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HomeMy WebLinkAboutThieneman Construction/UTL/$5,448,000/West Ground Storage Tank Booster Pump StationBy Sergey Grechukhin at 11:03 am, Jan 21, 2025 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 NOT PRESENT Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 West Ground Storage Tank Booster Pump Station City of Carmel, Indiana Contractor’s Affidavit and Waiver of Liens and Claims EXHIBIT D CONTRACTOR’S AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS (__) FINAL (__) PARTIAL (__) PAYMENT TO FOLLOW OWNER: City of Carmel, Indiana Department of Public Works. PROJECT: CONTRACTOR:CONTRACT DATE: ________________________________ being duly sworn states that he or she is the ___________________ of CONTRACTOR, which was awarded Contract No. __________________ with the OWNER in accordance with the contract terms and conditions to install and/or furnish certain materials and labor as follows: __________________________________________________________________________(“Work”) for the Project, DOES HEREBY STATE, WARRANT AND REPRESENT ON BEHALF OF THE CONTRACTOR the following: PARTIAL WAIVER That the balance due from OWNER is the sum of ($__________________________). ( ) Receipt of which is hereby acknowledged; or ( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS and which is given to and for said amount effective upon receipt of such payment. FINAL WAIVER That the final balance due from OWNER is the sum of ($________________________). ( ) Receipt of which is hereby acknowledged; or ( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS which is given to and for said amount effective upon receipt of such payment. THEREFORE, through the date hereof, Contractor waives and releases the Owner and Project of all liens or claims, including, but not limited to, claims for materials, equipment, labor, superintendence and other services or Work performed or furnished by Contractor and further affirms that no other party has any claim or right to lien on account of any materials, equipment, labor, superintendence and other services or Work performed or furnished to or for Contractor for the Project. Contractor agrees to indemnify, defend and hold the Owner and Project harmless, including costs and attorneys’ fees, from and against any and all claims or liens for any subcontractors, materials, supplies, equipment or labor furnished for, in connection with or incorporated into the Project by, through or under Contractor through the date hereof. This Affidavit and Waiver of Liens is given to induce Owner to pay the amount indicated above. Contractor represents that all employees, subcontractors or materialmen have been paid or will be paid from these funds. That through the date hereof, all Affidavits and Waiver of Liens and Claims are true, correct and unconditional and that there is no claim either legal or equitable to defeat the validity of said Affidavits and Waiver of Liens and Claims. That the following are the names of all parties who have furnished material or labor, or both, for said Work and all parties having contracts or subcontracts for specific portions of said Work or for material used in the construction thereof and the amount due or to become due to each, and that the items mentioned include all labor and material required to complete said Work according to Project plans and specifications: 1 2 3 4 5 6 7 CONTRACTOR TYPE OF WORK AMOUNT OF CONTRACT TOTAL RETAINED NET PREVIOUSLY PAID NET AMOUNT THIS PAYMENT BALANCE TO BECOME DUE TOTAL AMOUNT OF ORIGINAL CONTRACT EXTRAS TO CONTRACT TOTAL CONTRACT & EXTRAS CREDITS TO CONTRACT ADJUSTED TOTAL CONTRACT WORK COMPLETED TO DATE LESS RETAINAGE NET AMOUNT EARNED NET PREVIOUSLY PAID NET AMOUNT OF THIS PAYMENT BALANCE TO BECOME DUE Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 West Ground Storage Tank Booster Pump Station City of Carmel, Indiana Contractor’s Affidavit and Waiver of Liens and Claims This instrument has been executed as of the __________ day of __________________, 20____. CONTRACTOR:___________________________ By: Name: Title: STATE OF INDIANA COUNTY OF Sworn to and subscribed before me the undersigned authority on this _____________ day of ______________________, 20____. Notary Public, State of Printed Name of Notary [ SEAL] My Commission Expires: ____________________ Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 West Ground Storage Tank Booster Pump Station City of Carmel, Indiana Subcontractor’s Affidavit and Waiver of Liens and Claims EXHIBIT E SUBCONTRACTOR AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS (__) FINAL (__) PARTIAL (__) PAYMENT TO FOLLOW OWNER: City of Carmel, Indiana Department of Public Works. PROJECT: SUBCONTRACTOR:CONTRACT DATE: ________________________________ being duly sworn states that he or she is the ___________________ of SUBCONTRACTOR, which entered into a contract in writing with _______________ (“CONTRACTOR”) who was awarded Contract No. __________________ with the OWNER in accordance with the contract terms and conditions to install and/or furnish certain materials and labor as follows: __________________________________________________________________________(“Work”) for the Project, DOES HEREBY STATE, WARRANT AND REPRESENT ON BEHALF OF THE SUBCONTRACTOR the following: PARTIAL WAIVER That the balance due from CONTRACTOR is the sum of ($_____________________). ( ) Receipt of which is hereby acknowledged; or ( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS and which is given to and for said amount effective upon receipt of such payment. FINAL WAIVER That the final balance due from CONTRACTOR is the sum of ($____________________). ( ) Receipt of which is hereby acknowledged; or ( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS which is given to and for said amount effective upon receipt of such payment. THEREFORE, through the date hereof, Subcontractor waives and releases the Owner, Contractor and Project of all liens or claims, including, but not limited to, claims for materials, equipment, labor, superintendence and other services or Work performed or furnished by Subcontractor and further affirms that no other party has any claim or right to lien on account of any materials, equipment, labor, superintendence and other services or Work performed or furnished to or for Subcontractor for the Project. Subcontractor agrees to indemnify, defend and hold the Owner, Contractor and Project harmless, including costs and attorneys’ fees, from and against any and all claims or liens for any sub- subcontractors, materials, supplies, equipment or labor furnished for, in connection with or incorporated into the Project by, through or under Subcontractor through the date hereof. This Affidavit and Waiver of Liens is given to induce Contractor to pay the amount indicated above. Subcontractor represents that all employees, subcontractors or materialmen have been paid or will be paid from these funds. That through the date hereof, all Affidavits and Waiver of Liens and Claims are true, correct and unconditional and that there is no claim either legal or equitable to defeat the validity of said Affidavits and Waiver of Liens and Claims. That the following are the names of all parties who have furnished material or labor, or both, for said Work and all parties having contracts or subcontracts for specific portions of said Work or for material used in the construction thereof and the amount due or to become due to each, and that the items mentioned include all labor and material required to complete said Work according to Project plans and specifications: 1 2 3 4 5 6 7 SUBCONTRACTOR TYPE OF WORK AMOUNT OF CONTRACT TOTAL RETAINED NET PREVIOUSLY PAID NET AMOUNT THIS PAYMENT BALANCE TO BECOME DUE TOTAL AMOUNT OF ORIGINAL CONTRACT EXTRAS TO CONTRACT TOTAL CONTRACT & EXTRAS CREDITS TO CONTRACT ADJUSTED TOTAL CONTRACT WORK COMPLETED TO DATE LESS RETAINAGE NET AMOUNT EARNED NET PREVIOUSLY PAID NET AMOUNT OF THIS PAYMENT BALANCE TO BECOME DUE Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 West Ground Storage Tank Booster Pump Station City of Carmel, Indiana Subcontractor’s Affidavit and Waiver of Liens and Claims This instrument has been executed as of the __________ day of __________________, 20____. CONTRACTOR:___________________________ By: Name: Title: STATE OF INDIANA COUNTY OF Sworn to and subscribed before me the undersigned authority on this _____________ day of ______________________, 20____. Notary Public, State of Printed Name of Notary [ SEAL] My Commission Expires: ____________________ Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Zurich American Insurance Co. Travelers Property Casualty Co. of Amer AGCS Marine Insurance Company 1/06/2025 MJ Insurance, Inc. dba The MJ Companies PO Box 3430 Carmel, IN 46082-3430 The MJ Companies 317 805-7542 317 805-7515 certificate@themjcos.com Thieneman Construction Inc. 17219 Foundation Pkwy Westfield, IN 46074 16535 25674 22837 A X X X CONTRACTUAL LIAB X XCU X X Y Y GLO9809065 INDEPENDENT CONTRACTORS INCLUDED 04/01/2024 04/01/2025 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 A X X X X PHYS DAMAGE Y Y BAP9809066 04/01/2024 04/01/2025 1,000,000 B X X X 10,000 Y Y CUP1T956672 04/01/2024 04/01/2025 10,000,000 10,000,000 A N Y WC9809064 3A STATES INCL: IL 3C STATES EXCL: ND 04/01/2024 IN KY OH WA WY 04/01/2025 X 1,000,000 1,000,000 1,000,000 C BUILDER'S RISK CONTRACT WORKS REPORTING FORM MZ193082914 04/01/2024 04/01/2025 25,000,000 NON COMBUST 2,500,000 JOISTED MAS 2,500,000 FRM;$5000 DED The additional insured and waiver of subrogation boxes above are marked based on the policy information shown below. The Certificate Holder and others as defined in the written agreement and the General Liability additional insured endorsement UGL2162ACW 02/19 (see attached endorsement) and Automobile Liability endt CA2048 10/13 (See Attached Descriptions) City of Carmel, Indiana Board of Public Works and Safety One Civic Square Carmel, IN 46032 1 of 2 #S1689031/M1619348 THIECONClient#: 17658 DMD1 1 of 2 #S1689031/M1619348 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) are included as additional insured subject to the terms, conditions and exclusions on the policy(ies). Waiver of Subrogation applies to the Certificate Holder and others as defined in the written agreement and the General Liability endorsement UGL925BCW 12/01, Automobile Liability endt UCA424FCW 04/14, and Workers Compensation per endt WC000313 04/84 subject to the terms, conditions and exclusions on the policy(ies) as permitted by law, when required by written contract. Primary & Noncontributory applies to the Certificate Holder and others as defined in the written agreement and the General Liability endorsement UGL2162ACW 02/19 and Automobile Liability endt CA2048 10/13 subject to the terms, conditions and exclusions on the policy(ies). Umbrella coverage extends over General Liability, Automobile Liability, and Employers Liability and is form following in regard to Additional Insured, Waiver of Subrogation and Primary & Noncontributory as defined by endorsement EU0001 07/16 and subject to the policy terms, conditions and exclusions on the policy. General Liability includes Additional Insured-Engineers, Architects or Surveyors Endorsement CG2007 04/13 and Additional Insured-Engineers, Architects or Surveyors Not Engaged By The Named Insured Endorsement CG2032 04/13, subject to the terms, conditions and exclusions on the policy. Amended definition of insured contract, CONTRACTUAL LIABILITY - RAILROADS, applies. Aggregate per Project applies as defined in the written agreement and the General Liability endorsement subject to the terms, conditions and exclusions on the policies. General Liability includes Contractual Liability subject to the policy terms, conditions and exclusions on the policy. No Explosion, Collapse or Underground exclusion on the General Liability. Builder's Risk includes $5,000,000 Limit/$25,000 Deductible for Earthquake Builder's Risk includes $5,000,000 Limit/$25,000 Deductible for Flood RE: Project: West Ground Storage Tank Booster Pump Station, City of Carmel, Indiana (the "Project"). HOLDER CON'T: City of Carmel, Indiana (Owner), By its Board of Public Works and Safety; Jones & Henry Engineers, Ltd (Engineer); Owner, Engineer and all Consultants as listed in the Special Conditions; Owner and Engineer; Owner and Contractor; The Contractor, Owner, Contractor, Engineer, all Subcontractors, and the officers, directors, partners, employees, agents and other consultants and subcontractors of any of them. 2 of 2 #S1689031/M1619348 Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 U-GL-2162-A CW (02/19) Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Additional Insured – Automatic – Owners, Lessees Or Contractors THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No.Effective Date: 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 under a written contract or written agreement executed by you, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" and subject to the following: 1. If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a. The Insurance Services Office (ISO) ISO CG 20 10 (10/01 edition); or b. The ISO CG 20 37 (10/01 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" arises out of: (1) Your ongoing operations, with respect to Paragraph 1.a. above; or (2) "Your work", with respect to Paragraph 1.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 1., insurance afforded to such additional insured: (a) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (b) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 2.If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a. The Insurance Services Office (ISO) ISO CG 20 10 (07/04 edition); or b. The ISO CG 20 37 (07/04 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 U-GL-2162-A CW (02/19) Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. in the performance of: (a) Your ongoing operations, with respect to Paragraph 2.a. above; or (b) "Your work" and included in the "products-completed operations hazard", with respect to Paragraph 2.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 2., insurance afforded to such additional insured: (i) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (ii) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 3. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a. Under the ISO CG 20 10 (04/13 edition, any subsequent edition or if no edition date is specified); or b. With respect to ongoing operations (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is 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, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 3., insurance afforded to such additional insured: (a) Only applies to the extent permitted by law; (b) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and (c) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement. 4. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a. Under the ISO CG 20 37 (04/13 edition, any subsequent edition or if no edition date is specified); or b. With respect to the "products-completed operations hazard" (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury" or "property damage" is caused, in whole or in part by "your work" and included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 4., insurance afforded to such additional insured: (1) Only applies to the extent permitted by law; (2) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; (3) Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to your execution of the written contract or written agreement; and Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 U-GL-2162-A CW (02/19) Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (4) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. B. Solely with respect to the insurance afforded to any additional insured referenced in Section A. of this endorsement, 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: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. 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. C. Solely with respect to the coverage provided by this endorsement, 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. Solely with respect to 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 under 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 Coverage Part by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74 U-GL-2162-A CW (02/19) Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. F. Solely with respect to the insurance afforded to an additional insured under Paragraph A.3. or Paragraph A.4. of this endorsement, the following is added to Section III – Limits Of Insurance: Additional Insured – Automatic – Owners, Lessees Or Contractors Limit 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 Section 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, conditions, provisions and exclusions of this policy remain the same. Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74