06/17/2020 Agreement ` w.. "0, Kevin Madok, CPA
Clerk of the Circuit Court& Comptroller—Monroe County, Florida
DATE: June 29, 2020
TO: Breanne Erickson, Contract Administrator
Project Management
FROM: Pamela G. Hancv .C.
SUBJECP: June 17th BOCC Meeting
Attached is an electronic copy of die following item for your handling:
C9 6th Amendment to die Construction Manager at Risk Agreement with Biltmore
Construction Co. Inc. to increase the Guaranteed Maximum Price (GMP) by $1,894,904.34 for
the Plantation KeyJudicial Courthouse and Detention Facility for a total combined GMP of
$34,187,462.06.The project is co-funded by the 2014 Revenue Bond and the One Cent
Infrastructure Sales Tax.
C14 Task Order with T.Y. Lin International in the amount of$176,000.00 for
Emergency Generator Replacement at die Stock Island Monroe County Detention Center.
Should you have any questions please feel free to contact me at (305) 292-3550.
cc: County Attorney
Finance
File
KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070
305-294-4641 305-289-6027 305-852-7145 305-852-7145
TASK ORDER FOR ON CALL PROFESSIONAL ENGINEERING SERVICES
BETWEEN MONROE COUNTY AND T.Y. LIN INTERNATIONAL
FOR EMERGENCY GENERATOR REPLACEMENT AT THE
MONROE COUNTY DETENTION CENTER
In accordance with the Agreement for On Call Professional Engineering Services made and entered
into on January 17, 2018, between MONROE COUNTY, ("County") and T.Y. LIN
INTERNATIONAL ("Consultant") where professional services are allowed in which constmction
costs do not exceed $2,000,000.00 or for study activity if the fee for professional services for each
individual study does not exceed $200,000.00("Agreement").
All terms and conditions of the Agreement apply to this Task Order, unless this Task Order amends,
adds, or modifies a provision or an Article of the Agreement of which will be specifically referenced
in this Task Order and the amendment, addition, or modification shall be precisely described. These
additions shall apply only to the project referenced in this Task Order.
This Task Order is effective on the 17 day of June 2020.
WHEREAS,the Stock Island Monroe County Detention Center is over 20 years old and has not had
any significant maintenance or upgrades performed since being built; and
WHEREAS,an electrical fire occurred at the building in April 2020 and has required the full-time use
of the backup generators until emergency electrical repairs can be completed; and
WHEREAS, the existing generators and generator system at the Detention Center are in need of
upgrades and replacement.
NOW THEREFORE, in consideration of the mutual promises obtained herein, the parties hereby
agree as follows:
1. In accordance with Article II Scope of Basic Services, of the Agreement, the Consultant
shall perform services as described below:
a. Phase 1 Design Services shall consist of replacement of existing roof mounted,
outdoor type 1000 kW, 480V, 3+ in-kind generator.
i. Consultant shall provide support in developing the RFP including
developing the engineering cost estimate, equipment specifications,
modifying the Stock Island Main Electrical Panel Upgrades drawings
completed by Consultant and dated January 14, 2020 for the generator
installation, and providing testing and commissioning requirements.
ii. Consultant shall confirm that existing generator size is adequate to handle
existing electrical loads.
Page 1 of 3
iii. Consultant shall obtain information on existing generator structuraVroof
support system and evaluate if in condition to be reused or provide
structural modifications if necessary.
iv. Consultant shall provide preliminary installation/removal
recommendations, such as possible crane location(s), laydown area,
shutdown window(s), etc.
v. Consultant shall address RFIs during the RFP response period as they
pertain to the scope of work.
b. Phase 2 Design Services shall consist of upgrades to existing generators control
system and refurbishment of the Phase I generator as a replacement for the
generator in the second floor generator room.
i. Consultant shall provide design documents for the generator control system
(modifications of Stock Island Main Electrical Panel Upgrades and
incorporation of applicable TY Lin Ground Fault Protection and Paralleling
Gear study and Schneider Electric Power Systems Analysis study)keeping
with a focus on reliability, simplicity and ease of use.
ii. Consultant shall provide design documents for refurbishment of the
existing 1000kW generator to be installed in the second floor generator room
iii. Design documents to include drawings and specifications,and engineering
cost estimates,while minimizing impact to existing structure.
iv. Consultant shall provide preliminary installation/removal
recommendations, such as possible crane location(s), laydown area,
temporary removal of ventilation louver(s), shutdown window(s), etc.
v. Consultant shall assist with development of RFP for Phase 2 and address
RFIs during response period.
2. In accordance with Article VII Compensation,of the Agreement,the County shall pay the
Consultant a lump sum fee of One Hundred Seventy-Six Thousand and 00/100 dollars
($176,000.00)paid on a percent complete basis for the following phases:
a. Phase I Design- $87,500.00,upon document review and approval by the Director
of Project Management.
b. Phase 2 Design-$88,500.00, upon document review and approval by the Director
of Project Management.
The remaining terms of the Agreement,not inconsistent herewith, shall remain in full force and effect.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
Page 2 of 3
IN WITNESS WHEREOF,each party caused this Task Order to be executed by its duly authorized
representative.
' .„S M) BOARD OF COUNTY COMMISSIONERS
Attest. KEVIN MADOK,Clerk OF MONROE CO TY, ORIDA
�� Q
By i..fa-„-��� u,Y/vBy:
Deputy Clerk) Mayor/Chairma
Date: "-s"'ti 17 �"o 2'' Mp(ROE COUNTY ATTORNEYS OFF)CE
J APPROVED AS TO FORM
ANT COUNTY ATTORNEY
DATE C-/.1 -2C/20
(Seal) CONSULTANT:
Attest: T,V.LIN INTERNATIONAL
e i AhmadA _...
By: .` •( U.\_—E% t(AA By: Hammoud „—.,,_._ '^
J Ahmad A.Hammoud.PE
PrinredJJame: _aP•1-1 y �U Printed Name:
Title: . I d �I('(2 /(2 e1j, LA)
Pr,i Title: DICE PRESIDENT
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Page 3 of 3
A�d CERTIFICATE OF LIABILITY INSURANCE DATE("�"T'"
3/1/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder le an ADDITIONAL INSURED,the policy(les)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).
NTACT
PRODUCER NAME Nancy FerTick
Dealey,Renton 8 Associates PHONE 510<OS3090 1FAX
xOl:510-452-2193
License#0020739
P.O. Box 12675 AD R DEESS: nferick®dealeyrenton.com
Oakland CA 94604-2675 IN8URER3IAFFORD4NG COVERAGE NAIC#
INSURER A'.National Fire Insurance of Hartford 20478
INSUREDT.Y. TYLININTEI INSURER B:Continental nsurance Company 35289
3.5 Lin InternationalStientl INSURERC:Valley Forge Insurance Company 20508
San Francisconis CAStreet, Ste.2300
San CA 94104 INSURER o:American Casualty Company of Reading, 20427
INSURER E:Aspen Specialty Insurance Company 10717
INSURER F:
COVERAGES CERTIFICATE NUMBER:32887588 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPEOP INSURANCE AWL SUBR POUCY EFT POLICY EXP LIMITSLIMITSLTXWHIT R POLICY NUMBER INENDON YYI ININDMYYI7
A X COMMERCIAL GENERAL U�Ae1LRY Y V 6056536518 3/1/2020 3/12021 EACH OCCURRENCE $1,000,000
GERENTED
CLAIMS-MADE L^J OCCUR PPR MSESO(E awnxxe) $1,000,000
X COMrMXuM LIeb MED EXP(My one parson) $15,000
X Cron LW PERSONAL&ADV INJURY 51,000,000
GEN'L AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE '52000,000
POLICYX JECTT LOC PRODUCTS-COMPr/V AGG E 2,000,000
•OTHER: 5
C AUTOMOBILE LIABILITY Y V 6045854067 3/12020 3l1/202t (EWcae001NGlE LIMIT $1,000,000
X ANY AUTO BODILY INJURY(Pe(perm) $
OWNED SCHEDULED BODILY INJURY(Pr nodal) $
AUTOS ONLY AUTOS PROPERTY DAMAGE
X AUTOS ONLY HIRED X AUTOS ONLY (Per uvdnt) 5
5
B UMBRELLA UAB X OCCUR Y V 6056538549 3/1/2020 3/12021 EACH OCCURRENCE _55,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED RETENTIONS $
O WORKERS COMPENSATION V 8056808508 I 3/1/2020 3/12021 X npTUTE ERR
A AND EMPLOYERS'LIABILITY Y/N 6056809061 3/1/2020 3/1/2021
ANYPROPRIETORTARTNEREXECUTIVE Ii XIA E.L.EACH ACCIDENT $1.000,000
OfFCERMEMBER EXCLUDED?RSamabmy In NH) EL.DISEASE-EA EMPLOYEE E1,000,000
n yes describe under
DESCRIPTION Of OPERATIONS below EL.DISEASE-POLICY LIMIT $1,000.000
E PriseelnH Liability LRA9P0120 3/1/2020 311/2021 35,000,000
5;W000 par
mClaim Aggregateual
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addllnel Remarks Schedule.may be etched N mere space Is required)
Re:All Operations of the Named Insured.Monroe County Board of County Commissioners and the State of Florida Department of Transportation are named as
Additional Insured for General and Automobile Liability as required by Written contract or agreement.Insurance is primary and non-contributory per policy form.
IBKIIY111 ENT
Ire
DA
CERTIFICATE HOLDER WAMIM I44k)cr :ANCELLATION 30 Days Notice of Cancellation
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Monroe County ACCORDANCE WITH THE POLICY PROVISIONS.
Board of County Commissioners
1100 Simonton Street#2-216 AUTHORIZEDR RESENTATWE
Key West FL 33040-3110
19198E-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
CHA
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the
Named Insured is required by written contract to add as an additional insured on this coverage part, including {I
any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement.
However, such person or organization is an Insured only with respect to such person or organization's liability
for:
A. unless paragraph B.below applies,
1. bodily injury, property damage,or personal and advertising injury caused in whole or in part by the
acts or omissions by or on behalf of the Named Insured and in the performance of such Named
Insured's ongoing operations as specified in such written contract;or
2. bodily injury or property damage caused in whole or in part by your work and included in the
products-completed operations hazard,and only if •
'..
a. the written contract requires the Named Insured to provide the additional insured such coverage;
•
and
b. this coverage part provides such coverage.
B. bodily injury, property damage,or personal and advertising injury arising out of your work described in
such written contract, but only it
1. this coverage part provides coverage for bodily injury or property damage included within the
products completed operations hazard;and
2. the written contract specifically requires the Named Insured to provide additional insured coverage
under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037.
•
II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not
provide such additional insured with:
A. coverage broader than required by the written contract;or
B. a higher limit of insurance than required by the written contract.
III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage,or personal and advertising Injury arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services. 'I
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports,
surveys,field orders,change orders or drawings and specifications;and
2. supervisory, inspection,architectural or engineering activities;or
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY
CONDITIONS,the Condition entitled Other Insurance, this insurance is excess of all other insurance available
to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance
CNA75079XX(1-15) Policy No: 6056538518
Page 1 of 2 Endorsement No:
Effective Date:03/01/2020
Insured Name: T.Y.un Intecnatlnnal
Copyright CNA Al Rights Reserved. Includes copyrighted material of insurance services Office,Inc.,with its permission.
CNA
Blanket Additional Insured - Owners, Lessees or
Contractors -with Products-Completed
Operations Coverage Endorsement
is required by written contract to be primary and non-contributory, this insurance will be primary and non-
contributory relative solely to insurance on which the additional insured Is a named insured.
V. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the
addition of the following: •
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim,or any occurrence or offense which may result in a claim;
2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance
the additional insured has for any loss covered under this coverage part;
3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the
investigation,defense,or settlement of the claim;and
4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or
program applies to a loss that the Insurer covers under this coverage part. However, if the written
contract requires this insurance to be primary and non-contributory,this paragraph(4)does not apply to
insurance on which the additional insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer
receives written notice of a claim from the additional insured.
VI. Soiety with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended
to add the following definition:
Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part,provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy;and
B. was executed prior to:
1. the bodily injury or property damage;or
2. the offense that caused the personal and advertising Injury
•
•
•
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown
below,and expires concurrently with said Policy.
CNA75079XX(1-15) Policy No:
Page 2 of 2 Endorsement No:
Effective Date:
Insured Name:
Copyright CNA Al Rights Reserved. Includes copyrighted material of Insurance Services Office,Irc.,vnth its permission.
CNA CNA PARAMOUNT
Waiver of Transfer of Rights of Recovery Against
Others to the Insurer Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Any person or organization whom the Named Insured has agreed in writing in a
contract or agreement to waive such rights of recovery, but only if such
contract or agreement:
1. is in effect or becomes effective during the term of this Coverage
Part; and 2. was executed prior to the bodily injury, property damage
or personal and advertising injury giving rise to the claim.
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
It is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To The Insurer
is amended by the addition of the following:
Solely with respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery
the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage
arising out of the Named Insured's ongoing operations or your work done under a contract with that person or
organization and included in the products-completed operations hazard.
All other terms and conditions of the Policy remain unchanged.
This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
CNA75008XX(1-15) Policy No:6056536518
National Fire Insurance Co of H Effective Date: 03/01/2020
Insured Name: T.v.Lin International
Copyright CNA All Rights Reserved. Includes mpynghted material of Insurance Services Office,Inc.,with its permission.
CNA 6045854867 C(Ed. 049)X
(Ed. 04/12)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS EXTENDED COVERAGE ENDORSEMENT
- BUSINESS AUTO PLUS -
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I. LIABILITY COVERAGE 4. An "employee" of yours is an "insured"while
A. Who Is An Insured operating an "auto" hired or rented under a
contract or agreement in that "employee's"
The following is added to Section II, Paragraph name, with your permission,while performing
Al., Who Is An Insured: duties related to the conduct of your
business.
1. a. Any incorporated entity of which the
Named Insured owns a majority of the "Policy," as used in this provision A.Who Is An
voting stock on the date of inception of Insured, includes those policies that were in
this Coverage Form; provided that, force on the inception date of this Coverage Form
b. The insurance afforded by this provision but:
A.1. does not apply to any such entity 1. Which are no longer in force; or
that is an "insured" under any other 2. Whose limits have been exhausted.
liability "policy" providing "auto"
coverage. B. Bail Bonds and Loss of Earnings
2. Any organization you newly acquire or form, Section II, Paragraphs A.2. (2) and A.2. (4)
other than a limited liability company, are revised as follows:
partnership or joint venture, and over which 1. In a.(2), the limit for the cost of bail bonds is
_.. _.._ you maintain majority ownership interest. changed from $2,000 to$5,000; and
The insurance afforded by this provision A.2.: 2. In a.(4), the limit for the loss of earnings is
a. Is effective on the acquisition or changed from $250 to$500 a day.
formation date, and is afforded only until C. Fellow Employee
the end of the policy period of this
Coverage Form, or the next anniversary Section II, Paragraph B.5 does not apply.
of its inception date, whichever is earlier.
Such coverage as is afforded by this provision C.
b. Does not apply to: is excess over any other collectible insurance.
(1) "Bodily injury" or"property damage" II. PHYSICAL DAMAGE COVERAGE
caused by an "accident" that A. Glass Breakage - Hitting A Bird Or Animal -
occurred before you acquired orFalling Objects Or Missiles
formed the organization; or
(2) Any such organization that is an The following is added to Section III,
"insured" under any other liability Paragraph A.3.:
"policy" providing"auto" coverage. With respect to any covered "auto," any
3. Any person or organization that you are deductible shown in the Declarations will not
required by a written contract to name as an apply to glass breakage if such glass is repaired,
additional insured is an "insured" but only in a manner acceptable to us, rather than
with respect to their legal liability for acts or replaced.
omissions of a person, who qualifies as an B. Transportation Expenses
"insured" under Section II - Who Is An
Insured and for whom Liability Coverage is Section III, Paragraph A.4.a. is revised, with
afforded under this policy. If required by respect to transportation expense incurred by
written contract, this insurance will be you, to provide:
primary and non-contributory to insurance on a. $60 per day, in lieu of$20; subject to
which the additional insured is a Named
Insured. b. $1,800 maximum, in lieu of$600.
CNA63359%X Copyright,CNA Corporation,2000. Page 1 of 3
(Ed. 04/12) Includes copyrighted matenal of the Insurance servicesOffice used with its pemiisWon.
CNA63359XX
cNA (Ed. 04/12)
C. Loss of Use Expenses Section III, Paragraphs B.4.c and B.4.d. are
Section III, Paragraph A.4.b. is revised, with deleted and replaced by the following:
respect to loss of use expenses incurred by you, c. Physical Damage Coverage on a covered
to provide: "auto" also applies to "loss" to any
a. $1,000 maximum, in lieu of$600. permanently installed electronic equipment
including its antennas and other
D. Hired "Autos" accessories.
The following is added to Section III. d. A $100 per occurrence deductible applies to
Paragraph A.: the coverage provided by this provision.
5. Hired "Autos" G. Diminution In Value
If Physical Damage coverage is provided under The following is added to Section III,
this policy, and such coverage does not extend Paragraph B.B.:
to Hired Autos, then Physical Damage coverage Subject to the following, the"diminution in value"
is extended to: exclusion does not apply to:
a. Any covered "auto" you lease, hire, rent a. Any covered "auto" of the private
or borrow without a driver, and passenger type you lease, hire, rent or
b. Any covered "auto" hired or rented by borrow, without a driver for a period of 30
your"employee"without a driver, under a days or less, while performing duties
contract in that individual "employee's" related to the conduct of your business;
name, with your permission, while and
performing duties related to the conduct b. Any covered "auto" of the private
of your business. passenger type hired or rented by your
c. The most we will pay for any one "employee" without a driver for a period
"accident" or "loss" is the actual cash of 30 days or less, under a contract in
_ value, cost of repair, cost of replacement that individual "employee's" name, with
or $75,000, whichever is less, minus a your permission, while performing duties
$500 deductible for each covered auto. related to the conduct of your business.
No deductible applies to "loss" caused c. Such coverage as is provided by this
by fire or lightning. provision is limited to a "diminution in
d. The physical damage coverage as is value" loss arising directly out of
provided by this provision is equal to the accidental damage and not as a result of
physical damage coverage(s) provided the failure to make repairs; faulty or
on your owned "autos." incomplete maintenance or repairs; or
e. Such physical damage coverage for the installation of substandard parts.
hired "autos" will: d. The most we will pay for "loss" to a
1 Include loss of use, provided it is the covered"auto" in any one accident is the
1 1 lesser of.
consequence of an "accident" for
which the Named Insured is legally (1) $5,000; or
liable, and as a result of which a (2) 20% of the "auto's" actual cash
monetary loss is sustained by the value(ACV).
leasing or rental concern.
(2) Such coverage as is provided by this III. Drive Other Car Coverage —Executive Officers
provision will be subject to a limit of The following is added to Sections II and III:
$750 per"accident." 1. Any "auto" you don't own, hire or borrow is a
E. Airbag Coverage covered "auto" for Liability Coverage while being
The followingis added to Section III, used by, and for Physical Damage Coverage
while in the care, custody or control of, any of
Paragraph B.3.: your"executive officers," except:
The accidental discharge of an airbag shall not a. An "auto" owned by that "executive officer
be considered mechanical breakdown. or a member of that person's household; or
F. Electronic Equipment
CNA63359XX copyright.CNA Corporation,2000. Page 2 of 3
(Ed. 04/12) Incrudescopydghted material of the Insurance Servicesomice used with itspermimon.
CNA63359XX
CNA (Ed. 04/12)
b. An "auto" used by that "executive officer The following is added to Section IV,
while working in a business of selling, Paragraph A.5. Transfer Of Rights Of
servicing. repairing or parking"autos." Recovery Against Others To Us:
Such Liability and/or Physical Damage Coverage We waive any right of recovery we may haw,
as is afforded by this provision. because of payments we make for injury or
to the greatest of those coverages damage, against any person or organization for
(1) Equalany coveted "add.; whom or which you are required by written
afforded
contract or agreement to obtain this waiver from
(2) Excess over any other collectible us.
insurance. This injury or damage must arise out of your
2. For purposes of this provision, "executive officer activities under a contract with that person or
means a person holding any of the officer organization.
positions created by your charter, constitution, You must agree to that requirement prior to an
by-laws or any other similar governing document, "accident" or"loss."
and, while a resident of the same household,
includes that person's spouse. C. Concealment, Misrepresentation or Fraud
Such "executive officers" are "insureds" while The following is added to Section IV,
using a covered "auto" described in this Paragraph B.2.:
provision. Your failure to disclose all hazards existing on the
IV. BUSINESS AUTO CONDITIONS date of inception of this Coverage Form shall not
A. Duties In The Event Of Accident, Claim, Suit prejudice you with respect to the coverage afforded
provided such failure or omission is not intentional.
Or Low
The following is added to Section IV, D. Other Insurance
Paragraph A.2.a.: The following is added to Section IV,
(4) Your "employees" may know of an
Paragraph B.5.:
"accident" or "loss." This will not mean Regardless of the provisions of Paragraphs 5.a.
that you have such knowledge, unless and 5.d. above, the coverage provided by this
such "accident" or "loss" is known to policy shall be on a primary noncontributory
you or if you are not an individual, to any basis. This provision is applicable only when
of your executive officers or partners or required by a written contract. That written
your insurance manager. contract must have been entered into prior to
The following is added to Section IV, "Accident"or"Loss."
Paragraph A.2.b.: E. Policy Period, Coverage Territory
(6) Your "employees" may know of Section IV, Paragraph B. 7.(5).(a). is revised to
documents received concerning a claim provide:
or "suit." This will not mean that you a. 45 days of coverage in lieu of 30 days.
have such knowledge, unless receipt of
such documents is known to you or if V. DEFINITIONS
you are not an individual, to any of your Section V. Paragraph C. is deleted and replaced
executive officers or partners or your by the following:
insurance manager.
B. Transfer Of Rights Of Recovery Against "Bodily injury" means bodily injury, sickness or
Others To Us disease sustained by a person, including mental
anguish, mental injury or death resulting from any of
these.
CNA63359XX Copyright,Can Corporation,2000. Page 3 of 3
(Ed. 04/12) Includes copyrighted material of the Inarance Services Office used with its permission.
CNA POLICY NUMBERS: 6056808508 AND 6056809061 (Edig'69 B
WORKERS'COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE POLICY
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached.
It is agreed that Part One Workers'Compensation Insurance G.Recovery From Others and Part Two Employers'
Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE-
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California
exposure.The amount is
G-19160-B Page 1 of 1
(Ed. 11/97)