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HomeMy WebLinkAboutVegetation Assessment at Aviation Park, Applied Ecological Services r 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: Mark J. O'Leary Date: July 26, 2017 Applied Ecological Services, Inc. Subject: Executed Agreement for Vegetation PO Box 256 Assessment at Aviation Business Park Brodhead,WI 53520 Please find: ® 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 Agreement These are being transmitted as indicated below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review&Comment Remarks: Enclosed is the executed agreement for the vegetation assessment at Aviation Business Park. A City of Oshkosh Purchase Order will follow shortly. Please reference this Purchase Order number on all of your invoices. If you have any questions, please contact us. cc: Signed: Trac L. Taylor l:\Engineering\Tracy Taylor\James'Agreements\AES LOT-Executed Agreement_7-26-17.docx AGREEMENT -M day of 1::yWL/V ' 2017, by and between the This AGREEMENT, made on the 1�;& CITY OF OSHKOSH, party of the first part, hereinafter refe4ed to as CITY, and APPLIED ECOLOGICAL SERVICES, INC., PO Box 256, Brodhead, WI 53520, party of the second part, hereinafter referred to as the CONSULTANT, WITNESSETH: The CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following AGREEMENT for VEGETATION ASSESSMENT AT AVIATION BUSINESS PARK. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the PROJECT described in this AGREEMENT: Mark J.O'Leary-Principal Ecologist 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 IL CITY REPRESENTATIVE The CITY shall assign the following individual to manage the PROJECT described in this AGREEMENT: John Ferris,P.E.-Civil Engineering Supervisor ARTICLE 111. SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's Proposal. The CITY may make or approve changes within the general Scope of Services in this AGREEMENT. If such changes affect CONSULTANT's cost of or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. All reports, drawings, specifications, computer files, field data, notes, and other documents and instruments prepared by the CONSULTANT as instruments of service shall remain the property of the CITY. l:\Engineering\Tracy Tay1or\Jamcs'Agrcernents\AES Agreement-Vei;Assess-Aviation Bus Park 6-30- Page 1 of 5 17.doex ARTICLE IV. STANDARD OF CARE The standard of care applicable to CONSULTANT's services will be the degree of skill and diligence normally employed by professional consultants or consultants performing the same or similar services at the time said services are performed. CONSULTANT will re-perform any services not meeting this standard without additional compensation. ARTICLE VI. RECORD DRAWINGS Record drawings, if required, will be prepared, in part, on the basis of information compiled and furnished by others. CONSULTANT is not responsible for any errors or omissions in the information from others the CONSULTANT reasonably relied upon and are incorporated into the record drawings. ARTICLE VII. CITY RESPONSIBILITIES The CITY shall furnish, at the CONSULTANT's request, such information as is needed by the CONSULTANT to aid in the progress of the PROJECT, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the CONSULTANT's work, the CITY will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE X. TIME OF COMPLETION The work to be performed under this AGREEMENT shall be commenced and the work completed within the time limits as agreed upon in the CONSULTANT's Proposal. The CONSULTANT shall perform the services under this AGREEMENT with reasonable diligence and expediency consistent with sound professional practices. The CITY agrees the CONSULTANT is not responsible for damages arising directly or indirectly from any delays for causes beyond the CONSULTANT's control. For the purposes of this AGREEMENT, such causes include, but are not limited to, strikes or other labor disputes, severe weather disruptions or other natural disasters, failure of performance by the CITY, or discovery of any hazardous substances or differing site conditions. If the delays resulting from any such causes increase the time required by the CONSULTANT to perform its services in an orderly and efficient manner, the CONSULTANT shall be entitled to an equitable adjustment in schedule. ARTICLE XI. COMPONENT PARTS OF THE AGREEMENT This AGREEMENT consists of the following component parts, all of which are as fully a part of this AGREEMENT as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument I:\Engineering\Tracy Taylor\James'Agreements\AES Agreement-Veg Assess-Aviation Bus Park_6-30- Page 2 of Jr 17.docx 2. CONSULTANT's Proposal dated June 26, 2017 and attached hereto In the event any provision in any of the above component parts of this AGREEMENT conflicts with any provision in any other of the component parts, the provision in the component part first enumerated above shall govern over any other component part which follows it numerically except as may be otherwise specifically stated. ARTICLE XII. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the AGREEMENT the total sum as set forth below, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto: • Time and Materials Not to Exceed$3,000 (Three Thousand Dollars). • Attached fee schedule(s) shall be firm for the duration of this AGREEMENT. B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay the CONSULTANT within thirty (30) calendar days after receipt of such statement. If any statement amount is disputed, the CITY may withhold payment of such amount and shall provide to CONSULTANT a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services shall be negotiated and set forth in a written amendment to this AGREEMENT executed by both parties prior to proceeding with the work covered under the subject amendment. D. Indirect Costs. Indirect costs such as computer time, printing, copying, cell phone charges, telephone charges, and equipment rental shall be considered overhead and shall not be invoiced separately to the PROJECT. E. Expenses. Expenses may be billed with up to a maximum of 10% mark-up. All invoices with expenses shall include supporting documentation of the expense. Failure to include the supporting documentation will result in the reduction of payments by the amount of those expense(s)not including documentation. ARTICLE XIII. HOLD HARMLESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims, and demands which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CONSULTANT, his/her agents or assigns, his/her employees, or his/her subcontractors related however remotely to the performance of this AGREEMENT or be caused or result from any violation of any law or administrative regulation, and shall indemnify or refund to the CITY all sums including court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the CITY's written demand for indemnification or refund for those (:\Engineering\Tracy Taylor\James'Agreements\A ES Agreement-Veg Assess-Aviation Bus Park 6-30- Page 3 of 5 17.docx actions, claim, and demands caused by or resulting from intentional or negligent acts as specified in this paragraph. Subject to any limitations contained in Sec. 893.80 and any similar statute of the Wisconsin Statutes, the CITY further agrees to hold CONSULTANT harmless from any and all liability, including claims, demands, losses, costs, damages, and expenses of every kind and description (including death), or damages to person or property arising out of re-use of the documents without consent where such liability is founded upon or grows out of the acts or omission of any of the officers, employees or agents of the City of Oshkosh while acting within the scope of their employment. ARTICLE XIV. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE XV. TERMINATION A. For Cause. If the CONSULTANT 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 CONSULTANT. In this event, the CONSULTANT shall be entitled to compensation for any satisfactory,usable work completed. B. For Convenience. The CITY may terminate this AGREEMENT at any time by giving written notice to the CONSULTANT no later than ten (10) calendar days before the termination date. If the CITY terminates under this paragraph, then the CONSULTANT shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain 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. ARTICLE XVI. RE-USE OF PROTECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form, are instruments of service for this PROJECT,whether the PROJECT is completed or not. The CITY agrees to indemnify CONSULTANT and CONSULTANT's officers, employees, subcontractors, and affiliated corporations from all claims, damages, losses, and costs, including,but not limited to,litigation expenses and attorney's fees arising out of or related to the unauthorized re-use, change, or alteration of these project documents. ARTICLE XVII SUSPENSION DELAY OR INTERRUPTION OF WORK The CITY may suspend, delay, or interrupt the services of CONSULTANT for the convenience of the CITY. In such event, CONSULTANT's contract price and schedule shall be equitably adjusted. I:\Engineering\Tracy Taylor\James'Agreements\AES Agreement-Veg Assess-Aviation Bus Park 6-30- Page 4 of rJ 17.ciocx ARTICLE XVIII. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than the CITY and CONSULTANT and has no third-party beneficiaries. In the Presence of: CONSULTANT By: (Seal of Consultant Pr\irr\ifr,)cxk P r�_ I 11 V if a Corporation) (Specify Title) By: (Specify Title) CITY OF OSHKOSH By: 11 % (Witness) Mark A.Rohloff, City Manager And: , City(Witness) Pamela R.Ubrig,City ClerK APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this AGREEMENT. '_Cit Ci At. Comptroller' L\Engineering\Tracy Tay1or\jarnes'Agreernents\AES Agreement-Veg Assess-Aviation Bus Park-6-30- Page 5 of Jr 17.docx gm fin, ri E A OL" . . YX RECEIVED APPLIED ECOLOGICAL SERVICES JUN 2 '�17 DEPT OF PUBLIC IVOP1<S May 30, 2017 (Revised June 26, 2017) OSHKOSH ��ISC, O SIN John Ferris, PE Civil Engineering Supervisor City of Oshkosh 215 Church Avenue Oshkosh,WI 54903-1130 RE: Proposal for Vegetation Assessment at Aviation Business Park(AES#17-0565) Dear John, Please find below a Scope of Work and Fee estimate for completing a vegetation assessment of a new detention pond at the Aviation Business Park. Project Understanding and Scope of Work We understand the City of Oshkosh requests that Applied Ecological Services, Inc. (AES)to assess the establishment of native vegetation at two locations at the Aviation Business Park as outlined in green per the drawing below.The business park is generally located south of Ripple Avenue just east of the Wittman Regional Airport. i r F—I L n 11-E TI.PIF E ������� - � A.1UA i G EI .F;: .:+•fir F _ EL Eil t, n I V�.I,i1 FCE IIL-- — _•Eu[ •d.L lir;P•'C.'IF G=Ct P. 7� fin'�• - -� i A " 7.2 WJL.1 APPLIED ECOLOGICAL SERVICES The project includes the completion of an assessment of the vegetation at two locations in the Business Park.The northeast area includes assessing the seeding of native vegetation above the normal water level.The southeast area includes the assessment of the feasibility to manage this area as a wetland. We understand the southeastern referenced area was not impacted during construction of the Business Park and the northeastern area was seeded during the late summer to early fall of 2016.The area was seeded per a seed mix supplied by John Ferris to AES with the heading:S34074 Mix Submittal-1. AES will visit both sites and assess the establishment of vegetation.AES will assess the success or failure of the original 2016 seeding and recommend procedures for re-seeding the ponds if necessary.AES will provide management recommendations for the preserved southeastern wetland. It is understood that prescribed burning may be a viable option at this site assuming an arrangement can be made with the airport. Deliverable: Summary memorandum with management recommendations. Fee: $3,000 Schedule AES is prepared to execute and complete services outlined in this proposal as determined with the Client. Additional Services Requests for additional services or staff will be documented by AES (if given verbally), and the work commence upon City approval of an estimated fee for that effort in accordance with the original contract. Thank you for considering this proposal. Please call with questions. Sincerely, Mark J. O'Leary, Principal Ecologist Applied Ecological Services, Inc. RECEIVED 11 JL il APPLIED Exhibit A: RATE SCHEDULE Y.M1 ECOLOGICAL MLI SERVICES Rates for Consultants and support Services D L-:l' l v I N U u L 1 C WORKS OSHKOSH, WISCONSLN PROFESSIONAL TITLE RATE Principal Ecologist $150—250/hour Principal Ecotoxicologist $170—200/hour Principal Environmental Engineer $130—190/hour Senior Communications Consultant $170/hour Senior Ecologist $110—160/hour Senior Engineer $130—180/hour Senior Geologist $180—200/hour Senior Hydrologist $100—150/hour Senior Landscape Architect/Planner $130-200/hour Landscape Architect $ 100—170/hour Staff Cartographer/GIS analyst $ 80—140/hour Staff Ecologist $ 80—140/hour Staff Engineer $110—160/hour Staff Biologist $100—150/hour Staff Ecological/Landscape Designer $ 75—125/hour Associate Ecologist $ 50-70/hour Associate Ecological/Landscape Designer $ 50—75/hour CADD/GIS Draftsperson $ 75—125/hour Technical Assistant $ 60/hour Clerical $ 60—75/hour OTHER SERVICES Construction Oversight $ 80-120/hour Technical Writing $100/hour Automated Data Compliance/Processing $ 40/hour GPS System $250/day EXPENSES Transportation mileage $ 0.60/mile Per Diem $ 50/person/day Computer Plotting—Black and White $ 1.50/square foot Computer Plotting-Color $ 3/square foot Black and White Copies and Prints $ 0.10/page Color Copies and Prints $ 0.25/page 11 x 17 prints—color $ 2/sheet CD burning $ 1 each DVD burning $ 5 each Scanning—small document $ 0.10/page Scanning—large document $ 3.50/square foot GPS Equipment $ 250/day Computer Processing $ 35/hour AC40R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 111.� 7/13/2017 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(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). CONTACT PRODUCER NAME: Trisha Stark M3 Insurance Solutions, Inc. PHONE FAX 828 John Nolen Drive AIC No Ext: A/C No: Madison WI 53713 �CE1v$� ADDRESS: trisha.stark@m3 ins.com PRODUCER i _ CUSTOMER ID#:APPLE-1 ��y� INSURER(S)AFFORDING COVERAGE NAIC# 9 INSURED ,���� 3. ,4S INSURERA:Zurich American Insurance Co. 16535 Applied Ecological Services Inc \,I(� INSURERB:Tokio Marine Specialty Ins. Cc 17921 West Smith BrodheadWI53520-93555 DL,�'� �,. 3w��GC�NS�N INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:514710144 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A GENERAL LIABILITY Y GLO-0111561-02 3/1/2017 3/1/2018 EACH OCCURRENCE $1,000,000 '.. DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 CLAIMS-MADE F-_1 OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICYFX PRO- X LOC $ A AUTOMOBILE LIABILITY Y BAP0111558-02 3/1/2017 3/1/2018 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ A X UMBRELLA LIAB X OCCUR Y AUC0111682-02 3/1/2017 3/1/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $0 $ A WORKERS COMPENSATION WC-0111572-02 3/1/2017 3/1/2018 X WCSTATU- 0ER AND EMPLOYERS'LIABILITY YIN T�(RY.,LI„MI„T,SER„.,__„-„_.................._... ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional/ PPK1584344 12/1/2016 12/1/2017 Professional/Retn 5,000,000/20,000 Pollution Liability Pollution/Retention 2,000,000/50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) City of Oshkosh, its officers, council members, agents, employees and authorized volunteers are additional insured on a primary, non-contributory basis as respects General Liability, Automobile and Umbrella where required by written contract. 30 days notice of cancellation to City of Oshkosh applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh IN ACCORDANCE W HIOTHE POLICY PROVISIONS.N DATE THEREOFWILL BE DELIVERED SIONS, Attn: City Clerk 215 Church Avenue PO BOX 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Additional Insured —Automatic — Owners, Lessees Or ZURICH"' Contractors Policy No. Eff. Date of Pol. IExp. Date of Pol. Eff.Date of End. I Producer No. AWL Prem Return Prem. 'GLO-0111561-02 t 3/1/2017 3/1/2018 9062000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured:Applied Ecological Services, Inc. Address(including ZIP Code): 17921 W Smith Rd, Brodhead,WI 53520 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II—Who Is An Insured is amended to include as an additional insured any person or organization whom you 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 by law; 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(04/13) Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. POLICY NUMBER BAP0111558-02 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON—CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule if not shown above will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph Al. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: BAP0111558-02 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON—CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule if not shown above will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 Blanket Notification to Others of Cancellation ZURICH or Non-Renewal Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. AWL Prem Return Prem. GLO-0111561-02 13/1/2017 3/1/2018 9062000 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; 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 3. Must be in an electronic format that is acceptable to us. 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: a. Cancellation, if cancelled for any reason other than nonpayment of premium;or b. Non-renewal, but not including conditional notice of renewal. 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.