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HomeMy WebLinkAbout2017 CIP Subsurface/ Amendment No.1 �Z_ CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE,P.O.BOX 1130,OSHKOSH,WI 54903-1130 PHONE: (920)236-5065 FAX(920)236-5068 LETTER OF TRANSMITTAL To: Patrick Bray Date: -April 20, 2017 PSL Inc. Subject: Executed Amendment No. 1 1125 West Tuckaway Lane, Suite B 2017 CIP Subsurface Exploration Menasha,WI 54952 &Geotechnical Engineering Evaluation Services Please find: Z Attached ❑ Under Separate Cover ❑ Copy of Letter ❑ Contracts ❑ Amendment ❑ Report ❑ Agenda ❑ Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ Diskette ❑ Zip Disk ❑ Other Quantity Description 1 Executed Amendment No. 1 These are being transmitted as indicated below: ❑ For Approval ❑ For Your Use ❑ As Requested ❑ For Review&Comment Remarks: Enclosed is the executed Amendment No. 1 for the 2017 CIP subsurface exploration and geotechnical engineering evaluation services. If you have any questions, please contact us. City Clerk's-Original cc: —File-Original Signed:���� Tr c L. Taor 1:\Engineering\Soil Borings\2017\PSA LOT-Executed CA#1-4-20-17.docx AMENDMENT NO.I The CITY OF OSHKOSH,hereinafter referred to as CITY, and PROFESSIONAL SERVICE INDUSTRIES,INC., 1125 West Tuckaway Lane,Suite B,Menasha,WI 54952,hereinafter referred to as the CONSULTANT,entered into an agreement for SUBSURFACE EXPLORATION AND GEOTECHNICAL ENGINEERING EVALUATION FOR 2017 CAPITAL IMPROVEMENTS PROJECTS on November 17,2016. Paragraph C in ARTICLE XII. PAYMENT included the provision that 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. THEREFORE, the CITY and the CONSULTANT agree to insert the following paragraph after the first paragraph in ARTICLE Ill. SCOPE OF WORK: The CONSULTANT shall provide the services described in the CONSULTANT's Estimate Worksheets dated March 20,2017. The CITY and the CONSULTANT further agree to insert the following bullet point after the first bullet point in Paragraph A of ARTICLE XII. PAYMENT: Payment for Amendment No. 1 shall be a Time and Materials Sum not to exceed $22,112.75 (Twenty Two Thousand One Hundred Twelve Dollars and Seventy-Five Cents) All other terms contained within the November 17,2016 agreement remain unchanged and in effect. In the Presence of: CONSULTANT By: (Seal of Consultant if a Corporation (Specify Title) By: (Specify Title) CITY OF OSHKOSH By: (Witness) Mark A.Rohloff,City Manager And: (Witness) Pamela R.Ubrig,City Clerk 3 AP ROVED: I hereby certify that the necessary provisions have been made to pay the liability which which will accrue under this Agreement. y Wtto ttorney City Comptroller 1:\Engineedng\Soil Borings\2017\PSI CA#IJ-24-17.docx Page 1 of 1 Information Menasha Office fi 5 A 7 �11125 W. Tuckaway Lane, Suitep&CEIVED TO BL>'l�u On Menasha,Wisconsin 54952 Engineering • Consulting• Testing MAR 2 1 2017 DEPT OF PUBLIC WORKS PROFESSIONAL SERVICE INDUSTRIES, INC.(PSI) ESTIMATE WORKSHEET OSHKOSFL, WISCONSIN Client Name: City of Oshkosh,Wisconsin Date: March 20,2017 Project Name: Mary Jewell Park Wastewater Lift Station PSI Proposal No.: PO-0094-193575 Extra Project Location: Oshkosh,Wisconsin ITEM DESCRIPTION UNIT QTY UNIT PRICE PRICE TOTAL s 1 Boring Layout Lump Sum 1 $225.00 $225.00 I €' 2 Mobilization/DailyTravel/Traffic Control Lump Sum 1 $300.00 $300.00 i €I' 3 Soil Borings Feet 20 $13.95 $279.00 4 Rock Coring Feet 65 $75.00 $4,875.00 5 Well Supplies Feet 85 $15.00 $1,275.00 6 Boring Log Preparation Lump Sum 1 $250.00 $250.00 Total Estimated Fee: $7,204.00 Project Scope: Drill and sample two (2) soil test borings with one to 50 feet and the second to 35 feet below ground surface. When auger refusal is encountered, rock coring will be completed.A total of 85 lineal feet of drilling is proposed. Representative soil samples will be obtained at 2-% foot intervals within the unconsolidated formation. Install temporary groundwater monitoring wells within the borings. As requested by the City of Oshkosh,the well installation will not follow NR141 procedures. The wells will consist of 2-inch diameter Schedule 40 PVC monitoring well. The monitoring wells will be performed with a truck-mounted drill rig utilizing continuous flight 3-Y4" ID hollow stem auger to advance the boreholes to bedrock. Rock coring will be attempted with a 2-Y4"OD NQ core barrel. If the borehole needs to be enlarged for the installation of the 2-inch well,an additional charge will be applied. Soil cuttings generated from the soil boring will be left onsite. Typically, they are thin spread adjacent to the boring locations or within green spaces. We have not included any costs for offsite disposal of soil cuttings. PSI will contact Diggers Hotline for public utility clearance. Boring locations and elevations will be performed by the City of Oshkosh. Boring logs and Well Logs will be provided to the City of Oshkosh. No evaluation or recommendations will be provided. Information Menasha Office AM AE-ft P wrqwirja—WJ1125 W. Tuckaway Lane, Suit PCEIVED To Build On Menasha,Wisconsin 5452" Engineering • Consulting• Testing [JAR 2 1 2017 DEPT OP PUj3LIC iVORICS PROFESSIONAL SERVICE INDUSTRIES,INC.(PSI) ESTIMATE WORKSHEET OSHKOSH, 1VISCON.sji4 Client Name: City of Oshkosh,Wisconsin Date: March 20,2017 Project Name: Water Filtration Plant Clear Wells PSI Proposal No.: PO-0094-193575 Extra Project Location: Oshkosh,Wisconsin ITEM DESCRIPTION UNIT CITY UNIT PRICE PRICETOTAL I I 1 Boring Layout Lump Sum 1 $225.00 $225.00 E 2 Mobilization/Daily Travel/Traffic Control Lump Sum 1 $300.00 $300.00 l 3 Soil Borings Feet 50 $13.95 $697.50 4 24 Hour Water Level Reading Lump Sum 1 $150.00 $150.00 1 5 Site Restoration Lump Sum 1 $250.00 $250.00 6 Atterberg Limits Each 2 $85.00 $170.00 7 Sieve Analysis(hydrometer) Each 2 $95.00 $190.00 8 Project Engineering and Reporting Lump Sum 1 $550.00 $550.00 Total Estimated Fee: $2,532.50 Project Scope: Drill and sample two (2)soil test borings each to a depth of 25 feet below ground surface. A total of 50 lineal feet of drilling is proposed. Representative soil samples will be obtained at 2-% foot intervals within the unconsolidated formation. PSI will contact Diggers Hotline for public utility clearance.Boring locations and elevations will be performed by the City of Oshkosh. 7 Inforjnation Menasha Office J;m%P%C1125 W. Tuckaway Lane, Suite B TOBuild On Menasha,Wisconsin 54952 Engineering • Consulting • Testing �. 2O1 Cf 1'T- PROFESSIONAL SERVICE INDUSTRIES, INC.(PSI) ESTIMATE WORKSHEET N1f�R t),It�t,IC WORKS Client Name: City of Oshkosh,Wisconsin Date: Janua Project Name: Library Parking Lot PSI Proposal No.: PO-0094-193575 Extra Project Location: Oshkosh,Wisconsin ITEM DESCRIPTION UNIT CITY UNIT PRICE PRICE TOTAL Q I p3 E 1 Boring Layout Lump Sum 1 $75.00 $75.00 2 Mobilization/Daily Travel/Traffic Control Lump Sum 1 $75.00 $75.00 E 3 Soil Borings Feet 30 $13.95 $418.50 E 4 Projet Engineering and Reporting Lump Sum 1 $325.00 $325.00 Total Estimated Fee: $893.50 InfoYn?ation Menasha Office rg57" 1125 W. Tuckaway Lane, Suite B =2 kT0BB On Menasha,Wisconsin 54952 Engineering • Consulting • Testing PROFESSIONAL SERVICE INDUSTRIES,INC.(PSI) ESTIMATE WORKSHEET Client Name: City of Oshkosh,Wisconsin Date: Feb7Gd?�2�),C���7 W jSCONSIN OSHK Project Name: Unknown Street PSI Proposal No.: PO-0094-193575 Extra Project Location: Oshkosh,Wisconsin ITEM DESCRIPTION UNIT CITY UNIT PRICE PRICE TOTAL E l r 1 Boring Layout Lump Sum 1 $225.00 $225.00 2 Mobilization/Daily Travel/Traffic Control Lump Sum 1 $300.00 $300.00 3 Soil Borings Feet 120 $13.95 $1,674.00 4 Projet Engineering and Reporting Lump Sum 1 $1,000.00 $1,000.00 Total Estimated Fee: $3,199.00 InfoYfYlGltlon Menasha Office 1125 W. Tuckaway Lane, Suite B �T0 Build On Menasha,Wisconsin 54952 Engineering • Consulting • Testing PROFESSIONAL SERVICE INDUSTRIES, INC.(PSI) ESTIMATE WORKSHEET OR — Client Name: City of Oshkosh,Wisconsin Date: Fevrrupr)r 17;=2011BLIC VJOttKS W ISCONSIN OSHKOSH. Project Name: Sawdust Dristict PSI Proposal No.: PO-0094-193575 Extra Project Location: Oshkosh,Wisconsin ITEM DESCRIPTION UNIT QTY UNIT PRICE PRICE TOTAL 1 Boring Layout Lump Sum 1 $350.00 $350.00 r E 2 Mobilization/Daily Travel/Traffic Control Lump Sum 1 $425.00 $425.00 3 Soil Borings Feet 195 $13.95 $2,720.25 I 4 Projet Engineering and Reporting Lump Sum 1 $1,450.00 $1,450.00 Total Estimated Fee: $4,945.25 Information Menasha Office 1125 W. Tuckaway Lane, Suite B To Build On Menasha,Wisconsin 54952 Engineering • Consulting • Testing �LC�tvEL' PROFESSIONAL SERVICE INDUSTRIES, INC.(PSI) ESTIMATE WORKSHEET Client Name: City of Oshkosh,Wisconsin Date: February 2 2gaU7 i�LIC WORKS OLI' � W ISCONSIN `11� 1IK0 I1. Project Name: Eveline Street PSI Proposal No.: PO-b6 -193575 Extra Project Location: Oshkosh,Wisconsin ITEM DESCRIPTION UNIT QTY UNIT PRICE PRICE TOTAL 1 Boring Layout Lump Sum 1 $225.00 $225.00 2 Mobilization/Daily Travel/Traffic Control Lump Sum 1 $300.00 $300.00 3 Soil Borings Feet 130 $13.95 $1,813.50 f'. i 4 Projet Engineering and Reporting Lump Sum 1 $1,000.00 $1,000.00 Total Estimated Fee: $3,338.50 CORO® DATE(MM/DD/YYYY) A C" CERTIFICATE OF LIABILITY INSURANCE 03/28/2017 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(les)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 _ CONTACT '... NAME: Marsh USA Inc. FA 500 Dallas Street,Suite 1500 ���� P"�NNo Ext: AIC No Houston,TX 77002 _ — �z�cc.� E-MAIL s: Attn:Houston.Certs@Marsh.com ADDRE INSURERS AFFORDING COVERAGE NAIC# 905863-PPJ-GAWUP-16-17 INSURER A:Zurich American Insurance Company 16535 INSURED PROFESSIONAL IQR�{S INSURER B:Greenwich Insurance Company 22322 608NORTH STA TONS RE DT STRIES,INC. C VU ELIC ONSVlA INSURER C:Navigators Insurance Company 42307 RIPON,WI 54971 D_V'V Q SH W lSC INSURER D:XL Specialty Insurance Company 37885 QSk`hQ INSURER E:American Guarantee&Liability Ins Co 26247 INSURER F: COVERAGES CERTIFICATE NUMBER: HOU-002901869-01 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /LTR AODL SUBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY GLO5415693-03 1010112016 10/0112017 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 €: MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY PE Q LOC PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: $ B AUTOMOBILE LIABILITY RAD9437814 10/01/2016 10101/2017 CEa accidentOMBINED SINGLE LIMIT $ i,000,000 IXANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS NON-OWNED PeOPERTYtDAMAGE $ HIRED AUTOS X AUTOS C UMBRELLA LIARX OCCUR CH16EXR8547521V 10/0112016 10/01/2017 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAR CLAIMS-MADE 'Excess of Auto and' AGGREGATE $ 4,000,000 DED I I RETENTION$ 'Employers'Uability' $ D WORKERS COMPENSATION RWD3001195(AOS) 10/01/2016 10/01/2017 X STATUTE ERH AND EMPLOYERS'LIABILITY D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑N NIA RWR3001196(WI) 1010112016 10/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEO$ 1,000,000 If yes,describe under1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Excess of General Liability, UC5415694-03 10/01/2016 10/01/2017 Each Occurrence 6,000,000 Auto and Employers Liability General Aggregate 6,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re:CITY OF OSHKOSH PSI PROJECT 0092739 City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as additional insured(except as respects all coverage afforded by the Workers'Compensation and Professional Liability policies)as required by written contract. The General Liability coverage applies as primary and non•contfibutory where required by written contract. Contractual Liability is included in the General Liability subject to the policy terms,conditions and exclusions. COVERAGE FOR XCU IS INCLUDED IN THE ABOVE GENERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. John Shahidi f=----- -- ='% '- @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 905863 LOC#: Houston ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. PROFESSIONAL SERVICE INDUSTRIES,INC. 608 NORTH STANTON STREET POLICY NUMBER RIPON,WI 54971 CARRIERNAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Professional Liability: Policy k.IPRO206920-01 Carrier:Steadfast Insurance Company-NAIC#26387 Effective Dates:0913012016 to 09/30/2017 Limit:$4,293,600 Each Claim/Aggregate SIR:$1,000,000 i I f i I i j ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Insured —Automatic — Owners, Lessees Or ZURICH" Contractors Policy No, I Eff. Date of Pol. I Exp. Date of Pol. I Eff. Date of End. I Producer No. Add'I. Prem Return Prem. GL05415693-03 10101/2016 1 10/0112017 1 10/01/2016 1 14012000 1 n/a I nla THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Testing Holdings USA, Inc Address(including ZIP Code): 2 Riverway,Suite 500, Houston, TX 77056 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section 11 —Who Is An Insured is amended to include as an additional insured any person or organization whom you i are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for"bodily injury", "property damage" or "personal € and advertising injury"caused, in whole or in part, by: 1. Your acts or omissions;or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products-completed operations hazard",which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted bylaw; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications;or b. Supervisory, inspection,architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment,training or monitoring of others by that insured, if the"occurrence" which caused the "bodily injury" or"property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U-GL-1175-F CW(04113) Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,Wth Its permission. C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence"or offense that may result in a claim; 2. We receive written notice of a claim or"suit"as soon as practicable;and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance;and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV—Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same"occurrence",offense, claim or"suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III—Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement;or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. I i i U-GL-1175-F CW(04113) � Page 2 of 2 Includes copyrighted material of Insurance Ser\ces Office,Inc.,Wth Its pennisslon. Blanket Notification to Others of Cancellation ZURICH or Nan-Reneiwal Policy No, I Eff. Date of Pol. I Exp. Date of Poi. I Eff. Date of End. I Producer No. Add-1. Prem Return Prem. GLO5415693-03 10101/2016 1 10/01/2017 1 10/0112016 1 14012000 1 n/a n/a THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has been cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured if you are required by written contact or written agreement to provide such notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been sent to the first Named Insured. Such list: 1. Must be provided to us prior to cancellation or non-renewal; I 2. Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed; and j3. Must be in an electronic format that is acceptable to us. I B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mail or deliver such notification to each person or organization shown in the list: 1. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium;or 2. At least 30 days prior to the effective date of: it a. Cancellation, if cancelled for any reason other than nonpayment of premium;or E' b. Non-renewal, but not including conditional notice of renewal. i C. Our mailing or delivery of notification described in Paragraphs A.and B. of this endorsement is intended as a courtesy only. Our failure to provide such mailing or delivery will not: 1. Extend the Coverage Part cancellation or non-renewal date; 2. Negate the cancellation or non-renewal; or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided to us as described in Paragraphs A. and B. of this endorsement. All other terms and conditions of this policy remain unchanged. U-GL-1521-A CW(10/12) Page 1 of 1 Includes copyrighted material of Insurance services Office,Inc.,with Its permission. ENDORSEMENT# This endorsement, effective 12:01 a.m., October 1, 2016 forms a part of Policy No. RAD9437814 issued to PROFESSIONAL SERVICE INDUSTRIES, INC. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason,other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s)or entity(ies) according to the notification schedule shown below: Number of Days Name of Person(s)or Entity(ies) Mailing Address: Advanced Notice of Cancellation: Per the most current schedule 30 Days maintained by Marsh USA Inc., and furnished to XL Catlin Insurance no less than 45 days prior to the effective date of cancellation. All othertetms and conditions of the Policy remain unchanged. IXI 405 0910 Page 1 of 1 2010 X.L.America, Inc. All Rights Reserved. May not be copied without permission. Endorsement#2 Blanket Notification to Others of Cancellation ZURICH PollcyNo. Eff.Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add9 Prem. Return Prein. IP R0206920-01 September 30,2016 September 30,2017 September 30,2016 14012000 -- -- Named Insured and Mailing Address: Producer: Professional Services Industries Inc.. Marsh USA Inc 1901 S Meyers Road, Ste 400 500 Dallas Street, One Allen Center Oakbrook Terrace, IL 60181 Suite 1500, Houston,TX 77002 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Contractor's Protective Professional Indemnity and Liability Insurance Policy In consideration of the premium already charged,it is agreed that the policy is amended as follows: i A. If we cancel this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium,we will deliver electronic notification that such Coverage Part has been cancelled to each person or organization shown in a Schedule provided to us by the First Named Insured. Such Schedule: j 1. Must be initially provided to us within 15 days: a. After the beginning of the policy period shown in the Declarations; or b. After this endorsement has been added to policy; s 2. Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3. Must be in an electronic format that is acceptable to us; and 4. Must be accurate. E Such Schedule may be updated and provided to us by the First Named Insured during the policy period.Such updated Schedule must comply with Paragraphs 2., 3.,and 4. above. B. Our delivery of the electronic notification as described in Paragraph A.of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. Delivery of the notification as described in Paragraph A. of this endorsement will be completed as soon as practicable after the effective date of cancellation to the first Named Insured. C. Proof of emailing the electronic notification will be sufficient proof that we have complied with Paragraphs A. and B. of this endorsement. D. Our delivery of electronic notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: 1. Extend the Coverage Part cancellation date; 2. Negate the cancellation; or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. E. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule I provided to us as described in Paragraphs A. and B. of this endorsement. STF-CPP-161-A CW (11110) i Page 1 of 2 i I?? I ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. I i i 0 pI h i I "4 I I t STF-CPP-161-A CW (11110) Page 2of2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 57 (Ed 12/10) ENDORSEMENT# I G i j This endorsement, effective 12:01 a.m., 10-01-2016, forms a part of Policy No. RWD3001195 issued to Professional Service Industries, Inc. by XL Specialty Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT This endorsement modifies insurance provided underthe following: WORKERS'COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY In the event coverage is cancelled for any statutorily permitted reason,other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s)or entity(ies) according to the notification schedule shown below: Number of Days Name of Person(s)or Entity(ies) Mailing Address: Advanced Notice of Cancellation: Per the most current schedule 30 maintained by Marsh USA Inc., and furnished to XL Catlin Insurance no less than 45 days prior to the effective date of cancellation. All other terms and conditions of the Policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. RWD3001195 Endorsement No. Insured Professional Service Industries, Inc. Premium Included Insurance Company XL Specialty Insurance Company Countersigned by WC 99 06 57 Ed. 12110 ©2010 X.L. America, Inc. All Rights Reserved. May not be copied without permission.