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HomeMy WebLinkAboutFoggle Pump & Supply Inc - Desert Sunset Irrigation Well Cleaning & Rehabilitation (Agreement No. 21-006)CONTRACT MRSC SMALL WORKS ROSTER Desert Sunset Irrigation Well Cleaning and Rehabilitation Agreement No. 21-M6 THIS CONTRACT is made and entered into this day of202_1 by and between the City of Pasco, Washington, a Municipal Corporation, hereinafter referred to as "City", and Fogle Pump and Supply Inc., hereinafter referred to as "Contractor." WHEREAS, the Project qualifies under RCW 39.04.155 as a small works roster contract, or a limited public works contract; and WHEREAS, the City having sought and secures quotations from its small works roster, and the Contractor being duty qualified as a Contractor on the small works roster having submitted a quotation acceptable to the City. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows: 1. Description of Work. The Contractor shall furnish all equipment, labor, tools, materials and appurtenances and perform all services in a workmanlike manner and in accordance with the pians and specifications as provided in the Project Description and Specifications, attached hereto as Exhibit A. 2. Compensation. Compensation for the performance of the service and materials as described in Exhibit A, and shall be: That amount set in the quotation attached hereto as Exhibit D subject to any retainage or withholdings as provided below. 3. Time of Completion. The work covered by this Contract shall be completed with all respects within 60 calendar days from the date of the Notice to Proceed. Once the work is commenced, the Contractor shall diligently pursue the work to completion within the time specified in this Contract. 4. Wty of Contractor. Contractor warrants that it is qualified to be awarded a public works contract in compliance with RCW 39.04.354; and further agrees to comply with all State and Federal laws relating to the employment and wage rates to be paid. S. Indemnification. 5.1 The Contractor shall defend, indemnify, and hold harmless the City, its officers, officials, agents, employees, and volunteers from any and all claims and causes of action, including, but not limited to, actions of law or administrative proceedings for all injuries to persons or damages to property, and all losses, damages, demands, Desert Sunset irrigation Well Gleaning and Rehabilitation — 21-006 Page 1 MRSC Small Works Roster Agreement#: [21-006] — Fogle Pump and Supply Inc. suits, judgments, including attorney fees, arising out oil or as a result oft or in connection with the work performed under this Agreement, and caused or occasioned in whole or in part by reason of errors, negligent acts or omissions of the Consultant or its subcontractors in the performance of this Agreement, except for injuries and damages caused by the sole negligence of the City, its officers, employees, agents, and volunteers. 5.2 Should a Court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injuries or damages to property caused by or resulting from the concurrent nt negligence of the Contractor, and the City, its officers, employees, agents and volunteers, the Contractor's liability and obligation to defend hereunder shall only be the proportionate extent of the Contractor's negligence. 5.3 It is further agreed that the indemnification provided herein constitutes the Contractor's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. 5.4 No liability shall attach to the City by reason of entering into this Agreement except as expressly provided herein. 5.5 This indemnification shall include e damages, penalties and attorney fees sustained as a result of Contractor's delayed or failed. performance. 5.6 This waiver has been mutually negotiated by the parties, and the provisions of this section shall survive the expiration or termination of this Agent. 6. Insurance. The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, its agents, representatives, employees, or subcontractors. 6.1 Minimum Scone of Insurance. Contractor shall obtain insurance of the types described below: 6.1.1 Automobile Liability insurance covering all owned, non -owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 6.1.2 Commercial General Liability insurance shall be written on ISO occurrence form CO 00 01 and shall cover liability arising from premises, operations, independent contractors and personal injury and advertising injury- The City shall be named as an insured under the Contractor's Commercial General Liability insurance policy with respect to the work performed for Desert Sunset Irrigation Well Cleaning and Rehabilitation — 21-006 Page 2 MRSC Small Works Roster Agreement#: [21-W] —Fogle Pump and Supply Inc. the City using an additional insured endorsement at least as broad as ISO endorsement form CG 20 26. 6.13 Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 6.1.4 Professional Liability insurance appropriate to the Contractor's profession. 6.2 Minimum Amounts of Insurance, Contractor shall maintain the following insurance limits: 6.2.1 Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 6.2.2 Commercial General Liability insurance shall be written with limits no less than: ❑ $1,000,000 each occurrence; ® $2,000,000 general aggregate; or ❑ $ each occurrence; and $ general aggregate 6.2.3 Professional Liability insurance shall be written with limits no less titan: ❑ $1,000,000 per claim; ® $1,000,000 policy aggregate limit; or ❑ $ per claim; and $ per policy aggregate limit 6.3 Other Insurance Provisions. The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 6.3.1 The Contractor's insurance coverage shall be primary insurance as respects the City. Any insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 6.3.2 The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 6.4 Acceptability ofImm. Insurance is to placed with insurers with a current A.M. Best rating of not less than A:VII. 6.5 Verification of Coverage. Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not Desert Sunset Irrigation Well Cleaning and Rehabilitadon — 21-006 Page 3 MRSC Small Works Roster Agreement#: [21-006] — Fogle Pump and Supply Inc. necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. 7. Retainaze and Performance Bond. 7.1 Unless it is waived as provided below, the Contractor shall provide and post for the benefit of the City a Performance and Payment Bond issued by a qualified surety insuring the Contractor's performance of all the provisions of the Contract and payment of all labors, mechanics, and subcontractors and materialmen as required by RCW 39.08.010. 0 The City shall hold a 10% retainage in lieu of a performance bond per RCW 39.08.010 7.2 The City shall withhold five percent (50%) of the money due to the Contractor for the work performed under this Contact until completion and/or acceptance of the Contract as provided by RCW 60.28.011. Contractor may elect an option for management of the statutory retainage by notice to the City of the elected option under RCW 60.28.011. 8. Work Site Conditions. The work performed under this Contract is done at the Contractor's risk and that Contractor is familiar with the conditions present and other contingencies likely to affect the work and has submitted their quote accordingly. The Contractor will assume the responsibility and risk of all loss or damage to materials or work which may arise prior to completion. The Contractor shall keep the work site in a neat, orderly condition and after completion of the work, the Contractor shall, at its expense, clean up and remove all refuse and unused materials of any kind resulting from the work. 9. General Provisions. 9.1 For the purpose of this Contract, time is of the essence. 9.2 Notice. Notice provided for in this Contract shall be sent by: 9.2.1 Personal service upon the Project Administrators. 9.2.2 Certified mail to the physical address of the parties, or by electronic transmission to the e-mail addresses designated for the parties below. 9.3 The Project Administrator for the purpose of this Contract shall be: 9.3.1 For the City: Albert Obermiller, or his/her designee Public Works Project Coordinator 1025 S Gray St. Desert Sunset Irrigation Well Cleaning and Rehabilitation — 21-006 Page 4 MRSC Small Works Roster Agreement#: [21-006] — Fogle Pump and Supply Inc. Pasco WA 99301 obermillerar_a-' oasco-wa. Dov 9.3.2 For the Contractor: Alaina Fogle, or his/her designee Fogle Pump and Supply Inc. 2250 N. Hwy Colville, WA 99114 Alaina@foglepump.com 10. Plante Resolution. This Contract has been and shall be construed as having been made and entered into and delivered within the State of Washington, and it is agreed by each party hereto that this Agreement shall be governed by the laws of the State of Washington. In the event of a dispute regarding the enforcement, bres * default or, interpretation of this Contract, said dispute shall be resolved by arbitration pursuant to RCW 7.04A, as amended, with both parties waiving the right of a jury trial upon trial de novo, with venue placed in Pasco, Franklin County, Washington. The substantially prevailing party shall be entitled to its reasonable attorney fees and costs as additional award and judgment against the other. IN WITNESS WHEREOF, the parties have executed by their duly authorized official this Contract in triplicate, each of which being deemed an original on the date first written above. Crff OF PASCO. WASHINGTON By:WZtev CONTRACTOR By: etft,&'t I A Alaina Fogle, Direct ef- ons Desert Sunset Irrigation Well Cleaning and Rehabilitation — 21-006 Page 5 MRSC Small Works Roster Agement#: [21-(}06j — Fogle Pump and Supply ire. Schedule A Desert Sun Cleaning and Rehabilitation March 7.n -4t' Move service truck, pump truck and frac unit from Colville. Tear down fence and open roof access to pump house. Use frac unit with brush to brush well removing initial layer of scaling. Add liquid descaler chemical to well using frac unit to brush and agitate. As acid is consumed by the well, use frac unit with venturi clean out tool to recirculate water into sediment holding tank and back into well. Use PH strips to test the PH of the well every 3-4 hours. When PH holds steady at around 2, camera the well and record video. Sanitize the well using Wel-Chlor plus. Replace fence and roof access. Secure work site and equipment nightly. EXHIBIT A Request for Quote Scope of Work The quote shall include a description and associated cost for the following line items: ➢ Timeline of work ➢ Mobilization/demobilization ➢ Post -cleaning video inspection ➢ Cleaning method ➢ Treatment ➢ Rehabilitation/re-development ➢ Site cleanup - to include removal of all material removed from the well ➢ Any remediation required, i.e. pH adjustment, sediment disposal, etc. Information about the Desert Sunset Irrigation Well A site visit will be required to bid on this job. The site visit will be on January 19th, 2021 at 9:OOam. This work shall start after February 15th, 2021, and must be completed and invoiced before March 31St 2021. Information is from a City inspection in January 2021. • 16" diameter well. • The year of construction is unknown. • Depth is 201.2'. • Screen is perforated -166'-198'. • Static water level -164.7' • Possible presence of biofouling and incrustation which are possibly plugging screens and perforations. • Inspection video can be found at https://Pascofileshare.com/link/cLfNfGCil849KEZv1ED3Xkh (Instruction for fileshare site located on last page) General Considerations Site Safety - The CONTRACTOR shall mark, barricade or take other safety measures as necessary to prevent tampering with the work site and to eliminate dangerous conditions for persons or animals in the area. All tanks, pits, or other excavations shall be properly flagged and barricaded as required to eliminate any potential health hazards. The CONTRACTOR is expected to maintain the site and any related equipment and supply storage areas in a clean and orderly manner in order to prevent injury to people and animals. The CONTRACTOR shall maintain a first aid kit, fire extinguisher, and other safety equipment required for the work by regulation on site at all times. All work shall be conducted in accordance with applicable State and Local regulations. • Noise and Working Hours - The CONTRACTOR shall comply with all applicable laws, orders, and regulations concerning the prevention, control, and abatement of excessive noise. Request for Quotes: Desert Sunset Page 5 of 8 Well Cleaning and Rehabilitation EXHIBIT A Discharge of Water - The CONTRACTOR shall be responsible for preventing the release of water, or any other materials used in or related to the rehabilitation operation from the immediate vicinity of the work site onto neighboring properties or any open water bodies. Prevention of Contamination • The CONTRACTOR shall use a minimum of hydrocarbon products, other than fuel, motor oil, hydraulic oil and grease that is normally used on site. • No hydrocarbon -based lubricants or oils shall be used on equipment that will enter the borehole. • Should any spills occur, the CONTRACTOR shall immediately repair the cause and take the necessary steps to contain and thoroughly remove all contaminated soils and materials, and transfer such wastes off site for legal disposal at the CONTRACTOR'S expense. Site Access and Preparation • Access — The well site is located south of Laredo dr., east of the Porto Lane intersection, in Casa Del Sol Park in pasco,WA. This well is in a fenced area in a building. • Services and Supplies — No on site water or power is available. The CONTRACTOR is responsible for inquiring about the availability of services and supplies needed for rehabilitation activities. The CONTRACTOR assumes full responsibility for all supporting services and supplies necessary to properly undertake the work, not limited to water and power, and is entitled to no additional compensation for the lack of any such services or supplies. Request for Quotes: Desert Sunset Page 6 of 8 Well Cleaning and Rehabilitation EXHIBIT B N ❑ O2 m O 1p m m V 0 Vt A W N O D Q _ ❑ Iy N NN 1 � m m D � T m g I T � �f �1 f[1 0 C! x 'Q m C] m o I 3 D c m � m m 8 1g l8 M IfR IW {/f W N N N tJ t0 �O W N1 Y V 8 $ eig A W N H O 1p 00 V m Vt A W N O W N H T m A T m �f �1 f[1 0 C! x 'Q m C] m 3 m ,$ 3 m 00 ,0 3 �' m m w m m o m N Qm N j' m � c N 7 A a w 3 3, 33,39 w +++ w v+ w c n � a N f+ �ppp+ Vpf VVn f�E O 8 N N V1 iA i!� to iry ih Vf Vr N H N 1A 1A N 1/r i/s N to N 1/r N N �1 m D w N 3 0 8 8 8 8 8 8 � a OO O O O !On O O O O CO O O O O G O O O G O O W C 3 D O v O O S O UO O O O O OO oOp oOp � G 3 V p a m o III C � � .T 3 O !D O d D 3 0 e PERFORMANCE BOND BOND TO THE CITY OF PASCO Bond No. 107368796 KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, Fogle Pump & Supply, Inc. as principal, and Travelers Casualty and Surety Company a corporation organized and existing under the laws of the State of CT, as a surety corporation, and qualified under the laws of the State of Washington to become surety upon bonds of contractors, as surety, are jointly and severally held and firmly bound to the City of Pasco in the penal sum of ***Thirty Two Thousand Three Hundred and Eight and 50/100*** ($32,308.50), for the payment of which sum on demand we bind ourselves and our successors, heirs, administrators or personal representatives as the case may be. This obligation is entered into a pursuance of the statutes of the State of Washington, and ordinances of the City of Pasco. Dated at Spokane, Washington, this 18th day of February, 2021. Nevertheless, the conditions of the above obligation are such that: WHEREAS, pursuant to action taken by the City Council of the City on a" , 201�1the Mayor and City Clerk of the City of Pasco have let or are about to let to the said Fogle Pump & Suppfy, Inc., the above bounden principal, a certain contract, the same contract being numbered 21-006 and providing for Desert Sunset Well Cleaning and Rehabilitation (which contract is referred to herein and is made a part hereof as though attached hereto.) WHEREAS, the said principal has accepted, or is about to accept the said contract, and undertake to perform the work wherein provided for in the manner and within the time set forth. NOW, THEREFORE, if the said Fogle Pump & Supply. Inc. shall faithfully perform all of the provisions of said contract in the manner and within the time therein set forth, or within such extensions of the time as may be granted under the contract, and shall pay all laborers, mechanics, subcontractors, and material men, and all persons who shall supply said principal or subcontractors with provisions and supplies for the carrying on of said work, and shall indemnify and hold said City of Pasco harmless from any loss or damage occasioned to any person or property by reason of any carelessness or negligence on the part of said principal, or any subcontractor in the performance of said work, and shall indemnify and hold the City of Pasco harmless from any damage or expense by reason or failure of performance as specified in said contract or from defects appearing or developing in the material or workmanship provided or performed under said contract after its acceptance thereof by the City of Pasco, then and in that event this obligations shall be void; but otherwise it shall be and remain in full force and effect. Approved as to Form: Travelers CasuaIt nd Surety Company Surety She& Donovan, Attorney In Fact 2W Fogle Pump & Supply, Inc.. Contractor PAYMENT BOND To City of Pasco, Washington Bond No. 107368796 The City of Pasco, Washington, City has awarded to Fogle Pump & Supply. Inc. (Principal), a contract for the construction of the project designated as Desert Sunset Well Cleaning and Rehabilitation, Project No. 21-006, in Pasco, Washington (Contract), and said Principal is required under the terms of that Contract to furnish a payment bond in accord with Title 39.08 Revised Code of Washington (RCW). The principal, and Travelers Casualty and Surety Company (Surety), a corporation organized under the laws of the State of CT and licensed to do business in the State of Washington as surety and named in the current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City, in the sum of ***Thirty Two Thousand Three Hundred and Eight and 50/100*** US Dollars ($32,308.50) Total Contract Amount, subject to the provisions herein. This statutory payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with RCW Titles 39.08, and 39.12 including all workers, laborers, mechanics, subcontractors, and material suppliers for the carrying on of such work, and all taxes incurred on said Contract under Title 50 and 51 RCW an all taxes imposed on the Principal under Title 82 RCW; and if such payment obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two (2) original counterparts and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL Fogle Pump & Supply, Inc. zumh 02/18/2021 Principal Signature Date Printed Name Ufuj:ior off- o t m Title SURETY Travelers Casualty and Surety Company Y' 8/2021 Surety Sig ure Date Shelly Donovan Printed Name Attorney In Fact Title Name, address, and telephone of local office/agent of Surety Company is: A iant Insurance Services, Inc. 818 W. Riverside Ave., Ste. 800, Spokane, WA 99201, (509) 324-3025 Approved as to form: Signature Title PBA Date TRAVELERSJJ Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint SHELLY DONOVAN of SPOKANE , Washington , their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 17th day of January, 2019. &� Y AArD - 4�COOL VA State of Connecticut City of Hartford ss. By: Robert L. Rane , enior Vice President On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2021 Anna P. Nowik, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this 18th day of February , 2021 t ftm". Q A COWL 1 � Kevin E. Hughes, Assistant Secretary To verify the authenticity of this Power ofAttorney, please calf us at 1-800-421-3880, Please refer to the above-named Attorney -in -f=act and the details of the bond to which this Power ofAttorney is attached. Quote Price item No. es tion 5Nt '_- & tea!kd Price -- - 1 Mobilization/DeZb,,Illzal,on Lump Sum -..-}� 1 4 l: i,1..• n t '✓P32 �% ''�.�; 2 Cleaning Lump Sum 1 6C) 6D - Iq,000, 6D 2a Chemical Gal / Lbs (circle one) 2b i Cleaning TimeHrs 3 Rehabilitation Lump Sum 1 .! L L,r r'YGI/1�Gt>!fS I 'Gf¢C�Y qj� OEM cD 8Uu. 3a L6 `WAab rimefGti Hrs 4 Post work Video Lump Sum 1 5 Remediation (if applicable) Lump Sum 6nD 1 ti ' r6 Cleanup Lump Sum 1 The undersigned has reviewed the RFQ and is familiar ': Sub Total with the requirements herein, and has verified the quote to be true and correct. Tax Rate 8.696' / 8.0%) Circle appropriate tax rate ,46,_ t Total Signature Datea�.50 Reason Order was placed with the successful vendor. ❑ Lowest Price ❑ Quality Best Delivery Service ❑Only Source [Best Design Request for Quotes: Desert Sunset Page 7 of 8 Well Cleaning and Rehabilitation �CC�RU" FOOLPUM 41 F _.� CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE 6S ISSIIEa AS A MATTER OF 9YFORIIt/►TiON ONLY AND CONFER 9 NO MGM UPON THE CERTIFICATE HOAR. THAS CERTIFICATE DBEs NOT AFfRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED dY THE POLICINyS BELOW. THIS CERTIFICATE OF 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, tfw P~I* INEst have ADDRiOtU1l WSIMp If SU13ROGATiON IS WAIVED, subject to the and coadl iom of dw provisfo� or be , fi's certificate does not confer ri0hts to the certificate holder In Niru of'rich apalM.y, Csrtata Policies rmy esquire an aslant. A statettfant on tPRODUCEIt AMent Insurance Services. Inc. 818 IAC RlVeraWe Ave Ste+( Spokane, WA 49201 mp arsueean _ - —MW Ate_&Wk"M NOW C"Uft n]L -- 21-I mmaa ■ • — 2280 N HWmoy 3 i lfiG Colville, WA 96114 COVERAGES y - TF4T IS TO CERTIFY THAT THE POLICIES E.4 OFMEET INSURANCE t LVED BELOW HAVE 13EE'�l ISSUED T4 THE iM ED NAMED MOVE FOR THE POLICY P13� EDtGITED. NOTVMTHSTAtiDRNG ANY REOt NT, Tt7Mr1 OR CONIXTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIIICATE AMY BE ISSUED OR MAY PERTAIN, THE INSURANCE AMMED BY THE POS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIOM AND CONDITIONS TIONS OF SUCH POLICIES. LIMITS SHOWN. _AWAY HAVE BEEN REDUCED BY PAID CLA*& t TYfrE 0f MataGllCa oust - --.-. --- A r ._ __ vol to wwaER re,'� d._ eta Lam X ooruelta�aaetsalciaearrr --- __� u accua X I X 5Xsa221 1111/2020 11/1/2021 10,41 — 1,040 04 PM �F, s 29 1 x I wC AM AM momy OWLY UNDPOUAUM . «« MCIMILIAS « M y AS 1 t • K« 0 • M M a UTNE NIA: : _NAM_ 4 _� �s 2,0000a �ot,Crs=rtea�o4_ $ 2,ON.O M - MT a 1.004.001 1111/'2020 11/1!2021 y�W�trir+�tpbrs�ea-_ - --- YSPKaocifl . S 11ti12f20 1111/2021 — Et EACNA099W — 1,000,6N EL. LAW - 1E"F„Aepwyw_„1, _ -. 1,000,E C-11-136_ _ __ 1,000,000, osscenr w oR Wpo" TI r i:!De atry acarb ,an. 9 .d t..a.ce,.dr„w,o .esraauirad) RE: AOnarenera No. 21-006 for Desert 8ueeset Art�aHon Wali 1=11 ep and Rehab en City of POSCO, Rs officers, officials, ate,, employees $ vdunbers are named as additional hmkuW as it reWas to general N *Nf Iy $ of mAwogatlon is Wanted by wrHtan cwitr iffy In accordance with then tarmc and conditions of the policies_ The above o� �m C011er>Qe pfbteary and R City of Pasco, WashkXr on Public Warks Project Coordinator 1028 S Gray St Pasco, WA 99MI SMNrATIVE 019W2015 ACORD CORPORATION. AN eigIft rsswve& The ACORD Oulu and Iopo are registered aurins of ACORD SHOUIX AMIE OF THE ABOVE DaCRe POLICM W cJNtCELL D 11 TILE KKPIMTX N OATS THt'sieDF, ltvtlt a MULL BE olaAiIA911eo IM ACCOitD11NCE MAiTH TI£ POtJCY /IEooMAt i ACORD 25 (2018/03) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. GENERAL LIABILITY ELITE EXTENSION This endorsement modifies insurance provided under the f0owing: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include the following clarifications and extensions of coveiraW. The provisions of the Coverage Form apply unless modified by endorsement A. EXPECTED OR INTENDED INJURY The aggregate limit listed above Is the most we will Section I — Cie A, Exclusion a. is amend pay for all damages because of 'Property damage' as follows: to property in the care custody and contrd of or s- 'Bodily injury or "property damage' expected prey loaned to an insured during the policy or Intended from the standpoint of an insured. This exclusion does not apply to *bodily injury' Any payment we make for damages because of or 'property damaq ' resulting from the use of 'property image" to property in the cane, custody reasonable face to orate& persons or property. and control of or property loaned to an insured will B. NON4341YNED WATERCRAFT apply against the General Aggregate Limit shorn in Section I Coverage A. Exclusion 9.(2) is the the decimations, amerxled as toilows: obligation Sat to pay damages on your behalf (2) A watercran you do not own that is: applies only to the amount of damages in excess of the deductible amount listed above. (a) Less than 60 feet tong; and We may pay any part or all of the deductible (b) Not being used to cony person(s) or amount fisted above. We may pay any part or all of the deductible amount to effect settlement property fog a charge; of any claim or 'suit" and upon notification by C. EXTENDED PROPERTY DAMAGE COVERAGE us, you will promptly reimburse us for that part Section I — Coverage A Exclusions j.(3) and (4) is of the deductible we paid. amended to add the following: c. if two or more coverages apply under one Paragraphs (3) and (4) of this exclusion do not "occurrence", only the figs per claim apply to tools or equipment loaned to you, provided deductible applicable to these coverages will they are riot being used to perform operates at apply the time of toss. d. insurance provided by this provision is excess SCHEDULE over any other insurance, whether primary, excess, contingent or any other basis. Since Limlta Of Insurance Deductible insurance provided by this andorsernent is - X5.000 Each Occurrence $250 Rmi Claim excess, we will have no duty to defend any claim or 'suit" to which Insurance provided by $10„000 Annual Aggregate this endorsement applies if any other insurer - a. The each occurrence limit listed above is the has a duty to defend such a claim or `suit. if no other insurer defends, we wr11 undertake to most we will pay for all damages because of . do so but we will be e0illed to the insureds property damage to property in the care, rights against all those other insurers. custody and control of or property loaned to an D. Insured as the result of any one "occurrence', PROPERTY DAMAGE —ELEVATORS regardless of the number of: Section 1— Coverage A.2. Exclusions paragraphs (1) insureds; J (3). 1-(4), i46) and k. do not apply to use of (2) claims made or `suits' brought; elevators. This insurance afforded by this provision is excess over any valid and Collectible property (3) persons or organizations making claims or insurance (including any deductible) available to bringing "suits”. the insured and Section IV — Commercial General L.iabiliiy Conditions Paragraph 4. Other Insurance is changed accordingly. CG7578(2-19) Wudes copye*W niaodr of 1So PrW-t :- trrc, % tti its pfrfisriotr. Pap i of 6 E. RRE, LIGHTNING OR EXPLOSION DAMAGE Except Wtie e I Is used In the term -hostile fw, , the word fire nckxies fire, lighbirig or explosion wherever R appears In the Coverage Form. Under Section i — Coverage A. the last paragraph (after the exclusions) is repWced with the k4lcvAng: Exclusbm c. through n. do not apply to damage by fie, smoke or Mage from automatic fire protection systms to prerr es while rented to you or temporarily occup0d by you with permission of the owner• A separate limit of ln3urzince applies to this coverage as described in Section M — Limits; of Insurance. F. MEDICAL PAYMENTS If Section I — Coverage C. Medical Pa is is not othennse etaci led from this Coverage Form: The mquirement, in the insuring Agreement of Coverage C., that 090raft must be incurred and reported to us wrkhln one year of the accident date is c hanged to throe years G. SUPPLEMENTARY PAYMENTS Su Mary PRIFF1011ft — e* A and 8 Paragraphs 11. and 1.d. are replaced by the foilOwing: 1.b. Up to $5,000 for cost of ball bonds required because of aOcidents or traffic bw violations arising out of the use of any vehicle to which the Bodily injury Liability Coverage applies. We do not have to furnish these bonds. 1.d.AIIreasonable incurred by the insured at our request to . us in the inves#igatron or defense of the claim or "stair, including actual loss of eamings up to $500 a day because of time off from work. SUBSIDIARIES AS WWREDS Section 0 — Who Is An Insured is amended to add the following: 1J. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of this policy. However, Insured does not include any subsidiary that is an insured under any other general iiabilitgr poky, or would have been an insured under such a policy but for terminatim of that policy or the exhaustion of that policy's limits of liability. BLANKET ADDITIONAL INSUREDS — AS REQUIRED BY CONTRACT 1. Section Il — Who Is An Insured is amended to indttde as an additional Insured any person(s) or oig (s) subject to provsi" in Paragraph 2. below, (hereinafter referred to as additional insured) when you and such person(s) or ar ni¢ation(s) have agreed in a wry contract or written agreement that such person(s) or organization(s) be added as an additional insured on your policy pied that the written contract or agreement Is: a. Currently in effect or becomes effective during the policy period; and b. Executed prior to an "occumerxe' or offense to which this insurance Mould However, the nsurance afforded to such additional Insured: a. end applies to the wdent permitted by law; b. WM not be broader than that which you are required by the contact or agreement to provide for such additional insured; and c. Applies only if the person or organization is not specifically named as an additional insured under any other provision of, or endorsement added to, Section U — Who Is An insured of this policy. 2 As provided herein, the insurance coverage provided to such additional insureds is limited to: a. Any Controlling Interest, blit only with respect to their liability arising out of their financial control of you; or premises they awn, maintain, or control while you lease or occupy these Premises. This insurance does not apply to atructrral alterations, new construction and demolition operations performed by or for that person or organic. b. Any architect, engitnaerr°, or surveyor engaged by you but only with respect to fiabdtY for "bodily k1u7', "Prey damage" or "personal and advertising miurY" caused, in whole or in pe, by your acts or omissions or the ads or omissions of those aging on your behalf: (1) In connection with your premises; or (2) in the performance of your ongoing operations. With respect to the insurance afford to these additional insureds. the foil ng additional exclusbn applies: This insurance does not apply to "bodily inj"9. "property dee" or "personal and advertising injury" wising out of the rendering of or the failure to render any professional services by or for YOU. Including: (i) The preparing, r proving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, flee orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. CG757ti(219) (nolo tturww ON ISO Properties, W- With ag pWrrl$SWL Pape 2 of 6 C. d. 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 damagen, or the offense which caused the "personal and advertising Injury`,. involved the rendering of or the failure to render any professional services by or for you. Any manager or lessor of a premises leased to you, but only with respect to liability arising out of the ownership, maintenance or use of that part of a premises leased to you, subject to the following additional exclusions: This insurance does not apply to: (1) Any 'occurrence which takes place atter you cease to be a tenant in that premises. (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. Any state or governmental agency or subdivision or pokcW sem, subjed to the following: (1) This insurance applies only with respect to ft Mowing hazards for which any state Or governrnexntal agency or subdNzion or political suitidnism has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: (a) The exp, maintenance, repair, construction, miction or removal of advertising signs, ate, canopies, cellar entrames, coal how, driveways, manholes, marquees, twist away openings, sidewalk vaults, street banners or decorations and similar exposures; or (b) The Win, miction or removal of atm; or (c) The ownership, maintenance or use of any elevators covered by this Insurance. (2) This insurance apples only with respect to operations performed by you or on your behalf for which any state or gDvernmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: (a) "Bodily injury", "Property daMaW or "Personal and advertisNV "W arising out of operations perforrned for the federal government, state or municipality; or (b) "Bodily inajurr or „property damage" inducted within the "products.. Completed operations hazard'. e. Any vendor, but only with respect to 'bodily inW or 'Property dam" arising out of "Your products' which are distributed or sn in the regular course of the vendors business. With respect to the insurance afforded to these vendors, the following additional exclusions apply - (1) The insurance afforded any vendor does not apply to: (a) "Bodily injury' or "Property damage for which any vendor is obkjated to Pay danvQft by reason of the assumpbon of liability in a contract or agreerrmt This exclusion oboes not apply to RaWlity for darnages that any vendor would have in the absence of the contra or agreement (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by any vendor, (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original containK; (e) Any failure to make such ir>sictions, adjustments, tests or servicing as any vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations perfon-ned at any vendors premises in connection with the sale of the product; (9) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for any vendor, or CG75M-19) Inckdst oorryrip dzd milia! of Iso Prop riles, hoc. with pen nlssiom Pape 3 of 6 (h) "Bodily injury" or "property darnage" arising out of the sole negligence of any vendor for its own ads or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Subparagraphs (d) or (f); or (s) Such inspections, adjustrments, tests or servicing as any vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sate of the products - (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products_ f. Any Mortgagee, Assignee Or Receiver, but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of the premises by you. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. 9• Any Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land teased to you. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: (1) This insurance does not apply to: (a) Any "occurrence" which takes place aft you cease to lease that land; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. h. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury', "property damage or "personal and advertising injury' caused, in whole or in part by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any 'occurrence' which takes place after the equipment lease expires. Any Owners, Lessees, or Contractors for whom you are performing operations, but only with respect to liability for "bodily injury" "property damage" or "personal and advertising injury" caused, in whoie or in per, by (1) Your acts or missions; or (2) The acts or oma of those aging on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed_ With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) "Bodily Injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, appmving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and spetions; 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. (2) "Bodily injury" or "property damage" occurring after. CG7578(2-18) tncltdss copyrtghisd MWA6,1 of ISO P1op8dkM kV— Vitro it-, pen"MIOn. Pace 4 of 6 (a) All work, including materials, parts This endorsement shaj not increase the or equipment fumished in connection with such work, on the aPPkable Limits of Insures shown in the Declarations. project (ofd+' than service, maintenance or repairs) to be J. COVERAGE FOR INJURY TO C049WLOYEES performed by or on behalf of the ANDIOR YOUR OTHER VOLUNTEER WORKERS additional insured(s) at the location Section i1— Who is an insured, Paragraph 2.a. (1) is Of the covered operations has been amended to add the_following: completed; or e. Pana�aphs (a), (b). and (c) do not apply to your (b) That portion of "your work" out of which the injury or damage arises 'employees' or "vdunteer workers" with respect to 'bodily irrjtrty' to a Wem ployW or other has been put to its intended use by "volunteer worker'. any Pemw or organization otherDamages than another contractor fB owed to an � �' „ emplta or "volunteer or subcontractor engaged In performing operations for worker" will be seduced by any amountpaidor available co - a principal as a part of the same projecL ��too�th,�epurred „ �jwidwww Or 'volunteerworker" orkert uncle ottherrvalid and collectible insurance. y j. Any Grantor of Licenses to you, but only K HEALTH CARE SERVICE PROFESSIONALS AS INSUREDS - INCIDENTAL_ MALPRACTICE with respect to their liability as grantor oflicenses to YOU. Section 11— Who is an Para~ La. (1) Their status as additkwW insured under (d) is amended as this endorsement ends when: This provision does not apply to Nurses, Ernergency 1. The {bias granted you by such Medical Technicians, or P who provide Pry heathrare servers on yourbehalf. o pe(s) Organization(s) expires; or 2. Your license is terminated or revoked hthwevsr this exception does notin the business or aPPfy if a� occupation P�r+dl►g Y such by such person(s) or organization professional services. Prior to expiration of the license as stipulated by the contract or L NEWLY FORMED OR ACQUIRED agreement ORGANIZATIONS k. Any Grantor of Franchise, but only with Section ti — Who Is An Insured, Paragraph 3.a. is respect to their liab ty as grantor of a replacedby the following: franchise to you. 3.a. Coverage under this provision is afforded until I. Any Co-owner of Insured Premises, but the end of the policy period. only with respect to their liability as co- This provision does not aPPIY if newly formed or owner of any Insured premises. acquired uir� organizations coverage is ear either by m. Any Con Concessionaires Trading Under Your th provisions of the Coverage Form or by Name. but only with respect to their liability eradorsernernts. as a concessionaire trading under your M. DAMAGE TO PREMISES RENTED TO YOU name. Section Ill — Limits of Insurance, Paragn4,h 6. is 3. Any insurance provided to any additional replaced by the following: insured doss not apply to "bodily injury, "property damage" or 'personal and advertising Sutalflct to &a,above, the Damage To Premises injury* arising out of the sole negligence or Rented To You Lind, or $500,000, wtwhew is higher, is the most we will pay under Coverage A for wdMful misconduct of the additional insured or its 'employees* damages because of "property damage" to any one agents, or any other representative of the additional insured. prom, while rented to you, or in the case of damage by fire, sinuate or leakage from automatic 4. With respect to the insurance afforded to these Protection systems, white rented to you or temporariiy additicmal insureds, the following is added to occupied by you with permission of the owner. Section til — Limits of Insurance: - N. MEDICAL PAYMENT: — INCREASED LIMITS If coverage provided to any additional insured Section III — UmIts of Insurance, Paragraph 7. is is required by a contract or agreement, the replaced by the following: most we will pay on behalf of the additional insured is the amount of insurance: 7. Subject to Paragraph '.I. above, $10,000 is the a. Required by the contract or agreement; or Medical Expense Limit we wilt pay under Coverage C for all medical expenses because of b. Available under the applicable Limits of "bodily injury" sustained by any one person, Insurance shown in the Declarations; unless the amount shown on the Declarations of whichever is less. this Coverage Part for Medical Expense Umff states: CG7578(2-19) Inchrdec coprtmtd m r3, :l of ISO , l+- wift its perms OrL Pike 5 of 6 (a) No Coverage; or (b) $1,000; or (c) $5,000; or (d) A fimit higher than $10,000. O. DIMES IN THE EVENT OF OCCURRENCE, OFFENSE. CLAM OR SUIT Section IV — COMM01rdal General Llabfttly Condittorm Paragraph 2 is amended to add the e. The r+equirerrm t in Condition 2.a, that you must see to It that we are notified as soon as practical of an "occurrence or an of ienm which may result in a claim, applies only when the 'occurrence or offense is known to. (1) You, if you ars an individual or a limited liability company. (2) A partrw, if you are a partnership; (3) A member or rnmiagw, d you are a limited liabR4 company: (4) An 'examOm officer' or insurance rnarvW, if you are a co+porWion; or (5) A wee, if you are a trust. f. The requirement in Condition 2bx that you must see to it that we receive notice of a claim or'sW as soon as practimbie will not be considered breached unless the breach occurs atter such claim or `suit' is known to: (1) You, if you are an individual or a limited IlabPlrky company; (2) A per; If you are a partnership; (3) A member or managw. if you are a united liability corm; (4) An °ftecutiV a affiCar' or insurance manager, if you are a corporation; or (5) A t if you are a trust. P. PRIMARY AND NONC0.NTr4mHORY — ADDMONAL INSURED EXTENSION Section IV — Comrrar cbd General Liability Conditions raph 4, Other Insurance is amended to add to ibkwkV: This insurance is Primary to and will not seek contribution frau any other insurance availabie to an additional insured under your policy provided that: (1) The adder insured is a Named Insured under such other wwawce, and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. However, y the additional insured has been added as an additional insured on other policies, whether primary, excess, contingent or on any other basis, this insurance is excess over any other insurance rewrdless of the written ?gram between you and an " ° Ins Q. UNINTENTIONAL FAILURE TO DISCLOSE EXPOSURES Section IV — Commercial Gen al LFdtiray Conditions Paragraph 6. Representations is amended to add the foilaMring: If you uninterrtion* fait to dwiose any exposures existing at the inception date of your poPay, we will not deny omwage under the Coverage Form solely because of such faifure to asdose. Hower, this Provision does not affect our right tD comet additional Premium or exercise our right of motion or non- renewal. This provision does not apply to any krx)wn injury or dame which is excluded under any other provision of this policy. R. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Section IV — CommwcW General Liability CondPJ*n Paragraph & Transftr Of Rights Of Recovery Against Others To Us is amended to add the following: We vrd wa any right of recovery we may have against any Person or organization because of Payments we make for injury or damage arising out Of. 1. Your ongoing operations; or 2 `Your work' included in the 'products- cornPleted operations hazard". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. is In effect or becomes effective during the term of this poficy; and 2. Was executed prior to loss. S. MENTAL ANGUISH Section V — D ninon 3. is replaced by the folloMng: amity iryury means bodily injury, sickness or disease sustained by a person, including menial anguish or death resulting tom bodily injury, sickness or disease_ T. LIBERALIZATION If we revise this endorsement to Provide greater coverage without additional Premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. OG75M--1 S) In"" oopyrighbd maWdal of 180 PropwtiM kw- with Rs pwrrdsi L Page 6 of 6