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HomeMy WebLinkAboutRuekert-Mielke/Water AuditCITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920) 236-5065 FAX (920) 236-5068 To: Mr. Scott Beduhn, P.E. Ruekert-Mielke 258 Corporate Drive Suite 200 Madison, WI 53714-2407 Please find: � Attached ❑ Copy of Letter ❑ Meeting Notes ❑ Specifications LETTER OF TRANSMITTAL � Contracts ❑ Photos ❑ Estimates Quantit Descri tion 1 Executed A reement ❑■ � ■ ■ Date: June 8, 2015 Sub�ect: Executed Agreement Water Audit Services Under Separate Cover Amendment ❑ Report ❑ Agenda Mylars ❑ Change Order ❑ Plans Diskette ❑ Zip Disk ❑ Other These are being transmitted as indicated below: ❑ For Approval � For Your Use ❑ As Requested Remarks: ❑ For Review & Comment Enclosed is a copy of the executed agreement for the water audit services. A City of Oshkosh Purchase Order will follow shortly. Please reference this Purchase Order number on all of your invoices. If you have any questions, please contact us. Steve Brand — Copy City Clerk's Office — Original cc: _ File — Original Signed: Tracy L y or I:\EngineennB�T�O' Teylof�Steve 8rantl Agreemen�slRuekert-Mielke LOT-Exewtetl AgreemenbWir Autlit Serv_6-845.tloat A GREEMENT This AGREEMENT, made on the � day of ��(i-��e-- , 2015, by and between the CITY OF OSHKOSH, party of tha first part, hereinafter referred to as CITY, and RUEKERT-MIELKE, 258 Corporate Drive, Suite 200, Madison, WI, party of the second part, hereinafter referred to as the CONSULTANT, WITNESSETH: That the CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following AGREEMENT for WATER AUDIT SERVICES. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shail assign the following individual to manage the PROJECT described in this AGREEMENT: Scott A. Beduhn, P.E. - Senior Project Manager B. Changes in Project Manager. The CITY shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The CITY shali be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE II. CITY REPRESENTATIVE The CITY shall assign the following individual to manage the PROJECT described in this AGREEMENT: Stephan Brand - Public Works Utilities Bureau Manager ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's Proposal. CITY may make or approve changes within the general Scope of Services in this AGREEMENT. If such changes affect CONSULTANT's cost of or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. All reports, drawings, specifications, computer files, field data, notes, and other documents and instruments prepared by the CONSULTANT as instruments of service shall remain the property of the CITY. ARTICLE IV. STANDARD OF CARE The standard of care applicable to CONSULTANT's services will be the degree of skill and diligence normally employed by professional consultants or consultanls performing IdErpinearirglTrec/TaylMSleve9randApreemenlsWUake�-M1tlelkeAB�eamen4NM�ISen4�21- Pa 01of5 1GdoGY 9 the same or similar services at the time said services are perFormed. CONSULTANT will re- perform any services not meeting this standard without additional compensation. ARTICLE V. OPINIONS OF COST. FINANCIAL CONSIDERATIONS, AND SCHEDULES In providing opinions of cost, financial analyses, economic feasibility projections, and schedules for the PROJECT, CONSULTANT has no control over cost or price of labor and materials; unknown or latent conditions of existing equipment or structures thai may affect operation or maintenance costs; competitive bidding procedures and market conditions; time or quality of pertormance by operating personnel or third parties; and other economic and operational factors that may materially affect the ultimate project cost or schedule. Therefore, it is understood between the parties that the CONSULTANT makes no warranty that the CITY's actual project costs, financial aspects, economic feasibility, or schedules will not vary from CONSULTANT's opinions, analyses, projections, or esiimates. ARTICLE VI. RECORD DRAWINGS Record drawings, if required, wili be prepared, in part, on the basis of information compiled and furnished by others. CONSULTANT is not responsible for any errors or omissions in the information from others that the CONSULTANT reasonably relied upon and that are incorporated into the record drawings. ARTICLE VII. CITY RESPONSIBILITIES The CITY shall furnish, at the CONSULTANT's request, such information as is needed by the CONSULTANT to aid in the progress of the PROJECT, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the CONSULTANT's work, the CITY will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE VIII. TIME OF COMPLETION The work to be performed under this AGREEMENT shall be commenced and the work completed within the time limits as agreed up�n in the CONSULTANT's Proposal. The CONSULTANT shall perform the services under this AGREEMENT with reasonable diligence and expediency consistent with sound professional practices. The CITY agrees that the CONSULTANT is not responsible for damages arising directiy or indirectly from any delays for causes beyond the CONSULTANT's control. For the purposes of this AGREEMENT, such causes include, but are not limited to, strikes or other labor disputes, severe weather disruptions or other natural disasters, failure of performance by the CITY, or discovery of any hazardous substances or differing site conditions. If the delays resulting from any such causes increase the time required by the CONSULTANT to perform its services in an orderly and efficient manner, the CONSULTANT shall be entitled to an equitable adjustment in schedule. GErpineatlrp\TreryTeylM5leveBreMAgreemenlsUiueker-htielkeAgreeman4WtrAudtServ 4-11- P'd e 2 of 5 15.dou 9 ARTICLE IX. COMPONENT PARTS OF THE AGREEMENT This AGREEMENT consists of the following component parts, all of which are as fully a part of this AGREEMENT as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument 2. CONSULTANT's Proposal dated March 4, 2015 and attached hereto In the event that any provision in any of the above component parts of this AGREEMENT conflicts with any provision in any other of the component parts, the provision in the component part first enumerated above shall govern over any other component part which follows it numerically except as may be otherwise specifically stated. ARTICLE X. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the AGREEMENT the total sum as set forth below, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto: Lump Sum Not to Exceed $15,500 (Fifteen Thousand Five Hundred Dollars). B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay ihe CONSULTANT within thirty (30) calendar days after receipt of such statement. If any statement amount is disputed, the CITY may withhold payment of such amount and shall provide to CONSULTANT a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services shall be negotiated and set forth in a written amendment to this AGREEMENT executed by both parties prior to proceeding with the work covered under the subject amendment. D. Indirect Costs. Indirect costs such as computer time, printing, copying, cell phone charges, telephone charges, and equipment rental shall be considered overhead and shall not be invoiced separately to the PROJECT. E. Expenses. Expenses may be billed wiih up to a maximum of 10% mark-up. All invoices with expenses shall include supporting documentation of the expense. Failure to include the supporting documentation will result in the reduction of payments by the amount of those expense(s) not including documentation. ARTICLE XI. HOLD HARMLESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims, and demands which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CONSULTANT, his/her agents or assigns, his/her employees, or his/her subcontractors related however remotely to the performance of this AGREEMENT or be caused or result from any violation of any law c�oui�enre�T�enraNansieveerenany��mem.vmakx-M�aikaq9�eem�o-wvn�aisen_a-zi- Pege 3 of 5 u.e«. or administrative regulation, and shall indemnify or refund to the CITY all sums including court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the CITY's written demand for indemnification or refund for those actions, claim, and demands caused by or resulting from intentional or negligent acts as specified in this paragraph. Subject to any limitations contained in Sec. 893.80 and any similar statute, of the Wisconsin Statutes, the CITY further agrees to hold CONSULTANT harmless from any and all liability, including claims, demands, losses, costs, damages, and expenses of every kind and description (including death), or damages to person or property arising out of re-use of the documents without consent where such liability is founded upon or grows out of the acts or omission of any of the ofiicers, employees or agents of the City of Oshkosh while acting within the scope of their employment. ARTICLE XII. INSURANCE The CONSULTANT agrees to abide by the attached Cify of Oshkosh Insurance Requirements. ARTICLE XIII. TERMINATION A. For Cause. If the CONSULTANT shall fail to Tulfill in timely and proper manner any of the obligations under this AGREEMENT, the CITY shall have the right to terminate this AGREEMENT by written notice to fhe CONSULTANT. In this event, the CONSULTANT shall be entitled to compensation for any satisfactory, usable work completed. B. For Convenience. The CITY may terminate this AGREEMENT at any time by giving wriiten notice to the CONSULTANT no later than ten (10) calendar days before the termination date. If the CITY terminates under this paragraph, then the CONSULTANT shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain afl terms and conditions of the AGREEMENT and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment to this AGREEMENT. ARTICLE XIV. RE-USE OF PROJECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form, are instruments of service for this PROJECT, whether the PROJECT is completed or not. CITY agrees to indemnify CONSULTANT and CONSULTANT's officers, employees, subcontractors, and affiliated corporations from all claims, damages, losses, and costs, including, but not limited to, litigation expenses and attorney's fees arising out of or related to the unauthorized re-use, change, or alteration of these project documents. 1:1Ergiireanng\Treq TeyiMSteve 9renA ApreemenlsViueker-Mlelke Agreemen4lW �1 Sarv_941. Pa9e ,4 Of 5 75.Eaa ARTICLE XV. SUSPENSION. DELAY. OR INTERRUPTION OF WORK CITY may suspend, delay, or interrupt the services of CONSULTANT for the convenience of CITY. In such event, CONSULTANT's contract price and schedule shall be equitably adjusted. ARTICLE XVI. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than CITY and CONSULTANT and has no third-party beneTiciaries. In the Presence of: CONSULTANT �� �(/./�,� g� c w.,.� �"��'U uuL�.tlA�i d By: V�� ��'F� Senior Vice President, COO (Seal of Consultant if a Corporation) (Specify Title) ���„ �„� � �,,,� ,,.��'� & MIF���,,, ; �� : �---- .. �i- ; ����pRP O RA Tt-�� _ - SEAL .' = =,,. • �. ��-.. - %,"9(ikE --•-•' �:�1;`,�`� ,, S H A, �, '��uni�n„�• (Witness) (Witness) � (Specify Title) CITY OF OSHKOSH � And: �����//`�,L./ Mark . Rohloff, City Manager � ��� ��� � Pamela R. Ubrig, City Clerk' APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which � ' � will accrue under this AGREEMENT. Cit A orney ���C� �o.� nM City Comptroller isa IneMplhecyTeylMSieveBreMlpreemenuVt�eker-AtielkeApreemenFYYVAudtServ C-21- Pa9e 5 Of 5 \ Ruekert • Mielke Your infraspzwture Ally 258 Corporate Drivc, Suite 200 • Madismi, W[ 53714-2407 • Tcl. (60S) 819-2600 Mr. Stephan Brand Director of Utility Operations Oshkosh Water and Wastewater Utilities 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 Re: Water Audit Dear Steve: March 4, 2015 RGCCIV$D APR 142015 UGP�PUF PUBLIC 1N!'1RKS OSHKOSH, WISCONSiN As the governing body regulatin� the sale of drinking water, the Wisconsin Public Service Commission (PSC) has established a limit for the amount of water that a utility produces but is not sold to custoi7ners or used by tl�e utility in the production of water or maintenance of the water system. This general iule is in place as a protection for custormers that could otheiwise be burdened with the additional cost of waterproduction in significaut excess of actual need. The Ciry of Oshkosh Water Utiliry has historically reported unaccounted-for water levels in excess of the thceshhold set by the PSC of 15 perccnt. Over the past five years of available PSC data (2009 - 2013) the Utility has reported an average unaccounted for water of approximately 20 percent. Although the Utiliry has actively worked to reduce its unaccouuted-for water, the annual losses reported remain above the allowable level set by the PSC. At this time the Utility is looking to perfonn an outside review of its water accountability based around AW WA's free water audit software. Ruekert & Miellce, Iua (R/M) appreciates the opporhmity to assist the Oshkosh Water Utility on this important project. Project Descrlption This project involves a rcview and evaluation of the Utility's water accountability and water loss control measures. Scope of Work Services to be provided for tl�e Project are as described as follows: Task 7 — Water Audit 1. Revie�v Water Utility operating data related to pmnpage, sales, water accountability and non- revenue �vater volumes. Waukesha, �VI Kenosl�a, WI Madison, WI Itasca, IL www.ruckerbmiclko.com \ Ruekert • Miellce Mr. Stephan Brand Water Audit March 4, 2015 Page 2 Yoar Infrastn�cture Ally a. Review existing metering points, meter calibration data, and water use calculations used to determiue the voh�mes of raw water, treatment process water, and finished treated water at the water filh•ation plank b. Prepare a water balance utilizing Ihe most recently available data of water production, water sales, and other authorized water use activities. c. Prepare a Watce Audit using AWWA's free water audit software. 2. Perform a Real Loss Component Analysis using WaterRF's free aualysis sofivare. 3. Review historical water main break data. Compare annual break histoiy with annual water losses. 4. Review the cunent billing process including activities by both Utility and Billiug staff from meter rcading to payments received. 5. Review curcent water loss calculations and regularory reporting including the generation/collection of source data as well as the detennination of water loss. a. Meet with Utility staff to discuss the methods used to estimate water usage/loss for hydrant flushing, repairs and water production. 6. Review and comment omcurrent water loss control activities perfonned by the Water Utility including: a. LeakDetection b. Meter Technology i. Review customer meter testing, accuracy, and replacement process a Infonnalion Management 7. Prepare an RFP for Leak Detection Services for the Owner to use in soliciting bids, 8. Prepare findiugs, conclusions and recommendations based on the updated water audit, component analysis and review of Utility data and activities. 9. Prepare a Technical Memorandum summarizing the cuiTCnt water audit. a. Provide a draft copy of the Technical Meinorzndutn in .pdf fonnat to Owner for review and comment. U. Meet with Owner to discuss draft Tecimical Memorendum. a Incarporatc Owuer comments and Fonvard a final copy of the Technica] Memorandum in .pdf format to Owner. d. Provide up to 4 printed copies of the final Technical Memorandum. \Vaukesl�a, \VI Kenosha, WI Madison, WI Itasca, IL www.rueknrt-mielke.com \ Ruekert • Miellce Mr. Stephan Brand Water Audit March 4, 2015 Page 3 Yonr Bi&astnw[ure Ally Assumptions Tlie proposed engineering fee is based on the following assumptions: 1. All eollectiou of data, staFf iuterviews, facility visits and procedural reviews will be completed in no more than 2 visits. 2. That the Utility can provide at its expense, the follo�ving in a timely manner as not to delay the services: a. Copies of available reports, drawings, specifications, design and operational data pertinent to the Project b. An up-to-date GIS file showing the location, size, material, and installation date of existing �vater mains and water services (if available). c. An existing computcr model of the water system. d. Design and operating data for facilities such as well pump stations and storage reseivoirs e. Historical water sales a�id pumpage data. f. Aistorical �vater main break data. g. Access to utility staff and water system components as may be necessaiy for the completion ofthe work Estimated Fee for Services Billing for this project will be on a lump sum basis, for the specific scope of work listed herein. R/M Uills monthly for seivices, expenscs, and equipment as the work is completed. Note that any changes and/or additions to the scope of work as requested by the Utility during tlie project may result in an increase to these fees. R/M's estimated fee for this work is listed below: Work Item Water Audit Estimated Fee $ 15,500 Schedule We will pei�form our services as quickly as is consistent with the orderly progress of the Work. We anticipate an approximate 8-(0 week schedule to complete the audit, beginning tvith the initial data request. This schedule inay however need to be extended depending on the amount of additional data or fie]d verification that is required to complete the audit. Wankesha, WI Kenosha, WI Madison, WI Itasca, �i��vw. ruekeri-m iel ke. com \ Ruekert • Mielke Mr. Stephan Brand Watcr Audit March 4, 2015 Page 4 Your IufrastmcNre Ally We look fonvard to working with you ou d�is project. Please coutact me at your convenieuce to meet and review tl�is proposal together, I can be reached at 608.819.2600 (offtce) or 715350.9002 (mobile). Thank you again for the opportunity to assist the City of Oshkosh Water Utility with tl�is important project. Very huly yours, RUEKERT & MIELKE, INC. .5�--��7 ,-- ---,-� Scott A. Beduhn, P,E. Senior Project Manager SAB Enclosure cc: Jason P. Lietha, P.E. File C�DNUhe\WOhNwina� Dcctlopmenl'AiLkoN\W�L•� Audi��Brud.10150131.Wq<rAWi�Jrca Waukesha, WI Kenosha, WI Madison, WI Itasca, IL �vww.ruekert-mielke.com CERTIFICATE OF LIABILITY INSURANCE OATE�MMIDD/YYVV) 05�Q5�2�15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, su6ject 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 cert'rficate holder in lieu of such endorsement(s). PRODUCER -COMACT Willia of Illinois, Inc. .NAME. c/o 26 Century Blvd � PHONE F�% r�,�i`%EL AIC No E# Q-879-945-]398 H/C No:1-888-467-2378 P.O. Hwc 305191 -` Z� E-Malt ._ . ... _. _________ ___ � ADDRESS:ceztificatee@willie.e� nasnville� 'a'w �icavoayi �>w '_ � INSUREORUekert 6 Mielke, Inc. Ree willia.�a W233 N2080 Ridgeviex Pazkaay Waukesha, YR 531881020 - � 2015 L�f_1'�t' OF PUBLIC \)j411�1_):iH. �ViS( 2266] COVER.4GES CERTIFICATE NUMBER:we99ao5 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUR4NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH POLIGES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE L R ! POLICYEFF POLICYEXP LIMITS LTR I I POLICV NUMBER �� MMIDDiYY MMIDDIn I COMMERCIALGENERALLIABIIITY I EqCHOCCURRENCE S N I CLAIMS-MADE OCCUR PREMISES Eaocwrrence 5 MEDERP(Anyoneperson) 5 PERSONALBADVINJURV S GEN'LAGGREGATEIIMITAPPLiESPER' GENERALAGGREGATE E POLICY � PR� � LOC PRODUCTS-COMP/OPA6G f JECT OTHER: E AUTOMOBILE LIABILRV I i COMBMED SINGLE LIMIT s Ea acciaent ANVAUTO BODIIVINJURY(Perperson) S ALLOWNED SCHEDULED ! BODILVINJURV(Pe�aai�ent) f AUTOS AUTOS NON-0NMED .PROPERTY DAMAGE f , HIREDAUTOS AUTOS ' Peraccident 5 UMBRELLALIAB OCCUR Ii ! FACHOCCURRENCE E EXCESSLIAB CLAIMS-MADE ' I AGGREGATE E . DED I RETENTION E I I I S I WORKERS COMPENSATON STATUTE I O�TH- ANDEMPLOYERS' W+BIIJTY Y/N OFFlCERMIEMB�REXCWDEO EWTIVE ❑N�A E.LEACHACCIDENT S (MantlalorylnNH) EL.�ISEASE-EAEMPLOYE E 'Ifyes eescn�e maer � �DESCRIPTIONOFWERNTIONSEeIOw E.LDISEASE-POLICYLIMIT E A'Fmteseioml Liability H@tG295'/958A003 !02/27/2015 02/2�/2016 �er Claim 52,000,000 ggsegate 54,000,000 DESCRIPTION OF OOERATIONS I LOCATIONS i VEXICLES (ALOR� 101, NtlUI[ionel Rerturks ScM1etlule, may be attac�e0 it mo�e space Is requiretl) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL�CY PROVISIONS. City oF Oehkoah Depax�nt o£ Public Worka I AUTHORIZED REPRESENTATNE 215 Chuzch AvenvO N Bw� 1130 J�/r �� ,� OsNCOSh� WI Sd903-113� +'4�#-� �i�M'V OO 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SR ID:9130213 BATCH:HatCh p: 13759C ��1 RUEKBMI-07 JHARR ,4c'oRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `� 5/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RICaHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DpES NOT AFFIRMATIVEL`C OR NEGATNELY AMEN�, EXTEND OR ALTER THE COVERAGE APFQRDE� BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N SUBROGA710N IS WAIVED, subject to the terms and cond'Rions of the policy, certain policies may require an endorsement. A statement on thls certificate dces not confer rights to the certificate holder in lieu of such endorsement(s). vROOUCER License i� 1�0290819 NAME: CT Jennifer Harris Sheboygan, WI-Maritime Insurence Group, a tlivision of Hub Int. Midwest PHONE 920 457-7781 Aic, No :(920) 451-8248 632 Niagara Avenue E/C. No e:� :( .� Shebovaan. W153081 ADORESS: ___ ____— —T—� -- �URED RuekeR & Mielke Inc W233 N2080 Ridgeview Parkway Waukesha, WI 531 8 8-1 0 20 q;Selective Insurance Company of Amenca _�12572 BiSelective Insurence Comparry of South Carolina !19259 c:FederallnsurenceCompany 20281 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AeOVE FOR THE POLICY PERIOD INDICATED. NO7lMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUR4NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE �yN51 X COMMERCIALGENERALLIABILJN CWM&MQDE � OCCUR X GEML AGGREGATE LIM7T APPLIES PFR: POIICY �. JECT � LOC OTHER: AUTOM0911E 11ABILT' A X �rnuro ALL OIMJED SCHEDULED AUSOS µ0O Vv1�ED X HIREDAUTOS X AtJ�OS J( UMBRELLALIAB X pCCUR /� EXCESSLIAB CWMSN I �ED X REfEM10NE � WORKERS COMPENSATION IANDEMPLOYERS'LIPBILRV � B �ANVAft�PRIETOR�PARTNEftIEKECUTIVE ( OFFICER/MEMBER EXCLUDEDI � li (Mantl9lory in NM) 'I(yes,desaibe Cer DESCftIPTIIXJ OF OPER4TIONS below C D EPLIFiduciary � N/A � 0?127/2015 � O7J27/2016 JUN -12015 �EPT OF PUBLIC �'� OR[:S OSH, N��S� NSIN OSHK 02/27/207 5 I 02/27/2016 02/27I2015 � 02127/2016 uMiTs EACHOCCURRENCE 5 ��� PREMISES Eaocarrenre E � MED EXP (My one person) 5 PERSOW+LBADVINJURV S ��Q GENER4LAGGREGA7E E 3A !E EOaB�IpFD,SINGIELIMIT 5 BODILY INJURV (Per person) S BODILYINJURV(Peramtlent) E ROPE. DAM4GE y Pa accEent S EACHOCCURRENCE E ovz�izu+s I ovz7izo�s I E.�. �c,,,,�,o�,r S S 7 DESCRIPTON OF OPERATONS / LOCATIONS I VEHICLES (ACORD 101, AOE&ional Remarks SMetlule, may be atfacM1etl X more space is �equired) :iry of Oshkosh, antl ils officers, council members, agents, employces & authorized volunteers are recognized as an Adtlkional Insured as regards General _lability & Auto Liabiliry. As per Form #CG7202 1 217 1,#CA7735 02l10 & tor Completed Operations as per Form #CG7921 Ni14. Umbrella is Following Form. 2overoge is Primary NoncorKributory. (RE: WaterAUdit) r.. City of Oshkosh Scott Beduhn 215 Church Avenue PO Box1130 Oshkosh, VN 54903-1130 SHOULD ANY OF THE ABOVE DESCRIBFD POLICIES BE CANCELLm BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTXORQEDftEPRESENTATVE �j�� /'r� . . � ,.`GJ .�—.i 2 � OO 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014I01) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU COMMERCIAL GENERAL LIABILITY CG 79 21 11 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION 11 — WHO IS AN INSURED is amended to include as an additional insured any person or organi- zation whom you have agreed in a written contrect, written agreement or written permit to add as an addi- tional insured on your policy. Such person or organi- zation is an additional insured only with respect to liability for "bodily injury' or "property damage" caused, in whole or in part, by "your work" and included in the "products-completed operations hazard". The above provision does not apply unless the written contract or written agreement has been executed (executed means signed by the named insured) or the written permit issued prior to the "bodily injury' or "property damage". B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 pro- fessional architectural, engineering or survey- ing services, including: (1) The preparing, approving, or failing to pre- pare or approve, maps, shop drewings, opinions, reports, surveys, field orders, change orders or drawings and specifi- cations; or (2) Supervisory, inspection, architectural or engineering activities. This coverage shall be excess with respect to the person or organization included as an additional insured by its provisions; any other valid and collectible insurance that person or organization has shall be primary with respect to this insurance, unless this coverage is required to be primary and/or not contributory in the contract or agreement referred to above. Copyright, 2014 Selective Insurance Company of America. All rights reserved. CG 79 21 11 14 Includes copyrighted material of Insurance Services O�ce, Inc., with its permission. Page 1 of 1 ELITEPAC General Liability Extension COMMERCIAL GENERAL LIABILITY CG 72 02 12 11 SUMMARY OF COVERAGES (including index) This is a summary of the vanous additionai coverages and coverage modifcations provided by this endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3-through-8) for changes affecting your insurance protection. DESCRIPTION Primary and Non-ConGibutory Provision - Additional Insureds Blanket Additional Insureds - As Required By Contract Broad Form Vendors Coverage Not-forvprafit Members - Including Club Members Not-for-proft Members - as additional insureds Not-for-profit Members Medical Payments Not-for-proft Members - defned Damage To Premises Rented To You ($500,000) Qncluding Fire, Lightning or Ezplosion) Electronic Data Liability ($100,000) Golf Amendments Golfing Facili6es - defned Golf and Tennis Pros - as additional insureds Limited Property Damage - caused by golf balls Members Medical Payments Products Amendment - Medical Payments - limited on premises coverage Recreational Medical Payments - limited amateur golf coverage Waiver of Rights of Recovery - members and guests Incidental Malpractice Exclusion modifed Knowledge of Occurrence, Claim, Suit or Loss Liberalization Clause Medical Payments - increased limit ($15,000) Mental Anguish Amendment (Not applicable to New York) Newly Formed or Acquired Organizations Non-Owned Aircraft Copyright, 2011 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Offce, Inc., with its permission. PAGEFOUND Page 7 Page 5 Page 6 Page 5 Page 4 Page 8 Page 3 Page 4 Page 8 Page 6 Page 3 Page 4 Page 4 Page 4 Page 7 Page 6 Page 7 Page 7 Page 6 Page 8 Page 5 Page 3 CG 72 02 12 11 Page 1 of 8 DESCRIPTION Non-Owned Watercraft (under 60 feet) Personal And Advertising Injury Contractuai Exciusion Amended (Excludes Advertisement) Discrimination and Humiliation Amendment (Not applicable in New York; Excludes Advertisement) Products Amendmen[- Not-for-profit and Golf Supplementary Payments Amended - Bail Bonds ($5,000) and Loss of Earnings ($1,000) Temporary Workers Employee Definition Amended (including status as an insured) Employer's Liability Exclusion Amended (Not appiicable in New York) Injuries or Damages by Certain Employees (co-employee damages) Unintentional Failure to Disclose Hazards Waiver of Transfer of Rights of Recovery (subrogation) When Two or More Coverage Paris of this Policy Apply to a Loss Copyright, 2011 Seiective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services O�ce, Inc., with its permission. PAGEFOUND Page 3 Page 4 Page 7 Page 4 Page 4 Page 8 Page 3 Page 5 Page 7 Page 7 Page 3 CG72021217 Page 2 of 8 ELITEPAC General Liability Extension COMMERCIA� GENERAL LIABILITY CG 72 02 12 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifes the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Part identified in this endorsement will be amended as shown below. However, when two or more Coverage Parts of this policy appty to a loss, oniy the broadest coverage of this policy wilt apply, unless specifcally stated othenvise within the particular amendment covering that loss. COVER.4GES - Amendments SECTION I- COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY COVERAGE EXTENSION Property Damage -"Golfing Facilities" If you operate a"golfng facility", Paragraph 1. Insuring Agreement under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended to inciude the following: "Property damage" to any property not owned by you, caused by golf balls originating from your premises, regardless of your legal liability for the damage. The most we will pay under this estension is a sub-limit of $2,500 per "occurrence". No deductible applies to loss under this extension. EXCLUSIONS Employer's Liability Amendment (This provision is not applicabie in New York). The following is added to Exclusion e. Employer's Lia- bility under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: (7) Any aircraft, not owned or operated by any insured, that is hired, chartered or loaned with a paid crew. However, if the insured has any other vaiid 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 N- COMMER- CIAL GENERAL LIABILITY CONDITIONS. Damage To Premises Rented to You A. The last paregraph of Paragraph 2. Exclusions under COVERAGE A BODILY INJURY AND PROP- ERTY DAMAGE is deleted in its entirety and replaced with the following: Exclusions c. through n. do not appiy 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. B. Paragraph 6. under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: This exclusion also does not appty to any "temporary 6. Subject to Paragraph 5. above, the most we will worker". pay under COVERAGE A for damages because Non•Owned Aircraft, Auto or Watercreft of "property damage" to any one premises, while The following is added to Exdusion g. Aircreft, Auto Or rented to you, or in the case of damage caused Watercraft under COVERAGE A BODILY INJURY by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: of the owner, for all such damage caused by fire, This exclusion does not apply to: lightning or explosion proximately caused by the (6) A watercraft you do not own that is less than 60 feet same event, whether such damage results from long, and not being used to carry persons or fire, lightning or explosion or any combination of property for a charge. Any person is an insured who the three, is the higher of $500,000 or the uses or is responsible for the use of such watercraft amou�t shown in the Declarations for the with your expressed or implied consent. However, if Damage To Premises Rented To You Limit. . 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 Insurence, b. Ezcess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8 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 prem- ises while renled to you or temporarily occupied by you with the permission of the owner is not an "insured contracP'; Electronic Data Liability Exclusion p. Electronic Data under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or ina- bility to manipulate "electronic data" that does not result from physical injury to tangible property. The most we will pay for damages arising out of the loss of, loss of use of, damage to, corruption of, ina- bility to access, or inability to manipulate "electronic data" that results from physical injury to tangible property is a sub-limit of $100,000 for "property damage" because of all applicable loss of "electronic data" arising out of any one "occurrence". SECTION I• COVERAGE B PERSONAL AND ADVER- TISING INJURY LIABILITY EXCLUSIONS Contractual Exclusion Amendment Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND AOVERTISING INJURY, 2. Extlu- sions is deleted in its entirety and replaced with the fol- lowing: e. Contrectual 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. SECTION I- COVERAGE C MEDICAL PAYMENTS EXCLUSIONS Any Insured Amendment Exclusion a. Any Insured under COVERAGE C MEDICAL PAYMENTS, 2. Exdusions is deleted in its entirety and replaced with the following: a. Any Insured To any insured. This exclusion does not apply to: (1) "Golfing facility" members who are not paid a fee, salary, or other compensation; (2) "Not-for-profit members"; 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 Operetions Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: f. Products-Completed Operations Hazard Induded 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, if you are a not- for-profit operation or a"golfing facility". This exclusion exception, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Recreational Medical Payments -Amateur Golf Exdusion e. Athletics Activities under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports or athletic contests. If you are a"golfing facility", this exclusion does not apply to a person injured as a result of their partici- pation in amateur athletics that are recrea[ional in nature. This exdusion 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 traffc 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, 201 t Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8 B. Subparagraph 1.d. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: d. AII reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the daim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work. SECTION II - WHO IS AN INSURED • Amendments Not-for-Profit Organization Members The following paragraph is added to SECTION tl - WHO IS AN INSURED: If you are an organization other than a partnership, joint venture, or a limited liability company, and you are a not- for-profit organization, your officials, trustees, board members, insurance managers, and "not-for-profit mem- bers" are included as additional insureds, however only with respect to their liability for your activities or activities they perform on your behalf. Empioyees As Insureds Modified A. � C. Subparagraph 2.a.(1)(a) under SECTION II - WHO IS AN INSURED does not apply to "bodily injury" to a"temporary worker' caused by a co-"employee" who is not a"temporary worker". Subparagraph 2.a.(2) under SECTION II - WHO IS AN INSURE� does not apply to "property damage" to the property of a"temporary worker' caused by a co-"employee" who is not a"temporary worker'. Subparagraph 2.a.(1)(d) under SECTION II - WHO IS AN INSURED does not apply to "bodily injury" caused by cardio-pulmonary resuscitation or first aid services administered by a co-"employee". Newly Formed Or Acquired Organizations A. Subparagraph 3.a. under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. B. The following paragraph is added to SECTION II - WHO IS AN INSURED, Paragraph 3: If you are engaged in the business of construction of dweliings three stories or less in height, or other buildings three stories or less in height and less than 25,000 square feet in area, you will also be an insured with respect to "your work" only, for the period of time described above, for your liability arising out of the conduct of any partnership or joint venture of which you are or were a member, even if that partnership or joint venture is not shown as a Named Insured. However, this provision only applies if you maintain or maintained an interest of at least ffty percent in that partnership or joint venture for the period of that partnership orjoint venture. This provision does not apply to any partnership or joint venture that has been dissolved or othenvise ceased to function for more than thirty-six months. With respect to the insurance provided by this provision, Newly Formed or Acquired Organizations, the follow- ing is added to SECTION IV - COMMERCIAL GEN- ERAL LIA8ILITY, Paragraph 4. Other Insurance, Sub- paragraph b. Excess Insurance: The insurance provided by this provision, Newly Formed or Acquired Organizations, is excess over any other insurance avaiiable to the insured, whether primary, excess, contingent or on any other basis. (All other provisions of this section remain unchanged). Blanket Additional Insureds - As Required By Contract Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to indude as an additional insured any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your policy. Such person or organi- zation is an additional insured only with respect to liabil- ity for "bodily injury" or "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your ongoing operations, "your producY', or premises owned or used by you; however this provision does not include any architects, engineers, or surveyors with respect to any injury or damage arising ou[ of the rendering or failure to render any professional services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawin9s and specifcations; and Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services O�ce, Inc., with its permission. Page 5 of 8 b. Supervisory, inspection, architectural or engi- neering activities. 2. Your maintenance, operation or use of equipment, other than aircraft, "auto" or watercraft, rented or leased to you by such person or organization. A person or organizatiods status as an additional insured under this endorsement ends when their contract, or agreement with you for such rented or leased equipment ends. With respect to the insurv ance allorded to these additional insureds, this insur- ance does not apply to any "occurrence" which takes place after the rental agreement or equipment lease expires. The provisions of this coverage extension do not apply unless the written contract or written agreement has been executed (executed means 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) whom you have agreed in a written contract or written agreement to add as an additional insured on 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 distrib- uted or sold in the regular course of the vendor's busi- ness, 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 Iiability in a contract or agree- ment; 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 ezpress 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 faiWre to make such inspections, adjust- ments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with Ihe sale o( [he product; or _ Products which, after dishibution or sale by you, have been Iabeled 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 con- tainer, entering into, accompanying or containing such products. The provisions of this coverage eMension do not apply unless the written contract or written agreement has been executed (executed means 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 fallowing: (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 occupa- tion of providing any such professional services. "Golfing Facilities" - Golf or Tennis Pros The following is added to SECTION II • WHO IS AN INSURED: If you operate a"golfng facility", any golf or tennis pros are additional insureds. Golf or tennis pros means any person, other than your "employees", whose primary responsibilities include golf or tennis instruction or operetion of a golf or tennis pro shop, however only with respect to their liability for your activities, or activities they perform on your behalf, or their liability for the main- tenance, use or operation of golf or tennis pro shop premises you rent or lease to them. SECTION III - LIMITS OF INSURANCE Increased Medical Payments Paragraph 7. under SECTION III - LIMITS OF INSUR- ANCE is deleted in its entirery and replaced with the fol- lowing: 7. Subject to Paragraph 5. above, the Medical Expense Limit under COVERAGE C will be $15,000, or the amount shown in the Declarations for Medical Expense Limit, whichever is higher, for all medicai expenses because of "bodily injury" sustained by any one person. This provision, Increased Medical Payments, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Offce, Inc., with its permission. Page 6 of 8 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; 3. An "executive offcer" or insurance manager, if you are a corporation; 4. Your members, managers or insurance manager, if you are a limited liability company; or 5. Your elected or appointed officials, trustees, board members, or your insurance manager if you are an organization other than a partnership, joint venture, or limited liability company. Primary and Non-Contributory Provision The following is added to Paragraph 4. Other Insur- ance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance shall be excess with respect to any person or organization included as an additional insured under this policy, any other insurance that person or organization has shall be primary with respect to this insurance, unless: (1) The additional insured is a Named Insured under such other insurance; �Z) (3) You have agreed in a written contract, written agree- ment or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis; and The written contract or written agreement has been executed (ezecuted means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage" or "personal and adver- tising injury". Unintentional Failure To Disclose Hazards The following is added to Paragraph 6. Representations under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: However, if you should unintentionally fail to disclose any existing hazards in your representations to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage underthis Coverage Part based upon such failure to disclose hazards. Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Trensfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "produc[s-completed operations hazard", if: 1. You have agreed to waive any right of recovery against that person or organization in a written con- tract or written agreement, 2. Such person or.organization is an additional insured on your policy; or 3. You have assumed the liabiliry of that person or organization in that same contract, and it is an "insured contracf'. The section above only applies to [hat person or organ- ization identified above, and only if the "bodily injury" or "property damage" occurs subsequent to the execution of the written contrect or written agreement. If you are a"golfing facility", we will also waive any right of recovery we may have against any of your members or their guests because of payments we make for "bodily injury" or "property damage" arising out of their actions at your premises to which this Coverage Part applies. However, this provision does not appty to "bodily injury" or "property damage" that is expected or intended by your member or their guest. Liberalization The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If we revise this Coverege Part to provide more coverage without additional premium charge, subject to our filed company rules, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. SECTION V - DEFINITIONS Discrimination And Humiliation (This provision does not apply in New York). A. The following is addetl to Defnition 14. "Personal and advertising injury": "Personal and advertising injury" a�so means "dis- crimination" or humiliation that results in injury to the feelings or reputation of a natural person, however only if such "discrimination" or humiliation is: Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Inciudes copyrighted material of Insurence Services Office, Inc., with its permission. Page 7 of 8 1. Not done by or at the direction of: a. The insured; or b. Any "executive office�' director, stockhalder partner, manager or member of the insured; 2. Not done intentionally to cause harm to another person. 3. Not directly or indirectly related to the employ- ment, prospective employment or termination of employment of any person or persons by any insured. 4. Not arising out of any "advertisement" by the insured. B. The following defnition 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 per- son, because of that person's race, religion, gender, sexual orientation, age, disability or physical impairment; or a 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. Electronic Data The following definition is added to SECTION V- DEFINITIONS: � "Electronic data" means information, facts or programs stored as or oq created or used on, or transmitted to or from computer software (including systems and applica- tions 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, Defnition 17. "Property damage" is deleted in its entirety and replaced by the following: 17. "Property damage" means: a. Physical injury [o tangible property, induding 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 manip- ulate "electronic data", resWting from physical injury to tangible property. AII 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- DEFINITIONS is deleted in its entirety and replaced by the following: 5. "Empioyee" includes a"ieased worker", or a "temporary worker". Golfing Facility The following definition is added to SECTION V- DEFINITIONS: "Golfing facility" or "golfng facilities" means a golf course, golf club, driving range, or miniature golf course. Mental Anguish Amendment (This provision does not apply in New York). Definitian 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-proft organization, including clubs and churches, who receive no fnancial or other compensation. Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Offce, Inc., with its permission. Page 8 of 8 F � § /'T EUTEPAC COMMERCIAL AUTOMOBILE EXTENSION COMMERCIAL AUTO CA 77 35 02 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUlLY. This Supplemental Schedule is provided when the BUSINE55 AUTO COVERAGE FORM inciudes the Commercial Automobile Extension endorsement CA T7 35. This Schedule supplements the Business Aulo Declarations. FXTENSIONS OF COVERAGE AND ADDITIONAL COVERAGES DESCRIPTION Limited Liability Companies Coverage Extension Newly Acquired Or Formed Organizations Coverage Extension Employees - Non-Ownership Coverage Extension Non-Ownership EMension - Public Entities Coverage Extension 8lanket Additional Insureds Expenses For Bail Bonds And Loss Of Earnings Bail Bonds Loss OfEarnings f,,,,, EmPloyer's Liability Amendment Fellow Employee Amendment Care, Custody Or Control Amendment Towing And Labor Glass Breakage Hired Car Physical Damage Coverage � � � Auto Loan/Lease Gap Coverege Personal EBects Deductible Reimbursement - Public Entities Additional Trensportation Expenses Airbag Coverage Expanded Audio, Visual, And Data Electronic Equipmen[ Copyright, 2010 Selective Insurance Company of America. All rights reserved. includes copyrighted material of Insurance Services Office, Inc., wi[h its permission. INSURED'S COPY Coverage E�Aension $3,000 Limit of Insurence 51,000 Per Day Limit of Insurance Coverage Extension Coverege Extension Coverage EMension Coverage Extension Coverage Extension Coverage Extension Coverage Extension $500 Limit of Insurance Coverage Extension $60 per disablement up to a maximum $1,900 Limit o(Insurance Coverage Extension Coverage EMension CA 77 35 02 10 Page 1 of 8 DESCRIPTION Limit Of Insurance Physical Damage Oeductible -(Radio Frequency) Vehicle Tracking System Limit Of Insurance � Muttiple Deductibles Duties In The Event Of Acciden[, Claim, Suit Or Loss Waiver Of Subrogation Concea�ment, Misrepresentation Or Fraud Policy Period, Coverage Terriiory Two Or More Coverage Forms Or Policies �ssued By Us Mental Anguish Permanently Attached Eq�ipment Volunteer Worker Copyright, 2010 Selective Insurance Company o( America. All rights reserved. Includes copyrighted ma[erial of Insurance Services Office, Inc., with ils permission. INSURED'S COPY Coverage EMension� Coverege Extension Coverage EMension Coverage EMension Coverage Extension Coverage EMension Coverage Extension Coverage EMension Coverage Extenslon Definitian Definitian Definition � � CA 77 35 02 10 Page 2 of 8 s � � � � � ELITEPAC COMMERCIAL AUTOMOBILE EXTENSION COMMERCIAL AUTO CATT 35 Q2 t� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 1T CAREFULLY. This endorsement modifies the insurance pmvidetl under tha foliowing: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless modified by the endorsement. Amendments to SECTION II—LIAB1LfiY COVERAGE Limited Liability Companies The following is added to SECTfON I{, A. 1. — Who Is An Insured: d. I( you are a limited liability company, you are an Insured for any covered "auto." The provisions oF WHO IS AN INSURED applicable to anyone else using a covered "auto" you own, hire or borrow, also apply to Iimited liabilRy companies. Your members and managers are also "insur- eds" while using a covered "auro" you dodt own, hire ar borrow during the course o( their duties for you. But, members or managers are not an insured for any covered "autos" owned by them or members of their household. Newly Acqutred Or Formed Orga�izattons The foltowing is added to SECTION II, A. 1. — Who Is An Insured: e, Any organization you newly acquire or (orm, other tnan a partne�ship, joint venture or limited liability company, and ove� which you maintain ownership or majority interest, will qualify as a Named Insured if there is no similar insurance available to that organization, However. 1. Coverage under this provision is afiorded only until the 180[h day after you acquire or form the organization or the ead of the policy period, whichever is earlier; 2, Coverage does not appty to "bodity injury" or "property damage" resulting from an "accident" that occurred betore you acquired or formed lhe wganization. No person or organization is an "insured" with raspect to the conduct of any current or past partnership, joint venture or limited liability com- pany ihat is not shown as a Named Insured in Ihe Declarations. Employees - Non-Ownership The following is added to SECTION 11, A. 1. — Who Is An Insured: f. Any employee of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal atfairs. Non•Ownership Extension - Publtc En6ties The followinq is added to SEC710N 11, A. 1. — Who Is An Insured: g, Any board memder or othe� elected or appointed otficial, member of the adminisirative stafT, student teacher or other authorized volun- teer or member is an "insu�ed" while using a covered "auto" you don't own, hire or borrow during the course of their duties for you as a School, Manicipality or other Governmental En- tity, or Emergency Services Organization. Anyone who supplies that "auto" is also an "insured." BlanKet Addt6onal Insureds The following is added to SECTtON I�, A. 'I. — Who Is M lnsured: h. Any person or organization wi[h whom you agreed, because oF a written contract, agree- ment or permit, to provide insurance such as is afforded under this Coverage Part, but oniy with respect to your ownership, maintenance or use of a covered "auto." This provision only applies if the written contrac[ or agreemenl has peen executed or permR issued pfior to the "bodily injury" or "property damage." This coverage shall be primary and not con- tributory with respect Io [he person or organiza- tion included as an "insured" under this sedion. Any other insurance that person or organizatio� has shall be excess and not cont�ibutory with respect�to this insurance, but this provision only applies i( R is required in the written contract, agreement or permit identified in this section, and is pe�mitted by law. Copyrighi, 2010 Se�ective Insurance Company of America. qll righls reservetl. Indudes copyrighted material of Insurance Services O(fice, Inc., with its permissio�. INSt1RED'S COPY CA 77 35 U2 10 Page 3 of 8 Expenses For Bail Bonds And Loss Of Eamings The foHowing modiFes SECT[ON II, A. 2. a. — Supplementary Paymants: Paragraphs (2) and (4) of SECTION II, A. 2. a. — Suppiementary Payments are deleted in their entirety and replaced with the following: (2) We will pay up to the Limit of Insuranre shown on the Commercial Automobile Exiension Sup- piemental Schedule for ihe mst of bail bonds (including bonds for related traKc Iaw viola- fions) required because of an "accidenY' we cover. We do not have to furnish these bonds. (4) We wili pay up to the limit of insurance shown on the Commercial Automobile EMension Sup- plemental Schedule all reasonabie expenses incurred by the "insured" at our request, including actual loss of earnings because of [ime off from work. Employer's Liability Amendment The /oNowing is added io SECTION 1!, 8. A. — F�cclusio�s: c, This exclusion also daes not apply to any "volunteer worker." For Fire Companies, Ambulance Squads and Rescue Squads, the Employee Indemnification and Employer's Liability exclusion does not apply if �he "bodily injury" resutts from the use of a covered "auto" you own, hire or borrow, But, [his coverage extension is only provided fo: 1. Members of the "insured" Fire Company, Am6ulance or Rescue Squad, while such mem- ber is operating within the scope of their official duties, with respect to ciaims rr�ade or surts brought against such member Tor injuries to a feliow member of the "insured" organization, or for injuries to members oi other Fire Compa- nies, Ambulance Squads o� f2escue Squads; and 2. The "insured" organiza[ion with respect to claims made or suits brought against Ihe "insured" organization for injuries to members of other Fire Companies, Ambuiance Squads or Rescue Squads. Fellow Employee Amendment The following is added to SECTIDN 11, B. 5. — F�cdusfcns: For "insureds" O[her Than Fire Companies, Ambu- lance Squads and Rescue Squads, the Fellow Employee exclusion does not appiy if the "bodily injury" results from the use o( a covered "auto" you own or hire. For Fire Companies, Ambulance Squads and Rescue Squads, the Fellow Employee exciusio� does not apply if the "6odity injury" resutts from thi use of a covered "auto" you own, hire or 6orrow. B�t, this coverage extension is only provided to: t. Members of the "insured" Fire Company, Ambu- lance or Rescue Squad, while such member is operating within ihe scope of their oF6cia! duties, with resped to claims made or suits brought agaiRSi such member for injuries !o a fellow member af thC "insured" organization, or for injuries to members of other Fire Compa- nies, Ambulance Squads or Rescue Squads; and 2, The "insured" organiza[ion with respect to claims made or suits brought against the "insured" organization for injuries to members of other Fire Companies, Ambulance Squads or Rescue Squads. Care, Custody Or Canlrol Amendment The folfowing is added [o SECTiON il, 8. 6, — Exclusions: The Care, Custody Or Control excluslon does not apply to property not owned by any insured, subject to [he Following: 1. The most we wil! pay under fbis exception for any one accident is $1,000; and 2. A deductibte of $500 per accident applies to th; � exception. Amendme�ts to SECTION III —PHYSICAL DAMAGE COYERAGE Towing And Labor The following modlfies SECTIDN ill, A. 2. —Towing SECTION 111, A. 2. —Towing is deleted and repiaced with the following: We will pay ai( �easonable [owing and labor costs up to $75 each time a covered Private Passenger Type Vehicle, Sociaf Service Van, Sociat Service Bus or Light Truck is disabled and up to $150 per disablement for Medium Weight Tructcs. For labor charges to te reimbursable however, the labor must be performed at the place of disablement. Glass Breakage The following is added to SECTION III, A. 3. — Glau Breakaga —HFriing A Bird Or Anlmal —FalUng Objecxs: d. If damage to gtass is repaired in lieu o( beirtg replaced, no deductible will apply fo� repair onfy. Copyright, 2010 Seledive Insurance Company of America. All righis reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SNSURED'S CQPY � CA 77 35 02 10 Page 4 of B Hired Car Physical Damage Coverage ('"� The following is added to SECTION III —PHYSIGAL DAMAGE COYERAGE, Paragraph A. 4. Coverage Extensfons; § f � � � _ c. If Comprehensive, Specified Causes of Loss or Collision coverage is provided by this policy, you may eutend Ihat coverage to apply to Physical Damage "loss" to hired "autos." We will provide coverage equal to the broadest caverage available to any covered "auto" shown in [he Declarations. But, the most we will pay for "Ioss" lo a hired "auto° in any one "accident" is ihe lesser of: i. s�s,000; o� 2. The actual cash value of the damagetl or stolen propeAy as of the time of the "loss"; or 3. The actual cost of repairing or replacing the damaged or stolen property wifh other properfy of tike kind or quality. A part is of like kind and quality when i! is of equa! or betfer condition than the pre-accident part. We wIII use the original equipmenf (rom fbe manufacturer when: (a) The operational safety of lhe vehicle might otherwise be impaired; (b) Reasonable and diligent eftorts to locate Ihe appropriale rebuilt, aftermarket o� used part have been u�successful; (c) A new original equipment part of like kind and qualiry is available and w'rl! result in the lowest overall repair cost; (d) For vehicles insured under policies written on or before December 31, 2003, the vehide has been used no more than 15,000 miles unless the pre-accident condition warrants otherwise; or (ej For vehicles insured under policies written on or after January 1, 2004, the vehicle has 6een used no more than Z0,000 miles unless the pre-accideni contlition warranis othenyise. For each hired "auto" our obligation to pay "loss" wdl be reduced by a deducfible equal to the highest deductible applicable to any owned "auto" (or that mverage. No deducti6le will be applied to "Ioss" caused by fire or lightning. We will also pay up to $750 per "accident" for loss of use of the hired "aulo" if it resWts from an "accident" !or which you are legalty Bable. The lessor must suF(er an actual financial "loss" for ihis coverage io apply. Hired Car Physical Damage Coverage provided by this extension is excess over any other collectible insurance. Auto Loan/Lease Gap Coverage The following is added to SECTtON Ilf, A. 4. — Co�erege Extensions: d. If a long-term leased "auto" is a covered "auto" for the Physical Damage Coverage applicable to a to[al "loss," and the lessor is an additional insuretl under this Coverage Part, we will pay the difference between amounts you owe the lessor under the lease terms and the amount of insurance paid the lessor for the total "loss" of the covered "auto" minus: any payments over- due at the time of ihe loss; any financial penalties imposed due to wear and tear, high mileage o� similar charges; any security deposits not refunded by the lessor; any cosls for credit life, health and accident, or disability insurance; any costs for extended warranties; or any carry over 6alances �rom previous leases or loans. You are responsible (or the deductible applicable lo the "loss" Forthe covered "auto." Personal E(feds The following is added to of SECTION III, A. 4. — Coverage E�Aensions: e, If Comprehensive Coverage is provided on this coverage form (or a covered "a�to" you own and that rovered "auto" is stolen, we will pay up to the Limit oF Insurance shown on the Com- mercial Automobile Extension Supplemental Schedule, without application oi a deduc[ible, for personal effects that are stolen with ihat cov- ered "auto." Personal e(fects do not include jewelry, fools, money or securilies. This cover- age is excess over any other collectibie insur- ance. The Following is added to SECTION III, A. 4. — Coverage Extensions: f. IF you are a Board oi Education, Municipality or other Governmental Entity, or Volunteer Emer- gency Services Organization, we wiil pay up to $1,000 or the amounl of the deductibie under any auto policy available to your volunteer or employee, whichever is Iess, for any "loss" described in this sec[ion to any "auto" ownetl or used by a volunteer or empioyee while en route to and during any officiat duty authorized by you. In no evenl will we pay for any "loss" under this Coverage to any "auto" owned, hired, or borrowed by your organization. Copyright, 2010 Selective Insurance Company of America. All rigbts reserved. Includes copyrighted ma[erial of Insurance Services Office, Inc., with its permission. INSU(iE0'S COPY CA 77 35 02 10 Page 5 of 8 Additional TronsportatSon Bcpenses The fol�owing modifies SECTION Ifl, A. 4. a. — Transportalion Ezpenses SEGTION III, A. 4. a. —TransportaGon E�enses is deleted in its entirety and replaced wilh the following: a. We will pay up to the Maximum Limit of Insur- ance shown on the Commercial Automobile Extension Supplemental Schedule for temporary transportation expense incurred by you because of any "losses" to wvered "autos," but only if the covered "autos" carry the coverages and meet the requirements described in 1, or 2. below: 1. We wiil pay the above tempo�ary transportation expense for total theft ot a covered "auto" if you carry either Comprehensive or Specified Causes o( Loss Covewage. We will only pay for such expenses incurred during the period beginning 24 hours after [he thefl and ending, regardless of the policy's expiration, when the covered "auto" is retumed to use or we pay for its "loss." 2. For "Ioss" other than the total iheft to a covered "auto" under Comprehensive Coverage or Specified Causes of Loss Coverage, or for any "loss" under Collision Coverage to a covered "auto." We will only pay for those expenses incurred during the policy pe�iod beginning 24 hours afterthe "Ioss" and ending, regardiess of ihe policy's expiration, wilh ihe lesser of the number of days reasonably required to repair or replace the wvered "auto," or 30 days. This provision 2. of [his E�ension does not apply while there are spare or reserve "autos" avail- able to you for your operations. Airbag Caverage The following is atlded to SECTION III, B. 3, a. — Exdusions: However, this exclusion relating to mechanical breakdown does not apply to (he accidentat discharge of an airbag. Expanded Audia, Vlwal, And Data Eledronic Equtpment The following modifies SECTION III, B. 4. d. a. — Exdusions: The following Is added to SECTiON 111, B. 4. d. a.: For purposes of this endorsement, any re(erence to equipment (or the reproduction of sound also includes video and global positioning systems. SECTION III, B. 4. d. a. is deleted in its entirety. Physfcal Damage Deductibte - (Radio Frequency'� Vehida Tracking System LIMff OF INSURANCE THE FOILOWING MQDIFIES SECTfON III, C. LIMRS OFINSURANCE SECTION III, C. — lIM(fS OF INSURANCE is deleted in i�s entirety and replaced with the following: {This provision does not apply in New York.) The most we will pay for a"loss" in any one "acci- dent" is the lesser of: '1. The actual cash value of the damaged or stolen property as o(the time of the "Ioss"; or 2. The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality; or 3. If you are a Municipality or other Governmental Entity, or an Emergency Services Organization: a. The cost to replace the entire covered "auto" and its "permanently attached equip- ment", for covered "autos" designated in the schedule as being insured on either a stated amount or value guard basis as of the time of the "loss," with a compareble new "auto" and "permanently attached equipment" manufactured to current slandards set bw� nationally recognized organizations such a. 7 but not limited to, NFPA or the US Depart- ment of Transportation; but, the most we will pay under this paragraph for owned or leased "autos" you acquire after the poiicy begins and not described in the decfarations is the least af items 1., Z., or 3.a. of this section; or b. (This provision does not apply in New York) The additional repair or replacement oosts necessary to customize the damaged cov- ered "auto" with permanently installed equipment of like kind and quality, without deduction for depreciation, if Ihe "auto" is speci(caity oulfitted for use by chiefs, - captains, police, administrators and others in comparable positlons and is scheduled, but the "auto" is not designated on the - schedule as being insuretl on an agreed- value basis. We will aiso pay under this provision for the cos[ of installallon onto a replacement "auto" if the covered "auto" Is not repairable, and we will pay (or property owned by "you" that is permanently installed in an "auto" not owned by you. Copyright, 2010 Selec[ive Insurance Company o(America. All rights reserved. Indudes copyrighted material o( Insurance Services Office, Inc., with its permission. INSURED'S COPY � CA 77 35 02 10 Page 6 of 8 � N a � � � �� � �:.. � � � � .� The Io�lowing is added to S£CTION III, D. — Deductible: Any Comprehensive Coverage Deductible stiown in the Declaralions witl be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a radio frequency tracking device and that device was the method ot recovery of ihe veh(cle Amendments To SEGTION N—BUSINESS AUTO- MOBfLE GONDiitONS Multiple Dedudibles The following is added to SEC7tON N, A. —Loss Conditions: 6. I( a Comprehensive or Specified Causes of Loss Coverage "loss" from one "accident" involves two or more "covered autos," onry the highest deductibte applicable to those coverages will be applied to the "accident," if the cause of the loss is covered ta� those vehicles. This provision only applies iF you carry Comprehensive or Specified Causes of Loss Coverage for Yhose vehicles, and does not ex[end coverage to any "covered autos" for which you do not carry socb coverage. Duties In The Event OT Accident, Claim, Suit Or Loss The following is added to SECTION lV, A. 2. a. — Dutlas In The Erenl Of Acddent, Ctaim, Suit Or Loss: The notice requirements tor reporting "accident,° claim, "suit" or "loss" information to us, including provisions related to the subsequenl investigation of such, "accident", claim, "suit" or "loss" do not apply until the "accidenY', ctaim, "suiY' or "loss" is known to: 7, You, ityou are an individual; 2. A partner, i(you are a partnershlp; 3. An executive officer or insurance manager, if you are a corporation; 4. Your members, managers or insurance man- ager, if you are a limited liability company; 5. Your eleded or appointed o�cials, trustees, baard members, or your insurance manager, if you are an organization other than a partner- ship, joint venture, or limited liabilify company, But, this section does not amend the provisions relating to notification of police, protection or examination of the property which was subject to the "loss". Waiver Ot SubragaGon The foliawing madities SECTiON fY, A. 5. —7ransler Of Rights Ot Recovery Against Us 70 others: SECTfON N, A. 5. —Transfer Ot Rights Oi Recovery Against Us To Others is deieted in ds entirety and rep�aced with the following: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury" or "property damage" arising out of a covered "auto" only when you have assumed lia6ility for such "bodily injury" or "property damage" under "insured contract." In all other respeMS, it a person or organiza[ion [o or from whom we make payment uhder this Coverage Form has rights to recover damages from another, those rights are transferred to us, Concealment, Misrepresentation Or Fraud The following is added to SECTION N, B. 2. — Cancealment, Mfsrepresentadon Or Fraud: e, If you should unintentionalfy fai! Yo disclose any existing hazartls in your representations to us al the inception date of ihe policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under [his Coverage Part based upon such failure. Policy Period, Coverege TerrRory The tollnwing modifies SEGTION N, B. 7. —General Condit(ons: SEC710N N, 8. 7. — Policy Period, Co�erage Ter�• tory is modified as follows: The definition of coverage territory is amended to include anywhere in the world for wvered "autos" hired on a shor! term (30 days or less) basis. The "insured's" responsibility to pay damages must be determined in a"suit" brought in: 9. The Urtited States of America; 2. The [erritories or possessions of the United States o( America; 3. Puerto Rico; or 4. Canada; or in a settlement we agree to. Two 0► More Coverage Forms Or Polides Lssued By US The foliowing modifies SEC710N N, B. 8. —Genera! Conditlons: Copyright, 20i0 Selective Insurance Company of America. All rights reserved. Includes copyrighied material o( Insurance Services Office, Inc., with its permission. INSURED'S COPY CA 77 35 02 10 Page 7 of 8 SECTION N, B. 8. —Two Or More Coverage Forms R. Or Palides lssued By Us is deleted in its entirety and replaced wi[h 1he Foliowing: 8. Two Or More Coverage Forms Or Poltcies Issued By Us If a"loss" covered under this Coverage Part also involves a"loss" to other property (rom the same "accident," which is covered under a Commercial Property o� Inland Manne Cover- age Part issued by us or any member company of ours for you, only the higi�est deductible applicable to those caverages will 6e app{ied io the "accidenY'. Amendments to SECTION Y— DEFIN(TIONS The following is added to SECTION Y— DEFINI- T10N5: Q. Menta{ Angulsh (This provision does not apply in New York.) For jurisdictions other than New York, the definition of "bodily injury" is amended to include mental anguish resu�ting (rom any bodily injury, sick- ness or disease sustained by a person. (In New York, mental anguish has been determined to be "bodily in�ury.'� Permanently Attached Equipment "Permanently attached equipment" mean� equipment that is welded, bolted, or perma- nently screwed to the dashboard, fire wall or body o! the "auto". Equipment inserted on per- manently installed side brackets with or without the use of setscrews or tension, or portable fire fighting and/or rescue related equipment, shall no[ be construed as "permanently attached equipment". S. Volunteer Worker "Volunteer worker" is a person who performs business du[ies (or you, for no financial or other compensation. Copyright, 2010 Selective Insurance Company oi America. All rights reserved. Inciudes copyrighted material of Insurance Services Oifice, Inc., with Its permission. INSURED'S COpY � CA 77 35 02 10 Page 8 of 8 l