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CORRESPONDENCE - RFP - 8073 ENGINEERING SERVICES FOR WATER, WASTEWATER & STORMWATER FACILITIES CAPITAL IMPROVEMENTS PROJECTS (8)
Utilities Work Order Form Official Purchasing Form Last updated 10/2017 WORK ORDER PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND HDR ENGINEERING, INC. WORK ORDER NUMBER: U201903 PROJECT TITLE: U2019 Sewer System Improvements ORIGINAL BID/RFP NUMBER & NAME: U8073, Engineering Services for Water, WW and Stormwater Facilities Capital Improvements MASTER AGREEMENT EFFECTIVE DATE: UMay 15, 2015 ARCHITECT/ENGINEER: U HDR Engineering, Inc OWNER’S REPRESENTATIVE: UJames Rose WORK ORDER COMMENCEMENT DATE: UJune 7, 2019 WORK ORDER COMPLETION DATE: UJanuary 27, 2020 MAXIMUM FEE: (time and reimbursable direct costs): U$94,643.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: UCompletion of the preliminary design for the rehabilitation of three (3) sewer reaches within North Fort Collins; Maple/Pearl Wastewater Main Replacement; North College Wastewater Improvements; and City Park Wastewater Main Replacement. See attached supporting documentations. Service Provider agrees to perform the services identified above and on the attached forms in accordance with the terms and conditions contained herein and in the Master Agreement between the parties. In the event of a conflict between or ambiguity in the terms of the Master Agreement and this Work Order (including the attached forms) the Master Agreement shall control. The attached forms consisting of UeightU (8) pages are hereby accepted and incorporated herein, by this reference, and Notice to Proceed is hereby given after all parties have signed this document. SERVICE PROVIDER: HDR Engineering, Inc. By: Date: Name: Title: Page 1 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 June 21, 2019 Brad Martin Senior Vice President Utilities Work Order Form Official Purchasing Form Last updated 10/2017 OWNER’S ACCEPTANCE & EXECUTION: This Work Order and the attached Contract Documents are hereby accepted and incorporated herein by this reference. ACCEPTANCE: Date: James Rose, Civil Engineer III REVIEWED: Date: Marisa Donegon, Buyer II APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Matt Fater, Director, Civil Engineering ACCEPTANCE: Date: Andrew Gingerich, Director, Water Field Operations ACCEPTANCE: Date: Theresa Connor, Utilities Deputy Director ACCEPTANCE: Date: Kevin Gertig, Utilities Executive Director (if greater than $1,000,000) ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) ACCEPTANCE: Date: Darin Atteberry, City Manager (if greater than $1,000,000) ATTEST: Date: City Clerk (if greater than $1,000,000) Page 2 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 June 6, 2019 June 7, 2019 June 21, 2019 June 21, 2019 June 24, 2019 June 24, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES Page 3 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Fort Collins Utilities | 2019 Sewer R&R Predesign Scope of Work hdrinc.com 1 Scope of Work Date: Tuesday, May 28, 2019 Project: 2019 Sewer R&R Predesign Project Understanding and Approach The objective of this project is to complete the preliminary design for the rehabilitation of three sewer reaches within north Fort Collins. A future task order would then advance the design of these improvements through construction documents leveraging the city’s APDS process for construction. The three sewer rehabilitation project are identified as Maple/Pearl Streets, North College, and City Park as shown on the images below. North College Project Area Page 4 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Fort Collins Utilities | 2019 Sewer R&R Predesign Scope of Work hdrinc.com 2 Key Project Issues and Data Needs The Maple/Pearl and North College projects are identified as BFO Offers 9.47 and 9.48 while the City Park project is budgeted for 2021 which is outside the current 2019 – 2020 Biennial Budget. Key issues from the BFO process and information discussed with FCU and HDR staff are summarized in the following sections Maple/Pearl Streets As noted in the BFO Offer Summary, the project will replace aging wastewater infrastructure with new infrastructure that meets current standards. The Wastewater Collection Master Plan identified this project as a high priority based on the pipe condition and serviceability. Discussions with FCU staff indicate these lines require frequent jetting and flat pipe slopes are a contributing factor to the overall system performance. This project is fully funded for design and construction in 2019. Prior to initiating the predesign scope, FCU is planning on collecting new CCTV video. It is recommended the CCTV be extended to the next downstream manhole, east of the Maple and Pearl intersection. North College As noted in the BFO Offer Summary, the project will replace aging wastewater infrastructure with new infrastructure that meets current standards. The Wastewater Collection Master Plan identified this project as a high priority based on the pipe condition and inflow/infiltration. This project will span two years with design in 2019 and construction in 2020. Prior to initiating the predesign scope, FCU is planning on collecting new CCTV video to better assess issues and opportunities. It is recommended the CCTV be extended east of the Lake Canal crossing toward Jerome Street to facilitate investigation of an alternative system configuration. Page 5 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Fort Collins Utilities | 2019 Sewer R&R Predesign Scope of Work hdrinc.com 3 City Park Information on this project area as presented in the Wastewater Collection Master Plan identifies these sewers as a high priority for condition rehabilitation and inflow/infiltration reduction. This severity of the system issues intended to be verified with the predesign scope. A key issue is the existing sewer that spans the backyards of the homes along Mulberry creating access issues and increased risk of root intrusion. This project is planned to progress through pre- design only with the goal of define the project need and updating the construction cost estimate. Final design and construction is planned for 2021. Prior to initiating the predesign scope, FCU is planning on collecting new CCTV video to better assess issues and opportunities. Predesign Phase Task 1. Project Management, Coordination and QA/QC Task 1.1 Project Management, Accounting and Quality Control Initiate project accounting, budget and resource management tools. Prepare a project guide that clearly identifies the project work elements, deliverables, budget and schedule. Prepare monthly invoices and progress reports. Perform QA/QC reviews of calculations and supporting documents. Task 1.2 Project Coordination Meetings Hold bi-weekly meetings as needed at City offices to discuss progress, address technical issues, and review submittal comments. Key Assumptions: 6 month Work Order duration with 12 bi-weekly project meetings Deliverables: Action item log Monthly invoices Task 2. Data Collection, Review and Basemapping Task 2.1 Data Collection and Review Review Wastewater Collection System Master Plan Review City collected CCTV data Review wastewater collection system master plan to identify issues for each project area. Prepare brief tech memo summarizing the data available, system condition, and key issues affecting serviceability and condition of existing sewer system. Perform sewer surveys of each site (3) to collect rim, invert and pipe data for each manhole in the identified survey limits. Task 2.2 Prepare Project Basemaps Prepare project basemapping for each Project Area in AutoCAD to facilitate alternative and predesign analysis. Data sources are expected to include GIS and AutoCAD files. Layers are anticipated to include: o Parcels/ROW from Larimer County GIS data. o Topography (2014 LiDAR) processed to 1-ft contour intervals Page 6 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Fort Collins Utilities | 2019 Sewer R&R Predesign Scope of Work hdrinc.com 4 o City Utilities with linework provided from U-view exports to AutoCAD o City aerial imagery suitable for 1”=50’ scale drawing preparations. Prepare a project overview map for each Project Area Key Assumptions: U-view mapping, GIS data, and LIDAR data are sufficient for predesign analysis supplemented with project developed sewer manhole elevation data Deliverables: Data summary with Project Area overview maps Task 3. Maple-Pearl St Sewer Preliminary Design Task 3.1 Identify Project Issues and Opportunities Attend a site walk with FCU staff and record observations on Project Area overview map Prepare Project Characterization Mapping summarizing project scope, issues, constraints and opportunities. Review, update and refine during progress meetings. Task 3.2 Develop and Evaluate Alternatives Collaborate to develop and evaluate alternatives along with potential construction methods based on Issues and Opportunities Mapping Develop concept level plan view mapping to present alternatives, identify impacts, and coordinate estimates of construction costs. Assess alternatives based on team-developed evaluation factors including maintenance access, stakeholder impacts, ROW acquisition, utility conflicts/relocations, etc. Summarize the evaluation of alternatives in a fact sheet format. Prepare an Alternatives Analysis memo that summarizes the alternative process and identifies the recommended plan Task 3.3 Predesign Drawings and Cost Estimating Prepare sewer plan and profile sheets of proposed improvements to refine recommended plan and assess/address potential utility conflicts, identify constructability challenges, and develop estimates of probable engineer’s construction cost. Key Assumptions: Project Area limits will remain essentially the same as in the scope of work. Deliverables: Project Issues and Opportunity Map Alternative analysis memo with supporting alternatives and recommended plan mapping Preliminary design sewer plan and profile drawings Task 4. North College Sewer Preliminary Design Task 4.1 Identify Project Issues and Opportunities Attend a site walk with FCU staff and record observations on Project Area overview map Prepare Project Characterization Mapping summarizing project scope, issues, constraints and opportunities. Review, update and refine during progress meetings. Page 7 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Fort Collins Utilities | 2019 Sewer R&R Predesign Scope of Work hdrinc.com 5 Task 4.2 Develop and Evaluate Alternatives Collaborate to develop and evaluate alternatives along with potential construction methods based on Issues and Opportunities Mapping Develop concept level plan view mapping to present alternatives, identify impacts, and coordinate estimates of construction costs. Assess alternatives based on team-developed evaluation factors including maintenance access, stakeholder impacts, ROW acquisition, utility conflicts/relocations, etc. Summarize the evaluation of alternatives in a fact sheet format. Prepare an Alternatives Analysis memo that summarizes the alternative process and identifies the recommended plan Task 4.3 Predesign Drawings and Cost Estimating Support Prepare sewer plan and profile sheets of proposed improvements to refine recommended plan and assess/address potential utility conflicts, identify constructability challenges, and develop estimates of probable engineer’s construction cost. Key Assumptions: Project Area limits will remain essentially the same as in the scope of work. Deliverables: Project Issues and Opportunity Map Alternative analysis memo with supporting alternatives and recommended plan mapping Preliminary design sewer plan and profile drawings Task 5. City Park Sewer Preliminary Design Task 5.1 Identify Project Issues and Opportunities Attend a site walk with FCU staff and record observations on Project Area overview map Prepare Project Characterization Mapping summarizing project scope, issues, constraints and opportunities. Review, update and refine during progress meetings. Task 5.2 Develop and Evaluate Alternatives Collaborate to develop and evaluate alternatives along with potential construction methods based on Issues and Opportunities Mapping Develop concept level plan view mapping to present alternatives, identify impacts, and coordinate estimates of construction costs. Assess alternatives based on team-developed evaluation factors including maintenance access, stakeholder impacts, ROW acquisition, utility conflicts/relocations, etc. Summarize the evaluation of alternatives in a fact sheet format. Prepare an Alternatives Analysis memo that summarizes the alternative process and identifies the recommended plan Task 5.3 Predesign Drawings and Cost Estimating Support Prepare sewer plan and profile sheets of proposed improvements to refine recommended plan and assess/address potential utility conflicts, identify constructability challenges, and develop estimates of probable engineer’s construction cost. Key Assumptions: Project Area limits will remain essentially the same as in the scope of work. Deliverables: Page 8 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Fort Collins Utilities | 2019 Sewer R&R Predesign Scope of Work hdrinc.com 6 Project Issues and Opportunity Map Alternative analysis memo with supporting alternatives and recommended plan mapping Preliminary design sewer plan and profile drawings Page 9 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER COST DETAIL Page 10 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 HDR Engineering Contract Manager/ Senior Project Manager/QC Rich Thornton Project Engineer III, Nick Humphrey Project Engineer III, Robert Moore CAD Designer Senior Project Accountant Clerical Assistant Hours Labor Total Expenses HDR Fee Total Fee $ 240 $ 155 $ 155 $ 120 $ 125 $ 65 Task Description Maple-Pearl St Sewer Task 1.1 Project Management, Accounting and QC 4 6 10 $ 1,710 $ 86 $ 1,796 $ 1,796 Task 1.2 Project Coordination Meetings 4 4 4 12 $ 2,200 $ 110 $ 2,310 $ 2,310 Task 2.1 Data Collection and Review 4 4 8 $ 1,240 $ 62 $ 1,302 $ 1,000 $ 2,302 Task 2.2 Prepare Project Basemaps 2 2 8 12 $ 1,580 $ 79 $ 1,659 $ 1,659 Task 3.1 Identify Project Issues and Opportunities 2 16 10 28 $ 4,160 $ 208 $ 4,368 $ 4,368 Task 3.2 Develop and Evaluate Alternatives 2 12 4 18 $ 2,820 $ 141 $ 2,961 $ 2,961 Task 3.3 Predesign Drawings and Cost Estimating 4 32 24 2 62 $ 8,930 $ 447 $ 9,377 $ 9,377 Sub-total 16 70 10 46 6 2 150 $ 22,640 $ 1,132 $ 23,772 $ 1,000 $ 24,772 North College Sewer Task 1.1 Project Management, Accounting and QC 4 6 10 $ 1,710 $ 86 $ 1,796 $ 1,796 Task 1.2 Project Coordination Meetings 4 4 4 12 $ 2,200 $ 110 $ 2,310 $ 2,310 Task 2.1 Data Collection and Review 4 4 8 $ 1,240 $ 62 $ 1,302 $ 1,500 $ 2,802 Task 2.2 Prepare Project Basemaps 2 2 8 12 $ 1,580 $ 79 $ 1,659 $ 1,659 Task 4.1 Identify Project Issues and Opportunities 2 24 12 38 $ 5,640 $ 282 $ 5,922 $ 5,922 Task 4.2 Develop and Evaluate Alternatives 2 20 8 30 $ 4,540 $ 227 $ 4,767 $ 4,767 Task 4.3 Predesign Drawings and Cost Estimating 4 40 32 2 78 $ 11,130 $ 557 $ 11,687 $ 11,687 Sub-total 16 10 94 60 6 2 188 $ 28,040 $ 1,402 $ 29,442 $ 1,500 $ 30,942 City Park Sewer Task 1.1 Project Management, Accounting and QC 4 6 10 $ 1,710 $ 86 $ 1,796 $ 1,796 Task 1.2 Project Coordination Meetings 4 4 4 12 $ 2,200 $ 110 $ 2,310 $ 2,310 Task 2.1 Data Collection and Review 4 4 8 $ 1,240 $ 62 $ 1,302 $ 2,200 $ 3,502 Task 2.2 Prepare Project Basemaps 2 2 8 12 $ 1,580 $ 79 $ 1,659 $ 1,659 Task 5.1 Identify Project Issues and Opportunities 8 32 16 56 $ 8,800 $ 440 $ 9,240 $ 9,240 Task 5.2 Develop and Evaluate Alternatives 4 24 12 40 $ 6,120 $ 306 $ 6,426 $ 6,426 Task 5.3 Predesign Drawings and Cost Estimating 4 48 40 2 94 $ 13,330 $ 667 $ 13,997 $ 13,997 Sub-total 24 114 10 76 6 2 232 $ 34,980 $ 1,749 $ 36,729 $ 2,200 $ 38,929 Hours 56 194 114 182 18 6 570 Fee $13,440 $30,070 $17,670 $21,840 $2,250 $390 $ 85,660 4,283 $ 89,943 $ 4,700 $ 94,643 City of Fort Collins Utilities 2019 Sewer R&R Predesign King Surveyors Page 11 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT C WORK ORDER SCOPE DETAIL Page 12 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 ID Task Mode Task Name Duration Start Finish 1 PO Award and NTP 1 day Fri 6/7/19 Fri 6/7/19 2 Task 1. Project Management 120 days Mon 6/10/19Wed 11/27/19 5 Task 2. Data Collection and Review 30 days Mon 6/24/19Wed 8/7/19 6 Task 2.1 Data Collection, Data Review, and Survey 20 days Mon 6/24/19Wed 7/24/19 7 Task 2.2 Prepare Project Basemaps 10 days Thu 7/25/19 Wed 8/7/19 8 Task 3. Maple-Pearl St Sewer Preliminary Design 55 days Thu 8/8/19 Wed 10/23/19 9 Task 3.1 Identify Project Issues and Opportunities 10 days Thu 8/8/19 Wed 8/21/19 10 Task 3.2 Develop and Evaluate Alternatives 15 days Thu 8/22/19 Wed 9/11/19 11 Task 3.3 Predesign Drawings and Cost Estimating 30 days Thu 9/12/19 Wed 10/23/19 12 Task 4. North College Sewer Preliminary Design 65 days Thu 8/8/19 Wed 11/6/19 13 Task 4.1 Identify Project Issues and Opportunities 15 days Thu 8/8/19 Wed 8/28/19 14 Task 4.2 Develop and Evaluate Alternatives 20 days Thu 8/29/19 Wed 9/25/19 15 Task 4.3 Predesign Drawings and Cost Estimating 30 days Thu 9/26/19 Wed 11/6/19 16 Task 5. City Park Sewer Preliminary Design 70 days Thu 8/22/19 Wed 11/27/19 17 Task 5.1 Identify Project Issues and Opportunities 20 days Thu 8/22/19 Wed 9/18/19 18 Task 5.2 Develop and Evaluate Alternatives 20 days Thu 9/19/19 Wed 10/16/19 19 Task 5.3 Predesign Drawings and Cost Estimating 30 days Thu 10/17/19Wed 11/27/19 May Jun Jul Aug Sep Oct Nov Dec Qtr 2, 2019 Qtr 3, 2019 Qtr 4, 2019 Task Split Milestone Summary Project Summary Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only External Tasks External Milestone Deadline Progress Manual Progress Page 1 Project: Schedu Date: Fri 5/24/1 Page 13 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT D CERTIFICATE OF INSURANCE CONTRACTOR shall submit Certificate of Insurance in compliance with the Contract Documents. Page 14 of 14 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 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-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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 AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? 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: HDR Engineering, Inc. 1917 South 67th Street Omaha, NE 68106 Additional Insureds: The City, its officers, agents and employees. 22 Willis Towers Watson Midwest, Inc. fka Willis of Minnesota, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance SR ID: 17984041 BATCH: 1204863 CERT: W11280651 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CG 25 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to operations at a single designated "loca- tion" shown in the Schedule above: 1. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damag- es because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Loca- tion General Aggregate Limit for that desig- nated "location". Such payments shall not re- duce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggre- gate Limit for any other designated "location" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Location General Aggre- gate Limit. All locations owned by or rented to the Named Insured Policy Number: TB2-641-444950-039 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 04 05 09 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which cannot be at- tributed only to operations at a single designated "location" shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Location General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Location Gen- eral Aggregate Limit. D. For the purposes of this endorsement, the Defi- nitions Section is amended by the addition of the following definition: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III – Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. Policy Number: TB2-641-444950-039 All construction projects not located at premises owned, leased or rented by a Named Insured DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III – Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CG 20 10 04 13 ,623URSHUWLHV,QF Page 1 of 2 32/,&<180%(5 7% COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 A. Section II – Who Is An Insured LV DPHQGHG WR LQFOXGH DV DQ DGGLWLRQDO LQVXUHG WKH SHUVRQ V CG 20 10 04 13 ,QVXUDQFH6HUYLFHV2IILFH,QF Page 2 of 2 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization with whom you have agreed, through written contract, agreement or permit to provide additional insured coverage. ,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV Any location where you have agreed, through writtencontract, agreement or permit, to provide additionalinsured coverage DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CG 20 37 04 13 ,QVXUDQFH6HUYLFHV2IILFH,QF Page 1 of 1 32/,&<180%(5 7% COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 352'8&76&203/(7('23(5$7,216/,$%,/,7<&29(5$*(3$57 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization to whom or to which you are required to provide additional insured status in a written contract, agreement or permit except where such contract or agreement is prohibited. Any location where you have agreed, through written, contract, agreement or permit, to provide additional insured coverage for completed operations. ,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV A. Section II – Who Is An Insured LVDPHQGHGWR LQFOXGHDVDQDGGLWLRQDOLQVXUHGWKHSHUVRQ V LC 24 20 02 13 /LEHUW\0XWXDO,QVXUDQFH$OOULJKWVUHVHUYHG ,QFOXGHVFRS\ULJKWHGPDWHULDORI,QVXUDQFH6HUYLFHV2IILFH,QFZLWKLWVSHUPLVVLRQ 3DJHRI 3ROLF\1XPEHU 7% ,VVXHGE\ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT – SCHEDULED ADDITIONAL INSURED 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 352'8&76&203/(7('23(5$7,216/,$%,/,7<&29(5$*(3$57 /,4825/,$%,/,7<&29(5$*(3$57 Schedule Person or Organization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ocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CA 20 48 10 13 ,QVXUDQFH6HUYLFHV2IILFH,QF Page 1 of 1 32/,&<180%(5 $6 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ $872'($/(56&29(5$*()250 %86,1(66$872&29(5$*()250 02725&$55,(5&29(5$*()250 :LWK UHVSHFW WR FRYHUDJH SURYLGHG E\ WKLV HQGRUVHPHQW WKH SURYLVLRQV RI WKH &RYHUDJH )RUP DSSO\ XQOHVV PRGLILHGE\WKLVHQGRUVHPHQW 7KLVHQGRUVHPHQWLGHQWLILHVSHUVRQ V Policy Number: AS2-641-444950-049 Issued by: Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - NONCONTRIBUTING This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage form. Schedule Name of Person(s) or Organizations(s): Any person or organization where the Named Insured has agreed by written contract to include such person or organization Regarding Designated Contract or Project: Any Each person or organization shown in the Schedule of this endorsement is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The following is added to the Other Insurance Condition: If you have agreed in a written agreement that this policy will be primary and without right of contribution from any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement was executed prior to the "bodily injury" or "property damage", then this insurance will be primary and we will not seek contribution from such insurance. © 2010, Liberty Mutual Group of Companies. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. AC 84 23 08 11 Page 1 of 1 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CG 24 04 05 09 ,QVXUDQFH6HUYLFHV2IILFH,QF Page 1 of 1 32/,&<180%(5 7% WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 352'8&76&203/(7('23(5$7,216 /,$%,/,7< &29(5$*(3$57 SCHEDULE Name Of Person Or Organization: As required by written contract or agreement ,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV 7KHIROORZLQJLVDGGHGWR3DUDJUDSK8. Transfer Of Rights Of Recovery Against Others To UsRI Section IV – Conditions: :HZDLYHDQ\ULJKWRIUHFRYHU\ZHPD\KDYHDJDLQVW WKH SHUVRQ RU RUJDQL]DWLRQ VKRZQ LQ WKH 6FKHGXOH DERYH EHFDXVH RI SD\PHQWVZHPDNH IRU LQMXU\ RU GDPDJH DULVLQJ RXW RI \RXU RQJRLQJ RSHUDWLRQV RU \RXUZRUNGRQHXQGHUDFRQWUDFWZLWKWKDWSHUVRQ RU RUJDQL]DWLRQ DQG LQFOXGHG LQ WKH SURGXFWV FRPSOHWHG RSHUDWLRQV KD]DUG 7KLV ZDLYHU DSSOLHV RQO\ WR WKH SHUVRQ RU RUJDQL]DWLRQ VKRZQ LQ WKH 6FKHGXOHDERYH DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 CA 04 44 10 13 ,QVXUDQFH6HUYLFHV2IILFH,QF Page 1 of 1 32/,&<180%(5 $6 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ $872'($/(56&29(5$*()250 %86,1(66$872&29(5$*()250 02725&$55,(5&29(5$*()250 :LWK UHVSHFW WR FRYHUDJH SURYLGHG E\ WKLV HQGRUVHPHQW WKH SURYLVLRQV RI WKH &RYHUDJH )RUP DSSO\ XQOHVV PRGLILHGE\WKHHQGRUVHPHQW SCHEDULE Name(s) Of Person(s) Or Organization(s): $Q\SHUVRQRURUJDQL]DWLRQIRUZKRP\RXSHUIRUPZRUNXQGHUDZULWWHQFRQWUDFWRIWKHFRQWUDFWUHTXLUHV\RXWR REWDLQWKLVDJUHHPHQWIURPXVEXWRQO\LIWKHFRQWUDFWLVH[HFXWHGSULRUWRWKHLQMXU\RUGDPDJHRFFXUULQJ ,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV 7KH Transfer Of Rights Of Recovery Against Others To Us FRQGLWLRQ GRHV QRW DSSO\ WR WKH SHUVRQ V WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 00 03 13 1DWLRQDO&RXQFLORQ&RPSHQVDWLRQ,QVXUDQFH,QF3DJHRI Ed. 4/1/1984 :HKDYHWKHULJKWWRUHFRYHURXUSD\PHQWVIURPDQ\RQHOLDEOHIRUDQLQMXU\FRYHUHGE\WKLVSROLF\:HZLOOQRW HQIRUFHRXUULJKWDJDLQVWWKHSHUVRQRURUJDQL]DWLRQQDPHGLQWKH6FKHGXOH 7KLVDJUHHPHQWDSSOLHVRQO\WRWKH H[WHQWWKDW\RXSHUIRUPZRUNXQGHUDZULWWHQFRQWUDFWWKDWUHTXLUHV\RXWRREWDLQWKLVDJUHHPHQWIURPXV LIM 99 04 03 14 © 2014 Liberty Mutual Insurance. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Policy Number TB2-641-444950-039 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Organization(s): Email Address or mailing address: Number Days Notice: As required by written contract or written agreement As required by written contract or written agreement 30 A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 LIM 99 04 03 14 © 2014 Liberty Mutual Insurance. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Policy Number AS2-641-444950-049 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Organization(s): Email Address or mailing address: Number Days Notice: Per Schedule on File 30 A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF MATERIAL CHANGE WC 99 20 15 3DJHRI (G &RS\ULJKW/LEHUW\0XWXDO*URXSRI&RPSDQLHV$OO5LJKWV5HVHUYHG :HZLOOQRWPDNHFKDQJHVWKDWUHGXFHWKHLQVXUDQFHDIIRUGHGE\WKLVSROLF\XQWLOZULWWHQQRWLFHRIVXFK UHGXFWLRQKDVEHHQGHOLYHUHGWRWKRVHVFKHGXOHGEHORZDWOHDVW GD\VEHIRUHWKHHIIHFWLYHGDWHRIWKH PDWHULDOFKDQJHWRWKHLQVXUDQFHDIIRUGHGE\WKLVSROLF\ 2XUIDLOXUHWRSURYLGHQRWLFHXQGHUWKLVHQGRUVHPHQWZLOOQRWDIIHFWWKHYDOLGLW\RIWKHFKDQJHVH[FHSWDVLW UHODWHVWRWKHSHUVRQRURUJDQL]DWLRQOLVWHGEHORZ NAME $VUHTXLUHGE\ZULWWHQ FRQWUDFWRUZULWWHQDJUHHPHQW ADDRESS ,QQRHYHQWZLOOWKHQRWLILFDWLRQEHOHVVWKDQWKHPLQLPXPGD\VUHTXLUHGIRUQRWLILFDWLRQE\VWDWHVWDWXWH 1RWLILFDWLRQZLOOEHSURYLGHGWRDOOSDUWLHVLQDPDQQHUDVUHTXLUHGE\VWDWHVWDWXWHLIDQ\ 7KLVHQGRUVHPHQWLVH[HFXWHGE\WKH/LEHUW\,QVXUDQFH&RUSRUDWLRQ 3UHPLXP (IIHFWLYH'DWH ([SLUDWLRQ'DWH )RUDWWDFKPHQWWR3ROLF\1R :$' &RXQWHUVLJQHGE\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB $XWKRUL]HG5HSUHVHQWDWLYH (QG6HULDO1R DocuSign Envelope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quired by written contract 30 Days or written agreement $OORWKHUWHUPVDQGFRQGLWLRQVRIWKLVSROLF\UHPDLQXQFKDQJHG ,VVXHG E\ )RU DWWDFKPHQW WR 3ROLF\ 1R :$' (IIHFWLYH'DWH 3UHPLXP ,VVXHG WR DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 7KLVDJUHHPHQWVKDOOQRWRSHUDWHGLUHFWO\RULQGLUHFWO\WREHQHILWDQ\RQHQRWQDPHGLQWKH6FKHGXOH 6FKHGXOH :KHUHUHTXLUHGE\FRQWUDFWRUZULWWHQDJUHHPHQWSULRUWRORVV ,VVXHGE\ )RUDWWDFKPHQWWR3ROLF\1R:$' (IIHFWLYH'DWH 3UHPLXP ,VVXHGWR DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 RU RUJDQL]DWLRQ V VKRZQ LQ WKH 6FKHGXOH EXWRQO\WRWKHH[WHQWWKDWVXEURJDWLRQLVZDLYHGSULRU WRWKHDFFLGHQWRUWKHORVVXQGHUDFRQWUDFWZLWK WKDWSHUVRQRURUJDQL]DWLRQ DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 RURUJDQL]DWLRQ V ZKRDUHLQVXUHGVIRU&RYHUHG$XWRV/LDELOLW\&RYHUDJH XQGHU WKH :KR ,V $Q ,QVXUHG SURYLVLRQ RI WKH &RYHUDJH )RUP 7KLV HQGRUVHPHQW GRHV QRW DOWHU FRYHUDJH SURYLGHGLQWKH&RYHUDJH)RUP SCHEDULE Name Of Person(s) Or Organization(s): $VUHTXLUHGE\ZULWWHQFRQWUDFW ,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV (DFKSHUVRQRURUJDQL]DWLRQVKRZQLQWKH6FKHGXOHLV DQLQVXUHGIRU&RYHUHG$XWRV/LDELOLW\&RYHUDJHEXW RQO\WRWKHH[WHQWWKDWSHUVRQRURUJDQL]DWLRQTXDOLILHV DV DQ LQVXUHG XQGHU WKH :KR ,V $Q ,QVXUHG SURYLVLRQFRQWDLQHGLQ3DUDJUDSK A.1. 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DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR 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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis Towers Watson Midwest, Inc. fka Willis of Minnesota, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA HDR Engineering, Inc. 1917 South 67th Street Omaha, NE 68106 Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella/Excess Liability on a Primary, Non-contributory basis where required by written contract. Waiver of Subrogation applies on General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation where required by written contract. Umbrella/Excess policy is Follows Form over General Liability, Auto Liability and Employers Liability. Project: 8073 Engineering Services for Water, Wastewater & Storm Facilities Capital Improvements. City of Fort Collins, Colorado Attn: Purchasing Department P. O. Box 580 Fort Collins, CO 80522 05/17/2019 1-877-945-7378 1-888-467-2378 certificates@willis.com Liberty Mutual Fire Insurance Company 23035 Ohio Casualty Insurance Company Liberty Insurance Corporation 24074 42404 W11280651 A 2,000,000 1,000,000 Contractual Liability 10,000 2,000,000 4,000,000 4,000,000 YY TB2-641-444950-039 06/01/2019 06/01/2020 A 2,000,000 YY AS2-641-444950-049 06/01/2019 06/01/2020 B 5,000,000 Y Y EUO(20) 57919363 06/01/2019 06/01/2020 5,000,000 C WA7-64D-444950-019 Y 1,000,000 No 06/01/2019 06/01/2020 1,000,000 1,000,000 SR ID: 17984041 BATCH: 1204863 DocuSign Envelope ID: 587D60B0-9190-4373-9AE2-95BB02973F17 Page 1 of 2