CDM Smith, Inc. – Fourth Amendment to Agreement – Clement Avenue 1
FOURTH AMENDMENT TO AGREEMENT
This FOURTH AMENDMENT TO AGREEMENT (“Fourth Amendment”), is entered into this ____ day of ___________, 2023 (the “Effective Date”), by and between the CITY OF ALAMEDA, a municipal corporation (the " City"), and CDM SMITH, INC., a Massachusetts corporation, whose address is 220 Montgomery Street, Suite 1418, San Francisco, CA 94104 (the "Provider"), with reference to the following facts and circumstances:
RECITALS:
A. On December 18, 2018, an agreement was entered into by and bet ween City and Provider ("Original Agreement") in an amount not to exceed $600,301.
B. On June 10, 2020, the parties entered into a First Amendment o f the Agreement ("First Amendment") to extend the term of the Agreement to June 30, 2022.
C. On July 7, 2020, the parties entered into a Second Amendment o f the Agreement ("Second Amendment") to increase the compensation by $530,332, for total compensation under the Agreement not to exceed $1,130,633.
D. On July 5, 2022, the parties entered into a Third Amendment of the Agreement ("Third Amendment") to increase the compensation by $230,000, for total compensation under the Agreement not to exceed $1,360,633.
E. City and Provider desire to modify the Agreement on the terms and conditions set forth herein.
NOW, THEREFORE, in consideration of the foregoing, which are incorporated herein by reference, and for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, City and Provider agree as follows:
1. Section 1 (“Term”) of the Agreem ent is modified to read as follows:
“The term of this Agreement shall commence on the 18th day of D ecember 2018, and shall terminate on the 30th day of June 2025, unless terminated earlier as set forth herein.”
2. Section 2 (“Services to be Performed”) of the Agreement is mo dified to read as follows:
“Provider agrees to do all necessary work at its own cost and expense, to furnish all labor, tools, equipment, materials, except as otherwise specified, and to do all necessary work included in Exhibits A, A1, A2 and A3 as requested. The Provider acknowledges that the work plan included in Exhibits A, A1, A2 and A3 is tentative and does not commit the City to request Provider to perform all tasks included therein.”
3. Section 3 (“Compensation to Provider”) of the Agreement is mo dified to read as follows:
“a. By the 7th day of each month, Provider shall submit to the C ity an invoice for the total amount of work done the previous month. Pricing and acco unting of charges are to be according to the fee schedule as set forth in Exhibits B, B1, B2 and B3 and incorporated
CDM Smith, Inc. – Fourth Amendment to Agreement – Clement Avenue 2 herein by this reference. Extra work must be approved in writi ng by the City Manager or his/her designee prior to performance and shall be paid on a Time and Material basis as set forth in Exhibits B, B1, B2 and B3.”
“b. The total compensation under this Fourth Amendment to Agreeme nt shall not exceed $300,000. Total compensation for this Agreement is $1,660,633.”
4. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect.
Signatures on Next Page
CDM Smith, Inc. – Fourth Amendment to Agreement – Clement Avenue 3 IN WITNESS WHEREOF, the parties have caused this modification of Agreement to be executed on the day and year first above written.
CDM SMITH, INC. CITY OF ALAMEDA
A Massachusetts Corporation A Municipal Corporation
William E. Hurrell, P.E. Jennifer Ott
Vice President City Manager
RECOMMENDED FOR APPROVAL
Allen Tai
Acting Planning, Building and
Transportation Director
APPROVED AS TO FORM:
City Attorney
Celena H. Chen
Chief Planning Counsel
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ABCDEFGJO Holder Identifier : 7777777707070700077763616065553330763617457315446607543026663417311073751476157220120736041113063011207162055772274552071622335720327700772661153221271207362055132076130077727252025773110777777707000707007 6666666606060600062606466204446200600220626224002006020026262040220062222240620600220602200626224000206002006262242200062200260422600020602220626226000206000024262202400066646062240664440666666606000606006 Certificate No : 570096932037
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY )
12/22/2022
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 rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AM END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P OLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONST ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AU THORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
PRODUCER
Aon Risk Services Northeast, Inc.
Boston MA Office
53 State Street
Suite 2201
Boston MA 02109 USA
PHONE
(A/C. No. Ext):
E-MAIL
ADDRESS :
INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 19410 Commerce & Industry Ins Co INSURER A :
15792 Underwriters At Lloyds London INSURER B :
42404 Liberty Insurance Corporation INSURER C :
23035 Liberty Mutual Fire Ins Co INSURER D :
33600 LM Insurance Corporation INSURER E :
INSURER F :
FAX
(A/C. No .): 800-363-0105
CONTACT
NAME:
CDM Smith Inc.
75 State Street Suite 701
Boston MA 02109 USA
COVERAGES CERTIFICATE NUMBER : 570096932037 REVISION NUMBER :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A BOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH R ESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUR ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S UBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . Limits shown are as requested
POLICY EXP
(MM /DD /YYYY )
POLICY EFF
(MM /DD /YYYY )
SUBR
WVD
INSR
LTR
ADDL
INSD POLICY NUMBER TYPE OF INSURANCE LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
POLICY LOC
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence )
MED EXP (Any one person )
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP /OP AGG
X
X
X X
GEN 'L AGGREGATE LIMIT APPLIES PER :
$2,000,000
$500,000
$10,000
$2,000,000
$4,000,000
$4,000,000
C 01/01/2023 01/01/2024 TB7611B8T8Z6043
PRO-
JECT
OTHER :
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
BODILY INJURY ( Per person)
PROPERTY DAMAGE
(Per accident)
X
BODILY INJURY (Per accident)
$2,000,000 D 01/01/2023 01/01/2024 COMBINED SINGLE LIMIT (Ea accident)
AS2-611-B8T8Z6-063
EXCESS LIAB
OCCUR
CLAIMS-MADE AGGREGATE
EACH OCCURRENCE
DED
UMBRELLA LIAB
RETENTION
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT
$1,000,000
X OTH-
ER
PER STATUTE E 01/01/2023 01/01/2024
AOS
WC5611B8T8Z6023
E 01/01/2023 01/01/2024
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / AN
WI
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under
DESCRIPTION OF OPERATIONS below
$1,000,000
WA561DB8T8Z6013
Each Claim PSDEF2300033 01/01/2023 01/01/2024
Professional/Claims Made $1,000,000 Aggregate
Archit&Eng Prof B $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Clement Avenue Safety Improvements.
The City of Alameda, its City Council, boards, commissions, officials, employees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of the City of Alameda in accordance with the policy provisions of the General Liability and Automobile Liability policies.
CANCELLATION CERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVE
City of Alameda
Building, Planning, and Transportation
Department, Attn: Gail Payne,
Senior Transportation Coordinator
2263 Santa Clara Avenue, Room 130
Alameda CA 94501 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE LLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS .
AGENCY CUSTOMER ID:
ADDITIONAL REMARKS SCHEDULE
LOC #:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER : ACORD 25 FORM TITLE : Certificate of Liability Insurance EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED AGENCY
See Certificate Number :
See Certificate Number :
570096932037
570096932037
Aon Risk Services Northeast, Inc.
10518329
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits.
INSURER
INSURER
INSURER
INSURER
INSURER(S) AFFORDING COVERAGE
Page _ of _
NAIC #
CDM Smith Inc.
TYPE OF INSURANCE
POLICY NUMBER LIMITS
WORKERS COMPENSATION
C WA761DB8T8Z6033 01/01/2023 01/01/2024
MA & PR
N/A
ADDL
INSD
INSR
LTR
SUBR
WVD
POLICY
EFFECTIVE
DATE
(MM/DD/YYYY)
POLICY
EXPIRATION
DATE
(MM/DD/YYYY)
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Professional Liab Policy PSDEF2300033
AGENCY CUSTOMER ID:
ADDITIONAL REMARKS SCHEDULE
LOC #:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER : ACORD 25 FORM TITLE : Certificate of Liability Insurance EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED AGENCY
See Certificate Number :
See Certificate Number :
Aon Risk Services Northeast, Inc.
10518329
570096932037
570096932037
Page _ of _
CDM Smith Inc.
Beazley (Syndicates 2623/0623) - 25%
BRIT (Syndicate 2987) - 25%
Munitus (Syndicate 4242) - 12.5%
Re/Rn (Syndicate 1458) - 10%
Castelmga (Syndicate 2525) - 5%
Convex (Syndicate 1984) - 7.50%
Berkshire - 15%
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 POLICY NUMBER: TB7611B8T8Z6043 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to provide
for such additional insured.
B. With respect to the i nsurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equipment
furnished in connection with such work, on the
project (other than service, maintenance or
repairs) to be performed by or on behalf of the
additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a principal
as a part of the same project.
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; 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.
CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
Any Person or Organization to whom you become
obligated to include as an Additional Insured as a result of any contract or agreement you enter into.
Per the contract or agreement
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
LC 24 20 11 18 © 2018 Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy Number TB7-611-B8T8Z6-043
Issued by Liberty Insurance Corp.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OTHER INSURANCE AMENDMENT – SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person (s) or organization(s) shown in the Schedule of this endorsement that qualifies as an additional insured on this Policy, this Policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV – Conditions will not apply. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV – Conditions will apply. However, this insurance is excess over any other insurance availabl e to the additional insured for which it is also covered as an additional insured for the same "occurrence", claim or "suit".
Schedule
Name of Person(s) or Organization(s):
Any person(s) or organization(s) to whom you are obligated by a written agreement to procure Additional Insured coverage under your policy.
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: TB7611B8T8Z6043 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of Sec-
tion IV – Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing oper ations or
"your work" done under a contract with that person or
organization and included in the "products-completed
operations hazard". This waiver applies only to the
person or organization shown in the Schedule above.
LIM 99 01 05 11 © 2011 Liberty Mutual Group of Companies. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy Number TB7-611-B8T8Z6-043
Issued by LIBERTY INSURANCE CORPORATION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO THIRD PARTIES
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART
MOTOR CARRIER COVERAGE PART
GARAGE COVERAGE PART
TRUCKERS COVERAGE PART
EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART
SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM
Schedule
Name of Other Person(s) /
Organization(s):
Email Address or mailing address: Number Days Notice:
A Schedule of each person or
Organization provided to us by
the First
Named Insured within 15 days of
written cancellation notice
received by
the First Named Insured for any
reason other than nonpayment of
premium
As Required by Written Contract
30 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days liste d above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Ou r failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy.
All other terms and conditions of this policy remain unchanged.
CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: AS2-611-B8T8Z6-063 COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
SCHEDULE
Name Of Person(s) Or Organization(s):
Blanket - Any person or organization whom you have agreed in writing to add as an Additional Insured but only to coverage and minimum limits of insurance required by the written agreement,and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision
contained in Paragraph A.1. of Section II – Covered
Autos Liability Coverage in the Business Auto and
Motor Carrier Coverage Forms and Paragraph D.2. of
Section I – Covered Autos Coverages of the Auto
Dealers Coverage Form.
CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: AS2-611-B8T8Z6-063 COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us,but only if the contract is executed prior to the injury or damagae occuring.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others
To Us condition does not apply to the person(s) or
organization(s) shown in the Schedule, but only to the
extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or
organization.
LIM 99 01 05 11 © 2011 Liberty Mutual Group of Companies. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy Number AS2-611-B8T8Z6-063
Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO THIRD PARTIES
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART
MOTOR CARRIER COVERAGE PART
GARAGE COVERAGE PART
TRUCKERS COVERAGE PART
EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART
SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM
Schedule
Name of Other Person(s) /
Organization(s):
Email Address or mailing address: Number Days Notice:
Blanket – as required by written
contract
30 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days liste d above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Ou r failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy.
All other terms and conditions of this policy remain unchanged.
WM 90 18 06 11 © 2011 Liberty Mutual Group of Companies Page 1 of 1 Ed. 06/01/2011 All Rights Reserved
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO THIRD PARTIES
A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy.
SCHEDULE
Name of Other Person(s) / Email Address or mailing address: Number Days Notice:
Organization(s):
Per Schedule on file with Broker Per Schedule on file with Broker 30 All other terms and conditions of this policy remain unchanged.
Effective Date 1/1/2023 Premium $
Issued by LM Insurance Corporation
For attachment to Policy No. WA5-61D-B8T8Z6-013
Issued to
CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: TB7-611-B8T8Z6-043 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location And Description Of Completed Operations All persons or organizations with whom you have
entered into a written contract or agreement, prior
to an “occurrence” or offense, to provide additional
insured status.
All locations as required by written contract or
agreement entered into prior to an “occurrence” or
offense.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work"
at the location designated and described in the
Schedule of this endorsement performed for that
additional insured and included in the "products -
completed operations hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to provide
for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the applicable
limits of insurance.