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WWTP Door replacements/ Oshkosh
IZ, &46 CONTRACTOR AGREEMENT: WWTP DOOR REPLACEMENTS CITY OF OSHKOSH THIS AGREEMENT,made on the 315+day of OCTOBER,2016,by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and LAFORCE, INC. 1060 W. MASON STREET, GREEN BAY,WI 54303, hereinafter referred to as the CONTRACTOR, WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, enter into the following agreement. The Contractor's proposal is attached hereto and reflects the agreement of the parties except where it conflicts with this agreement, in which case this agreement shall prevail. ARTICLE I. COMPONENT PARTS OF THE CONTRACT This contract consists of the following component parts, all of which are as fully a part of this contract as if herein set out verbatim, or if not attached, as if hereto attached: 1. Proposal Solicitation 2, This Instrument 3. Contractor's Proposal In the event that any provision in any of the above component parts of this contract 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 1I. PROTECT MANAGER A. Assignment of Project Manager, The Contractor shall assign the following individual to manage the project described in this contract: (Chris Roest, LaForce, Inc.) 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 shall 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 III. CITY REPRESENTATIVE The City shall assign the following individual to manage the project described in this contract: (Pete Gulbronson, Environmental Compliance Manager) 1 r ARTICLE IV. SCOPE OF WORK The Contractor shall provide the services described in the City's Invitation for Bid for the Project titled Wastewater Treatment Plant: Door Replacements dated September 24,2016,and the contractor's bid form and materials attached.as Exhibit A.If anything in the Bid Form conflicts with the Bid Specifications, the provisions in the Bid Specifications shall govern. The Contractor may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the City. ARTICLE V. CITY RESPONSIBLITIES The City shall furnish, at the Contractor's request, such information as is needed by the Contractor to aid in the progress of the project, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the Contractor'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 VI, TIME OF COMPLETION The work to be performed under this contract shall be completed by ARTICLE VII. PAYMENT A. The Contract Sum. The City shall pay to the Contractor for the performance of the contract the sum of $64,600.00, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto. Pee schedules shall be firm for the duration of this Agreement. B. Method of Payment. The Contractor shall submit itemized monthly statements for services. The City shall pay the Contractor within 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 Contractor 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. 2 F ARTICLE VIII. CONTRACTOR TO HOLD CITY HARMLESS The Contractor covenants and agrees to protect and hold the City of Oshkosh harmless against all actions,claims and demands of any kind or character whatsoever which may in any way be caused by or result from the intentional or negligent acts of the Contractor,his agents or assigns, his employees or his subcontractors related however remotely to the performance of this Contract or be caused or result from any violation of any law 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. ARTICLE IX. INSURANCE The Contractor shall provide insurance for this project that includes the City of Oshkosh as an additional insured. The contractor's certificate of insurance for this project is attached as Exhibit B. ARTICLE X. TERMINATION A. For Cause. If the Contractor shall fail to fulfill 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 the Contractor. In this event, the Contractor shall be entitled to compensation for any satisfactory, usable work completed. B. For Convenience. The City may terminate this contract at any time by giving written notice to the Contractor no later than 10 calendar days before the termination date, If the City terminates under this paragraph,then the Contractor shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain all 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. 3 j In the Presence of: CONTRACTOR/CONSULTANT LL 9L, By: 4 CAD (Seal of Contractor (Specify Title) if a Corporation.) By: (Specify Title) CITY OF OSHKOSH By: — ���" Mark A. kohloff, City Manager 4 (Wi es And: Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the necess- ary provisions have been made to pay the liability which will accrue �--- under this contract. ity Attorney City Comptroller 4 CITY OF OSHKOSH BID PROPOSAL FORM Page I of I WASTEWATER TREATMENT PLANT: MOOR REPLACEMENTS From: LaForce, Inc. (bidder's company name) BID PROPOSAL DEADLINE: FRIDAY,.00TOBER 14, 2.016 @ 10.00 A.M. Date: October 14,2016 Addenda: Receipt of Addenda numbered 0 of 0 are hereby understood, acknowledged and included in bidder's bid proposal form, If no addenda were issued for this project please write"N/A"above. In compliance with the advertising for Bids and having carefully examined the drawings and specification for the Work and the Site of the proposed work and having determined all of the conditions of the work, the rules, regulations, laws, codes, ordinances, and other governing circumstances relating to this project, the undersigned proposes to furnish all labor, Materials and Equipment necessary to complete the construction indicated on the drawings and described in the project manual to include all described work completed to the Owners' satisfaction, By Submission of this Bid, each Bidder certifies, and in the case of a joint Bid, each party thereto certifies as to Its own organization, that this Bid has been arrived at independently without consultation, communication, or agreement as to a matter relating to this Bid and with any other Bidder or with any competitor. We, the undersigned, propose to furnish all labor and materials per the project specifications or noted deviations for the following amount(s): BASE BID: TOTAL BASE BID* 64,600.00 Sixty-Four-Thousand Six Hundred Dollars (Base Bid Price—in Words) *Please include Table 2 document with your bid submittal. She grand total for Table 2 should match the Total Base Bid amount. Warranty Details: _ 1-Year, Material and Labor SIGNATURES j Date: 10/14/16 Name of Company: La Force, Inc, Submitted by: (name/title) Chris Roest/Salesman Emalf, Or@laforceine.com Address of Company: 1060 W Mason Street, Green Bay,WI 54303 phone: 920-366-4335 That I have examined and carefully prepared this Proposal from the plans and Specifications and i have checked the same in detail before submitting this Proposal; that I have full authority to make such statements and submit this Proposal in (Its) (their) behalf, and that said statements are true and correct. Signature _ 7 -, ?��=� _ Title Salesman 22 LaForce Inc, 10/14/2016 Table 2 Wastewater Treatment Plant Door Replacement City of Oshkosh, Wisconsin DOOR DESIGNATION LOCATION OF DOOR LUMP SUM COST OF EACH DOOR Door Al Main Entry Door into Truck Bay $2,605.00 (With Window) Door A2 Second Floor from Storage Room to $2,430.00 Roof Outside Entry Door-Down from the Door B side of the Administration Building $2,590.00 (With Window) Between Administrative Building and Door C $3,075.00 Truck Ba (With Window) Door D Pump Room Door Thud(3td) $2,945.00 Level Down Door E Double Doors--Truck Bay to DAFT $4.,110.00 Area(With Windows) Door F Outside Entry Door to Shop $2,575.00 Door G Double Doors--Back Side of Shop $4,725.00 Door H Single Door Back Side of Shop(With $3,510.00 Window) Door from Electric Room to Haulers Door I $3,125.00 Area(With Window) Door J Double Doors from CL2 Delivery $11,540.00 i Door K1 Door at East End of Fe Room $2,230.00 Door K2 Door at west End of Fe froom $4,110.00 Door at Front Side of Building"A" i Door L (With window)$ 2,600.00 Door at Back Side of Building"B" Door M $2,600.00 ith Window) Door N Double Doors to Gas Compressor $4,640.00 Door O Double Doors to Digester Building $5,190.00 (With Windows) GRAND.TOTAL $64,600.00' LAFOINC-01 KUTEAS ,4corzr�° CERTIFICATE OF LIABILITY INSURANCE DATE 10/3113 10111201201 Y1) 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME Cr Willis Towers Watson Certificate Center Willis of Wisconsin Inc. PHaNE 877 945.7378 FAx c/o 26 Century Blvd Arc Ne Ext:( ) arc Ne: (888)467-2378 P.O.Box 30591 ADDRESS:Certificates@wlllis.COm Nashville,TN 37230.5191 INSURERS AFFORDING COVERAGE NAIC 0 INSURERA:Travelers Indemnity Company of America 26666 INSURED INSURER B:Travelers Property Casualty Company of America 26674 LaForce,Inc. INSURERC:Travelers Indemnify Company of CT 25682 1060 West Mason Street INSURER D: Green Bay,VVI 54303 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER., 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 DESCR18ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSR d'rVD POL[CYNU{ABER id31DD 1.1MlODlYYYY A X COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIM1IS44ADE N OCCUR X �X Y-630-1 E04B426-TIA-16 02/0112016 02101/2017 DAMAGE TO RENTED 300 000 PREMISES Ea occurrence , $ MED£XP(Any one person) S 10,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY a JE O, N LOC PRODUCTS-COMPIOP AGO S 2,000,00 OTHER: Deductible s 0 AUTOMOBILE LIABILITY -0'WD LIMIT $ 1,000,00 B X ANYAUTO X X Y-810-1 E052936-TIL-16 02/01/2016 02/01/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 60014Y INJURY(Per accident) $ AUTOS AUTOS HIRFDAU705 NON-OWNED PROPERTYDAMAGE $ AUTOS (Par. Per acc.Wenl $ X UMBRELLA LLAB X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLNMS-IAADE X X SM-CUP-1E364736-TIL-16 02/01/2016 02101/2017 AGGREGATE s 10,000,00 DEDFX RETENTION$ 0 ProdlCompOpsAgg $ 10,000,000 WORKERS COMPENSATION XOTH AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETORIPARTNERIEXECUTIVE Y!N X DTAEUB-1E04363.8-16 02/0112016 02/0112017 E,L.EACH ACCIDENT $ 1,000,000 OFFICFR'7AEMBERFXCLUDEa? �NIA tMandatoryinNH) E.L.DISEASE-EA EMPLOYE $ 1r000r000 If yes,describe under DESCRIPTION OFOPERAT}ONSbeloN E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Work Comp&Emp Liab X AEUB-1 E04365-1.16 0210112016 0210112017 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached if mare space is required) _ LaForca Job#Blanket. General Aggregate Per Project applies when required by written contract. Blanket Additional Insured applies to the General Liability per attached endorsement CGD604 0813-Blanket Additional Insured-Automatic Status if required by written contract(Contractors). Blanket Waiver of Subrogatlon applies to the General Liability policy when LaForce,Inc.has agreed to do so as part of a written contract per attached SEE ATTACHED ACORD 1011 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh Attn:City Clerk AUTHORIZED REPRESENTATIVE 216 Church Avenue ) 1I PO Box 1130 Sia f�tv Oshkosh WI 64903-1130 1 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:LAFOINC-01 KUTEAS LOC#; 1 ACOR®F ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Willis of Wisconsin, Inc. LaForce,Inc. 1060 West Mason Street POLICYNUMBER Green Bay,WI 54303 EE PAGE 1 CARRIER NAIL CODE EE PAGE 1 SEE P 1 EFFECTIVE DA TE,SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL,REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 26 FORM TITLE: Certrflcate of Liability Insurance Description of OperationsfLocations/Vohicles: endorsement CGD453 0713-Xtend Endorsement For Commercial Industries. Additional Insured Clause and Waiver of Subrogation apply in favor of the Certificate Holder and others required by written contract per the terms stated above. Blanket Additional Insured applies to the Auto Liability per attached endorsement CAT474 0215-Blanket Additional Insured- Primary&Noncontributory With Other Insurance. Blanket Waiver of Subrogation applies to the Auto Liability policy when LaForce,Inc.has agreed to do so as part of a written contract per attached endorsement CAT353 0216-Business Auto Extension Endorsement. Blanket Additional'Insured to the Umbrella over Commercial General Liability and Auto Liability as required by written contract per attached form UM0001 1103(pg.6&7 of 13)and endorsement UM0639 0214-Amendment-Other Insurance-Designated Persons or Organizations For Whom You Have Agreed In A Written Contract To Provide Insurance used In conjunction with form CGT801. Blanket Waiver of Subrogation applies to the Umbrella policy when LaForce,Inc.has agreed to do so as part of a written contract per attached endorsements UM0469 0408-Waiver of Transfer of Rights of Recovery Against Others To Us used in conjunction with form CGT800. Commercial Umbrella is Follow Form to the Underlying Policies. General Liability,Auto Liability and Umbrella Liability policies shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured's. Waiver of Subrogation applies to the Workers'Compensation policy when LaForce,Inc.has agreed to do so as part of a written contract and as permitted by law per attached WC000313-Waiver of Our Right To Recover From Others Endorsement, Additional Insureds:City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers. ACORD 101 (2008101) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGE SCHEDULE COVERAGE LIMITS POLICY TYPE: Workers Compensation & Employers Workers Compensation--Per Statute Liability (AZ, IL, IN, MI, TX, MO & ON) CARRIER: Travelers Indemnity Company of CT $1,000,000 E.L. B1 by Accident POLICY TERM: 0210112016—02/01/2017 $1,000,000 E.L. Bi By Disease-Each Emp. POLICY NUMBER: YVYAEUB-1E04365-1.16 $1,000,000 E.L. BI By Disease-Pol. Limit 3 , I COMMERCIAL OENERAL UABITITY Palfcy: YG30-1Eed9426Tt{1-Q6 THIS ENDORSEMENT CHANGES THE POLICY.PLE7ASE RM IT CAREFULLY. i BLANKET ADDITIONAL INSURM --a AUTOMAM STATUS it MQUIRED BYWRITTEN CONTRACT (CONTRAGTORS) i This endorsementmr)dlffes Insurance provided under thefoflowIng: COM MERC IAL GENERAL LIAR ILITY COVEMCI E PART 1, The following Is addod to SECTION ti•••WHO IS (a) Tho Addiliohal Ineured Owners, AN INSURED, Dtssees or Conirectors—Scheduled Any person ororgsnfzaiiort that Person or Organization endorsement ? Cd 20 i0 0104 or CO 70 10 04 13, � a. You agree In a;'wrttto contract requiring ki- the AddMonal Insured -- Owners t surance"to iodade ria an gdditianel insured Lessees or Contractors-•CompJeted 1 on this Cove rage Part,and Oporallons endorsement 04 20 37 b- Jdas not been added as an additional Insured 07 04 or CG 20 3T 04 13, or both of for the same project by al1mrhmont of an ran- such endorsements with either of d❑rsement under ibis Coverage Part which those adiflon dates;or t Includes such person or nrganizatlon In the endorsement's sch(zdulo; (b) r=uder or both of the foig: the Additional Insured -- Owners,nora, Ons- , is an insured,but: sees or Contractors -- Schodufed ar, only 4tiYllt respect to liability for"bodlfy injury", Person Or Organization end❑roement "property damags"or'psmonaf Jn)ur/';and CG 2010,or the Additional Insured—Owners, Lessees or Conlraotors -- H_ My as described Irk Paragraph(1),(2)or(3) Gampleted Operations endorsemeiii below,whichever applies; CG 20 37, wilt W an edition date of t (1) if the 'Wriftan contract raquirinu Insur- such ehdorsernentsperWed; ' ance"specifically requlros you to provide the parson or organizetton is an additional addfflonal insyred Coverage to that par- lnsurocf only If tho injury or damage Is i son or organrzation by tho use of: eausad, In whole or In part, by acts or (a) 'rhe Additional insured — Owners, omisslons of you or your suhcontractor in lessees or Contractors —(rorm FI) the performance of Yyour work'to which endorsement CC 201011$6,or the NnItterl c irad requiring fnsurancer" p) Mther or both cif the follovdrig: the applies;or Additlonal Insured — Owners, Las- (3) If na'rlher Paragmph(1)nor(2)above ap� i sees or Controolms M Scheduled plies: I ' Person Or Organlmllon endorsement (a) The person or organization Is an ad- i CG 20 11)101]1,or the AddIdonat Ia- Monet Insured only If, and to the ex sured•-Ovrners,Lessees or Contrao- tent that, the-InJgry or damage Is ions -- Completed Oporntlons en- caused by acts or omisslons of you or dolsemen(OG 20 3710 01; your subcontractor in the perform- the person or organlzefinn Is art addftionei ante of 1�om world to which the"wrif- jnsured only If the injvey or damage arises ten confmrt requiring Insurance'zip- out of"Your WoX to Whloh the 'Wrlffon plies;and contract rewiring insurenae"applres; (b) 'me person of organlzatldn does not (2} If the 'wrtften contract requIting Insur- qualify as an addlflonaf Insured with anoa"spectffcally requires you fn provide resper,E to the Independent acts or additional Insured coverage to that per- omisslons of such person or organ€- son ororgankaflon by the Else of; z3ffon. OG 1}S 04¢B 13 02137ha Ymvelets Indemnity Company M dubic msnNrd. Page 1 of 3 , 1 • • .......... ......• • •.• • • - , , ..• •• • ..- • ....... �� • I • r COMCIALGENERAL LIA rNCVALLIABI Y • I l 1 � 1 poticy: Y630-•rlao4e425-W-16 2, The Insurance provided to the additional Insured and collectible other insurance,whether primary, i r by this endorsement is Ihnited as follow & excess, wrifingent or or;any other basis,that is Per- o. If the I lmits of Insurence fits Coverage available to the additional insured when that per- If the shown in the ur ace of ns exceed ig son or organbra(Ion is an additional insured,oris minimum limits e lie we. required by the any other Insured that does not quallfy as a "written contract requiring insurance.", the in- named insured,undersuc other insurance. surance provided to the addMonal insured wilt 4. As a condition of coverage pravlded to 1hv addr be llrnited to such mn nlrnum roqufred ftmtta of tlonal insured by this endoreamant liability, For the purposes of determining a• "lite addibvnal insured roust sive, us wriiien wbether this Ilmitatian applies, the minlmum notice as soon as practicable of an "occur- limits of liability required by thed'written cortj ronce" or an offense which may result In a tract requlrtnq Insurance" will he considered claim. To the extent possiblo, such hofioe to Include the minimum timitsoflfabllity'of any should include: I Umbrella or Excess llablllty Coverage required (1) How, where acid where the."om-urrence" for the additional insured by that'�rrdtten con- l tract requiring lnsurance`_This endorsement or offense,took plat of will not Increase the Broils of Insurance de- (2) The names orxf addresses of any fhjured l scribed In saaon If[ [-imps Of Insurance. • persons and vrltnesses;and b. The Insurance provided to the addl onaf in- (3) The nature and location of any Injury or leered does not apply to'Wily injury',"prop- damage arising out of the"accurrence3'or erty damage or"personal injury"arlsing out offense, of the rendering of, or failure to render, any b, If vfnlm Is made or quit"is brought against professlorral archltaCtural,engineering or sur- 'the additiooai insured, the nddltlonal insured veying services,indudlh8l trust; (1) The prepaMg, approving, or falling to (1) immediately record the bpvdflcs of the prepare or approve, maps, shop draw- afafm or"suit'and the data received;and ings, opinions, reporfe, surveys, field or- (z) Notify un as soon as practicable. dens or change orders,or the prepaOng, approving, or falling to prepare or ap- 7be addlhonal Insumd must see to it that we prove,drawir)gs and speclfioatlons;and receive wrVen hotice of the claim or"satin as (2) Supervisory, inspaotbn, architectural or soon as pracUcabfe. i engineering aclivides. c, "l he additional insurod roust IMmodfatolysend <. e, The Insurance provided to the additional tri- us copies of all logo?papers received In con- sured does not apply to `bodily Injury' or nectron with the claire or"salt,cooperate whir °property damage"caused by"yourvrorV'and us in the Investigation or settlement of the included In the "prnrfelrt-s-C!Ompleted opera- clabn or defense against the"spit", and vtIl, tions hvxard"unless the"u+rltien conhact re. erwise comply with all policy eorrditions. qulring Insurance°speclffealiy requites you to d, The additional Insured trust tender the de- provide.such oovarage for that additional In- fense end Indemnity of any claim or"sult"to J sured during the policy period. any provider of other Insurance which vouid 3. Tho Insurance provided to the additional Insured cover M6 additfonal insured for a lose we by Oils eudorsament is excess over any Valid nhd cover under this endomarnent. Hdvlever, this cohlectlble,voter insurance, whether primary, eX- condillon does not atfect whether the lnmr- cess, contingent or on any other basis, that Is ante provided to the additional insured by tills syrttlabletothe additional Insured.However,Ifthe endorsament Is primary to other Insurance 'urethan contract requiring insurance" specf Qally available to the additional insured which cov- requires that this Insurance apply an a primary ors that person or organlzatfon as a named basis or a primary and ran-contributory basis,this jnsurad as descilbod In Paragraph 3,above. insurance Is primary to other insurance avallablo 5 The€allowino g Is added to the I)KFINl17t]NS So to the uddftlonal Insured under which that person tion. or organlraton qualities as a named insured,and we will nil share with that other WVrahca, 13W "Written contract requiring insurance"rneans that the insurance provided to the additional Insured part of any written contract or agreement under by Oils endorsement sif11 Is excess over any valid urhtcb you are required to include a person or or- Page 2 of,3 4b2ota The Travelora k€demr4y Company,arfGhts reserved, GG I)6 g4 Oil 13 t i r� f � I COMMERCIAL GIrNi✓RAt.I.IABILI7Y Panty; Y630•lf±048425.TTA-l6 ganization as an additivnat insured an this Cutler a. After the signing and uxect,tton of the contract age Part; provided that the 'i3ociily IrJury" and orgmarnanf by you;and f property damaqWl occurs, and tete Ilpersnnal In- L While lhaf part of the cotilreclorsgreeulent Is jury" is mused by nn offense commllied, during in effoa. the policy period nnd, { r i t I � . 1;• CG D$04 os la 0 2018 T),s TmValara tndtrrdly comp-my.Ad rights rese"d. Paga 3 of 3 4 r r 1 - ' I . COMMERCIAL GFIRCRAL[.tAi31LITY Pclf.y. Y6313Ar14B425-TIA-1(; i THIS jwMDORSVPhENT CHARGES THI;POLICY,PLEASE READ IT CAREFULLY. I � I XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES l : I —Ng endorsementmodlfiea insurance provided under the folloft)g: CommERmt_GENERAL LIABUTY COVERAGE PART GENrRAL DESCRII'7lON Orr COVERAGE—This endorsement broadens coverage.However;coverage for any Injury,damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part,and 7ftse coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an rndorsmnent The foliowtng listing Is a general rAvrf = age desoriphon only.Umltaffuol and exclusions may apply to these coverages.Read all rho provisions of fhis er'r- dorsemept and the rest or your poilcy carefully to detentilna rights,duties,artd what fs and is not covered. _. A. Broadened Narned Insured J, 6odlfy Injury To Co-Empioyees Ahd Co-Volurrteer a 13, 131anketAddluonat Insured—Broad Farm Vendors Workers ! ' Cr. Damage To r'rtrmisos Rented To You K. Aircraft Chartered Nytol Crew Perils of fire, exploslon, Ik htning, smoke, L. Non-Owned Watercraft--fncreasnd From 26 Feet water To Bu Feet l Limit increased to$360,000 !Vi_ Increased Supplementary payments F D, Blanket Waiver Of Subrogation ' Cost of ball bonds Increased to$2,500 F. Blanket Addi0onal Insured—0"3re, Managers Loss of earnings Increased to$500 per day Or Lessors Of premises N, Medical PayMar is-Increased Limit F. Uanket Additional Insured—t-sssots Of Leased Equipment A. Knowledge And Noi;ce Of Occurrence Or Offense G, Inoldentat Medical Matpractiee P_ ur)Intentlartal Omission H. PamonalInjury—Arsuinocl By Contract Reasonable, force -- SodifY Injury Or Property I. Amended Bodily injury Definition Damage : pRt7VISION5 131-OKET ADDITIONAL JNSl1REp BROAD A. 13ROADENFD NAMED IHSURPD The VElnq is S 't, The{allowing Is added to SECTION 11�WHO The fotiO4Jing is added to SECTION Jl WHO!S is AN1tvSt112E15. AN Ii�SURE.b. Any organi;/Oon, other than a partnership or Y Pin or organization tiler is a vendor and jolot venturo,over which you maintain mmor- that you hava agreed in a v,duen contract or ship or irtajorliy Interest On itis effective date agraement;to include as en addilfonal Insured on of tha policy quallfies as a Named.Insured, thls Coverage Part Is an Insured,but only�-iith re- However, coverage for any such orgaatcalton spent to liability for 'tmdily Injuty' or 'property N01 cease as afthe date during the polfoy pe_ damage'that riod that you no longer meintoln ov�nersh p of, a is causer#by an"ocoutronce"that takes place Dr majority,tnteresi fn,such organization. after you have signed and oxecuted that con- 2. The following replaces Paragraph 4.a. of traotoragreement;and -SECTION II-11'HD 15 AN ItlsUltED: b. Arses out of'your products° v&k h ase dis- , a. Coverage under this provision is afforded Mbrrted or sold in the regular course of such only untfl the 180th day after you acquire vendors business, or Form the organization or the end of the The poll--y period,whlchavet Is vadler,unfess Insurance prAvldad to such vendor is subject i roportad kr wdffng to us''Vlthln 186 days, to the following provistoru: cGDb580113 820f3'The'bavelasindant]Ityt4mpany.Allrights rPsetved, PagoIof7 fpoludcr mpydghtad r] iadal oflnsvronaesaMc"Mo,Irtu w0 h Prmltsion, i i i' COMMEROJAL GENERAL LIABILITY party: yo3Q-1r r14134ZVrJA,SB a. The Ifmlts of Instuanrs prnvjded to such von-- JURY AND PROPERTY DAMAGE L A131L- ; dor YAI be the limits which you agreed to pra- ITY; vide In the written contract or agreement, or Excluslans c.through n,do not apply Eo dam- the firnits shovrn In the rmeorations of this ege to premises whlle rented to you, or tam- Coverage Part,mrhIrhev"are less, poradly occupied by you with petrnlssion of b. The insurance provlded io such vender does the owner,C,�usat by: ; not apply to: a, Fire; (9) "Bodily injury" or °proper(y damago" for Iy, Explosion;- which the vendor is obligated to pay c, Ughtning; damages by reason of lha assumption of liobility In a contract or agreement. This d, Smoke resulting from such fire,explosion, e.xdusiur does not apply 10 liability for or lightpinrd;or damages that the vendor wood have In a. Water- the absence oftha confrsct or agreement; A separate limit of Insurance appllus 10 such (a) Any express warranty unauthorlxed by damage to premises as described In para- you; graph 6.of Section ill--Limits Of insurance. (g) Any physical or chemical u:Nmge ill your This€nsgranoe does not apply to damage-to prociuots' made intentionaity by such premises while rented to you, or ternporarity vendor, oceupled by you with permission of the (4) Repackaging, unless unpacked solely for oemar,caused by; the purpose of inspectlen,demonstration, a. RQpture, bursting, or operatian of pres- testing,or the substifullon of parts under sure iellef deyicos; ' inslruc6ons from the manufacturer, and b. Rupture a bumiing due to expansion or then repadaged In the 0691001 Container, srte#ling of the contents of any building or (S) Any failure to make such Inspections,ad- stnivAure,caused by or resulting from%va- justments, tests or servicing as Vendors agree to perforin or nomtagy andertake iv c, Fxplosion of steam batters,stoarn pipes, perform In the regular coarse of busfness, steam engines,or etaarn turbines, in connection with the dlsirlbudon or sale of your products, 2. The following replaces Paragraph 6.of Sr-G- (6) Demonstration, Instattatien, servicing Of TION III—LIMITS OF INSURANM repair operations,exceptsueh opr raffors Suhject to S. above, tine Damage To Prem- performed at such vendors premises In isms Rented TO You Limit Is the most we tivlli connection with the safe of"your prod- pay under coverage A for damages because ucts"i or of "property damage" to any one premises (7) "Your products"which,after distribution or %vhife rented to you, or totnpofadly dooupled sale by you, have been labried or refa- by you-vtith permission of tha owner, caused baled or used as a container, part or h1- by fire; explosion; llghlhlng smoke resulting gredlent of any other thing or substariuo from such fire,explosion,or Ilghtn€ng;or wa- by or for such Vendor. 'tor. The Damage To Profntsas Rented To coverage rrndsr thfs pruvlslun does not appiy fa; You Limit will apply to all damage proArna(ely arson or ofganlzation from whom you caused by the same "occurrence", whether a. Any p suers damage results from fire; explosion; have arxTuirod'your products", or any ingre- Ilghtning,smoke resulting frcm such fire, ex- diant, part or container entering into, accom- pioslon, or lightning; water, or any aombina- panyirV or contalhing suds products;or tion of any of those, b. Any vendor for which coverage as an adds. •ono pa"a To Premises Rented To You flonaf Insured specifically Is scheduled by err- Wm}t will be the hlgher oi: dorsentent, G, OAMAs ETO PREfA1sF3 RENTED Tt7 YDU t. The following replaces-the last;paragraph of b. Tne arnount Shawn on the Deolorat c)m of Paragraph 2, r:Xcf4slPrns, of SECTION I w this t:overega Part for Damage To Prem- ' GbVERAGES—GAVERAGE A BODILY 114- lsea Rented To You Limit. pege2of7 ®2012 The Trevelersindemrtllycarrpony.All rlahlstm"bd_ GG D4 5H OT 13 lidvdes topydghlod anterial of Intvrawe Services Wica,lta ulrh As perm'ssron, i I I COMMERCfAL GITNURA[,LIABILITY Policy. Y630-1Eo48425-TIA-46 I 3. The following replaces Paragraph a- of [he a. is"bodlly Injury"or`property damage°caused definition of insured contr4a'In the DEF1141- by an "occurrence" that takes place, or°per- , 'IONS soalion: sunt Injury"or"advortising injury'causvd by i a. A contract for a lease of premises. How- an offense That€s committed, after you have eve, that portion of tha contract for a signed and execuled that contract or agroe- lease, of premises that Inderrrnl#fes any mens and person or organrzaffon for damage to b. Arises out of the o)vrnership, maintenance or premises whiie rented to you, or tempo- use of that part:of any premises (eased to rarity occupied by you with permission of you. , the owner,calusod by: The insurance provided to such premises owner, i (4) Fire; manager or lessor is subject to the following pro- , VISlons: (2) Exploslon, a, The 11mRs of Insrirance provided to such (3) LlgiitnIng; premises owner, manager or lessor will be (4) Smoke resulting from such fire, ex- tho limits whlotr you agreed to provide In the plosion,or lightning,or writteh contract or agreement, or the limits shown on the Declaratlons of this Coverage } (5} Water. Pati,whichever are lass. i is not an insured oontmor; b. The Insuranca provided to such premises 4, The rollowing replaces Paragraph 4.b.(I)(b) yNnar,manager or lessor does riot apply to: i of SECTION IV—COMMERCIAL GVNERAL (1) °Bodily Injury' or "property eianlaga" LTAEKITY CONDWIONS: cmised by at, "occurrence" that takes (b) That is insurance for pmmises rented (o place,or"personal Injury"or"advertising you, or temporarily occupled by you with Injury'caused by an offense that Is com- the permisslolt of the ov,ner, mitted, after you cense to be a tenant in S, BLANKET WAIVER OF SUBROGATfON Thal premises;or The following Is added to Paragraph 8„Transfer (2) Structural afteraffons,nevi com(ruciion or T ; g damlltlon epwations psrfonnod by or on Of Rights Or kecoveW Against Others To tis, behalf of such premises owrisr,rr:s"ger of SECTION IV•-CQMMERCIAL GENERAL Lt- orfessor- ABILITY GONDJTiONS; a, 'file Insurance provided to such premises ' We waive any right of recovery via Inas have owner, manager or lessor N excrw--ss over any against any person or organization because, of valid and collectible other insurance available paymenis xve make for injury or damage arising to such pretnfses ovmer,manager or lessor, out of promises owned or occupied by or ranted unlass you have agreed in a written contract or loaned to you,ongoing.operations performed for this Insurance to apply on a primary or by you or ori your behalf, dorsa uhdor a contract conhibutory basis. with that person or organizsUon; ;'your work'{ or 1=- BLANKET ADDITIONAL tNSUREn—LCSSORS ; "your produo(sV,WD waive this right where you of LK-ASED EQUIPMENT have agreed to do so as part of a written centred. The following is added to SK:GTION tl-,WHO fS executed by you prior to loss, AN INS U RE D., = F. Pl-ANKET ADDITIU AL]NSI REV--OWNER$, Any person or organization that is an equipment MAKAGI;RS OR L_ SSORS OF PREMISE=S lessor and that you have agreed In a written con- The following is added to SECTION lI--WHO iS tractor agreement to Include as on additional In- N41N51,TRr:p: suced on this Coverage Part is an insured, but ; only with respect to Ilabi?fty for ")=edify injury'', Any person or urganizeflon that is a promises "proporb,damage°, "personal Injury"or"advortis- owner, manger or lessor and that you have Ing Jnjuy filet agreed In a w0afi contract or agreement to ? name as an edditionnl lnsured on (tris Coverage a. Is"bodlly Injury'`or"property damage"Caused Part is an insured,but only with respect to liability by an "orcu ranee°tat lakes pisco or°porgy a for"bodlly Injury", Oproperty darnage4, 'personal .opal injury'or"advertising Injury'caused by ; Injury*or"advertising injury that an of(enso that is commlifed, afiar you have Cly D4 511 137 43 ®2613lbe Travelarslhdarnhlry Rotnpally,All rights rosarvM. gaga a of 7 hdvdas C*Pyrightad materiel of insurance SLN,1088 Orilae,Ina VA(h lis pormis0m. ; r e ( commEfZCIAL Gr--NERAL LIABILITY Policy; YG30.1 r404Zl425,TIA-10' r ragrh 2. signed and executsd that contract or agroo 3. sEGTtONillfofl �iWH[t is Att�l1SUREP:a.(1)of menti and 6, is caused,in whole ur in part,by your acts or Unless you are in the business or occupation ornlsslons In the maintenance, operation or of providing professional health care services, Paragraphs (1)(a),M. (c)and fd) above do Use by you of equfprnent leased to you 6y not apply to any"bodlty Inlurl," arising cut of such equipment lessor, any providing or lalling to provide inclden(af The insurance provided to such equipment lessor medical services'by any ofyour"employees", is subject to the folldwIng provislons; other than an empioyed doctor, Any such a. The limits of Insurance prrovlded to such "grelE7loyee&" providing or Failing to provide equipment lessor M11 be lha limits vlhich you incidental rrled€cal selvices'during thelr,work n contract or hours for you will be deemed to be acting agreed to provide in the wdi(e agreement,or the limits shown on the Docla- within iha scope le lrela e to the Ont by y O TW]ons of this Coverage Part, whfohevor are or rbusining dutE related to ftto conduct of your business, Ws' 4• -rha fo(loving excfu.alon Is added to Para- b. Tho Insurance provided lu such equipment graph 2:,]"xrI'JsIor,s,of SECTION I—COY- Iessor clops not apply to any•lhodily fnfuryl or FRAGrs,cOVERACEi A BODILY INJURY "property danrageu caused by an"oocurrenre" ANA PROPERTY DAMME LIABILITY, Thal takes p4ace, or`parsortaf injury' or"ad gale Of Ahamraceultcals v'rtising Injuryn caused by err offense that is p carrrmiltad,after the equipment lease expires. "Bodily the vp lliful vioiatlon of a penal atafufedamage nor o. The Insurance provided to such equipmentordlnarsca relating(o the sale of pharmaceuti- lessor Is excess over any valid and coliectible cols committed by,or with the knowledge or other Insurance available to such equipment consent of,tha insured. (essor, unless you have agreed In a wdaen 5 The feilowtng I4 added Ia Paragraph 5. of contract for this lnsurance to apply❑n a prl- sr�CTION Il).-L 41TS OFINSURG,NCE: maty or contributory basis. 0, UIGIDN7AII�AIGAt-MALPRACTICE! For the purposes of determining the applfca ble Each occurrence Limit,all related acts or 1, The following Is added to the definition of°aG O[Olsslons comrTf9ad In the providing or fall- curreftco"In the DEFIAI[TIONG Section,; Ing to provide'Incidental medical services^to Unless ycu are In the buslnesa oroccupatien any one person will ba Considered one"co- of providing professional health care services, currenee°. "ocwmance"also means an act or omission s. The following Is added to Paragraph 0., rx eornmitted in provfdlrty or falling to provide cess Insurance, of SECTION IV -- COM, I 'Incdontal medicol services'to a person. �IMCIAL GEMMAL LIABILITY COM- 2. The following is added to (he DEFINFrI0T1S MRS; Section: 'Ihls Insurance Is excess over any valid and coliecu`ble other Insurance, whether primary, i "Inc[delital modloal sewlass"means; excess, contlngent or on any other basis,that a, ffedleal,surgtcnl,dental,laboratory,Way is available to any of.your `employes' for r or nursing service ortreafruent,advlr*or 'bodlly in]ury" that arisoa oat of providing or InsfrurfiDt,, or the related furnishing of failing to protjde'1AOdentat medical services° food or beverages; to any person to the extent not subject to b. The f j'mishfng or dispensing of drugs or Paragraph 2,a.(1) 1A SECTION tI --1NN0 IS dental or sttrgital supplleg Or AN INSURED. medical, N, PEIRWAL INJURY -- ASSUMED 13Y CoN- eppifences; TRACT c, First aid,or 1, The following replaces E;XOU310D e,,Cvrifroc- d, "Good Samaritalrservices. teal L,labf t ,, In Paragraph 2.of SECTION f 'Good SaMotan services"Walls any emer- COVERAGES -- COVERAGE 13 PER- genCy rnedioal services for which no❑Ornpan- SONAL AND A0WRTISINO INJURY I;—is demanded or recelved. FILI CY: ' Page 4 of 7 02013 The Travelsrs tndmmplly GoAvany,All d9hls reserved, 00134 58 0713 � Includes copyriphlod mate�4al onrisurance serVtnes OFtice,Ir4G.ullh Its peeirJssfon, ( i .. ............ .. ��. ......... i i.. COMMERCIAL GENERA LIA131€JTY � Palicyr Y530-'UG48425•TIA-t5 e, Contractual Liabllffy fthe insured and the Interests of the In- 'Personal inJury'or"advertising injury°for demnitee, whieh the insured is obllgated to pay 4. The follming replaces tha first subparagraph damages by reason of the nssumpLion of of Paragraph f of the definl(lon of "insured liability in a contract ar agreenrenL Tlils contract'in U)e DEFINITION$Socllon; eXalUslon does not apply to: f That part of ally othor contract or agree- (1) Hnbllity for damages that the Insured ment pertaining to your business(Mclud- would have In the cbsenC9 of the Ing an indemniffaat[M ora munlclpaRy In r contract or agreement;ur cvnner4on wJih work perform for a 2 Llablitt for damages because of mtsrhJOPA(ty)uncferwhtch you assume the i ( ) y tort Ilablflty of another party to pay for '�ersonal Injury assumed 1h a con- 'bodily Injury,*"property damage'or'per tract or agreement that is an insured sonal Injury Iv a thlyd person or organa a- contract",provided that the'petsonal ilon, Tort liability moans a liabffity ;hut injury"Is caused by an offehse com- would be imposed by law in the absence i mitled subsequent to[tie exeoullorr of ofany rontrac(or agreement, the Contt-act or agreernek Solely for f AMI;NOEO BODILY INJURY DIEF€NMON the purposes of liability asswrried In an 'Insured contract', reasonable at- The following replaces the definition of"bodily in- r tomeys fees and ncrx ssary 116gation Jury'In the DEFINITIONS Section; expenses incurred by or for a party 'fiodily In)ury" means bodily injury, metrial an- otherthan au insured%vill be deemed gulsh, mahfal Injury, shook, fright, disability, hu- to be damages because of"personal milfabon,sickness or dlsoase sustalned by a per- injurr,provided that: son,including death resulting from any of these at (a) Liability to such party for, or for anytime. the cost- of, that party's defense, J. BODILY INJURY TO CO-EMPLOYEES AND has also been assutlind In the GO-YOI-UNYEER WORICER3 some'Insured corutract;and The folla.PhM Is added to Paragmph 2.3.(7) of (b) Such attorney fees rind liflgallon SECTION 11--WHO 1$AN INSURED; expenses are for defense of That Paragraph(•1)(a) above does not apply to`bodlly patty,DgeEnst a civil or alternative Injury"to a co.'employea"fn the course or the co- dispute. resolution proceeding in "employee's employment by you or performkig which damages to which this la- duties related to the conduct of your business,or surance applies are alleged, to"bodily Injury"to your other'voiunteer workers 2. 7h4 following replaces the third sonieFice of while performing duffs related to the eohduot of your business, Paragraph•2. of SUPPL);E` ENYARY PAif IC AIRCRAFT GHART£EiEb WITH GREW Notwithstanding COVVfZAGESAANDB: Notwithstanding ilia provjsions of Paragraph The following is ridded to a dusion Q.,Aircraft, 2,b, 2)of Seafbil I—Coverage A--Bodily f n-• Auto Or 1Vatercr0t,In Paragraph 2,of SIECT€ON u {And Property Damage Lfnbifi ar Para- i—GOVhRAGF$—COVERAGE A BOMLY IN- jury N- J rY p y at)KYAND Pt2OP513TYDAMAGE 1-MILITY: graph 7.e.of Ser;Uon I--Coverage B.-Per- This exafoslon does not apply to an aircraft that tonal and Advertising Injury I-lablllly, such Is; payments loll not b a domed0 be demage n (a) Charlerod with crevvta any insured; because of'bodily Injwf,"pr pwty demega or°personal Injury`, and will not reduce the (b) Not owned by any Jnsuted;and limits of insurance fc) Not being used to carry any person ar prop- 3. Ttie follov4rly replaces Paragraph 2-d..of erty fora chargo. S1.IpFLEMYzNT•AIZY PAYMFNTS — COVE=-EZ- I-, Nola-OWNED WAT'ERGRAhT AGESAANp U' 1F The following replaces Paragraph (2) of FX- d. Xd. The allegations Jn the ""if end the [n- clusfon g., Aircraft, Auto or Watercraft, in formation we tmrnY aboutt tho "ocurr- Paragraph 2. Df SECTION I—COVERAGES rerice"or offense ars such that no conflict COVERAGI; A 1300ILY INJURY ANQ appears to exist between the Interests of PROPERTY DAMAGE L MILITY; GG P458 ur 13 *203Ths Travefom Indamal[yCornpahy.lulrighlsre9arved, Pa je 5 of T intludas capytlghtod tnatr3iel of Ins uranaaServltes pffica,Ina uiifr iEsparrn;sslun. • ' ) ' S1 •I I 1 l l C044MERC1AL GENERAL.LIABILITY policy; Y6730-1Eo48425411 IG J (2) Awatercrattyou'do not own that Is: e The following provisions apply to Paragraph (a) Fifty feet long or Ie55;and a.above,but only for itis purpoaSes of the in-, surance provided underfhls Coverage Part to (b) Not being used to carry arty person or yoU or any insured INIed In Paragraph 1.or 2. propelty far a charge, of Section If• Who Is An Insured: 2. The fb0mving Is added to Paragraph 2. of (1) Nodes to us of such`occwrance"or of- SEG'r10N 11. WH0 16 AN INSURED; tense must be given as scan as practice- Any person or orpanlzafion that,with your ex No only after the"occurrence"or offense press or Implied consent,either,uses or is re- is known.to you(If you are an individual), sponuMe for the use of a watercraft that you any of your pariners or rnembers who is do not own that Is: an Individual (lf you are a partnership or i (1) Figy feet long or Ion;and Jnlnt venture),any of your managers who Is ah individual(If yoU are a Ilmged llability i (2) Not befpg used to carry any parson kircompany),any of your ftustees who Is an ' property#or acharga. lndlvIdual (If you are a trust), any of your j INGI7CASED SUPPLEMENTARY PAYM-14TS "execufive officers"or directors(if you are I 1. The failoyfing replaces Paragraph 9_b. of alt organizatlon other lhah a parfnershlp, I SUPPLrzMENTARY PAYNIE NT`S — COVER- Joint venture, limited llabillly company or AGES A AND 13 of SECTION I--COVER- trust) or any "employee° authorized by AGES: you to give notice of an °6CCuf Cffce or 1 b. Up to $2,500 for cost of bail bonds re offense. � i ' quired because of accidents or Iraffle.law (2) If ycu are a parfnembip,Joint venturs,lim- � vlolaflons eflsintl out of the use of any ited)!abilitycompany orttust,and none of vehiolo to which the Bodily fnjury I.fAbllily your partners, Joint venture members, I Coverage applies.We do not have to fur- maaagavi or trustees are lndlvldtrafs, no- nish these bands, (ice to us of such occurrence"or offense 2_ The fo#lowhty fepjaczs paragraph I.d. of must be given as soon as practiceble only SUPPLEMONTAkY PAYMENTS - COVER- afferthe'oaourmnce"or offense Is known I ALES A ANO fT of SECT1014 I-- COVF)t by, As� S: (a) Arty individual who Is; d, All reason©ble expanses incurred by the (i) A partner or member of any part insured at our request to assist us In the n6rship otICK venture; lnvesllgaflen or defense of the claim or 'suIV,Including actual loss of aMings up f ii) A manager of any Itmited 1MVIly to $5500 a day because of tim© off from company; work. (fig)A trustee of any lrttsf;or N. MEDICAT-PAYMENTS--INGREASrD L(MIT (iv)An axocutiva officer or direotor of The foUmvIng replacos PArapraph Y,of SECTION any o(ifar organi-iation; Ill—LIMITS OF INSURANCE, that Is your partner, jobrt venture T. 8ubj(wf to 5. above, the Medical Fxpensa member,managerorfrustee•,or LWIt Is the most we%4111 pay under Coverag4 C,for all mcdlcal expenses bacausa of"bod- (b) Any "9mployge" aulhorizod by such Ily fnjury"susiNintA by any one peraosi, and partnership, Joint voitftlre, �mJted )I- will Iwill be the higher of: ability oompahy,trust or oifter organi- I xabon io give nDdca of an 'o=r- (a) $10,0013;or ranee"or offense, (b) Tha amount shown on the laeC)aMfion$of (S) Notice to us of such occurrence"or of- i this Coverage part for Medloal Fxpense tensa will be daomod to be given as soon Umii, as pracuoable If It)6 given In good fem bra O. MOWLEDGC AND NOTICE OF OGGUR- soon as practicable to your workers' RENCE OR OFFMI1 Cornpensa0Qn Insurer.This applfes only If The follovAhg Is added to PAragmPh 2-, nutles In you s"b_5egLenny give nofiee to us or the The went of Occurrence, Offeltse, Claim or occurrence or offense as upon as prsc- Suif, of SfrcTION Iv — COMMERCIAL GFN- ticable,after any of the porsohs described ERAL IJABILMYCONDITIONS: In Paragraphs e.(1)or(2) abave dlscov- Pagb 6 ori C�2013 The Travelers lfldarnRlry Company.M 69111s teservsd, Go D4 513 OT 13 Iht�t es copyrighted mafedat i0riwratl"s Seivlees W ab,ttnc,v/Ah Its petmisslon, I i .. .. . i Caly MERCIAL GCJJERAL LIABILITY , Policy: Y630-4B049425•Y1A-1S ars thrit the "occurrence"or offense roay your rights under this Insurance, However, (his result: fn sums to vAilch lite insurance provision does not affect our right to oofleet addl- prQvldad Under fhls Covwaga Part may Ronal pr¢mlurn or to exercise Dur rights of aanc�el- apply. laden or nonrenewal In accordance with apprlca- However, If this pogq imiudes an endorse- bla insurance laws or regulatiahs. MW that provides lirnitod coverage for"bod- RFASONABLE FORCE—13001f-Y INJURY OR fly InJtrr/' or "prupetfy damage' or poputioA PROPKRTY DAMAGE costs adsing out of a discharge, release or escape of"pollu(ents" which Con(alus a re- The following replaces Cxciuslon a•,Expected Or gulrement that(he dlsctl 9o, relew%o or es- Intended in)ury,In Paragropfl 2.of$E.CTION i-- cape of"pogUlanie must be reported to us COVERAGES w COVERAGE A I30DILY (N- NyMn rx spedfic BLIM al' of days atter !is JURYAND PROPFERTY PAIYAGE LIABILITY: abrupt aomrneocerriont, this Paragraph a. does nutaffecf lhatreg3llrsrraznt, a. LXpeott'd or lularided Injury or Damage P. UNINTrNTIONALOMISSION `andily lnjuty"or'property damaga"oxpeotad The foliowrng is added to Parograph 8., Repre- or Intended frons MA standpoint of the 'ih- senfations of SECTION IV �- COMMEROJAL surod.This oxcluslon dais not apply to`bod- C�1r11- At,1-tADILITY CONDITIONS: Ify i~or"property damage"resulting from The unintentional omissian of,orunfntenlinnaf eh lha use of reasonable ford (a protect any ror In,any infotma(lon provided by you why rye person or property. relied upon In Issuing this policy 4vlll not prejudlco i i i 1 CG 04 58 07 13 a2ot3 Tho rmvetpAs IndstrMy Company,An rtgfris feserved. Page'?of Y includes coo7ighted rmtarlaf at lnsWahce Sarvloes Office.rho.With IIs parrMs4orr. - 1 I r COMMERCIAL AUTO Policy:Y-810-11=052836-TIL46 THIS INDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -- PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE � This endorsement modifies insurance provided under the following, I. BUSINESS AUTO COVERAGE FORD i PROVISIONS 2. The following is added to Paragraph 13.5., Other 1, The following is added to Paragraph A.'I.c., Who Insurance of SECTION IV •- BUSINESS AUTO Is Aii Insured, of SECTION 11 COVERED CONDITIONS: I' AUTOS LIABILITY COVERAGE: Regardloss of the provisions of paragraph a. and i• Any person or organization who is required under paragraph d. of this part 5,Other Insuranca, this a written contract or agreement between you and Insurance is primary to and non-contributory with that person or organization, that Is signed and applicable other insurance under which an addi- executed by you before the "bodily injury" or tional insured person or organization is the first "property damage" occurs and that is in effect named insured when the written contract or 1 during the policy period, to be named as an addi- agreement between you and that person or or- tional. Insured Is an "insured" for Covered Autos ganization, that is signed and executed by you Wabi#Ity Coverage, but only for damages to which before the "bodily Injury" or "property damage" this Insurance applies and only to the extent that occurs and that is in effect during the policy pe- person or organization qualifies as an `Insured" riod, requires ibis insurance to be'pdmary and under the Who Is An insured provision contained in SECTION 11, non-contributory. i 4 CA T4 74 02 95 02015 Ths Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighled material of Insurance Services Office,Inc,with Its permisslom i I i• COMMERCIAL AUTO Policy.Y-810.11=052936-Tt L-9 6 THIS ENDORSEMENT CHANGES THE PDLICY, PLEASE REAR IT CAREFULLY. i BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement madifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage.However,coverage for any injury, damage or medical expenses descrlbed In any of the provisions of this endorsement may be excluded or ; Ilrnited by another endorsement to the Coverage Part,and these coverage broadening provisions do not apply to I the extent that coverage Is excluded or limited by such an endorsement,The following listing is a general cover- age description only,Limitations and excluslons may apply to these coverages.Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights,duties,and what is and Is not covered, A, BROAD FORM NAMED INSURED H, HIRED AUTO PHYSICAL DAMAGE--LOSS OF USI~`-"INCREASED LIMIT 13, BLANKET ADDITIONAL INSURED i TRANSPORTATION C. EMPLOYEE HIRED AUTO 1. PHYSICALStPHYSICALDAMAGE -- EXPENSES--INCREASED LIMIT D_ EMPLOYEES AS INSURED J. PERSONAL PROPERTY E, SUPPLEMENTARY PAYMENTS--INCREASED K. AIRBAGS LIMITS L, NOTICE AND KNOWLEDGE OF ACCIDENT OR ' F. HIRED AUTO -- LIMITED WORLDWIDE COV- LOSS ERAGE-,INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION 0. WAIVER OF DEDUCTIBLE--GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS � PROVISIONS A. BROAD FORM NAMED INSURED this Insurance applies and only to the extent that The following Is added to Paragraph A.1,,Who Is person or organlzailon qualifies as an "insured" An Insured,of SECTION ll—COVERED AUTOS under the Who Is An Insured provision Contained (ABILITY COVERAGE: C. Section It- LIABILITY f Any organization you newly acquire or form dui G EMPLOYEE HIRED AUTO Ing the policy period over which you maintain 1. The following is added to Paragraph A.9., 50% or more ownership interest and that Is not Who Is An Insured, of SECTION Il COV- separately Insured for Business Auto Coverage. EKED AUTOS LIABILITY COVERAGE- separately under this provision Is afforded only un- An "employee"of yours is an "insured"whlle til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganfzation or the end of the policy period,which- contract or agreement in an "employee's" ever is earlier, name,vrlth your permission,while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURBD ness. The following is added to Paragraph c. in A.7., 2. The following replaces Paragraph b. In 13.5., Who Is An Insured, of SECTION 11—COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who Is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age,the following are deemed to be cov- that person or organization, that Is signed and ered"autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "Property damage" occurs and that is In effect rent or borrow;and during the policy period, to be named as an addl- (2) Any covered"auto"hired or rented by tonal insured is an "Insured" for Covered Autos your"employee" under a contract in Liability Coverage, but only for damages to which an "employee's' name, with your CA T3 53 02 16 0201,5 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted rnatettal of Insurance SerAm oiflee,Ino,wilh its permission, i COMMI-RCIAL AUTO Policy:Y-810-16052936-TIL-16 permission, while performing dut#es (a) With respect to any claim made or"suit' related to the conduct of your busi- brought outside the United States of tress, America, the territories and possessions However, any"auto"that is leased, hired, of the United States of America, Puerta rented or borrowed with a driver is nota Rico and Canada; covered"auto". (I) You must arrange to defend the 'in- sured"INSURED against,and Investigate or set- tle any such claim or"suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured,of SECTION 11--COVERER AUTOS tions. LIABILITY COVERAGE: (It) Neither you nor any other involved Any"employee"of yours is an "Insured"wh)le us- "Insured" will make any settlement Ing a covered"auto"you don't awn,hire or borrow without our consent. In your business or your personal affairs, (iii)We may,at our discretion,participate E. SUPPLEMENTARY PAYMENTS—INCREASED in defending the"Insured" against,or LIMITS In the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2j, "suit', of SECTION 11—COVERED AUTOS LIAI3I1-- (iv)We will reimburse the "insured" for ITY COVERAGE; sums that the "Insured" legally must (2) Up to $3,000 for cast of bail bonds (in- pay as damages because of"bodily cludtng bonds for related traffic law viola- Injury"or"property damage"to whlch tions) required because of an "accident" this Insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described In Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, SECTION 11 — COVERED AUTOS l" of SECTION 11—COVERED AUTOS 1-]AI31L- LIABILITY COVERAGE. ITY GOVERAGR: (4) All reasonable expenses incurred by the (v} We will reimburse the "insured" for 'Insured" at our request, including actual the reasonable expanses Incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITER WORLDWIDE COV- "suit", but only up to and included ERAGE--INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) In Para- graph G., Limits Of Insurance, of graph 13.7., Policy Period, Coverage Territory, SECTION II -- COVERED AUTOS of SECTION IV -- BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not In TIONS: addition to such limit. Our duly to (5} Anywhere In the world, except any country or make such payments ends when we have used up the applicable limit of Jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the Insurance In payments for damages, United States of America applies to and pro- settlements or defense expenses. hlbits the transaction of business with or (b) This insurance Is excess over any valid within such country or Jurisdiction, for Cov- and collectible,other Insurance available ered Autos Liability Coverage for any covered to the"insured"whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver fora period of 30 days or less (c) This Insurance Is not n substitute for re- and that is not an"auto"you lease, hire, rent quired or compulsory Insurance in any or borrow from any of your "employees", country outside the United Stales, its ter- partners (if you are a partnership), members ritories and possessions,Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4• d32a rha'rravalara Indminity Company.All rights reserved. CA T3 53 02 15 Indudes copyrighted rnsierfal 4)f insurance Ser&e8 office,Inc.%&iitt Its permission. i i l COMMERCIAL AUTO Policy.Y-810-1E05293AD-TIL-16 You agree to maintain all required or (2) In or an your covered"auto", compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered"auto". i local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will coverage, not invalidate the coverage afforded by this poJlcy,but we will only be liable to the K. AIRBAGS same extent we would have been liable The following Is added to Paragraph 8,3., Exclu- had you complied with the compulsory In- sloes, of SECTION til — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It Is understood that we are not an admit- Exclusion 3.a, does not apply to "loss" to one or led or authorized insurer outside the more airbags in a covered"auto"you own that in- United States of•America, Its territories flate due to a cause other than a cause of"loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.15. and A.1.c., but ada.We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that"auto"is a covered"auto"for Compre- for compliance In any way with the laws hensive-Coverage under this policy; of other countries relating to insurance, b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE--GLASS ranty;and The following is added to Paragraph A., Deducti- c. The airbags were not intentionally Inflated. bre, of SECTION 111 — PHYSICAL, DAMAGE We will pay up to a maximum of$1,0D0 for any COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass Is repaired rather than LOSS replaced. The following Is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL.DAMAGE—LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE y-INCREASED LIMIT Your duty to give us or our aulhorized representa- The following replaces the last sentence of Para- live prompt notice of the "accident" or"loss" ap- graph A.4,b,, Loss Of Use Expenses, of SEC- plies only when the"accident" or"loss" is known TION N!—PHYSICAL IDAMAGE COVERAGE; to: However, the most we will pay for any expenses (a) You(if you are an individual); for loss of use is$65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident'. (c) A member(if you are a tlmited liability corn- 1. PHYSICAL DAMAGE -- TRANSPORTATION pany); EXPENSES--INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence In Para- manager(if you are a corporation or other or- graph AA.a., Transportation Expenses, of ganization);or SECTION III -- PHYSICAL DAMAGE COVED- (e) Any"employee"authorized by you to give no- AGE: Hoe of the"accident'or"loss". We will pay up to $60'per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense In- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered"auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONPI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., Cover- S. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery wo may have Personal Property against any person or organization to the ex- tent will a u to X400 for"lass" to wearing a - tent required of you by a written contract pay p g P signed and executed prior to any accident' parel and other personal property which Is: or"Joss",provided that the"accident"or"loss" (1) Owned by an"insured',and arises out of operations contemplated by CA T3 53 02 15 0 2045 Tho Travefers Indemnily company.AIJ rights resenvad. Page 3 of 4 includes copytIghfed malerial of insurance SeMoes Office,Inc,with Its parmissbn, i i COMMERCIAL AUTO Poliny,Y-846-1EO52936-TIL,-16 i such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated In such error in, any Information given by you shall not wntraet. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The foflowing Is added to Paragraph 13,2., con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION fV—BUSINESS AUTO CONDITIONS: . I I l i rk• Page 4 of 4 0205 The Traveler4Indemnity Carnpany.AI3 dghts reserved. CA T3 53 tit 15 Includes copyrighted material oilnsurahce servlws office,Inc.vrlth Itspermissl0n, r s II ' I l „ ��r woRKERscoMPV-,NSA.M14 .t x AND oars 7oara simV Fh9Pl,C)YERS LIM4LITY pQk1GY n,&AFroRDr Ci' 06x63 , ErST30RSl?trlFhtd WC GD G3 43(00)_OX f0L1CYldUI�4li4�1�, y'T7`rat�UB�4kff4�63.8-16 WAIVF-R OF OUR RIGHT TO MOVER FROM OTHF:Rs f�NpaW3EIAI 'F We,have the fight to recover our paymah(u(mm ahyorye 061e for"Injury covered by thio Policy. We wil not ernfotM our tight against the perwjn or organlzalion hunted In the schedule. [This agreen3ent applies only fo the mtehtthot yuu Pefform%YOTi under 61 written consrao(that requires yoV to obtain this agre8mentfrom ilsr) This agroemont shill not operate d1'reariy or indirectly to belleril any one not na med in the schedule. ; SGH El]tJl.r; AESiGNATIEP pl~'KSot`t: . t kTX kb R5o}r QIZ 0R041ilZAT1011 PDR CWCEr TV9'fh'911Rh'A RA61 ACRE r5I3 Br WRxxTEN CoA'XR)k ' L'U1 D IRTOR 1686 IxO r t i • iWfEOF ISSM; 07-01-963 STAsSIGft; 1 .I ` ' LWORKERS COMPENSATION AND O}7E TOWER SQUARE EMPLOYERS LIA81LI7Y POLICY MTFORD, CT 061$3 ENDORSEMENT WC 00 0313 (00)01 POLICY RUMBER; (MMUB-11?01365-1-16) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT M have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (Thjs agreement applies only to the extent that you perform work under a written contract that requires you to obtain Ihls agreement from us.) This agreement shall not operate directly or indiruclfy to benefit any one not named In the Schedule, SCHEDULE DESIGNATED PERSON; DESIGNATED ORGANIZATION. MY MRSON OR ORGANIZATION' FOR PIRICH THE INSURED HAS AGREED BY WRITTE14 CONTRACT EXECUTED PRIOR TO L055 TO F13RNI9A TH18 WAIV H. DATE OF ISSUE; 02-15-16 ST ASSIGN; i UMSRF'[_LA JfQiityt YSM.GVP-1E36473s-TlL-16 (3) Any statute,ordinance or regufation retat borrow while it Is being used In your husi- Ing to the sale,gM distribution or use of Hass. aIC°hotcb ' (tone ofthe fallmN*ig Is an insures under(1) This exclusion applies only If you are in the or(2)above: business of manufaclurins, disfiibArig, seg- (a) Any person employed by or engaged Ing,serving orfurnlstring Glcuhollo beverages. In the duties of an auto Galas agency, This excluslon does hot apply to '"bodily tn- repair shop, service station, storage Jury"cr°properly damage"to which any poficy garage or public partdng pf ace that , of "underlying tnsurance" listed in tf ee you do not operate, I: SCHEDULE OF UNDERLYING IRSURANCr (b) Tho awnar or lu:5see or any "auto" of(he DECLARAkTIONS of Otis Insurance, or hired by or for you or luaried to you, any renewal or replacement Ihereol-, applies and any agent or employee of such of would apply but for itia exhaustion of ds timer or lessee, limits of ilability,Covierage provided will follow the same protislorrs. terrrls, definitions, ex- b• �xooptas respec(s lire"auto Wwd% c(usfgns, limitations and conditions of the pol- (1) Yourexecuiive officers,employees,dlrec- fcy(les)of runderlying Insurahce°Ilsfed In the tors of stockholders whtla acting within SCHEDULE OF UNDERLYING INSURANCE ilia scope of their dutles;and of the DECLARATIONS of this fnsurahce. (2) ,qry person or organtzation Whlla oc.Ung , SECTION N—YVI40 IS AN INSURED. as real estate manager for you. 1. if you are deslgnaled in the beelarotlons as: a. Any orgaalxadon you twwly gequla or farm, a_ An lndi iduai,you and your spouse are in sur- other than a partnership or Jolntventure,and eds,but only h4 h respect to the Conduct of a over whlch you maintain ownership or malar- bUEfn of whict3 you era Elia sofa ewnor. Ity Interest,tivlll b6 dammed to be a Named In- sured.However,cove b. A partnership or Joint venture,you are an In- sured, does Dot apply to:Yout members, your partners, and (i) Rodify Injury'or properly darriaga" that thou&pouses are also fnsureds,ht only with occurrod before you acquired or formed tesetto pethe Don duct-of yourbuAness. the orgahlzaifon;and , a. A lunched liabWly oompany, you are an $1- (2) "Personal lnJury' or "adveriistng Injury" sured, Your rri tubers are else irisureds, but arising out of on`offense"committed be- oniy with respeot to 1:h4 conduct of your bust- fore you acquired orformed the.orgarka- Hess,Your managers are insureds, but only tion' I vhth respect to their duties as your managers. d. Any person or organization having proper 1 d_ An organfzatfon other than a partnership,Joint temporary custody of your properly if you die, venture or limited liability company,you are b4tonrY, Ian insured. (1) With respect to liability arising out of the e, A trust,you are an insured.Your trustees are maintenance or use of that proparfy,and also insureds, but only Milli respect to their (2) Until your legal representative has been duties as trustees. appointed. 2. Each of the fallowing is also an Insured: e, Your fecal repraserrtative If you die, but only a. As respells the"auto hazard': with respect to duties at;such,That r6presetr- tative wilt hate all your rights and duties un- (1) Anyone wing an "auto"you own{We or day thts insurance. burrow Including any pencil or organize- flon legally responsible for such use pro f. Any other person or Organization insured un vidod it IS with your petmisslon,and der any polloy of the undeitong Insuranca" IhAed in the SCHWUf_l; OF UNDERMNG (2) Any of your executive offlocus, directors, INSURANCE of the DECLARATIONS of this 1 partners, ernploya9s or stoc•Lfirofders,op- insurance for whom you have agreed In a j erating an auto"you do not oft, hire or writtan contract executed prior to Joss to pro- vide Insurahce.This Insurance is subject to alt Page 6 of 13 Copyright,The Travelers Indurcmnity Curnpany,2003 UM 00 0111 03 1 l 1 t UNWRGLLA i Polley: YSM•cuP-'f�3G4735-YiC.•4B the llraltadons upon coverage under such P0I- Non cumulafJoh of Personal and Advertising Irr lay of"underlying Insurance', and, the limits jury Ltmit if"petsonat Injury"andlor"advertising of Insurance afforded (o such person or or injury"is If by any one person or organl- ganfzatlon will be: zai[on during the policy period and during the pol- (t) The. ci fi`ererce bohvaen the "undertying Icy period of one or more prior andlorfuture poli- i Insurance"limbs and the min[rnum limits cies that include a GQMA'ERCIAL EXCESS LIA13ILfTY(tj4r[BKELLA)INSURAN00 policy of[nsurur,c which you agreed to protide; for 1 i the Insured issued by us or any afflllaled Insur- I or ante company,tha amount we wilt pay Is limited. (iii) Tha[[mhs of Insurance of this policy This po[Icyt Vorsuhdt and Advertising f njury Llrnft whlohever Is less, will be reduced by the amount of each payment _ IF the minimum limits of Insu anc�you agreed made by us and any affiliated insurance company lrndpr the other policies because of such °per to provide sueh parson or orgahizatlon In a sonal injury"andlor"adverifsing injury'. extttan contract are tirfho1yW1h1n the 'underly- Ing Insurance";this policy sba)I not aPPly 5. subject to z. or 3.above,whichever apQliesr the No person or organization Is an'Insured wllh re- Each Occurronce Limit is the most we will pay for sped to tite conduct of any current or past part- the sum of damages under Coverage A heoausc of ell"bodily injury"and"propetiy damage adslny nership or joint venture that is not shown as it oufofanyone"occurrent© Named lnsumd in the DorArfiliona. l to person is an lnsared as respects "bodily fn- Non cumulation of f=ach occurrence Limit--If ane "occurrence"causes "bodily[njury° andlor"prop-- jury` to a fellow employee unless hFairence for "damage"during the policy period and during such liability Is afforded t)y the"underfyfng insur the policy pedod of one or more prior andlor fu- once", tare poklaa that Include a COMM1=RCfAf. RX- 8E0,T[ON lit-LIMIT'S OF INSURANCE. CUSS LIABILITY (WARRPLLA) 114$URANCI~ 1. 'the Llmlfs of Insurance shown In the Dacl'dratlohs polIoyfot the Insured issued by us or any affiliated and the rules below fix the most We will pay re- Insurance company, the amount we will pay Is gardlese of the numberof, lfmitod. Th4s pollcy'd Each Occurrenoo-Limit tiWl j A. insureds; be reduced by the ara>,unt of each payment made f by us and any affillatod Insurance company randor j b• Claims made or"suits"hroughti or fhr;other poll cies becausa of such toccufrence"r a, persons or organizat(ons making crainis or To datohnrne the lltnit oP our liability,all"bodily injury" bringing'suits'. and 'property damage° urfsing out of oontinttous or i 2, Tiro Products-Completed operRtlorls Aggregate repeated exposure to the lama general cond1lons j Limit is the most we will pay under Covorage A shall be considered one°occurrence", for damages bemuse of injufy and damage in- The lfm[ts of this Insurance apply separately to each � eluded In the aproduds-comple[ed operations consobulNe annual period and to any remalnlng hazard" perlod of less than 12 months. The pot{cy period 3, Tha General Aogyegate Llrnft is the most We wll{ beylns with the effective date shown in the Daclara- pay for damages under Covemgo A and Cover- ffgps.If the policy period Is extended after issuance age B,except; for an additional porlod of less than 12 months, the a, Damages because of Injury end darnaga In- addiflonal period wilf be deafrred part of iha last 4 duded in the"produots-completed operavons prooedlnli pad❑d• j hazard",and SECT[ON 1V-,CONDITIONS, b. DamBq" because of Injury and damage In- t, APPEALS. duded in the"auto hazard". a, if the insured or the,Insured's'lrndadying In- d. Subject to�.above,the Personal and Advardsing sural"elects not to appeal a judgment which injury Urrn't Fs the most we w141 pay under Qovar- exceeds the"applicable underfylrx,I IImiN`,we age I3 for the sum of all damages because of aii may do so. "persohat Injury" and an"adve1stn1 injury" sus- p. If we do, we will pay a costs of the appeal. tainod by any one person or vrgarzratioft. We Vh also pay all costs on appeals related Uhl no 01 it 03 Copyriaht The Travelers indemnify Company,2003 Page'1 of 13 i I A r Uf,�I�RELIA 1 PQL1G1tNUt�iisF�z ysih cup-iE iBA735 TrI.i6 ISSUE DATE:02-01•19 rHrs V-N00R8JMr—NT C(IANGE8 THF-PoucY,p»H WAD rr CAREFULLY AMENDMENT - QTHrEk INSURANCE Dr-SIGN, TED PLRSONS OR ORGANl7-A.TIONS rOR WHOM YOU HAVE AGREED IN A.WRITTEN GC NTRAGT To PROVlDr INSU ANCH , i Thls ondmumetA amd&s Irigur.nm provided unABr the fol loWing; 1 COM&4ERCIAL E ESS LIADII-lY([J lJBRELLA)INSURANOE t ScHrnULr OF p£SIGKATED PERSONS OR DRGAWKFIONS , Person or nrya-r,Txaflaa: '• 9EFI W. TY 01 r � I 1 I , Pibled or Locatfort: I i r 's PROViSION15 or Iooaflon shown In that ecbeduls,ff gia WdKo,dvn� a Ybe fo!(rrNlflg[e added to paragraph 10.,!THEA Ili- Gant In vrh(ch you have agreed to provide insuranca "RANGE.,ofM-MIOMIv—CONAMOWp .: for that person or organzation spaclf(eal)y requires , However,fns arty perscxr ar nrganizat#onshavni In the that this lnsuranoa apply on a primary basin or a Rd_ mary iwd halroatdtlbutory bass, this Inw unca Wll St�redule Of psslgnalad Pprsohs Or Organlzatlans appy as If othwinsurance avagabte to eW persnr+ur f that qualifim as an Insured under Puagroiph 2_i, of orgahlMIQn Wder wh4r.Fi that parson Of organization SrETIaN it--!'I ko is AA IN$UAM for the pro ect TIM—as a riattrod Insured does pot eYJSt,and we WA 66 39 0214 razmvm Travel-�r6 inhwiRy Oompary,Allrla4wronrved. F'aga q of 2 i I _. . . _• . 1 3 € j t UM R RCt1A i Policy: YSh5-CUP-11=36473G-Trl_-1s will pot share with that other Insurance, Sur Us incur- which covers that person or organization as an addi- ance SUIT is oxcess over any vaUd and calls-dbte other tional innssad or as arlY other insured that does not Insuronce, wheftior sueh lnsuran- is stated to be quality as a narnod ins md. primary,contributing,excess,contingent.or othewAse, t . p� I - i ) I f ' � I " i .. f i i t page 2 Of 2 014 06 DD 02 14 1 I " COMMERCIAL GENERAL LIABIL;TY I POLICY ISAUE DATE. az-ol4t; i THIS ENDORSEWNT CHAWGr, T1�-P0L.ECY.Pf-FA8F RrAD IT CARF- UY, 1 i Thla endoraoment[nod}fies Idsuratica proOded under the folloi4 . color RC3GAX, lw,E;a lJat3x m {DMBR" wix xt1Su'pla Ck Al 1$DHEt C 0pt:R AINxGt7�,1" PXMQR1l OR ORaAffta=108 FOR WRolx YOU KWII ?arm]) xti A VRST=CONThkcf Yu Nk mj! x9;5(r TcN I , PPltgort OR dRGAti> A7CXoki ANY prXz,90�" 09 uRGWX2M-109 VAT QQ$LxP')XO AW A0 7CN,91 43 MWk )?ARKGHAYX 2_y I' 0 zs Aa 78SI P i pRpurcx OR tooATIOM, t 1 JIRY •PRp7ACx FOR A lyRRSDfT OR ORGAtTY,'GYe'r7C017" TFfXR' Tg SH4SVi7 XlT TIMI P)IISd1T 4R = ! 0R0,hfUynXAnTHIyO�l7 lUCTIOlf OY VITS 901M )+ , XLs txa k'k txmy Coki�RAm m 14iaol XO•U �Avr loR�.PI. 'ro RR6'ff1DK uTSLTRfog N'OX YKX!.L,, k)3"ON OR 'fty ? j Piwlyi= p9oVZbm HY TIM pojf lcy To i MC{ p)7 ,`i))( 0)j () 92WrzX'TXOt7"JILY ON' A PBTta"Y D,AGXffi OR 0, kRTIAXY YND 1 N0)T--(:=RXBU'XORy aASzs'. , i • f , 1 I� • . 1 ' PR{]C�UCi R WMM ON WMON9W VC 66C co TC of Pape 1of x 's J I 1 E i UMBRELLA C � POLICY NUMBER;Ysrn cur-a� sar�s-T►�T� f55UE bR'Ca �z-oT•�� THIS]ENDORSEMENT GHXNGF-8 THE POLICY,PLEASE READ 1•1 CARf;t'Uj.M WAIVER OF TRANSrrR OF MKS OF RUGOVERY ! r AGAINST OTHERS TO US � Thia eitdnrsefnArrtrnadEHes lnsuranre provided under{ha rollolaing; COM[ rRGIAL EXCEBa LIABILFW(OMBRELLA)INSURANCE f Is BCHF-Dl1L1= f j N.gmo of poraon(s)or 00a0['La110n(s): i S� T8 dA _ I i 5 t . t i i rf ' li i Wewalveany rightaOfrecomymmay Nye ayalmt c-, "YoOrwork" or'your produW' vrithtn the "prod- ahy persons)or orggn1zu1on(sj shovm to the Schad- cots-wmplefed operm4ons hnzord;or u1e ab❑m baaause of payrnents wa make ror"bod;fy a, `rho"auto hazard°. Injury","Prapedy damagf�'personal laj y"or"-dvop &,ftAnjcuy"ad ,singoutof '�ewalve these rf9htsonly 44+ttera you have agrees!N du so as part of a mitten confract or ngreemont elr 0 Pramisea oymod byyoo,(emporarily oaoupled by teres lata by you b0brs,and fn effactwhen,tha"Host• ynu EvM pamr sslon or iho mvmr, Dr fa$sda or tly injury at'property damage°odors, or the "per•• rmfed to you; conal(njury°ot("ti or ladve+fFsrng injury"offense Is b, Of)gotn9 operattmns peTOrynad by you,orfln)YOlr mmmtlled, behaif, sirdar a oomfteat or agr6a"ff 10h Ihat Tha weber applies only fo Me person{s)or organlza- petaan or organ}zeUnml iion�s)tbuv n ki the Schedula above. • I , UM Q4 69 04 OR OMO The7rave1w Companies irta Pago t of f f 1 II CoMMERCK GMF.RAL IJAWQTY P0L(cYNUM8r::R; Ysf1-cUp.fIE3G4735.71�-1G I53llEOATt oz•or-[s I 7Nf� t1E]QRSEf�Et1i CHANGES TIDE POLICY.PLEASE RJAb (T CARWJMY. I 1 � i W,&'VRR OV TRWSF)H OF KOM5 OF RX0N'THX AgAMT OT13r&RS TO US This"orsarfteltt mvdffius Insurance provNed under iia fo(Ivmffg, Goj3muom )3=90 LXA$)lm (Fi68MT-h) X2SSURA'C� MT pTRSoo OR o)z,,l"�XZ'ATXOrr RSTR YWHOK YOV 14AV.V XMNYD XK A WIZIMtr dO2iT tx0' OR �(H�f� '!Q t�AXVX /Ot'A KOUT Ob R$COVFRY, B= OAY VOR PB.YMS X45 119 )NECAUSE OF'r Ii i.. 11130bYLY XITTUP)V' OR "VROPWRTY MIR(19° TIIAT OLIM,9r OTR 2, "PkksOtMD MW" OR °AbV%RTISXW W" RX'f By All OYPD0, ; CORKITT D) 1; XVTER YOU RAW .>s5MCVI7lo 9[`I Y 6)MACT OP Al5RMr4D , I • I i t r f PRODUCER,WXTVG g OP Wls=Ngpm XDO OFFfCE- 06� a��� uo f age 1nf X I 1 i I�I f k i r I 1 I� - POE:fc�'-h�JM��R; r•sao-i�0499�.5•TIEi•!8 tB�rJFfiA�• oz-nTwzo-rs � 1 , [HIf t�1�01fi ) of t�T G�i/it ai i p� Y. ,.P,�rAst,Ci 4p 'ARE C./}[ rye {�,.( I+�}�.lC 1y'h]��p-R(�t[�`{{ -1 f-• Nib?t}��}- ` �E off}.F ' :l Th7sendar*emerttmodi6einsvruceQrovtdeduncler ,eollowtRg: ; ;� egN,��[.f�:�[Qr�x tsU►r!p��gfpaJ;��Cgtlxpfle�xac�rtTErohr,.�d; �nN�,�NEiVt'�;�:• _N�?1gT�e�u���ysi�ot�:'e4�`tkotii'>;riatv��; �0• z I f .. i . gk5ANVA'E;W i t AXM PNR509 0J2 'WRO f YW,L% " XGIt P 3X-A HIR.x'fikld , cot cr rr Y� cr o�;17A4TUAT -Ate`T M. ,.•coir,Ab AM'l, < ri'k� SR fip MUM sure,xaTaclr MCT,UDM(;, r - Tom, PA)�OQvP'bg "61 OW64 gFt ORM i2jXU IN, .6 �Ert xb t t t�nx .]xsuxnn.>{ c�xyan k�rfd a >rs.� xa� c�t,c a xatr pi' pa-lea) my ' �`•.� ,���il�,svca iu£�f��ia��q���;��.��9�'��'bA'� �t>�,Q�. . I- XbOkL8 :rite'�1pnH,�,�S'�a1�•�sr�r,z�z�snrr o�tQR�ii.2ti7.�C��v'�eFAP�A �x'�11�&�Sx�a� P�uyrsfol�sr .. 7f>+ta �cof 3h�jcffeyifor any,5 10 Y,Pe1m1l� If."depoWtk4w.6Ni Pik PbAo forany sly , ted@�pi1,��Prf�$?l t�on�tal'?��t;�;E��,�1i?��, �Y��`R�lr.�i#fes Yeasyr�• .�b�sb�I'4i'dap's}� �arid h� s afd?asgll stiotiYq. v'oaPce�a4 n?n shovrifor Mbtbhl�vhfIh'theschad6iEat�BvrrR'v!o ; the w10 mall N*�jk o notoe;yal4q•ffierporsai,or r .t��bn�a the•pef,�eiy,orar�ehrz�gvj�s}ir� ii,��. nr•�;�+.�ra�r�ho��,sn f�e•��{,e�u�:above. �V� 1 s i}P u1 QY�. �Nn Wllf rng)f 5ci filrnr�o9 dlw will mafl su*no. En this-a¢ifross sfiovm•fn rhe t address obown In:tlie scho4ulq tit4a al feast 421 scfincl* pbov, �f feast thk pam'tet of du3"s• a [»7>l���`ref d�Y �6 'gaf35 l��sp rh�7 sh -&Ikro'r •sohedutiaihho}re 61M efaf �C�a`t :araan4 'ion rhe lm @; ►�' � �' ��� ,c�)fafta� xP 4�tt�fafe, - I II.T-4--0q f o ' a�r1�`srl+�ir� rt b rit.1Y PJ�?MK t"g�'f ofd i • i I POLICY NUMBER:Y-810-1E052936-TIL-16 ISSUE DATE: 02-19-15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED ENTITY --- NOTICE OF CANCELLATION/NONRENEWAL PROVIDED BY US This endorsement modifies Insurance provided under the following: ! ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 3o NONRENEWAL; Number of Days Notice of Nonrenewal: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: i 1. YOU SEE TO IT THAT WE RECEIVE A �. WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH 1 PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US i OF THE CANCELLATION OF THE POLICY AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF � THE APPLICABLE NUMBER OF DAYS SHOTIN IN THIS ENDORSEMENT. I ADDRESS: THE ADDRESS FOR THAT PER50N OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US, PROVISIONS: A. If we cancel this policy for any statutorily permit- 1:3. If we decide to not renew this policy for any statu- ted reason other than nonpayment of premium, tority permitted reason, and a number of days is and a number of days is shown for cancellation in shown for nonrenewal in the schedule above, we the schedule above, we will mail notice of cancel- will malt notice of the nonrenewal to the person or lation to the person or organization shown in the organization shown in the schedule above. We schedule above. We will mall such notice to the will mall such notice to the address shown in the address shown In the schedule above at least the schedule above at least the number of days number of days shown for cancellation in the shown for nonrenewal In the schedule above be- schedule above before the effective date of can- fare the expiration date. collation. IL T4 00 12 09 02009 The Travelers indemnity company Page 1 of 3 I • j r r I PQ(_tGtt�Y1t��B�Ft; YS]h.C:UP-•IC364738•YfL.fG li�'$�1)=dATFi bz-0y•2U96 �1.��F,�.•�lf'7��F.-.H•i+-•FY 4'A �•����Rt,F-:•Y� 1j Phis�ticfOtsARjQ{ji•1ri%�r�ties insu�ai;c��oyid�dUAdei'{ji�(bt�p+}1��, � • C1t�ifr;E[.fA7(did: 1�'utnbarPfi7ayS-�ofi�a•o�G3�ceflation: �4, !- , - � ; f1Q3�1�K�5�'IALc f,!iunbarof;;]��s�+oticn.ot�oni�netvaii,'�0•,° � i �ssoir 6irRt �}Carri rsxsicr�,�bx�#ai akr x•xx��•,raf� cnt7��kc�'•muA�r - . Irol xcm ov 0nxrc Lr )q qV- Vis,Harz x i J,. #;Ot�,9IyHLi Vbt,A�Y3[1(x7 13 fi 5f1''T6G s�'�S S.bhkiiE39 oY�'.��td i�);fitsa t ax q� 7s��7�'xdtx,,•Yr��R'���US�RsY'. is � � • R�cElvT�il a�zL •I�Rati T#5 y ' i• TF�3x�1UpgF9g FOR Tt3A� �'S,B$Q�; qR . f�RXSSt• �� 'i • ©RC,�txZ�S'YU�r �NC�'UJ�1�'�•�II(�•�(�;�:C.E[� � . {�R1,,,W phyF,Whmtotili'•,po,77Ai1~ K. IC•}Je,dsa a{q wTr aly ls•ptiI1F3 fP�d'xsl • 'tEG xdz�s¢n'othel ihah;npnpaynient of Pram lmr Tui}'P�Q Cason'and a 0Fqr4days is attd 8 nury�per days s� nr�A fD�D4 ioaf�j[3a1t P k�Wp for rtanrsnewal���lg sFlredt��atwoc �s ffia$: u}�aAfY(� ivn`rs�rrt§ �iagogpf'a7IIricoi WOO dggeJptkhelaafsr'r4)U;Cotljt��b[solryoj' lfOri b b.taloll b 4 f o h ffp fie n ghrri I'_ �Sad¢�e.sh6v N'g acheii}G above; 'e 4v}[Iri�f!suiII}j' ofioa.in'thri wil'ma$such rsoUoa fn:{he afess ghotvtiit•tb$ tkgse s�fd fi lq ff:e srh ' �1x?�e at'je�St the sti ed .44 96 A dash th,� oaWN"r Qf days � Irrttm' of days,shvwu tr,can0atW fn iha s vn for.nonrane to$0',Kfi dWe h5bVe ba- 's 41�: #rRVe;�edore.,fF �ffndl'vq fiats vj( g4 °fAMA?Vr$,tioa Me-, •�ekl�klatr� • 3 l I ' WORMRS CnMNSATION > ANIS P-MPLOY�,:RS LIABUT-Y POLICY , c uacxag FNDORSrMCNTWQ$9 Of?11 (A) POLICY14UMOFR: YVYriEr7O-W0006-t-15 {• NOTICE OF GANGMAMN r non payment of premium byy-J,Wo agree That no caneellaflon or Ifrnitation of this popsy shad beooma 115the raurnber of day's Writfoh huilco spaclfled in sfthi 2 of fhe sahorfule has been meile4 to you and to j Or or-gahlzallafc desigiiatett lh Rem 9 of the 8chedula et the address indleafecl. , i t ; SCNr=DULC AV M!tSr)It' OR oRGMazwxOx AtxTrf WHOX YOU HAVE` ilC61 15D M A YQ)<;YW8tr n=RAcx THAs Nux:CC£ OF CAtr`Cki]`,alrxclT oR-Lxvmx Tax7iLTRTT02�S O Z•Hxs kbzrxCX WM Bk' alvolfi )WT 4M x ; J. yOtr M TO ;LT T",V WB R=%-jYE A W4 t-� 1O'..9t1P'aG'A` TO PAQVIM gucEr ItOTTcx, ZNCLUmNo m omy AM Anmgaa Pk' 1311c : woox OP, r 0I.WAHTZATXONr OTER TgE MaT rixhJM 7 OMTRM Rerun a(axcea FROK I (YS Oy THg CASTOSLT,ATjOtr ox )MIM 10 )iXMTJ710N OY 'T#lff r Dltlr-Y) VID 2, 1#hCY�YVx: iffM WRIMN 3tPf s A VgS't' 3,4 AAXB BUMB TiiS G 1p or M, Ai?pi•MAMA. 1Y Xk oil DAYS 8a0w v THVq c I '1 flri Ai D)MBH Volt THAT PERS09 OR OROblilZA):SON ;1NCWMAJ) xK OV09 V4xx7r 2r kRQVEOT mom 7t'ori' TO its. ' of Uays Wditen Notice: 3 0 Addltlomal Days :rrsorit changes tha policy to vAilch R Is atfachsd and is of vMva on tho dale Issued unless otherwise I uffon balbw W required anlTwhon Nz;en�orsernent is:rived sUbsequettf Lo prepgfattoh of t E`fec o Policy h'a� FxrdDTSOMbnt NO. Premium$ i r- �mparry CnttntersLgned by,- ; i - 3Lil=: Rz-UT•7s STASSIGN; Mage 1 of ' 1 i . I• i f . r Fr { �+ )htr NKERSOMPI~1ISA't R AND Aje skok w EMPLOY)=Rs HABIt_ITY r011cY . x7, cr os�ss END0K8- 0,Vl7WC 48 66 01-(a) POLICY NtJMBEFz YIOYAPW R-f l=aa�sa,a-i s AffSGANSIN CANCELLATION AND NONkENEWAL rMD0R$MKRT dwwmeht dpprie$only to the insurance proylded by the poky bemuse WjSE'4hsln is shwm in item U. )formation page, ncellailori Stiction(l7)of the Pat#Six-Conditions Is Meted and repfacei4 by the follawmg.' irrelfafior� ' Yn,r niay conte; this policy,Yost mast ti-or ur delier advance writteh notice to us stating ti,:hen the c3rweNalf6n is la fake effect,If you purchase repfacernent insurance, Ilio caticokillon becomes effective ' ori the dais flim new oovawgo beaotnus effeetiVe, if no repf4Fernont covorugo Is purchased, the canoell4on wW be affectve tfilrty(30)days after recelpt ol`WRIten 1,cNo¢by the Wlsconsln Cornpensadon !. Rayng Bureau, 1'Ja may cancel this poIIV t-or any reason If{fie potroy has been in effect for fess than sixty(Gu)days.)f � the poky is Issued fbr a Perm fangecffian one yearorforan kideUte,tame,We may r•,snce$Ith9 pol;oy fol any reason on ori annual ahrivetsary Pf the pollay eflec[iva dnfa.We may cancel the pi)cy at any other limaforthelolimving reasons: = a. you-fel[to pay all prmlurrts'41611 due,however,Yre worst delver or mol,flral class, not tens tan !' thirty(m)days advrlhee-i,,iN ti3rl Aute staffnq when the oancellatfon is to lake effed, �. a material mtarepresontdtler,; 1" :. a substantial tveac-th oftba obligallons,rolldNuns orwarmpties undertho puflcy;ar i. a substanflal change fn!ho risk we,assumed under the policy uldea-s it we*reasombIQ for us t4 foresee the change orexpecttha tisk when ws Issued the polloy. F wE>exncel farf ny perrnrssihfe reason other than non-payroont of premfurn,wa must deliYer or mall,first jas6, notfass fhaAl ttrtrty(30)days neUw slating Mon the csncellafimrl fs to take effect Dual kV that off ce to you al your malling address shown In Ifeni 4 orlhe fnforrnation Paga will ba s€rlficlantio prove elite, he policy period%Ylr end on the day raid hour stated In a riollce of Moollal3ori. anevra;f 'oth have the tight tri have the lmwaho6 rdnewed unfeas We deliver or mail to you not fen(han*sbdy 50)dayA advanu©wrlden hoBcestafing out hlontlan not Ib rehe',Y this polfoy. !e do not have to ranow the frhsurarlce If you dQ not pay the renewal premix."billing by the due date vr}f m accept replacement insurance,are kieurad e 904ere,requested or agree to nonrenewal, or If the )llcy le expresoy d"Inhaled as being nonrenewable. we renew the insurahDo,we may*a the policy fomes,Mies ants railng-plans vre are thsh trelr o for 'Oar rfsks.We may Ibn11 Iha pelioy to a h!"equlvelant to the term of-Ria oxplrtng pollcy or one year �iGheve{i'sless, _ Iva alias to renMY tho pOry on lass favorable terms,we kYlY hiQ0 at-deliver written notice of the naw 7111 by firstdass mall to you,the palfcy holder, et least sl (04)bays prior 10 tha renewn]date.The =r/iniflon of"leans"doea not 10GMiy manual nates,experience m6diffegUorr fades, nr dess;ffogt pn of SsllE� oz o E-1s ST ASSIGN; r I , ............ i fr � f WORKERS MhIPFNSATIONANO ; iawsx Sr�uArc� EMPLOYERS UASII J-I`Y POLICY l IPPrW, Cr 05183 [ll - . ENOOKSE61ENTWC,4H ur 118(R) i'Of_fCYIaUM�Et3; 1771"llfiU6-'[l3t)d363-8-9G � .'. j if we provide such notice within sbdy(60)days priorip the ranratiwaf dafe,fhe new farms u1ll,ttotfflke effsct I urrM sixty(64)clays aftar vidtiert n❑tics Is mallod or daifvcrQd,fn which case,you,fha po1`.ay haldoT,may t afact to Mfit;6 tho rValow,at parley"I any NO during the sNfy(BO)day pedod,The n0co will]noludb a staternentnryourririhIlo caricef,if you elect to cancci Ute rvhewel poJicy dudog the sixty fGO)day p-dad, the refum pren)lurn or adMoual prwrdtlrn charges shad be colculated proppr>fohally on Bim bask of the nld pmmfrtrrms. We,need not trail cr delver us tiAUcc Iftfse orgy dhaiige adverse to yott is t£prarrrfahn ifrcfeose(haq(a)is fess than 25%;ar;lb)resuf tsfrohi a chfArlga based oat your acilon tbaf t1hufs ih0 tlature OAU extent of the rrsh rnsured arlainsk irrcltlft,btftnot fimf(ed 0,a changa bt theclasslfleefions forthe busfr:ess, i viritferf agreernentadfadied fo arid trade o parto€fho poiicy,bstWeen the insurance oarflerand policyholder ,h eXtetlds the canceffation or nonrenewal noilfieation timeframe, w;fl supersede the eroremetatloned f icatlon retiWotrmontsfound in Items A.3.1 arsd B.•i.,respectively. ; r i issue, o2-a�-1B S7 ASSfG}J; r r . i _ i A0 Document A310 TM - 2010 Bid Bond CONTRACTOR: SURETY: (pare, legal status and address) (Nance,legal status and principal place LA FORCE INC. of business) P.O.Box 1b068 Green Bay,WI 54307.0068 Liberty Mutual Insurance Company This document has important legal 175 Berkeley Street consequences.Consultation with OWNER: Boston,MA 02116 an attorney Is encouraged with (Name,legal status and address) respect to its completion or CJT1Y CF MOSS modification. 215 UIURGf AVE, OSHKCSH, WI 54913 Any singular reference to Contractor,surety,Owner or BOND AMOUNT: 57o CF 94XW BID other party shalt be considered plural where appl€cable. PROJECT: (Name, location or address,and Project number, if any) CTTY OF CEHKOSH uffp Project Number,if any: 233 N CAMPBELL RD, OSHKOSH, WI 54902 The Contractor and Surety are bound to the Owner in the amount set forth above,for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor either(1)enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be specified in the bidding or Contract Documents,with a surety admitted in time jurisdiction of the Project and otherwise acceptable to the Owner,for the faithftiI performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof;or(2)pays to the Owner the difference,not to exceed the amount of this Bond,bchycen the amount specked in said bid and such larger amount for wlmieh time Owner may in good faith contract with another party to perform the work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect.The Surety hereby waives any notice of an agrecine t between the Owner and Contractor to extend the time in which the Owner may accept the bid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60)days in the aggregate beyond the time for acceptance of bids specified in the bid documents,and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty(60)days. If this Band is issued in connection with a subcontractor's bid to a Contractor,the tern Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project: any provision in this Bond conflicting with said statutory or legal requirement shall be deeined deleted herefrom and' provisions conforming to such statutory or oilier legal requirement shall be deemed incorporated herein.When so furnishedieihei ntent is that this Bond shall be construed as a statutory bond and not as a common law bond. Sign a scaled this day of OMBER, 2016 LA FORCE,INC. (Principal) JONAH BI HRM — SECRHARY m) (Title) LIBERTY MUTUAL.INSURANCE COMPANY (S rely) (Seal) (Jpitness) (Title) Roxanne Jensen,Attorney In Fact AIA Document ASI Om—2010.Copyright 01963.1976 and 2010 by The American Institute of ArchRaclls.All rights reserved. THIS.POWER OF ATTORNEY IS NOT VALID UNLESS ITIS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein,and they have.no authority to bind the Company except in the mariner and to the extent heroin stated. Certificate No, 6914592 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company. West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire.&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire;that Liberty Mutual Insurance Company is a corporation duly organized Order the laws of the.State of Massachusetts;and West American Insurance Company is a corporation duty organized under the(avis of the State of Indiana{herein collectively caileii ihe'Conlpanies`j,pursu' (to and by authority herein set forth;does herebyrlame,constitute and appoint, Brian L.Krause;Christopher H.Kondrick;Jeffr@y R.Meisinger;Kelly Cody'Kent Arps;Roxanna Jensen;;Trudy A Szalewski all of the city of Green Bay state of Wt each Individually if there be mare than one named,its irue and iavrhtl attorney-in•fact to retake,execute;seal,acknowledge and deliver,for and on its behalf as surely and as its act and deed,any and all underfakings,bonds,recognizarices and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duty signed by the president add attested by the secretary of the Companies In their own proper persons. IN WITNESS WHEREOF,this Power.of Attorney has been subscribed by an authorized officer oro R) I of the Companies and the irorporate seals of the Companies have been affixed. thereto this:13111 day of April 2015 ��40G A4�y,"sUR P`, suR9 � s„sue American Fire and Casally Company Qso �qt, °, �gy �s,s • a� v "� The Ohio Casualt Insurance Company. N � � � � 5. � fi � � � F Y z g t 8 u 1906 1912. 1991 Liberty Mutual Insurance Company 0 0 1514 0 West Amedcan Insurance Company 'gin vi Np a a; By: STATE OF PENNSYLVANIA. ss David M.Carey,Assistant Secretary 0 += COUNTY OF MONTGOMERY 20) On this 13th day of April 2015, before me personalty appeared David M.Carey,who acknowledged himself to be the Assistant Secretary,of American Fire and M - v w Casualty Company,Liberty Mulual Insurance Company,The Ohio Casualty Insurance Company,and V�stAmerican In Company,and that he,as such,being aulhorized:so to do, p. execute the foregoing instrument for the purposes therein contained by signing on.behalf of the corporations by himself as a duty authorized officer. 0)Uj 0? 1 t J f WISCONSIN SOCIETY OF ARCHITECTS THE AMERICAN INSTITUTE OF ARCHITECTS WIS. AIA DOCUMENT p JULY 1980 ED. WIS, A312 w a m P PUBLIC IMPROVEMENT ` PERFORMANCEILABOR AND MATERIAL N 3 PAYMENT BOND 0 THIS BOND IS TO BE USED ON PUBLIC IMPROVEMENT CONTRACTS PURSUANT O 0 TO SECTION 779.14 WISCONSIN STATUTES. Bond No.354035552 �i 3 KNOW ALL MEN BY THESE PRESENTS: that (More insert name and address or legal title of the Contractor, referred to in Sec.779.14 Wisconsin Statutes as the prime contractor) LA FORCE,INC. 1060 West Mason Street Green Bay WI 54303 as Principal, hereinafter called Principal, and, (here insert the legal tide and addreu of Surety) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 duly authorized and licensed to do business in the State of Wisconsin, as Surety, hereinafter called Surety, are held and firmly bound unto (Name and address or ]eget tide of Owner) CITY OF OSHKOSH 215 Church Avenue Oshkosh WI 54903-1430 as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinafter provided in the amount of Sixty Four Thousand Six Hundred and Doll00Dollars ($ 54,600.00 ), (Here insert a sum at leaf equal to the contract price) for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, suc- cessors and assigns, jointly and severally, firmly by them-presegts, WHEREAS, LA FORCE,INC. Principal has by written agreement dated 10/31/2016 , entered into a contract with Owner for WWTP Door Replacements,Oshkosh,WI in accordance with drawings and specifications prepared by (here insert full name, title and addreu) which contract is by reference made a part hereof and is required by Section 779.14,Wisconsin Statutes, a E to The said written agreement, drawings, specifications and amendments w N are hereinafter referred to as the Contract. PUBLIC IMPROVEMENT PERFORMANCE/1-ABOR-htATER1ALBOND TWO PAGES WIS,AIA DOC,WIS.A312AUGUST, 198912D. PAGE I C7 Copr, 1969 Wisconsin Society of Architects/AIA 321 S.Hamilton St, Madlson,Wis,53703 NOW, THEREFORE, THE CONDITION SOF THIS OBLIGATION, as required by Section 779.14, Wisconsin Statutes, is such that, if the`Principal shall faithfully perform the said contract and pay every person entitled thereto for all the claims for labor performed and materials furnished under the Contract, to be used or consumed in making the public improvement or performing the public work as provided in the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect, subject, however, to the following conditions: 1) No assignment, modification or change of the Principal and the Surety upon this bond for the Contract, or change in the work covered thereby, or recovery of any damages he may have sustained by any extension of time for the completion of the Con- reason of the failure of the Principal to comply with tract shall release the sureties on the bond, the Contract or with the Contract between the Prin- cipal and his subcontractors, If the amount realized 2) Not Iater than one year after the completion of on this bond is insufficient to satisfy all claims of work under the Contract, any party in interest may the parties in full, it shall be distributed among the maintain an action in his own name against the parties pro rata. Signed and sealed this 3rd day of November 2p IN THE PRESENCE OF: LA FORCE,INC. (Sea)) Brr i Whom �--� �r LIBERTY MUTUAL INSURANCE COMPANY Name of Surety eft By. {sell d4wi Thkt Roxanne Jensen Attorney-in-Fact APPROVED BY* IN THE PRESENCE OF: Owner By: {Seal) Whom Title: *This bond shall be approved in the case of the state by the state official authorized to enter into such con- tract, of a county by its district attorney, of a city by its mayor, of a village by its president, of a town by its chairman, of a school district by the director or president and of any other public board or body by the presiding officer thereof, PUBLIC IMPROVEMENT PERrORMANCE/LABOR-NIATERIAL 13OND TWO PAGES WIS.AIA DOC.WIS.A312 AUGUST 1989 ED. PAGE 2 THIS-POWER OF ATTORNEY ISNOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the.acts of those named herein,and they have no.authority to bind the.Company except In the manner and to the extent herein stated. Certificate No.1262166 American Fire and Casualty CompanyLiberty Mutual Insurance Company 1 The Ohio Casualty Insurance Company West American.Insurance Company E POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire lx Casualty Company and-the Ohio Casually Insurance Company are corporations duly organized.under the laws of lite 5tale.of New Hampshire,that Liberty Mutual Insurance Company is a.corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company. is a corporation duly organized under the laws of the State of Indiana(hereln.colieaGvelyxalled the"Companli S7,pursuant to and by:authority herein set forth,does hereby name,corisiitule. and appoint, Brian L.Krause;Christopher H.Kondrick•Christoher:Hovdeni Jeffrey A.Meisin er Kell Cod �Roxanne Jensen•TrudyA.Szalevvskl all of the city of Green Bev state of.WI. each individually if there W more than.one named,its true and lawful attorney-in fact to make,execute,seal,acknowledge and deliver,far and on its behalf as.surety and as its act and deed,any and all undertakings,bonds,recognizarices and other surety obligations,In pursuance of these presents and shall. be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their OW6 proper persons. IN W1TNWSS WHEREOF,this Power of Attorney.has been subscribed by an authorized officer or:officia(of the.Companies and the corporate seats of the Companies have been affixed thereto this 5th day of: February 2016 American Fire and Casualty Com ' PN4CA,gG t,SY1N5(� �41iiSUq :. �NIL75UgA y�_Company The Ohio Casualty Insurance Company to z n m 4 Liberty Mutual Insurance Company 1906 a o 1919 0 ' 1912 1991 ro West edoan Insurance Company N ��!rq lY` IC,-L yid(`hnErht'P�v� �J�lSsn'E1{iFs�1� J !tL:Al3R t' - ` /l . By c STATE OF PENNSYLVANIA ss David M.Cara Assistant Secretary COUNTY OF MONTGOMERY. 2. On this 5th day of February 2016, before me personally appeared David M. Carey,who acknowledged himseff to be the Assistant Secretary of American Fire and 0 w Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do, p 2 execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer..` - a> > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. 0 (lt pq COMMONWEALTH OF PENNSYLVANIA Q$yorr3v �t!! Notarial Seal Q 7 Teresa Pastella,Notary Public By; >�� Q O r y OF Plymouth Twp.,Montgomery County s.. �' g, � My Commission Expfres March 28,2017 Teresa Pastella,Notary Public L `Ry bj O y0y V?JU Member,Pennsylvanla Msoc atio+n of Notades p ++ qH1 3 (L. c L This Power o€Attomey is made and executed pursuant to an by authority of the following By-laws and Authorizations ofAmerioan Fire and Casualty Company,The Ohio Casualty Insurance v1 0)y. Company,Liberty Mutual Insurance Company,and WestAmodoan Insurance Company which resolutions are now in full force and effect reading as follows:. .. ARTICLE IV-OFFICERS'—Section 12.Power of Attorney.Any officer or other of@cial of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O *d, to such limitation as the Chairman or the President may prescribe,shall appoint such atforrleys•in-fact,as may be necessary to act.in behalf of the Corporation to.make,execute,seal, +. O, acknowledge and deliver as surety ally and all undertakings,bonds,recognizances and other surety obligations.Such attorneys•in-fact,subject to the limitations set.forth in their respective powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so ,Oexecuted,such instruments shall be as binding as if sighed by the President and attested to by the Secretary.Any power or authority granted to any representative or.altomeyin-fact under. > Lv the provisions of this article may be revoked at any time 4y the Board,the Chairman,the President or by the officer or officers granting such pourer or authority. � E_ ARTICLE All Execution of Contracls—SECTION 5.Surety Bonds and Undertakings:Any officer of the Company authorized for that purpose in writing by the chairman or the president, E. +�+ ` and subject to such limilations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact;as may be necessary to act in behalf of the.Company to make,execute, O seal,.acknowledge and deliver as surety any and all Undertakings,bonds,recognizances and other surety obligations,.Such attorneys-in-fact subject to the limitations set forth in their. Z v respective powers of attorney,shall have full power to bind the Company by their signature and execulion of any such instruments and to attach thereto the seal of the Company. When so 0 executed such instruments shall be as binding as if signed by the president and attested by the secretary. O Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carat',Assistant Secretary to appoint such attorneys-in- ~ fact as may be necessary to act on behalf of the Company to make,execute,seal,aoknowledge.and deliver:as suretyany and all undertakings;bonds,recognize nces and other surety. obligations. Authorization By unanimous consent of theCompany's Board of Directors,the:Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing Upon a certified copy of.any power of attorney issued by the Company in connection with surety bonds,shall be valid and.binding upon the Company with the same force and effect as though manually affixed. I,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and" West American Insurance.Companydo hereby certify that the original power of attomoy of which the foregoing.is a full,true and correct copyof the Power of Attwney executed by said Companies,is in full force and effect and has not.been revoked. 1 IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this (' day of ���C'171 b7-- _20 . AtyD.CASU L1,yY;itdS� �tt35Uq - �1NSUR - Q4, a 1906 0 0 1919 n > 1912 ° 1991 By: Gregory W.Davenport,Assistant Secretary - - �JY��+c�w-sem��a s,,y`�x��"���a .. oJ��rjhcH�t�' J •;var�. �" _ * * 311 of 500 LM ._12473_122013 WISCONSIN SOCIETY OF ARCHITECTS THE AMERICAN INSTITUTE OF ARCHITECTS WIS. AIA DOCUMENT A JULY 1980 ED. WIS, A312 a P PUBLIC IMPROVEMENT PERFORMANCEILABOR AND MATERIAL 3 PAYMENT BOND u THIS BOND IS TO BE USED ON PUBLIC IMPROVEMENT CONTRACTS PURSUANT O TO SECTION 779.14 WISCONSIN STATUTES. a Bond No.354035552 S vi KNOW ALL MEN BY THESE PRESENTS: that (Here insert name and address or legal title of the contractor, referred to In Sec.779.14 Wisconsin Statults as the prime contractor) LA FORCE,WC. 1060 West Mason Street Green Bay WI 54303 as Principal, hereinafter called Principal, and, (dere insert the legal title, and Addrru of sway) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 duly authorized and licensed to do business in the State of Wisconsin, as Surety, hereinafter called Surety, are held and firmly bound unto (Name and address or legal tide or Owner) CITY OF OSHKOSH 215 Church Avenue Oshkosh W1 54903-1130 as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinafter provided in the amount of Sixty Four Thousand Six Hundred and 00110013ollars ($ 64,600.00 ), (Herr insert it roar AS leas[ equal to the control price} for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, suc- cessors and assigns, jointly and severally, firmly by thesa.presertits, WHEREAS, LA FORCE,INC. Principal has by written agreement dated 10/31/2016 , entered into a contract with Owner for WWTP Door Replacements,Oshkosh,WI in accordance with drawings and specifications prepared by (mre insert fun name, title and Address) which contract is by reference made a part hereof and is required by Section 779.14, Wisconsin Statutes{ a n f in The said written agreement, drawings, specifications and amendments W N are hereinafter referred to as the Contract. 0 c PUBLIC IMPROVEMENT PERFORMANCE./LABOR•MATERIAL BOND TWO PAGES n, WIS.AIA DOC,WIS.A3t2AUGUST. 19891M. PAGE I p Copr. 1969 Wisconsin Society or Architects/AIA 321 S.Hamilton Si. Madison,Wis.$3703 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION, as required by Section 779.14, Wisconsin Statutes, is such that, if the'Principal shall faithfully perform the said contract and pay every person entitled thereto for all the claims for labor performed and materials furnished under the Contract, to be used or consumed in making the public improvement or performing the public work as provided in the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect, subject, however, to the following conditions: I) No assignment, modification or change of the Principal and the Surety upon this bond for the Contract, or change in the work covered thereby, or recovery of any damages he may have sustained by any extension of time for the completion of the Con- reason of the failure of the Principal to comply with tract shall release the sureties on the bond. the Contract or with the Contract between the Prin- cipal and his subcontractors. If the amount realized 2) Not later than one year after the completion of on this bond is insufficient to satisfy all claims of work under the Contract, any party in interest may the parties in full, it shall be distributed among the maintain an action in his own name against the parties pro rata, Signed and sealed this 3rd day of November ,2016 IN THE PRESENCE OF: LA FORCE INC. 1 r By= Wilom Met LIBERTY MUTUAL INSURANCE COMPANY Name of Surety By: f L'1CU�Y�t�k (3u1) Willies 'alai Roxanne Jensen Attorney-in-Fact APPROVED BY* IN THE PRESENCE OF: Owner Byr (Seal) Willies .ice. *This bond shall be approved in the case of the state by the state official authorized to enter into such con- tract, of a county by its district attorney, of a city by its mayor, of a village by its president, of a town by its chairman, of a school district by the director or president and of any other public board or body by the presiding officer thereof, PUBLIC IMPROVEMENT PERFORMANCE/LABOR•MATERIAL BOND TWO PAGES WIS.ATA DOC.WIS.A312 AUGUST 1989 ED. PAGE 2 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RBD BACKGROUND. This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except In the manner and to the extent herein stated. Certificate No.7262766 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company WestAmerican Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire S Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana[herein collectively called the"Companleal,pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Brian L.Krause;Christopher H.Kondfick;Christopher Hoyden;Jeffrey R.Melsinger;Kelly Cody;Roxanne Jenson;Trudy A.Szalewski all of the oily of Green_ Bad state of WI each individually if there be more than one named,its true and lawful attorney-in-fart to make,execute,seal,admowledge and deliver,for and on its behalf as surely and as its act and deed,any and all undertakings,bonds,recognisances and other surely obligations,In pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secrelary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 5th day of February 2016 0 c 15� �S11NS& ,,atsuyr P,,irssu American Fire and Casualty Company The Ohio Casually Insurance Company 1906 0 o f919 d 1912 ; 1991 a Liberty Mutual insurance Company : West edcan Insurance Company * * * # By: STATE OF PENNSYLVANIA ss David M,Care ,Assistant Secretary COUNTY OF MONTGOMERY 0 On this 5th day of February 2016 before me personally appeared David M.Carey, who acknowledged himself to be the Assistant Secretary of American Fire and d Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do, 0.2 execute the foregoing Instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. O PAs,, COMMONWEALTHOFPENNSYLVANIA ,} 41 P (/ \ Notarial Seal „Q Teresa Pastella,Notary Publio ey; O or Plymouth Twp.,Montgomery County Teresa Pastella,Notary Public d My Commission Expires March 2e,2017 y5YLVP� O Op� �? Ntemher,Penrtsylvanla Association of Notaries tL UThis Power of Attorney is made and executed pursuant to an by authority o€the following By-laws and Authorizations of American Fire and Casually Company,The Ohio Casualty Insurance u1 Company,Liberty Mutual Insurance Company,and West American Insurance Company which resolutions are now in full farce and effect reading as follows; M W ARTICLE W—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-In-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, + o,_ acknovdedge and deliver as surety any and all undertakings,bonds,recmgnizances and other surety obligations. Such attomeys-in-fact,subject to the limitations set forth in their respective 'a E ei powers of attorney,shall have full pourer to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so p executed,such instruments shelf be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under 7 a the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, w and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, o seal,acknowledge and deliver as surety any and all undertakings,bonds,fecognizances and other surety obligations. Such attorneys-fn-fact subject to the limitations set forth in their Z fJ respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seat of the Company. When so v Tall executed such instruments shall W as binding as if signad by the president and attested by the secretary. t°' Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of.the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-fn- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization--By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of ally assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. 1,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the orlgfnal power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked, IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of ��l/L'Y7l ��1� 20_&,___ SL�! JPyoN;'n3S& %tA i a;yb�Y�, �CFN yrr+taR�'i'�. S1406 "0 0 1919 0 7412 1991 By. Gregory W.Davenport,As Secretary 311 of 500 LMS 12873 122013