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HomeMy WebLinkAboutCC Resolution 14023 (Pump Repair Service)RESOLUTION NO. 14023 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL WAIVING COMPETITIVE BIDDING REQUIREMENTS AND AUTHORIZING THE DIRECTOR OF PUBLIC WORKS TO ENTER INTO AN AGREEMENT WITH PUMP REPAIR SERVICE COMPANY TO REPLACE AND/OR REPAIR SIX STORM WATER PUMPS, IN AN AMOUNT NOT TO EXCEED $250,000 FROM THE STORM WATER FUND. WHEREAS, the majority of the City's storm water pump stations were constructed in the 1950's and 1960's and therefore require routine maintenance due to their age, and normal wear and tear; and WHEREAS, the City Council adopted Resolution #13970 on July 20, 2015, waiving bidding and authorizing the Acting Director of Public Works to enter into an agreement with Pump Repair Service Company to repair six individual pumps; and WHEREAS, following initial analysis of the pumps, Pump Repair Service Company determined that additional repair work would be needed on San Quentin Pump Station Pump #2, and that Kerner Pump Station Pump #2 and Montecito Pump Station Pump #1 could not be repaired and needed replacement; and WHEREAS, the additional cost to repair San Quentin Pump Station Pump #2, and to replace instead of repair Kerner Pump Station Pump #2 and Montecito Pump Station Pump #1 exceeds by $100,000 ($84,115 plus $15,885 contingency) the contract amount approved by Council on July 20, 2105 via Resolution #13970, thereby necessitating a revised agreement, superseding any agreements entered into pursuant to Resolution #13970; and WHEREAS, Pump Repair Service Company is familiar with the City's older pumps and has the unique expertise and proven ability to repair and/or replace the pumps in question; and WHEREAS, section 2.55.070D of the San Rafael Municipal Code allows for the waiver of competitive bidding in circumstances such as these; and WHEREAS, there are sufficient funds in the City's Storm Water Fund (#205) to accommodate this proposed expenditure. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of San Rafael hereby waives competitive bidding for, and authorizes the Director of Public Works to enter into an agreement with Pump Repair Service Company in a form to be approved by the City Attorney, in an amount not to exceed $250,000. NOW, THEREFORE, BE IT FURTHER RESOLVED that the City Council of the City of San Rafael authorizes an appropriation of $250,000 from the Storm Water Fund to support this agreement and project contingencies. IT IS FURTHER ORDERED AND RESOLVED, that the Director of Public Works is hereby authorized to take any and all such actions and make changes as may be necessary to accomplish the purpose of this resolution. I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the foregoing resolution was duly and regularly introduced and adopted at a regular meeting of the Council of said City on the 5`h day of October 2015, by the following vote, to wit: AYES: COUNCILMEMBERS: Bushey, Colin, Gamblin, McCullough & Mayor Phillips NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None ESTHER C. BEIRNE, City Clerk File No.: 08.03.11 City of San Rafael ♦ California Form of Contract Agreement for Pump Station Maintenance/Repair or Replacement This Agreement is made and entered into this .S1'14 day of OCi odEQ 2015 by and between the City of San Rafael (hereinafter "City") and Pump Repair Service Company, a California corporation (hereinafter "Contractor"), and shall supersede any agreements entered into betewen the parties pursuan to City Council Resolution No. 13970 adopted on July 20, 2015. Witnesseth, that the City and the Contractor, for the considerations hereinafter named, agree as follows: I - Scope of the Work The Contractor hereby agrees to furnish all of the materials and all of the equipment and labor necessary, and to perform all of the work necessary to repair or replace the storm water pumps as specified below. The Contractor shall comply with the Insurance Requirements Sheet which is attached hereto as Exhibit I. II - Time of Completion (a) The work to be performed under this Contract shall be commenced within FIVE (5) WORKING DAYS after the date of written notice by the City to the Contractor to proceed. (b) All work shall be completed, including all punchlist work, within the time period as specified in the SCHEDULE in Section III hereafter, with such extensions of time as are provided for in the General Provisions. III - The Contract Sum The City shall pay to the Contractor for the performance of the Contract the amounts determined for the total number of each of the units of work in the following schedule completed at the unit price stated. ITEM DESCRIPTION SCHEDULE ESTIMATED QUANTITY UNIT UNIT PRICE TOTAL PRICE I San Quentin Pump Station Pump #2 - 8 seeks 1 LS @ $34,998.37 = $34,998.37 Repair 2 San Quentin Pump Station Pump #3 - 8 seeks 1 LS @ $7,123.10 = $7,123.10 Repair 3 Kerner Pump Station Pump #2 - 8 weeks 1 LS @ $62,392.18 = $62,392.18 Replacement 4. Lindaro Pump Station Pump #3 - Repair 6 weeks 1 LS @ $8,794.63 = $8,794.63 5 Montecito Pump Station Pump #1 - 8 seeks 1 LS @ $74,665.66 = $74,665.66 Replacement 6 North Francisco Pump Station Pump #5 16 weeks 1 LS @ $30,836.51 = $30,836.51 - Repair 7. Contingency $31,189.55 TOTAL $250,000.00 IV - Payments The Contractor shall invoice the City as material is received and as work is performed. V — Indemnification Contractor will indemnify, release, defend and hold harmless City, its officers, and employees, against any claim, demand, suit, judgement, loss, liability or expense of any kind, inlcuding attorney's fees, arising out of or resulting in any way, in whole or in part, from any acts or omissions, intentional or negligent, of Contractor or Contractor's officers, agents and employees in the performance of their duties and obligations under this contract. IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this Agreement the day and year first written above. ATTEST: 116 *Y�-- Esther C. Beirne City Clerk APPROVED AS TO FORM: Robert F. Epstein City Attorney File No.: 08.03.11 CITY OF SAN RAFAEL: 0 t4ma� Dean Allison Public Works Director Pump Repair Services Company: By: Printed NaT��`�'®� Title: A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) to/Dz/zols 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 Willie Insurance Services of California, Inc. (CONTACT NAME: c/o 26 Century Blvd (PHONE (FAX IAIr, No. E.0!1-877-945-7378 (A/C. Nol:1-888-467-2378 P.O. Box 305191 I E-MAIL ADDRESS: certificates®willis. cam Nashville, TN 372305191 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Valley Forge Insurance Company 20508 INSUREDPump Repair Service Co., Inc. INSURERB:Cvpres a Insurance Company 10855 P.O. Box 34327 I INSURER C: San Francisco, CA 94134 I INSURER D INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER W1121825 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 SUER LTR IN5D WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYYI (MMIDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES Ea occurrrencel $ 100,000 A $1,000 Prop. Damage I MED EXP (Any One person) $ 5,000 _ y y Ded. Per Occ. 2053779521 08/21/2015 08/21/20161 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 2,000,000 PES [� I 2,000,000 POLICY LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ _ ALL OWNED SCHEDULED BODILY INJURY $ _ AUTOS AUTOS (Per accident) NON -OWNED PROPERTY DAMAGE $ _ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIABHCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION X I I ERH AND EMPLOYERS' LIABILITY YIN B SPER TATUTE ( 1, 000, 000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA PUWC601926 E.L. EACH ACCIDENT $ 04/01/2015 04/01/2016 (Mandatory In NH) I E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) This Voids and Replaces Previously Issued Certificate Dated 08/24/2015 WITH ID: W1069661. City of San Rafael and County of Marin, its officers, agents and employees are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional 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 San Rafael AUTHORIZED REPRESENTATIVE Department of Public works P.O. Box 151560yp�`t�NR.sL.LLh� Pan Rafael, CA 94915-1560 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SR ID:10330885 BATCH:Hatch #: 17485-' AGENCY CUSTOMER ID: LOC #: ACCIOR" ® ADDITIONAL REMARKS SCHEDULE AGENCY Willie insurance Services of California, Inc. NAMED INSURED Pump Repair Service Co., Inc. POLICY NUMBER P.O. Hox 34327 See Page 1 San Francisco, CA 94134 CARRIER NAIC CODE See Page 1 See Page 1 I EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: certificate of Liability insurance Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability. Page 2 Of 2 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10330885 Batch #: 174855 W1121B25 CNA G -140331-D Pump Repair Service Co., Inc. Eff. 08/21/2015 to 08/21/2016 Policy #2053779521 (Ed. 01/13) BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS — WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II -Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The 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: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract'; or b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products -completed operations hazard," and only if: (1) The "written contract" requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.I. above, the words 'caused in whole or in part by' are replaced by the words 'arising out of. 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract"; c. That described in B.1. above; or d. That afforded to you under this policy, whichever is less. G -140331-D (Ed. 01/13) Page 1 of 2 Copyright, CNA All Rights Reserved. CNA G -140331-D Pump Repair Service Co., Inc. Eff. 08/21 /2015 to 08/21 /2016 Policy #2053779521 (Ed. 01/13) 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: a. The rendering of, or the 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; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit' under this insurance, and of any claim or "suit' that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit' to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract' requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury" or "property damage"; or b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G -140331-D (Ed. 01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. Copyright, CNA All Rights Reserved. POLICY NUMBER: 2053779521 Pump Repair Service Co., Inc. Eff. 08/21/2015 to 08/21/2016 CNA G-1 5115-A (Ed. 10/89) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES - NOTICE OF CANCELLATION OR MATERIAL COVERAGE CHANGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of cancellation or material change to: SCHEDULE 1. Number of days advance notice: 30 Days 10 Days Notice of Non -Payment 2. Name: City of San Rafael — Department of Public Works 3. Address: P.O. Box 151560, San Rafael, CA 94915-1560 G-1 5115-A Page 1 of 1 (Ed. 10/89) ALS o® CERTIFICATE OF LIABILITY INSURANCE I DA08/24/2015 08/24/2015 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 Willis Insurance Services of California, Inc. NAME: c/o 26 Centur Blvd PHONE (FAX y (AI¢, tJo_ Ertl:l-877-945-7378 1AIC. Nol1-888-467-2378 P.O. Box 305191 E-MAIL Nashville, TH 372305191 ADDRESS: cartificatesewillis.com INSURER(S) AFFORDING COVERAGE NAIC 9 INSURERA:Vallev Force Insurance Commanv 20508 INSUREDPump Repair Service Co., Inc. INSURER B:Cvpress Insurance Companv 10855 P.O. Box 34327 I INSURER C: San Francisco, CA 94134 I INSURER D I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER w1069661 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP m LIMITS IN1p vnPOLICYNUAIBER (MMIDD/YYYYI (MM1DDlYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS -MADE [X l OCCUR PREMISES (Fa occurrencel $ 100,000 A _$1,000 Prop. Damage Y y MED EXP (Any one person) S 5,000 Ded. Per Dec. 2053779521 '08/21/2015 08/21/20161 PERSONALS ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,Oo0,o00 POLICY JECT LOC I PRODUCTS-C01.1P/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT S _ (Ea acddenll _ ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED 1 BODILY INJURY (Par accident) $ AUTOS AUTOS $ NON -OWNED I (Per DAMAGE HIRED AUTOS AUTOS I! accidentl S UTABRELLAUABHCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE S DED I I RETENTIONS S PER O - WORKERS COMPENSATION 1 X 1 STATUTE I I ER B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN N/A PlJ[dC601926 04/01/2015 04/Ol/201oI EL EACH ACCIDENT S 1,000,000 M OFFICEREMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS belan E.L. DISEASE -POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of San Rafael and County of Harin, its officers, agents and employees are included as Additional insureds as respects to General Liability. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. 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 San Rafael AUTHORIZED REPRESENTATIVE Department of Public Works P.O. Box 151560 anjllwa& Pan Rafael, CA 94915-1560 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SR ID:10008741 aATCH:Batch #: 165228 AGENCY CUSTOMER ID: LOC #: AC40REP ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSUREO Willis Insurance Services of California, Inc. Pump Repair Service Co., Inc. POUCYNUMBER P.O. Box 34327 See Page 1 San Francisco, CA 94134 CARRIER I NAIL CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10008741 Batch 0: 165228 W1069661 G -140331-D Pump Repair Service Co., Inc. Eff. 08/21/2015 to 08/21/2016 Policy #2053779521 (Ed. 01/13) BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The 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: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract'; or b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products -completed operations hazard," and only if. (1) The "written contract" requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.I. above, the words 'caused in whole or in part by' are replaced by the words 'arising out of. 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract'; c. That described in B.1. above; or d. That afforded to you under this policy, whichever Is less. G -140331-D (Ed. 01/13) Page 1 of 2 Copyright, CNA All Rights Reserved. G -140331-D ��A Pump Repair Service Co., Inc. Eff. 08/21/2015 to 08/21/2016 Policy #2053779521 (Ed. 01/13) 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other Insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: a. The rendering of, or the 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; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this Insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury" or "property damage'; or b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G -140331-D (Ed. 01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. Copyright, CNA All Rights Reserved.