to this effect on the certificate, for any claims arising out of work performed under this Agreement. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement. Workers' Compensation & Employer’s Liability insurance shall conform with statutory limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee, or as required by Colorado law. B. General Liability. The Service Provider shall maintain during the life of this Agreement such General Liability as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for General Liability, shall not be less than $1,000,000 combined single limits for bodily injury and property damage. C. Automobile Liability. The Service Provider shall maintain during the life of this Agreement such Automobile Liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for Automobile Liability, shall not be less than $1,000,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Official Purchasing Document Last updated 8/23/2021 Services Agreement APEX PAVEMENT SOLUTIONS, LLC Page 12 of 12 EXHIBIT D CONFIDENTIALITY IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the “City”) pursuant to this Agreement (the “Agreement”), the Service Provider hereby acknowledges that it has been informed that the City has established policies and procedures with regard to the handling of confidential information and other sensitive materials. In consideration of access to certain information, data and material (hereinafter individually and collectively, regardless of nature, referred to as “information”) that are the property of and/or relate to the City or its employees, customers or suppliers, which access is related to the performance of services that the Service Provider has agreed to perform, the Service Provider hereby acknowledges and agrees as follows: That information that has or will come into its possession or knowledge in connection with the performance of services for the City may be confidential and/or proprietary. The Service Provider agrees to treat as confidential (a) all information that is owned by the City, or that relates to the business of the City, or that is used by the City in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City). The Service Provider shall not disclose any such information to any person not having a legitimate need-to-know for purposes authorized by the City. Further, the Service Provider shall not use such information to obtain any economic or other benefit for itself, or any third party, except as specifically authorized by the City. The foregoing to the contrary notwithstanding, the Service Provider understands that it shall have no obligation under this Agreement with respect to information and material that (a) becomes generally known to the public by publication or some means other than a breach of duty of this Agreement, or (b) is required by law, regulation or court order to be disclosed, provided that the request for such disclosure is proper and the disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the Service Provider shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure and shall promptly advise the City in writing of each such disclosure. In the event that the Service Provider ceases to perform services for the City, or the City so requests for any reason, the Service Provider shall promptly return to the City any and all information described hereinabove, including all copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or as to which it otherwise has access. The Service Provider understands and agrees that the City’s remedies at law for a breach of the Service Provider’s obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at law. DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/25/2021 CCIG 155 Inverness Drive West Englewood CO 80112 Spencer Dibble 720-330-7903 720-330-7903 Denese.Brooks@thinkccig.com License#:45339 Selective Insurance Company of 12572 APEXPAV-02 Pinnacol Assurance 41190APEXPavementSolutions,LLC PO Box 597 Golden CO 80402 Atlantic Specialty Ins.Compan 27154 263443112 A X 1,000,000 X 500,000 15,000 1,000,000 3,000,000 X X Y S230411501 1/1/2021 1/1/2022 3,000,000 A 1,000,000 X X X Y S230411501 1/1/2021 1/1/2022 A X X 5,000,000S2304115011/1/2021Y 1/1/2022 5,000,000 X 0 B X N 4153529 1/1/2021 1/1/2022 1,000,000 1,000,000 1,000,000 C Leased and Rented Equipment Replacement Cost when required by written contract 7900211590004 1/1/2021 1/1/2022 Limit Deductible $100000 $500 City of Fort Collins is listed as an additional insured on general liability and automobile liability as required by written contract.Umbrella policy is follow form. General liability is primary and non-contributory.30 Day Notice of Cancellation applies. City of Fort Collins Po Box 580 Fort Collins CO 80522 USA DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Policy Number S230411501DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com Apex Pavement Solutions LLC DBA Apex PO Box 597 Golden, CO 80402 CCIG 155 Inverness Drive West Englewood, CO 80112 (303) 799-0110 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P PEREZV - Underwriter 12/10/2020 16:23:06 4153529 57034165 359-B NCCI #: WC000313B Policy #: 4153529 ENDORSEMENT:Blanket Waiver of Subrogation Effective Date:December 10, 2020 Expires on: January 1, 2022 Pinnacol Assurance has issued this endorsement December 10, 2020 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: DD112757-4EDE-43AC-99B1-255845412415 Policy Number S230411501DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 1. The Limit of Insurance stated in the ElitePac Sched- ule; or 2. The actual cash value of the damaged or stolen property as of the time of the “loss”; or 3. The actual cost of repairing or replacing the dam- aged or stolen property with other property of like kind and quality. A part is of like kind and quality when it is of equal or better condition than the pre- accident part. We will use the original equipment from the manufacturer when: (a) The operational safety of the vehicle might otherwise be impaired; (b) Reasonable and diligent efforts to locate the appropriate rebuilt, aftermarket or used part have been unsuccessful; or (c) A new original equipment part of like kind and quality is available and will result in the lowest overall repair cost. For each leased, hired, rented or borrowed “auto” our obligation to pay “losses” will be reduced by a deductible equal to the highest deductible applicable to any owned “auto” for that coverage. No deductible will be applied to “losses” caused by fire or lightning. SECTION IV, B.5. Other Insurance Condition, Para- graph 5.b. is deleted in its entirety and replaced by the following: For Hired Auto Physical Damage Coverage, the follow- ing are deemed to be covered “autos’” you own: 1. Any covered “auto” you lease, hire, rent, or borrow; and 2. Any covered “auto” hired or rented by your “em- ployee” under a contract or agreement in that “employee’s” name, with your permission, while performing duties related to the conduct of your business. However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. HIRED AUTO LOSS OF USE COVERAGE The following is added to SECTION III, A.4. - Coverage Extensions: We will pay expenses for which you are legally responsi- ble to pay up to the Limit of Insurance shown on the ElitePac Schedule per “accident” for loss of use of a leased, hired, rented or borrowed “auto” if it results from an “accident”. This coverage extension does not apply to Emergency Services Organizations, Governmental Entities, and Schools. AUTO LOAN/LEASE GAP COVERAGE (Not Applica- ble in New York) The following is added to SECTION III, A.4. - Coverage Extensions: 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: 1. The amount paid under the Physical Damage Cover- age Section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of “loss”; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear, high mileage or similar charges; c. Security deposits not refunded by the lessor or financial institution; d. Costs for extended warranties, credit life, health, accident, or disability insurance purchased with the loan or lease; and e. Carry-over balances from previous leases or loans. You are responsible for the deductible applicable to the “loss” for the covered “auto”. PERSONAL EFFECTS The following is added to SECTION III, A.4. - Coverage Extensions: If this policy provides Comprehensive Coverage for a covered “auto” you own and that covered “auto” is stolen, we will pay up to the Limit of Insurance shown on the ElitePac Schedule, without application of a deducti- ble, for lost personal effects that were in the covered “auto” at the time of theft. Personal effects do not include jewelry, tools, money, or securities. This coverage is excess over any other collectible insurance. AIRBAG COVERAGE The following is added to SECTION III, B.3.a. - Exclu- sions: Mechanical breakdown does not include the accidental discharge of an airbag. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. EXPANDED AUDIO, VISUAL, AND DATA ELEC- TRONIC EQUIPMENT COVERAGE SECTION III, B.4. - Exclusions This exclusion does not apply to the following: 1. Global positioning systems; 2. “Telematic devices”; or 3. Electronic equipment that reproduces, receives or transmits visual or data signals and accessories used with such equipment, provided such equipment is: Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 We also cover “loss” to or “accidents” involving a cov- ered “auto” while being transported between any of these places. TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US - DEDUCTIBLES The following is added to SECTION IV, B.8. - Two Or More Coverage Forms Or Policies Issued By Us: If a “loss” covered under this Coverage Form also in- volves a “loss” to other property resulting from the same “accident” that is covered under this policy or another policy issued by us or any member company of ours, only the highest applicable deductible will be applied. AMENDMENTS TO SECTION V - DEFINITIONS BODILY INJURY INCLUDING MENTAL ANGUISH (Not Applicable in New York) The definition of bodily injury is deleted in its entirety and replaced by the following: “Bodily injury” means bodily injury, sickness, or disease sustained by a person, including death resulting from any of these. “Bodily injury” includes mental anguish resulting from bodily injury, sickness or disease sus- tained by a person. ADDITIONS TO SECTION V - DEFINITIONS COVERAGE TERRITORY “Coverage Territory” means: 1. The United States of America (including its territories and possessions), Canada and Puerto Rico; and 2. Anywhere in the world, except for any country or jurisdiction that is subject to trade or other economic sanction or embargo by the United States of America, if a covered “auto” is leased, hired, rented, or borrowed without a driver for a period of 30 days or less, and the insured’s responsibility to pay “dam- ages” is determined in a “suit” on the merits in and under the substantive law of the United States of America (including its territories and possessions), Puerto Rico, or Canada, or in a settlement we agree to. If we are prevented by law, or otherwise, from defending the “insured” in a “suit” brought in a location described in Paragraph 2. above, the insured will conduct a defense of that “suit”. We will reimburse the “insured” for the rea- sonable and necessary expenses incurred for the de- fense of any such “suit” seeking damages to which this insurance applies, and that we would have paid had we been able to exercise our right and duty to defend. EXTRA HEAVY TRUCK “Extra Heavy Truck” means a truck with a gross vehicle weight rating of 45,001 pounds or more. HEAVY TRUCK “Heavy Truck” means a truck with a gross vehicle weight rating of 20,001 pounds to 45,000 pounds. LIGHT TRUCK “Light Truck” means a truck with a gross vehicle weight rating of 10,000 pounds or less. MEDIUM TRUCK “Medium Truck” means a truck with a gross vehicle weight rating of 10,001 pounds to 20,000 pounds. PRIVATE PASSENGER AUTO “Private Passenger Auto” means a four-wheel “auto” of the private passenger or station wagon type. A pickup, panel truck or van not used for business is included within the definition of a “private passenger auto”. SOCIAL SERVICE VAN OR BUS “Social Service Van or Bus” means a van or bus used by a government entity, civic, charitable or social service organization to provide transportation to clients inci- dental to the social services sponsored by the organiza- tion, including special trips and outings. TELEMATIC DEVICE “Telematic Device” includes devices designed for the collection and dissemination of data for the purpose of monitoring vehicle and/or driver performance. This in- cludes Global Positioning System technology, wireless safety communications and automatic driving assistance systems, all integrated with computers and mobile com- munications technology in automotive navigation sys- tems. VOLUNTEER WORKER “Volunteer worker” means a person who performs busi- ness duties for you, for no financial or other compensa- tion. Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Policy Number S230411501 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”, then such person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”. c. The coverages provided in Paragraphs a. and b. do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the “bodily injury”, “property damage” or “personal and advertising injury”. d. Exclusions (1) With respect to the insurance afforded to additional insureds under a. Ongoing Operations the following is added to 2. Exclusions under SECTION I — COVER- AGE A — BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: This insurance does not apply to “bodily injury”, “property damage”, or “personal and advertising injury” occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) That portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contrac- tor or subcontractor engaged in perform- ing operations for a principal as a part of the same project. (2) With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations, the following is added to 2. Exclusions under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This insurance does not apply to: “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. e. Conditions With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations the following is added to Paragraph 4. Other Insurance, a. Primary Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary and will not contribute with any other insurance available to an additional insured under this coverage part provided that: (1) The additional insured is a Named Insured under such other insurance. (2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis. 2. PROPERTY DAMAGE CARE, CUSTODY OR CONTROL The following is added to Exclusion j. under SECTION I — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) do not apply for the limited purpose of providing the coverage and sub-limits of liability as set forth below. We will pay those sums that the insured becomes legally obligated to pay as damages arising out of “property damage” to: (1) Personal property in the care, custody or control of the insured; and Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 79 88 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 2 of 3 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 (2) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the “property damage” arises out of those operations. The most we will pay under (1) and (2) above in any one “occurrence” or for all damages during any one policy period is a sub-limit of $100,000. These limits are included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. Our right and duty to defend the insured against any “suit” for damages under (1) and (2) above ends when we have used up the applicable sub-limit of liability in the payment of judgments or settlements under it. 3. OTHER INSURANCE AMENDMENT — SUPPLE- MENTAL COVERAGE FOR INSURED’S INVOLVE- MENT IN A CONSOLIDATED (WRAP-UP) IN SUR- ANCE PROGRAM OR SIMILAR PROJECT The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDI- TIONS, Paragraph 4. Other Insurance b. Excess Insurance (1)(a): (v) That is covered by a consolidated (wrap-up) or similar insurance program provided by the prime contractor/project manager or owner of the construction project in which you are involved for your ongoing operations or operations included within the “products-completed operations hazard”, unless such consolidated (wrap-up) or similar program is specifically excluded from coverage on this policy. 4. FELLOW EMPLOYEE EXTENSION Under SECTION II — WHO IS AN INSURED Para- graphs 2.a. and 2.a. (1) are replaced by the following: a. Your “volunteer workers” only while performing duties related to the conduct of your business, or your “employees”, other than either your “executive officers” (if you are an organization other than a partnership, joint venture, or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. The Employers Liability exclusion (SECTION I — COVERAGES; COVERAGE A, exclusion e.) does not apply to this provision. However, none of these “employees” or “volunteer workers” are insureds for: (1) “Bodily injury” or “personal and advertising injury”: (a) Arising out of his or her providing or failing to provide professional health care services. 5. CONTRACTUAL LIABILITY (RAILROADS) Definition 9. Insured Contract is amended as fol- lows: Paragraph c. is deleted in its entirety and replaced with the following: Any easement or license agreement; Paragraph f.(1) is deleted in its entirety. 6. CONTRACTUAL LIABILITY AMENDMENT — (PERSONAL AND ADVERTISING INJURY) If it is required in a written contract, written agreement or written permit with the insured that any contractual liability exclusion for Personal Injury be removed from the policy, then Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND ADVERTISING INJURY, 2. Exclusions is deleted in its entirety and replaced with the following: e. Contractual Liability “Personal and advertising Injury” for which the insured has assumed liability in a contract or agreement arising out of an “advertisement”. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement” 7. WAIVER OF GOVERNMENTAL IMMUNITY We will waive, both in the adjustment of claims and in the defense of “suits” against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. 8. DAMAGE TO PREMISES RENTED TO YOU The Limit of Insurance for Damage To Premises Rented To You is increased to $1,000,000. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 79 88 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 3 of 3 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Policy Number S230411501 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 ElitePac® General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG 73 00 01 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. However, if (a) two or more Coverage Parts of this policy, or (b) two or more forms or endorsements within the same Coverage Part apply to a loss, coverage provision(s) with the broadest language will apply, unless specifically stated otherwise within the particular amendment covering that loss. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. COVERAGES - Amendments SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY EXCLUSIONS Employer’s Liability Amendment (This provision is not applicable in the State of New York). The following is added to Exclusion e. Employer’s Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion also does not apply to any “temporary worker”. Non-Owned Aircraft, Auto or Watercraft A. Paragraph (2) of Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclus- ions is deleted in its entirety and replaced with the following: (2) A watercraft you do not own that is: (a) Less than 26 feet long and not being used to carry persons or property for a charge; or (b) At least 26 feet, but less than 60 feet long, and not being used to carry persons or property for a charge. Any person is an insured who uses or is responsible for the use of such watercraft with your expressed or implied consent. However, if the insured has any other valid and collectible insurance for “bodily injury” or “property damage” that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. B. The following is added to Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion does not apply to: (6) Any aircraft, not owned or operated by any insured, which is hired, chartered or loaned with a paid crew. However, if the insured has any other valid and collectible insurance for “bodily injury” or “property damage” that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. Damage To Premises Rented to You A. The last paragraph of Paragraph 2. Exclusions under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE is deleted in its entirety and replaced with the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 3 of 9 Policy Number S230411501 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 B. Paragraph 6. under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to Paragraph 5. above, the most we will pay under COVERAGE A for damages because of “property damage” to any one premises, while rented to you, or in the case of damage caused by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner, for all such damage caused by fire, lightning or explosion proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of the three, is the amount shown in the Declara- tions for the Damage To Premises Rented To You Limit. C. Paragraph a. of Definition 9. “Insured contract” under SECTION V - DEFINITIONS is deleted in its entirety and replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with the permission of the owner is not an “insured contract”; Electronic Data Liability A. Exclusion p. Access or Disclosure Of Confidential Or Personal Information And Data-related Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Access or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: (1) Any access to or disclosure of any person’s or organization’s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information or any other type of nonpublic information; or (2) The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate “electronic data” that does not result from physical injury to tangible property. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. B. The following paragraph is added to SECTION III - LIMITS OF INSURANCE: Subject to 5. above, the most we will pay under COVERAGE A for “property damage” because of all loss of “electronic data” arising out of any one “occurrence” is a sub-limit of $100,000. SECTION I - COVERAGE C MEDICAL PAYMENTS EXCLUSIONS Any Insured Amendment Exclusion a. Any Insured under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: a. Any Insured To any insured. This exclusion does not apply to: (1) “Not-for-profit members”; (2) “Golfing facility” members who are not paid a fee, salary, or other compensation; or (3) “Volunteer workers”. This exclusion exception does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Product Amendment Exclusion f. Products-Completed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: f. Products-Completed Operations Hazard Included within the “products-completed operations hazard”. This exclusion does not apply to “your products” sold for use or consumption on your premises, while such products are still on your premises. This exclusion exception, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A AND B Expenses For Bail Bonds And Loss Of Earnings A. Subparagraph 1.b. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 4 of 9 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 (1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (2) The construction, erection or removal of elevators; or (3) The ownership, maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (a) “Bodily injury” or “property damage” arising out of operations performed for the federal government, state or municipality; or (b) “Bodily injury” or “property damage” included within the “products- completed operations hazard”. With respect to Paragraphs 2. through 4., this insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the “bodily injury” or “property damage” or “personal and advertising injury”. Broad Form Vendors Coverage Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) for whom you have agreed in a written contract or written agreement to provide coverage as an additional insured under your policy. Such person or organization is an additional insured only with respect to “bodily injury” or “property damage” arising out of “your products” which are distributed or sold in the regular course of the vendor’s business. However, the insurance afforded the vendor does not apply to: a. “Bodily injury” or “property damage” for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or f. Products which, after distribution or sale by you, have been labeled or re-labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or con- taining such products. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured prior to the “bodily injury” or “property damage”. Incidental Malpractice Subparagraph 2.a.(1)(d) under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: (d) Arising out of his or her providing or failing to provide professional health care services. This does not apply to nurses, emergency medical technicians or paramedics if you are not in the business or occupation of providing any such professional services. This also does not apply to “bodily injury” caused by cardio-pulmonary resuscitation or first aid services administered by a co-“employee”. This provision does not apply if you are a Social Service or Senior Living risk. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS - Amendments Knowledge Of Occurrence, Claim, Suit Or Loss The following is added to Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: The requirements under this paragraph do not apply until after the “occurrence” or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 7 of 9 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 b. Anyone considered an insured under SECTION II - WHO IS AN INSURED; 2. Not done intentionally to cause harm to another person. 3. Not directly or indirectly related to the em- ployment, prospective employment or termi- nation of employment of any person or persons by any insured. 4. Not arising out of any “advertisement” by the insured. B. The following definition is added to SECTION V - DEFINITIONS: “Discrimination” means: a. Any act or conduct that would be considered discrimination under any applicable federal, state, or local statute, ordinance or law; b. Any act or conduct that results in disparate treatment of, or has disparate impact on, a person, because of that person’s race, religion, gender, sexual orientation, age, disability or physical impairment; or c. Any act or conduct characterized or interpreted as discrimination by a person based on that person’s race, religion, gender, sexual orienta- tion, age, disability or physical impairment. It does not include acts or conduct characterized or interpreted as sexual intimidation or sexual harass- ment, or intimidation or harassment based on a person’s gender. Electronic Data The following definition is added to SECTION V - DEFINITIONS: “Electronic data” means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cell, data processing devices or any other media which are used with electronically controlled equipment. For the purpose of the Electronic Data Liability coverage provided by this endorsement, Definition 17. “Property damage” is deleted in its entirety and replaced by the following: 17. “Property damage” means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate “electronic data”, resulting from physical injury to tangible property. All such loss of “electronic data” shall be deemed to occur at the time of the “occurrence” that caused it. For the purpose of the Electronic Data Liability coverage provided by this endorsement, “electronic data” is not tangible property. Employee Amendment Definition 5. “Employee” under SECTION V - DEFINI- TIONS is deleted in its entirety and replaced by the following: 5. “Employee” includes a “leased worker”, or a “temporary worker”. If you are a School, “Employee” also includes a student teacher. Golfing Facility The following definition is added to SECTION V - DEFINITIONS: “Golfing facility” means a golf course, golf club, driving range, or miniature golf course. Mental Anguish Amendment (This provision does not apply in New York). Definition 3. “Bodily injury” under SECTION V - DEFINITIONS is deleted in its entirety and replaced with the following: 3. “Bodily injury” means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish resulting from any bodily injury, sickness or disease sustained by a person. (In New York, mental anguish has been determined to be “bodily injury”). Not-for-profit Member The following definition is added to SECTION V - DEFINITIONS: “Not-for-profit member” means a person who is a member of a not-for-profit organization, including clubs and churches, who receives no financial or other compensation. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 9 of 9 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 Policy Number S230411501 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415 DocuSign Envelope ID: DD112757-4EDE-43AC-99B1-255845412415