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PFI2018-00148 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12018-00148 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/20/2018 Parcel: SEG952 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: G.A.W Inc(DBA Vacx) Project Description: SEG 952, associated with work on SW Commercial between SW Lincoln and SW Main. G.A.W Inc (DBA Vacx)on behalf of Frontier Communications. vacuum potholing utilities to determine locations for storm, curb, and sidewalk improvements. Owner: FEES Description Date Amount PHONE: Contractor: PO BOX 70345 SPRINGFIELD, OR 97405 PHONE: 541-517-0754 FAX: Applicant: JASON JONES PO BOX 70345 SPRINGFIELD, OR 97405 PHONE: 541-517-0754 Total $0.00 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee/Applicant Signature: See application a 1 Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12018-00148 Type: Condition Name: Status: Severity: PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice Applicant must comply with all applicable provisions of federal and state law, the Tigard Municipal Code, and the terms of any agreement with the City of Tigard regarding work to be done pursuant to this permit. PFI_Utilities 02-WORK SITE AREA Applied Notice The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. The spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up and suspension of work to accomplish clean-up. PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to accomplish effective erosion control. PFI_Utilities 04-WORK SITE REPAIRS Applied Notice Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be reinstalled or replaced, with like kind of material. Obtain City approval of restoration work. PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition, American Traffic Safety Services Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work area. Traffic control devices, flag persons, etc., shall be in place prior to initiation of construction work and shall be effectively maintained. PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time, without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and area wide Emergency Services: 503-629-0111 (Tigard Police Dept.,Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met) and 503-431-2345(Tigard School District)and other service providers impacted by such closure. PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City approval of any access closures. PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in daylight between the hours of 7:00 a.m.to 7.00 p.m. Mon-Fri unless otherwise authorized by the City. PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m, unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized by the City Engineer. PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987. If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holder's expense. PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with affected utility agencies. PFI_Utilities 14-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is liable for hazards or damage resulting from the prosecution of the work. PFI—Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice Work under this permit shall include repair of existing facilities (roads, ditches, etc.)as may be necessary, as determined by the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the applicant's expense. PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>, to establish a preconstruction meeting. PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector twenty-four(24) hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI_Utilities 18-PERMIT/PLAN ON SITE Applied Notice A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work performance. PFI_Utilities 19-MONUMENT PROTECTION Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have authority to resolve problems,take corrective action and, in general,will be responsible in case of any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI_Utilities 21 -OTHER Applied Notice � gy CitV of Tigard RECEVED PUBLIC V.10RKS — I"IN GINI,I;RIN(; JUN 14 2018 d{ f public Facility Tmprovement (PFI) 113ARD INEERING �-r� y� ��M�...... :.� 1 1 PE OF i�'ORK DESCRIP'T'ION OF WORK (in the right-of-way) TYPE 1 - larancl-lise L titin•Work Check one: E utit.it;cs ❑ Sidewall/driveway approach ❑ Streetirnprt>vernents performed by N\\'\, PGF' and/or utiliti,agenc\. Detailed description: ;ioxe U. -Vo &-�-1 rr1YkC1- Uc<� ter= (►si'1 C.2 ❑ TYPE 2-:�ideu-alk;I�ri�e��'at'/ewer ��Ui t 1�r1 d`o S S v rn . 0� \fi'ork performed for the purpose of: t�Y1.�Y a'�i r.�5 • Sidewalk installation or repair. ., • Driveway approach installation Prc>pe rri address/Iocation(s): UL) ( 1�a� crc crL E and/car repair 1 e h 5 L-) HCL.y,SA S j t Salutan• sewer lateral u1stallation and/or main line tap ❑ TYPE 3-Dull scale Development Applicatit: VG Work perfonned with Land use :Address: PO )6L --2Q�46 approval wtvch includes ail\'of t:in/Marra�`nc, ,s;1� , err, Tip: 7L! the follo�tng: Phone: 5111.5 o� - �� I"mail: �c VeLc x, , t o Subdit kions or Partition,,; 1ft -75� a Street xlk-idemrig (,t)1it�tct panic: �ciS�-�, �u»c.-5 I hoI1r: •J�7- C7 • Mailihne installation for Saiutar\• t )�C ni sewer, Storm. sewer, Tigard water Contractor: CA' and/orTigard Water Serxice area (;('.B#: 12- I_axpiration: :Address: ?Q )( 203l,'S SUBMIT COMPLETED APPLICATION TO: Cinlstatc: �i7��{�:a- Q� �- -�- zip: 47) City of Tigard I'h(>ne: Y� 5c�", 7 t-j I lnail: ..).] - VC, . C 0tn Plan ninglEngin eering 13125 SW Hall Blvd. (.:otitact 11ame: �= -� J tt� Photic: 211 -S{'7-�7��7 Tigard,OR 97223 `, .� Applicatiins for"imnor work-in ri9hr-cif-war" 1 111"ieer: �� Y ��} lf� I✓ }'� t Mily ma)-he cmaikccl to: ' rowPetmitsg igard-or,gov -Address: Cinlstate: Zip: Phonc: .50F 2-21 --1131 Email: Case No.: 5 0 6!99 Contact name: application subnuttal fee(.07%of Engineer's Estimate) 1's ijnated value of work is regtnu-ed (if over 55,000):S Additional fees: («-ithin the public right-of-way) Application accepted: Is work related to a LAND-USE DECISION? F1Yes '/Na By I C Date: application ret=ieu7ed: If so, please specific (ANILP, SDH SL°B, etc.) caste #: B�,: Date: Is work related to a BUII.;DING PERMIT? D Yes [ x0 applicant notified: If so,please speci6, (BUILDING PL-?RM 1'1case#: By: A- S Date: I:\ENG\PermitApplicationsWt_application Effective 10/16/2017 �a..,«y.L-rY"`�w',.^.F 3 +33":•�"w.`�..'.'S.�S2:: 'm='��.^Er�SFi�2�w.�i�'."...t'�t"i,�_t.c. v=t1+T"_^�''.��''�' ''.^.1�1.�� 'St3'nf ..-. ..... .. ♦ .. City of Tigard • 13125 Sly`I-Iall Blvd. a Tigard,Oregon 97223 0 "v\-%r%v tigard-or.gov s 503-718-2421 e Page I of 4 APPLICANTS NOTE: Person specified as '`Applicant" shall be designated "Permittee and tiltall protide financial assurance for work, if required 1)}` the cite•pursuant to"I'N3C 15.0-11.14-0. With the CACCptl()Il of a 1161itl'()peraring pursuant to a valid frallchisr"wh the Cir.v(sf•1-1pircl,when the(m'rier and the ahPlicant at('cliffcrent po)p e,the applicant must he the purchaser()f record(,r a lessee in hosscssi(1n with written auth4m'zamm frwii the O,xncr()r an agent(4 Tile {>ancr. l-hc Owlwr('j must sigrl this applicariun in the space prurided (ur sul>init a��sittcn auth(mzaticm��ith this aPpIicari(1n f ranrltisccl l'tilittcs are Iml required t()obtain the()\vncr's s111laturc on t1w applicari(rn BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT: The above request does not violate ani recorded decd restrictions that may be attached to or imposed upon the subject ro cr t • If the application is granted, the applicant NN-111 eercisc the rights granted in accord2rIce with the terms and subject to all the conditions and limitations of the approval. :111 01 the above statements and the statements in any plat plan, attachinents, and exhibits transmitted herewith,are true;and the applicants so ackn0 NvIcdge that any peri-nit issued,based on this application, maN. be revoked if it is found that am ;such �taten"Ierlts are false. • The applicant has read the entire contents of the application,including the policies acid Ci•lter"la,and 1111derstands the requirements for approving or denyliig the applicatiot). -\ - Icant/.-authorized : e7�t's signature Print Dame Date SIGNATURES of each owner of the subject property, if required.. 0wnerls signature Print name Date Owner's signature. Print taame 1-Date Owner's signature print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SXX'1-lall 131t-d. ° Tigard,Oregon 97223 ° N,`-wwtigard-or.gov 50.3-718-2121 Page 2 of 4 DEVELOPMENT ENGINEERING FEES Public Facility Improvement (PFI) Permit: - p ® x APPLICATION FEE . Part 1: Required submittal Fee S300.00 FRANCHISE UTILITY AND SIDEWALK/ PERMIT FEE DRIVEWAY AND U'T'ILITY Part 2: :kll non-water system improvetne►nts CONNECTIONS,ETC. (work mi the right of way) Fnglneer's estimate 1 5"o (less S300.00 submittal fee) Fngineer's estimate X' 2` Plan Review Sketch (including information below) WATER SYSTEM FEE ❑ Dimensions Part 3: .All public tivater system improvements ❑ Street Name 1.`nl�llneer's estimate X 12"'�, ❑ Site_-address PFI Permit Fee Exemptions: FULL SCALE DEVELOPMENT There %%7111 be no permit fee charged,oras sura lice required for the follo«ing rn-pes of work: (Subdivisions/Partitions and Street Improvements) • Sidewalk repair (les: than 20 lineal feed Design Plans • Relocate or replace mailbox (G sets,2=106 or 22x.34) • bitch cleaning that does not involve regrading. • Weep hole repair ❑ Cover—Site,Vicinity,,Abbreviation,Legend • Curb repair or replacement (less than 20 lineal feet) ❑ General Notes(Citi•,Water,Sewer,etc.) • La xiz sprinkler syste:m installation or repair ❑ Street(Plan,Profile) • Street tree:pruning or planting ❑ Water,Storm and Sanitary (flan Profile) • Planter strip landscape maintenance ❑ Water Quality Facilities • Test wells ❑ Grading ❑ Landscaping/Tree Plan ❑ Composite Utihq-Plan(Electrical,Phone,Gas, Note: A cash assurance may he required per Stone,SanitanT,Water,Signage,Street Lights,etc) TMC 15.04.140. (customer deposit) ❑ Details ❑ Traffic Sight Distance ❑ Signing and Striping ❑ Street Light Plan and Photometric ❑ Engineers seal/signature ❑ Sheet label (project land use name,re;rasion and plan log block,dates and sheet numbers.) Additional Submittals (per Land Use conditions) ❑ Traffic Report ❑ Storm water Drainage Calculations ❑ Geotechnical Report ❑ Preliminary:Access Report(Sight Distance) ❑ Proposed Plat ❑ Pathway Design(if applicable) ❑ Water Department_approval ❑ Engineer's Construction Estimate PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13123 SNS'1-fall 13h-d. • "Tigard,Oregon 47223 • wxvwtigard-or.gov • 503-718-2421 • Page 3 of 4 SAMPLE SKETCH: I Edge of Pavement i I Ditch Streetlight i a C=a C X31 F 6s A C3 G-9=S G CZ=Y�0<®V C i1 S9� Rain Dndn Elm 7 iV15 S[.(NW eaw+e l°lrl e -Wo I �. I Existing Driveway C dCrk n b, I ` n � IL Od I 011� . > EXisting Shop: ° Poerpole . o I g CL 95 I ° PrropertyLine� e ° Fire Hydrant(FH) i I ° Scale: '1"=30' 1 � i ° d 5 1 A MINIMUM SKETCH REQUIREMENTS (Put`IN/A"if Not Applicable): North arrow Property lines & dime11s1011 Slope of property Street & street naine(s) Existing building, structures l'tility & street light poles Proposed work Exist711g curb car edge I rees l-:xisting S/W or of paN7er 1e11t Existing utility locations D/W apron (sewer,water,storm) PUBLIC FACILITY IMPROVEMENT PERMIT Cita,of Tigard . 13125 SNV Hall Bh d. n Tigard, Oregon 9?223 . wAv-,vtigard-or.gm, o 503-718-2421 e Page 4 of 4 l ® DATE(MM/DD/YYYY) ,d► �► CERTIFICATE OF LIABILITY INSURANCE 6/13/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kris Sutherland Ward Insurance Agency Inc. PHONE FAX PO Box 10167 AIC No Ext): 541-687-1117 A/C No):541-342-8280 Eugene OR 97440 ADDRESS: kris@wardinsurance.net INSURER 5 AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Company 24082 INSURED GAWINCO-01 INSURER B:Scottsdale Insurance Company 41297 GAW, I nc. Vac-X INSURER C:Ohio Casualt Ins Co PO Box 70345 INSURER D: Springfield OR 97475 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:331869636 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 SUBR POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y BKS56416655 3/10/2018 3/10/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE IX OCCUR PREMISES Ea occurrence $1,000.000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY 1 JE Q LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y BAS56416655 3/10/2018 3/10/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident C X UMBRELLA LIAB X OCCUR US056416655 3/10/2018 3/10/2019 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I X RETENTION$10 opo $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANYPROPRIETOR/PARTNER/EXECU I IVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B CONTRACTORS POLLUTION Y VRS0003055 11/17/2017 11/17/2018 PERCLAIM/AGGREGATE $2,000,000 PROFESSIONAL LIABILITY Y PER CLAIM/AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations and auto liability, including waiver of subrogation as required by written contract per attached endorsements.Certificate holder and all entities required by written contract are included as additional insureds as respects to the Contractors Pollution and Professional Liability.Umbrella goes over General Liability,Auto Liability and Employers Liability.Subject to policy limits,terms,conditions and exclusions. 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 Tigard 13125 SW Hall Blvd AUTHORIZED REPRESENTATIVE Tigard OR 97223 14-4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY With respect to coverage afforded by this endorsement,the provisions of the policy apply unless modified by the CG 88 10 04 13 endorsement. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. A. NON-OWNED AIRCRAFT Under Paragraph 2.Exclusions of Section I—Coverage A-Bodily Injury And Property Damage Liability, COMMERCIAL GENERAL LIABILITY EXTENSION exclusion g.Aircraft,Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured, is endorsement modifies insurance provided under the following: 2. It is hired,chartered or loaned with a trained paid crew; COMMERCIAL GENERAL LIABILITY COVERAGE PART 3. The pilot in command holds a currently effective certificate,issued by the duly constituted authority of the INDEX United States of America or Canada.designating her or him a commercial or airline pilot;and 4. It is not being used to carry persons or property for a charge. OBJECT PAGE However,the insurance afforded by this provision does not apply if there is available to the insured other valid ar collectible insurance,whether primary,excess(other than insurance written to apply specifically in excess of this )N-OWNED AIRCRAFT 2 policy),contingent or on any other basis,that would also apply to the loss covered under this provision. )N-OWNED WATERCRAFT 2 B. NON-OWNED WATERCRAFT Under Paragraph 2.Exclusions of Section I—Coverage A—Bodily Injury And Property Damage Liability, tOPERTY DAMAGE LIABILITY—ELEVATORS 2 Subparagraph(2)of exclusion g.Aircraft,Auto Or Watercraft is replaced by the following: 'TENDED DAMAGE TO PROPERTY RENTED TO YOU(Tenant's Property Damage) 2 This exclusion does not apply to: =DICAL PAYMENTS EXTENSION 3 (2) A watercraft you do not own that is: (a) Less than 52 feet long;and 'TENSION OF SUPPLEMENTARY PAYMENTS—COVERAGES A AND B 3 (b) Not being used to carry persons or property for a charge. )DITIONAL INSUREDS—BY CONTRACT,AGREEMENT OR PERMIT 3 C. PROPERTY DAMAGE LIABILITY—ELEVATORS HMARY AND NON-CONTRIBUTORY—ADDITIONAL INSURED EXTENSION 5 1. Under Paragraph 2.Exclusions of Section I—Coverage A—Bodily Injury And Property Damage Liability,Subparagraphs(3),(4)and(6)of exclusion j.Damage To Property do not apply if such )DITIONAL INSUREDS—EXTENDED PROTECTION OF YOUR"LIMITS OF INSURANCE" 6 "property damage"results from the use of elevators. For the purpose of this provision,elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. HO IS AN INSURED—INCIDENTAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN INSURED— 6 2. The following is added to Section IV—Commercial General Liability Conditions,Condition 4.Other :LLOW EMPLOYEE EXTENSION—MANAGEMENT EMPLOYEES Insurance,Paragraph b.Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, =WLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 whether primary,excess,contingent or on any other basis. JLURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU(Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: JOWLEDGE OF OCCURRENCE,OFFENSE,CLAIM OR SUIT 7 1. Under Paragraph 2.Exclusions of Section I-Coverage A-Bodily Injury and Property Damage 3ERALIZATION CLAUSE 7 Liability: a. The fourth from the last paragraph of exclusion j.Damage To Property is replaced by the )DILY INJURY REDEFINED 7 following: (TENDED PROPERTY DAMAGE g Paragraphs(1),(3)and(4)of this exclusion do not apply to"property damage"(other than damage by fire,lightning,explosion,smoke,or leakage from an automatic fire protection systerr AIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US— 8 to: HEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU (i) Premises rented to you for a period of 7 or fewer consecutive days;or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs(1),(3)and(4)of this exclusion do not apply to"property damage"to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III—Limits of Insurance. ©2013 Liberty Mutual Insurance ©2013 Liberty Mutual Insurance i 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 8 CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc-with its permission. Page 2 of 8 b. The last paragraph of subsection 2.Exclusions is replaced by the following: b. Premises or facilities rented by you or used by you;or Exclusions c.through n.do not apply to damage by fire,lightning,explosion,smoke or leakage C. The maintenance,operation or use by you of equipment rented or leased to you by such person from automatic fire protection systems to premises while rented to you or temporarily occupied by or organization;or you with permission of the owner.A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III—Limits Of Insurance. d. Operations performed by you or on your behalf for which the state or political subdivision has 2. Paragraph 6.under Section III—Limits Of Insurance is replaced by the following: issued a permit subject to the following additional provisions: 6. Subject to Paragraph 5.above,the Damage To Premises Rented To You Limit is the most we will 1 This insurance does nota I to"bodily injury","property damage",or"personal ersonal and pay under Coverage A for damages because of"property damage"to: ( ) apply y ry p p y g p advertising injury"arising out of the operations performed for the state or political a. Any one premise: subdivision, (1) While rented to you;or (2) This insurance does not apply to"bodily injury"or"property damage"included within the (2) While rented to you or temporarily occupied by you with permission of the owner "completed operations hazard". for damage by fire;lightning,explosion,smoke or leakage from automatic protection systems,or (3) Insurance applies to premises you own,rent,or control but only with respect to the following hazards: b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D.EXTENDED DAMAGE TO PROPERTY RENTED TO a) The existence,maintenance,repair,construction,erection,or removal of YOU(Tenant's Property Damage)-Paragraph 9.a.of Definitions is replaced with the following: advertising signs.awnings,canopies,cellar entrances;coal holes,driveways. manholes,marquees,hoist away openings,sidewalk vaults,street banners.or 9.a. A contract for a lease of premises.However,that portion of the contract for a lease of premises decorations and similar exposures;or that indemnifies any person or organization for damage by fire,lightning,explosion,smoke,or leakage from automatic fire protection systems to premises while rented to you or temporarily (b) The construction,erection,or removal of elevators;or occupied by you with the permission of the owner,or for damage to contents of such premises that are included in your premises rental or lease agreement,is not an"insured contract". (c) The ownership,maintenance,or use of any elevators covered by this insurance MEDICAL PAYMENTS EXTENSION However: If Coverage C Medical Payments is not otherwise excluded.the Medical Payments provided by this policy are amended as follows: 1. The insurance afforded to such additional insured only applies to the extent permitted by law;and Under Paragraph 1.Insuring Agreement of Section I—Coverage C—Medical Payments, Subparagraph(b)of Paragraph a.is replaced by the following: 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 o (b) The expenses are incurred and reported within three years of the date of the accident:and agreement to provide for such additional insured. EXTENSION OF SUPPLEMENTARY PAYMENTS—COVERAGES A AND B With respect to Paragraph 1.a.above,a persons or organization's status as an additional insured under this 1. Under Supplementary Payments—Coverages A and B,Paragraph 1.b.is replaced by the following: endorsement ends when: b. Up to$3,000 for cost of bail bonds required because of accidents or traffic law violations arising (1) All work,including materials,parts or equipment furnished in connection with such work out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have on the project(other than service,maintenance or repairs)to be performed by or on to furnish these bonds. behalf of the additional insured(s)at the location of the covered operations has been 2. Paragraph 1.d.is replaced by the following: completed,or d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit",including actual loss of earnings up to$500 a day because of time (2) That portion of"your work"out of which the injury or damage arises has been put to its off from work. intended use by any person or organization other than another contractor or subcontrac. engaged in performing operations for a principal as a part of the same project. ADDITIONAL INSUREDS-BY CONTRACT,AGREEMENT OR PERMIT 1. Paragraph 2.under Section II—Who Is An Insured is amended to include as an insured any person or With respect to Paragraph 1.b.above,a person's or organization's status as an additional insured under this organization whom you have agreed to add as an additional insured in a written contract,written endorsement ends when their written contract or written agreement with you for such premises or facilities ends. agreement or permit. Such person or organization is an additional insured but only with respect to liability With respects to Paragraph 1.c.above,this insurance does not apply to any"occurrence"which takes place afte for"bodily injury","property damage"or"personal and advertising injury" caused in whole or in part by: the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. a. Your acts or omissions,or the acts or omissions of those acting on your behalf,in the performance of your on going operations for the additional insured that are the subject of the The insurance provided by this endorsement applies only if the written contract or written agreement is signed written contract or written agreement provided that the"bodily injury"or"property damage"occurs, prior to the"bodily injury"or"property damage". or the"personal and advertising injury"is committed,subsequent to the signing of such written contract or written agreement;or We have no duty to defend an additional insured under this endorsement until we receive written notice of a"suis by the additional insured as required in Paragraph b.of Condition 2.Duties In the Event Of Occurrence, Offense,Claim Or Suit under Section IV—Commercial General Liability Conditions. ©2013 Liberty Mutual Insurance ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. Page 4 o' i 88 100413 Includes copyrighted material of Insurance Services Office.Inc..with its permission. Page 3 Of S 2. With respect to the insurance provided by this endorsement,the following are added to Paragraph 2. b. The following is added to Paragraph b.Excess Insurance: Exclusions under Section I-Coverage A-Bodily Injury And Property Damage Liability: When a written contract or written agreement,other than a premises lease,facilities rental This insurance does not apply to: contract or agreement,an equipment rental or lease contract or agreement,or permit issued by a. "Bodily injury"or"property damage"arising from the sole negligence of the additional insured, state or political subdivision between you and an additional insured does not require this insuran to be primary or primary and non-contributory,this insurance is excess over any other insurance b. "Bodily injury"or"property damage"that occurs prior to you commencing operations at the for which the additional insured is designated as a Named Insured. location where such"bodily injury"or"property damage"occurs. Regardless of the written agreement between you and an additional insured,this insurance is C. "Bodily injury","property damage"or"personal and advertising injury"arising out of the rendering excess over any other insurance whether primary,excess,contingent or on any other basis for of,or the failure to render,any professional architectural,engineering or surveying services, which the additional insured has been added as an additional insured on other policies. including: 1. ADDITIONAL INSUREDS-EXTENDED PROTECTION OF YOUR"LIMITS OF INSURANCE" (1) The preparing,approving,or failing to prepare or approve,maps,shop drawings, opinions,reports,surveys,field orders,change orders or drawings and specifications:or This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. (2) Supervisory,inspection,architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the 1. The following is added to Condition 2.Duties In The Event Of Occurrence,Offense,Claim or Suit: supervision,hiring,employment,training or monitoring of others by that insured,if the"occurrence"which An additional insured under this endorsement will as soon as practicable: 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. a. Give written notice of an"occurrence"or an offense that may result in a claim or"suit"under this insurance to us, d. "Bodily injury"or"property damage"occurring after: b. Tender the defense and indemnity of any claim or"suit"to all insurers whom also have insuranc, (1) All work, including materials, parts or equipment furnished in connection with such work, available to the additional insured;and 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 C. Agree to make available any other insurance which the additional insured has for a loss we cove completed:or under this Coverage Part. (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 d. We have no duty to defend or indemnify an additional insured under this endorsement until we engaged in performing operations for a principal as a part of the same project. receive written notice of a"suit"by the additional insured. e. Any person or organization specifically designated as an additional insured for ongoing operations 2. The limits of insurance applicable to the additional insured are those specified in a written contract or by a separate ADDITIONAL INSURED—OWNERS,LESSEES OR CONTRACTORS written agreement or the limits of insurance as stated in the Declarations of this policy and defined in endorsement issued by us and made a part of this policy. Section III—Limits of Insurance of this policy,whichever are less.These limits are inclusive of and not 3. With respect to the insurance afforded to these additional insureds,the following is added to Section III— in addition to the limits of insurance available under this policy. Limits Of Insurance: J. WHO IS AN INSURED-INCIDENTAL MEDICAL ERRORS f MALPRACTICE If coverage provided to the additional insured is required by a contract or agreement,the most we will pay WHO IS AN INSURED-FELLOW EMPLOYEE EXTENSION-MANAGEMENT EMPLOYEES on behalf of the additional insured is the amount of insurance: Paragraph 2.a.(1)of Section II-Who Is An Insured is replaced with the following: a. Required by the contract or agreement:or (1) "Bodily injury"or"personal and advertising injury": b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. (a) To you,to your partners or members(if you are a partnership or joint venture),to your members (if you are a limited liability company),to a co-"employee"while in the course of his or her This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. employment or performing duties related to the conduct of your business,or to your other PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION "volunteer workers"while performing duties related to the conduct of your business, This provision applies to any person or organization who qualifies as an additional insured under any form or (b) To the spouse,child,parent,brother or sister of that co-"employee"or"volunteer worker"as a endorsement under this policy. consequence of Paragraph(1)(a)above. Condition 4.Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is (c) For which there is any obligation to share damages with or repay someone else who must pay amended as follows: damages because of the injury described in Paragraphs(1)(a)or(b)above;or a. The following is added to Paragraph a.Primary Insurance: (d) Arising out of his or her providing or failing to provide professional health care services.Howeve If an additional insured's policy has an Other Insurance provision making its policy excess,and if you are not in the business of providing professional health care services or providing you have agreed in a written contract or written agreement to provide the additional insured professional health care personnel to others,or if coverage for providing professional health can coverage on a primary and noncontributory basis,this policy shall be primary and we will not seek services is not otherwise excluded by separate endorsement,this provision(Paragraph(d))doe contribution from the additional insured's policy for damages we cover. not apply. ©2013 Liberty Mutual Insurance 3 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 8 ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 6 o' Paragraphs(a)and(b)above do not apply to"bodily injury"or"personal and advertising injury'caused by an "employee"who is acting in a supervisory capacity for you.Supervisory capacity as used herein means the P. EXTENDED PROPERTY DAMAGE "employee's"job responsibilities assigned by you,includes the direct supervision of other"employees"of yours. However,none of these"employees"are insureds for"bodily injury'or"personal and advertising injury"arising out Exclusion a.of COVERAGE A.BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the of their willful conduct,which is defined as the purposeful or willful intent to cause"bodily injury"or"personal and following: advertising injury",or caused in whole or in part by their intoxication by liquor or controlled substances. a. Expected Or Intended Injury The coverage provided by provision J.is excess over any other valid and collectable insurance available to your "employee". "Bodily injury"or"property damage"expected or intended from the standpoint of the insured.Th NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES exclusion does not apply to"bodily injury"or"property damage"resulting from the use of Paragraph 3.of Section II-Who Is An Insured is replaced by the following. reasonable force to protect persons or property. 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US—WHEN REQUIRED IN A will qualify as a Named Insured if there is no other similar insurance available to that organization. CONTRACT OR AGREEMENT WITH YOU However: Under Section IV—Commercial General Liability Conditions,the following is added to Condition 8.Transi a. Coverage under this provision is afforded only until the expiration of the policy period in which the Of Rights Of Recovery Against Others To Us: entity was acquired or formed by you; We waive any right of recovery we may have against a person or organization because of payments we make fo b. Coverage A does not apply to"bodily injury"or"property damage"that occurred before you injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or acquired or formed the organization:and organization and included in the"products-completed operations hazard"provided: C. Coverage B does not apply to"personal and advertising injury"arising out of an offense 1. You and that person or organization have agreed in writing in a contract or agreement that you waive sui committed before you acquired or formed the organization. rights against that person or organization,and d. Records and descriptions of operations must be maintained by the first Named Insured. 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement. No person or organization is an insured with respect to the conduct of any current or past partnership,joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV—Commercial General Liability Conditions,the following is added to Condition 6. Representations: Your failure to disclose all hazards or prior`occurrences"existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior"occurrences'is not intentional. KNOWLEDGE OF OCCURRENCE,OFFENSE,CLAIM OR SUIT Under Section IV—Commercial General Liability Conditions,the following is added to Condition 2.Duties In The Event of Occurrence,Offense,Claim Or Suit: Knowledge of an"occurrence",offense,claim or"suit"by an agent,servant or"employee"of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1.of Section 11—Who Is An Insured or a person who has been designated by them to receive reports of "occurrences".offenses,claims or"suits"shall have received such notice from the agent,servant or "employee". LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge,your policy will automatically provide the coverage as of the day the revision is effective in your state. BODILY INJURY REDEFINED Under Section V—Definitions,Definition 3.is replaced by the following: 3. "Bodily Injury"means physical injury;sickness or disease sustained by a person.This includes mental anguish,mental injury,shock,fright or death that results from such physical injury,sickness or disease. ©2013 Liberty Mutual Insurance ©2013 Liberty Mutual Insurance 388 10 0413 Includes copyrighted material of Insurance Services Office.Inc,.with its permission. Page 7 of 8 CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 8 o' COMMERCIAL GENERAL LIABILITY CG 88 70 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S) - GENERAL AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ® A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" ® under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical ex- penses caused by accidents under Section I - Coverage C Medical Payments, which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to ® you: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations . ® 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Cov- erage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical ex- penses caused by accidents under Section I - Coverage C Medical Payments, which cannot be attrib- uted only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply. CG 88 70 12 08 Includes copyrighted material of ISO Properties,Inc.,with its permission. Page 1 of 1 COMMERCIAL AUTO CA 88 10 01 13 (2) If the Limits of Insurance of any other insurance policy have been exhausted;or (3) To "bodily injury" or "property damage" that occurred before you acquired or forme THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. organization. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT 2. EMPLOYEES AS INSUREDS endorsement modifies insurance provided under the following: SECTION II—LIABILITY COVERAGE, paragraph A.1.—WHO IS AN INSURED is amended to incluc BUSINESS AUTO COVERAGE FORM following as an insured: f. Any"employee"of yours while using a covered"auto"you do not own,hire or borrow,but only fo i respect to coverage afforded by this endorsement,the provisions of the policy apply unless modified by the endorsement. within the scope of their employment by you. Insurance provided by this endorsement is excess /ERAGE INDEX any other insurance available to any"employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written conte 3JECT PROVISION NUMBER agreement in that"employee's" name, with your permission, while performing duties related 1 conduct of your business and within the scope of their employment. Insurance provided b )ITIONAL INSURED BY CONTRACT,AGREEMENT OR PERMIT 3 endorsement is excess over any other insurance available to the"employee". ,IDENTAL AIRBAG DEPLOYMENT 12 =NDED DUTIES IN THE EVENT OF ACCIDENT,CLAIM.SUIT OR LOSS 19 3. ADDITIONAL INSURED BY CONTRACT,AGREEMENT OR PERMIT =NDED FELLOW EMPLOYEE EXCLUSION 5 SECTION II—LIABILITY COVERAGE, paragraph A.1. —WHO IS AN INSURED is amended to incluc )10,VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 following as an insured: )AD FORM INSURED 1 )ILY INJURY REDEFINED 22 h. Any person or organization with respect to the operation, maintenance or use of a covered " 'LOYEES AS INSUREDS(including employee hired auto) 2 provided that you and such person or organization have agreed in a written contract, agreeme 'ENDED CANCELLATION CONDITION 23 permit issued to you by governmental or public authority, to add such person, or organizatic RA EXPENSE—BROADENED COVERAGE 10 governmental or public authority to this policy as an"insured". SSS REPAIR—WAIVER OF DEDUCTIBLE 15 ED AUTO PHYSICAL DAMAGE(including employee hired auto and loss of use) 6 However,such person or organization is an"insured": ED AUTO COVERAGE TERRITORY 20 (1) Only with respect to the operation,maintenance or use of a covered"auto'; �N/LEASE GAP 14 2 Onlyfor"bodilyinjury" or"property dama e" caused b an "accident" which ,KED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) 16 O e g y ;SONAL EFFECTS COVERAGE 11 place after you executed the written contract or agreement.or the permit has issued to you:and 'SICAL DAMAGE—ADDITIONAL TRANSPORTATION EXPENSE COVERAGE g (3) Only for the duration of that contract,agreement or permit JTAL REIMBURSEMENT 9 'PLEMENTARY PAYMENTS 4 4. SUPPLEMENTARY PAYMENTS VING AND LABOR 7 D OR MORE DEDUCTIBLES 17 SECTION II—LIABILITY COVERAGE,Coverage Extensions,2.a.Supplementary Payments, paragrapl NTENTIONAL FAILURE TO DISCLOSE HAZARDS 18 and(4)are replaced by the following: VER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 20 (2) Up to$3,000 for cost of bail bonds(including bonds for related traffic violations)required becat :TION II—LIABILITY COVERAGE is amended as follows: an"accident'we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request,including actual loss of earnings 1. BROAD FORM INSURED $500 a day because of time off from work. SECTION II —LIABILITY COVERAGE, paragraph A.1. —WHO IS AN INSURED is amended to include the S. AMENDED FELLOW EMPLOYEE EXCLUSION following as an insured: In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded t d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the employer by the workers compensation exclusivity rule,or similar protection,the following provision is ad policy period. However:"insured"does not include any organization that: SECTION II—LIABILITY,exclusion B.S.FELLOW EMPLOYEE does not apply if the"bodily injury"result (1) Is a partnership or joint venture;or the use of a covered"auto"you own or hire. (2) Is an insured under any other automobile policy;or SECTION III—PHYSICAL DAMAGE COVERAGE is amended as follows: (3) Has exhausted its Limit of Insurance under any other automobile policy. 6. HIRED AUTO PHYSICAL DAMAGE Paragraph d.(2)of this provision does not apply to a policy written to apply specifically in excess of Paragraph A.4. Coverage Extensions of SECTION III —PHYSICAL DAMAGE COVERAGE, is amend this policy. adding the following: e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you If hired"autos"are covered"autos"for Liability Coverage,and if Comprehensive,Specified Causes of Lc own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days Collision coverage are provided under the Business Auto Coverage Form for any"auto"you own, the from the date of acquisition or formation. However,coverage under this provision does not apply: Physical Damage coverages provided are extended to"autos": (1) If there is similar insurance or a self-insured retention plan available to that organization; a. You hire,rent or borrow;or ©2013 Liberty Mutual Insurance ©2013 Liberty Mutual Insurance 88 10 01 13 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. Page 1 Of 7 CA 88 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page. b. Your"employee"hires or rents under a written contract or agreement in that"employee's"name.but only if the damage occurs while the vehicle is being used in the conduct of your business. 9. RENTAL REIMBURSEMENT subject to the following limit and deductible: SECTION III—PHYSICAL DAMAGE COVERAGE,A.COVERAGE,is amended by adding the following: A. The most we will pay for"loss"in any one"accident"or"loss"is the smallest of: a. We will pay up to$75 per day for rental reimbursement expenses incurred by you for the rental "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for (1) $50,000;or expenses incurred after the first 24 hours following the"accident"or"loss"to the covered"auto." (2) The actual cash value of the damaged or stolen property as of the time of the"loss",or b. Rental Reimbursement will be based on the rental of a comparable vehicle,which in many case! be substantially less than$75 per day,and will only be allowed for the period of time it should t� (3) The cost of repairing or replacing the damaged or stolen property with other property of like repair or replace the vehicle with reasonable speed and similar quality,up to a maximum of 30 d< kind and quality,minus a deductible. C. We will also pay up to$500 for reasonable and necessary expenses incurred by you to remov B. The deductible will be equal to the largest deductible applicable to any owned"auto"for that coverage. replace your tools and equipment from the covered"auto". C. Subject to the limit, deductible and excess provisions described in this provision, we will provide d. This coverage does not apply unless you have a business necessity that other"autos"availat coverage equal to the broadest coverage applicable to any covered"auto"you own. your use and operation cannot fill. e. If"loss"results from the total theft of a covered"auto"of the private passenger type,we will pay D. Subject to a maximum of$1,000 per"accident".we will also cover the actual loss of use of the hired this coverage only that amount of your rental reimbursement expenses which is not already prc "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial under Paragraph 4.Coverage Extension. loss. f. No deductible applies to this coverage. E. This coverage extension does not apply to: For the purposes of this endorsement provision,materials and equipment do not include"personal effec (1) Any''auto"that is hired,rented or borrowed with a driver;or defined in provision 11. 10. EXTRA EXPENSE-BROADENED COVERAGE (2) Any"auto"that is hired,rented or borrowed from your"employee". Under SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the exper For the purposes of this provision.SECTION V—DEFINITIONS is amended by adding the following: returning a stolen covered"auto"to you. The maximum amount we will pay is$1.000. "Total loss"means a"loss"in which the cost of repairs plus the salvage value exceeds the actual cash value. 11. PERSONAL EFFECTS COVERAGE 7. TOWING AND LABOR A. SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by addin following: SECTION III—PHYSICAL DAMAGE COVERAGE, paragraph A.2.Towing,is amended by the addition of the If you have purchased Comprehensive Coverage on this policy for an"auto"you own and that"auto"is s following: we will pay,without application of a deductible,up to$600 for"personal effects"stolen with the"auto." We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" The insurance provided under this provision is excess over any other collectible insurance. classified and rated as a private passenger type,"light truck"or"medium truck"is disabled: B. SECTION V—DEFINITIONS is amended by adding the following: a. For private passenger type vehicles;we will pay up to$50 per disablement. For the purposes of this provision, "personal effects" mean tangible property that is worn or carried insured." "Personal effects"does not include tools,equipment,jewelry,money or securities. b. For"light trucks", we will pay up to$50 per disablement. "Light trucks"are trucks that have a gross vehicle weight(GVW)of 10,000 pounds or less. 12. ACCIDENTAL AIRBAG DEPLOYMENT C. For"medium trucks",we will pay up to$150 per disablement. "Medium trucks"are trucks that have a SECTION III—PHYSICAL DAMAGE COVERAGE,B.EXCLUSIONS is amended by adding the following gross vehicle weight(GVW)of 10,001—20,000 pounds. If you have purchased Comprehensive or Collision Coverage under this policy;the exclusion for"loss"re However,the labor must be performed at the place of disablement. to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimburseme 8. PHYSICAL DAMAGE-ADDITIONAL TRANSPORTATION EXPENSE COVERAGE manufacturer's warranty. However, we agree to pay any deductible applicable to the other Covera warranty. Paragraph A.4.a., Coverage Extension of SECTION III—PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of$50 per day and a maximum limit of$1,500 13. AUDIO,VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III—PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclL 4.c.and 4.d.is deleted and replaced with the following: ©2013 Liberty Mutual Insurance ©2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office,Inc..with its permission. CA 88 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page, B8 10 01 13p Page 3 of 7 Exclusion 4.c.and 4.d.do not apply to: 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE a. Electronic equipment that receives or transmits audio,visual or data signals,whether or not designed Paragraph D.Deductible of SECTION III—PHYSICAL DAMAGE COVERAGE is amended by the addit solely for the reproduction of sound,if the equipment is permanently installed in the covered"auto"at the following: the time of the"loss"and such equipment is designed to be solely operated by use of the power from No deductible applies to glass damage if the glass is repaired rather than replaced. the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered"auto";or 16. PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this Paragraph D.Deductible of SECTION III—PHYSICAL DAMAGE COVERAGE is amended by the addit equipment,then our obligation to pay for,repair,return or replace damaged or stolen property will be reduced the following: by a$100 deductible. The deductible does not apply to"loss"caused by collision to such covered"auto"of the private pass type or light weight truck with a gross vehicle weight of 10,000 lbs.or less as defined by the manufactui 14. LOAN/LEASE GAP COVERAGE maximum loaded weight the"auto"is designed to carry while it is: A. Paragraph C., LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE is a. In the charge of an"insured": amended by adding the following: b. Legally parked:and C. Unoccupied. The most we will pay for a "total loss"to a covered "auto" owned by or leased to you in any one "accident"is the greater of the: The"loss"must be reported to the police authorities within 24 hours of known damage. 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is The total amount of the damage to the covered"auto"must exceed the deductible shown in the Declarati( subject at the time of the"loss"less the amount of: This provision does not apply to any"loss"if the covered"auto"is in the charge of any person or organi; engaged in the automobile business. a. Overdue payments and financial penalties associated with those payments as of the date of the"loss", 17. TWO OR MORE DEDUCTIBLES b. Financial penalties imposed under a lease due to high mileage, excessive use or Under SECTION III PHYSICAL DAMAGE COVERAGE. if two or more company policies or coverage abnormal wear and tear, apply to the same accident,the following applies to paragraph D.Deductible: C. Costs for extended warranties. Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, a. If the applicable Business Auto deductible is the smaller(or smallest)deductible it will be waived: d. Transfer or rollover balances from previous loans or leases, b. If the applicable Business Auto deductible is not the smaller(or smallest)deductible it will be re( e. Final payment due under a"Balloon Loan°, by the amount of the smaller(or smallest)deductible;or f. The dollar amount of any unrepaired damage which occurred prior to the"total loss"of a covered"auto", C. If the loss involves two or more Business Auto coverage forms or policies the smaller(or sm; g. Security deposits not refunded by a lessor. deductible will be waived. h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service For the purpose of this endorsement company means any company that is part of the Liberty Mutual Grot agreement on a covered"auto", SECTION IV—BUSINESS AUTO CONDITIONS is amended as follows: i. Any amount representing taxes, j. Loan or lease termination fees;or 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 2. The actual cash value of the damage or stolen property as of the time of the"loss". SECTION IV-BUSINESS AUTO CONDITIONS,Paragraph B.2.is amended by adding the following: If you unintentionally fail to disclose any hazards,exposures or material facts existing as of the inceptior An adjustment for depreciation and physical condition will be made in determining the actual cash or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will n value at the time of the"loss". This adjustment is not applicable in Texas. prejudiced. B. ADDITIONAL CONDITIONS However,you must report the undisclosed hazard of exposure as soon as practicable after its discover) we have the right to collect additional premium for any such hazard or exposure. This coverage applies only to the original loan for which the covered "auto" that incurred the loss 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT,CLAIM,SUIT,OR LOSS serves as collateral,or lease written on the covered"auto"that incurred the loss. SECTION IV—BUSINESS AUTO CONDITIONS,paragraph A.2.a.is replaced in its entirety by the follow C. SECTION V—DEFINTIONS is changed by adding the following: a. In the event of"accident",claim:"suit'or"loss",you must promptly notify us when it is known to: As used in this endorsement provision,the following definitions apply: 1. You,if you are an individual; "Total loss"means a"loss"in which the cost of repairs plus the salvage value exceeds the actual cash 2. A partner,if you are a partnership: value. 3. Member,if you are a limited liability company; 4. An executive officer or the"employee"designated by the Named Insured to give such n A"balloon loan"is one with periodic payments that are insufficient to repay the balance over the term if you are a corporation. of the loan,thereby requiring a large final payment. ©2013 Liberty Mutual Insurance ©2013 Liberty Mutual Insurance 98 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 7 CA 88 10 01 13 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. Page 1 To the extent possible,notice to us should include: (1) How,when and where the"accident"or"loss"took place; (2) The"insureds"name and address,and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV— BUSINESS AUTO CONDITIONS, paragraph A.S., Transfer of Rights of Recovery Against Others to Us,is amended by the addition of the following: If the person or organization has waived those rights before an"accident"or "loss",our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV — BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For"autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a `suit', on the merits, in the United States,the territories and possessions of the United States of America,Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an"auto'hired,leased.rented or borrowed with a driver. :TION V—DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V—DEFINTIONS,definition C.is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish. mental injury,shock,fright or death resulting from any of these at any time. VIMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS,paragraph A.—CANCELLATION condition applies except as follows: If we cancel for any reason other than nonpayment of premium,we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancellation. ©2013 Liberty Mutual Insurance 88 10 01 13 Includes copyrighted material of Insurance Services Office.Inc..with its permission. Page 7 of 7 Policy Number: VRS0003055 Effective Date: 11/17/2017 Expiration Date: 11/17/2018 VIRTUE RISK PARTNERS VIRTUE PACK COMMON POLICY CONDITIONS This endorsement modifies insurance provided under VIRTUE PACK SERVICE BUSINESS PACKAGE POLICY. Notwithstanding anything contained to the contrary in this VIRTUE PACK Service Business Package Policy,it is hereby agreed that all coverages bound and scheduled in the VIRTUE PACK Service Business Package Policy Declarations or the Contractors Pollution Liability Supplemental Declarations are subject to the following terms and conditions. In the event of a conflict between the provisions of these Common Policy Conditions and any Coverage Part, the provisions of these Common Policy Conditions shall control. A. LIMITS OF LIABILITY AND DEDUCTIBLE-ALL COVERAGE PARTS 1. With the exception of any defense costs paid under the Commercial General Liability Coverage Part, the General .Aggregate Limit Applicable to All Coverage Parts Combined, shown in the Declarations under Item III: Limits of Liability,is the most we will pay for the sum of CLAIMS, CLAIMS EXPENSES, occurrences or damages under all Coverage Parts, Optional Coverages, Supplemental Coverages, and Supplementary Payments under this VIRTUE PACK Service Business Package Policy. 2. If any CLAIM under any Coverage Part of this VIRTUE PACK Service Business Package Policy applies to multiple Coverage Parts,then the General Aggregate LimitApplicable to All Coverage Parts Combined,shown in the Declarations shall be limited to the highest applicable Limit of Liability payable under any one of the applicable Coverage Parts,with the exception of any applicable Excess Liability Coverage. B. ADDITIONAL INSURED 1. It is understood and agreed that Section II.WHO IS AN INSURED of the Commercial General Liability Coverage Part and Section IV. DEFINITIONS,Paragraph L INSURED of the Contractors Pollution Legal Liability and Professional Liability Coverage Parts,as applicable,are amended to include ADDITIONAL INSUREDS,but only with respect to liability for"bodily injury," "property damage,""personal and advertising injury"or LOSS caused,in whole or in part,by: a) "your work", YOUR SERVICES, or PROFESSIONAL SERVICES performed for that ADDITIONAL INSURED and included in the "products-completed operations hazard"; b) Your acts or omissions in the performance of your ongoing operations for that ADDITIONAL INSURED;or c) The acts or omissions of those acting on your behalf in the performance of your ongoing operations for that ADDITIONAL INSURED. However: 1. The insurance afforded to such ADDITIONAL INSURED only applies to the extent permitted by lav;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 J required by the contract or agreement to provide for such ADDITIONAL INSURED. 2. With respect to the insurance afforded to any ADDITIONAL INSURED,the following is added to Section III. LIMITS OF INSURANCE of the Commercial General Liability Coverage Part and Section V. LIMITS OF LIABILITY AND DEDUCTIBLE of the Contractors Pollution Legal Liability and Professional Liability Coverage Parts: I£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: a. Required by the contract or agreement;or b. Available under the applicable Limits of Insurance,whichever is less. VP E 101(5/15) Page 1 of 9 O 2015 Virtue Risk Partners,LLC It is understood and agreed that for the purposes of this Endorsement the following definition shall apply. A. ADDITIONAL INSURED means: 1. Any person or entity specifically endorsed onto this Policy-as an ADDITIONAL INSURED. If any, such ADDITIONAL INSURED shall maintain only those rights pursuant to this Policy as are specified by endorsement;or 2. Any person or organization the NAMED INSURED is required to name as an additional insured in a written contract or agreement,but only with respect to"your work,"YOUR SERVICES or PROFESSIONAL SERVICES performed by or on behalf of the NAMED INSURED for that person or organization.However, such persons or organizations are covered only with respect to "bodily injury,""property damage,""personal and advertising injury,"or LOSS arising out of"your work,"YOUR SERVICES or PROFESSIONAL SERVICES and are not covered for any"bodily injury,""property damage,""personal and advertising injury,"or LOSS arising out of the person's or organization's own liability. C. EXCLUSIONS There is no coverage whatsoever under this Policy for any of the following. We will also have no duty to defend the insured again any suit seeking damages to which this insurance does not apply. 1. Cross Suits Any liability or obligation from any CLAIM initiated,alleged or caused to be brought about by a NAMED INSURED or INSURED against any other NAMED INSURED or INSURED. This exclusion shall not apply to CLAIMS brought by any person(s) or organization(s)whom you agree,in a written contract,to name as an ADDITIONAL INSURED. 2. Prior Knowledge, Expected or Intended Injury BODILY INJURY,PROPERTY DAMAGE, ENVIRONMENTAL DAMAGE or POLLUTION CONDITIONS expected or intended, should have been known by, or could have reasonably been expected by any RESPONSIBLE INSURED, to give rise to a CLAIM. This exclusion shall not apply to BODILY INJURY resulting from the use of reasonable force to protect persons or property. 3. Intentional Acts BODILY INJURY, PROPERTY DAMAGE or ENVIRONMENTAL DAMAGE based upon or arising from any acts of an INSURED which are based upon or otherwise attributed to the INSURED'S intentional,willful, dishonest, fraudulent,malicious, deliberate or knowingly wrongful act,including but not liinited to such behavior or non-compliance with any statute,regulation,ordinance,administrate-e complaint,notice of violation,notice letter,executive order,or instruction of any governmental agency or body prior to or after inception of this Policy,including but not limited to an intentional discharge,seepage,disposal,dispersal, migration,release of any substance that could cause a POLLUTION CONDITION,committed by or at the direction of a RESPONSIBLE INSURED. This exclusion does not apply to a RESPONSIBLE INSURED that did not commit, participate in, or have knowledge of such an act. 4. Workers' Compensation Any liability or obligation of any INSURED under any workers compensation, disability benefits, unemployment compensation, employee benefits,pension sharing,ERISA law or any similar federal,state or local law and any amendments thereto. 5. Employment Practices Liability INJURY OR DAMAGE to: a. A person arising out of any: (1) Refusal to employ that person; (2)Termination of that person's employment; or (3) Employment-related practices,policies,acts or omissions, such as coercion, demotion,evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person;or NIP E 201(5/15) Page 2 of 9 O 2015 irtue Risk Partners,LLC b. The spouse, child,parent,brother or sister of that person as a consequence of INJURY OR DAMAGE to that person at whom any of the employment-related practices described in paragraphs (1),(2) or(3) above is directed. This exclusion applies whether the injure-causing event described in paragraphs (1), (2) or (3) above occurs before employment,during employment or after employment of that person. This exclusion applies: 1. Whether the insured may be liable as an employer or in any other capacity;and 2. To any obligation to share damages with or repay someone else who must pay damages because of the injury. 6. Employer's Liability BODILY INJURY to: 1. An EMPLOYEE of the INSURED, its parent, subsidiary or affiliate,arising out of and in the course of employment by the INSURED or while performing duties related to the conduct of the INSURED'S business;and 2. The spouse, child, parent, brother or sister of that EMPLOYEE as a consequence of Paragraph 5 a. above. This exclusion applies whether the INSURED may be liable as an employer or in any other capacity and to any obligation of any INSURED to share damages with or repay someone who must pay damages because of such BODILY INJURY. This exclusion does not apply to liability assumed by the INSURED under an INSURED CONTRACT. 7. Related Claims Any coverage provided under this Police shall not apply to a CLAIM previously reported to the Company or any CLAIM or CLAIMS EXPENSES involving substantially the same general conditions or allegations that gave rise to any demand as referenced in the application,including any addendum or addenda attached thereto. 8. Injunctive Relief Fines and Penalties Any CLAIM seeking injunctive relief or payment for fines or penalties. 9. Project Coverage Any liability or obligation from any project for which any INSURED is an insured on a separate project-specific policy issued by any insurance company. 10. Any CLAIM arising from: false arrest,detention or imprisonment,malicious prosecution;the wrongful eviction from, -wrongful entry into,or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies,committed by or on behalf of its owner,landlord or lessor; oral or written publication, in any manner,of material that slanders or libels a person or organization or disparages a person's or organization's goods,products or services;or oral or written publication,in any manner,of material thatviolates a person's right of privacy;the use of another's advertising idea in any advertisement;or infringing upon another's copyright,trade dress or slogan in your advertisement. 11. Unsolicited Communications Any liability or obligation, including obligations to pay damages or defend any claire or suit by reason of the assumption of liability in an INSURED CONTRACT, from unsolicited communications or allegations of unsolicited communications made by or on behalf of any INSURED. Unsolicited communications means any form of communication,distribution, or the transmittal or publication of information or material,including,but not limited to facsimile,electronic mail,postal mail,express mail, telephone,internet or-web-based advertisement,instant message, SMS message or text message that the recipient has not specifically requested Unsolicited communications includes,but is not limited to actual or alleged violations of. a. The Telephone Consumer Protection Act (47 U.S.0 227), including any amendment of, or addition to, such statute; b. The Controlling the Assault of Non-Solicited Pornography and Marketing .Act (15 U.S.0 7701), including any amendment of, or addition to, such statue;or c. Any other statue, ordinance or regulation relating to the communication, distribution or transmittal of unwanted content,information or material. VP E 201(5/15) Page 3 of 9 7 2015 Virtue Risk Partners,LLC 12.Access or Disclosure of Confidential or Personal Information Any liability or obligation arising out of any access to or disclosure of any person's or organization's confidential or personal information,including patents,trade secrets,processing methods,customer lists,financial information,credit card information,health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses,public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person's or organization's confidential or personal information. 13. Fire Suppression Negligence Exclusion Any liability or obligation arising out of the NAMED INSURED'S failure to provide safeguards,monitoring or emergency fire suppression equipment,during and up to one hour after performing any operations involving any activity or operation that generates sparks, flames or heat capable of causing combustion. 14. War Any liability or obligation of any INSURED caused,arising,directly or indirectly,out of a. War, including undeclared or civil war; b. Warlike action by a military force,including action in hindering or defending against an actual or expected attack,by any government, sovereign or other authority using military personal or other agents; or c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. 15. Radioactive Waste Any liability or obligation for radioactive,toxic or explosive properties of NUCLEAR MATERIAL. This exclusion shall not apply to the INSURED'S work as it relates to remediation and/or decommissioning of nonreactive sites which may contain or have become contaminated with Low-Level Radioactive Waste as defined in the 1-ow-Level Radioactive Waste Policy.Act and which is under the regulatory authority of the Atomic Energy Act of 1954, as amended. 16. NUCLEAR EXCLUSION I. Any obligation: A. Under any Liability Coverage, to injury, sickness, disease, death or destruction, BODILY INJURY or PROPERTY DAMAGE: 1. With respect to which an INSURED under the Policy is also an INSURED under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters,Nuclear Insurance Association of Canada or any of their successors,or would be an INSURED under any such policy but for its termination upon exhaustion of its limit of insurance;or 2. Resulting from the HAZARDOUS PROPERTIES of NUCLEAR MATERIAL and with respect to which: (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954,or any law amendatory thereof,or(b) the INSURED is,or had this policy not been issued would be, entitled to indemnity from the United States of America,or any agency thereof,under any agreement entered into by the United States of America,or any agency thereof, with any person or organization. B Under any Medical Payments Coverage, or under any Supplementary Payments ProviSlon relating to immediate medical or surgical relief, first aid,to expenses incurred with respect to BODILY INJURY, sickness,disease or death resulting from the HAZARDOUS PROPERTIES of NUCLEAR MATERIAL and arising out of the operation of a NUCLEAR FACILITY by any person or organization. C. Under any Liability Coverage, to injury, sickness, disease, death or destruction, BODILY INJURY or PROPERTY DAMAGE resulting from HAZARDOUS PROPERTIES of NUCLEAR MATERIAL,if: 1. The NUCLEAR MATERIAL is at, or has been discharged or dispersed from any NUCLEAR FACILITY owned by, or operated by or on behalf of,an INSURED;or 2. The NUCLEAR MATERIAL is contained in SPENT FUEL or WASTE and was at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an INSURED;or VP E 201(5/15) Page 4 of 9 ©2015 Virtue Risk Partners,LLC I The injury, sickness,disease,death or destruction,BODILY INJURY or PROPERTY DAMAGE arises out of the furnishing by an INSURED of services,materials,parts or equipment in connection with the planning, construction,maintenance,operation or use of any NUCLEAR FACILITY,but if such facility is located within the United States of America,its territories or possessions or. Canada, this exclusion(3) applies only to injury to or destruction of property at such NUCLEAR FACILITY, PROPERTY DAMAGE to such NUCLEAR FACILITY and any property thereat. As used in this Endorsement: A. HAZARDOUS PROPERTIES mean radioactive,toxic or explosive properties. B. NUCLEAR FACILITY means: 1. Any NUCLEAR REACTOR; 2. Any equipment or device designed or used for (a) separating the isotopes of uranium or plutonium, (b) processing or utilizing SPENT FUEL,or (c) handling,processing or packaging WASTE; 3. Any equipment or device used for the processing fabricating or alloying of SPECIAL. NUCLEAR MATERIAL, if at any time the total amount of such material in the custody of the INSURED at premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any of the combination thereof, or more than 250 grams of uranium 235; or 4. Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of WASTE including the site on which any of the foregoing is located,all operations conducted on such site and all premises used for such operations. C. NUCLEAR MATERIAL means SOURCE MATERIAL, SPECIAL NUCLEAR MATERIAL, or BY- PRODUCT MATERIAL. D. NUCLEAR REACTOR means any apparatus designed or used to sustain nuclear fission in a self- supporting chain reaction or to contain a critical mass of fissionable material. E. SOURCE MATERIAL, SPECIAL NUCLEAR 11/LA 1'ERIAL, and BY-PRODUCT MATERIAL have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. F. SPENT FUEL means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a NUCLEAR REACTOR. G. WASTE means any waste material: (a)containing BY-PRODUCT MATERIAL other than the tailings or waste produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its SOURCE MATERIAL content, and (b) resulting from the operation by any person/organization of any NUCLEAR FACILITY included in the first two paragraphs of NUCLEAR FACILITY. With respect to injury to or destruction of property, the word injury or the word destruction includes all forms of radioactive contamination of property. PROPERTY DAMAGE also includes all forms of radioactive contamination of property. D. GENERAL CONDITIONS 1. Actions Against Company: No action shall lie against the Company unless,as a condition precedent thereto, each INSURED has fully complied with all of the provisions of this Policy, or until the amount of the INSURED'S obligation to pay shall have been finally determined either by written agreement of the INSURED or by judgment against the INSURED after actual trial and appeal has been concluded. Any person,organization or legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this Policy to the extent of the insurance afforded by this Policy. No person or organization shall have any right under this Policy to join the Company as a party to any action against the INSURED to determine the INSURED liability,nor shall the Company be impleaded by the INSURED or his legal representative. 2. Additional Premiums: If, during this POLICY PERIOD, an increase in the risk or hazards covered hereunder occurs, the Company shall have the right to charge the appropriate additional premium. VP E 201(5/15) Page 5 of 9 OO 2015 Virtue Risk Partners,LLC 3. Assignment: This Policy may not be assigned and shall be void if assigned or transferred without prior written consent of the Company. 4. Bankruptcy or Insolvency: Bankruptcy or Insolvency of the INSURED or of the INSURED estate shall not relieve the Company of any of its obligations hereunder. 5. Cancellation: This Policy may be cancelled by the NAMED INSURED by surrender thereof to the Company or any of its authorized agents or by mailing written notification stating when thereafter the cancellation shall be effective.This Policy may be cancelled by the Company for any reason,by mailing to the NAMED INSURED at the address shown in the Policy written notification not less than 60 days (10 days for nonpayment.of premium) thereafter such cancellation shall be effective.Proof of mailing of such notification shall be sufficient proof of notification.The time of surrender or the effective date and hour of cancellation stated in the notification shall become the end of the POLICY PERIOD. Delivery of such written notification either by the NAMED INSURED or by the Company shall be equivalent to mailing.If the NAMED INSURED cancels, earned premium shall be computed in accordance with the customary short rate table and procedure.If the Company cancels, earned premium shall be computed pro rata. Premium adjustment may be either at the time cancellation is effected or as soon as practicable after cancellation becomes effective,but payment or tender of unearned premium is not a condition of cancellation. 6. Changes: Notification to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this Policy or estop the Company from asserting any right under the t ern-is of this Policy;nor shall the terms of this Policy be waived or changed, except by endorsement issued to forth a part of this Policy. 7. Choice of Law: The policy shall be governed and construed in accordance with the laws of the State of New York,without giving effect to conflict of law rules. 8. Coverage Territory. This Policy applies to CLAIMS made: a. In the United States of America (including its territories and possessions),Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph 1 above;or c. All other parts of the world if the injury or damage arises out of: i. Goods or products made or sold by the INSURED in the territory described in Paragraph a.above; or ii. The activities of a person whose home is in the territory described in Paragraph a. above,but is away for a short time on your business. provided the insured's responsibility to pay damages is determined in a CLAIM on the merits, in the territory described in Paragraph a. above or in a settlement we agree to. 9. Declarations and Representations: By acceptance of this Policy,the NAMED INSURED agrees that the statements contained in the Application for insurance,all supplemental materials,CLAIM information and any other information including submitted to the Company,including but not limited to the aforementioned,are accurate and complete at the time such information was reported. All subnutted information comprise the INSURED'S agreements and representations,and knowledge that this Policy is issued in reliance upon the truth of such representations and that this Policy Declarations,Provisions,and Endorsements embody all agreements existing between all INSUREDS and the Company and supersede any prior express or implied agreements relating to this Policy. The NAMED INSURED acknowledges and agrees that the Application and any other information submitted by the NAMED INSURED is incorporated into, and is part of,this Policy. The NAMED INSURED also acknowledges and agrees that the representations and warranties and contained in the Application or in any other information submitted by the NAMED INSURED in an effort to procure this Policy, are complete, true and correct and that the Company issued this Policy in specific reliance upon the representations and warranties contained in the Application and in any other information submitted by the NAMED INSURED. 10. Independent Counsel: In the event the INSURED is entitled by law to select independent counsel to defend the INSURED at the Company's expense,the attorney fees and all other litigation expenses the Company must pay to that counsel are limited to the rates the Company actually pays to counsel the Company retains in the ordinary course of business in the defense of a similar CLAIM or in the community where the CLAIM arose or is being defended. VP E 201(5/15) Page 6 of 9 ©2015 Virtue Risk Partners,LLC Additionally,the Company may exercise the right to require that such counsel have certain minimum qualifications with respect to their competency,including experience in defending CLAIMS similar to the one pending against the INSURED and to require such counsel to have errors and omissions insurance coverage.As respects any such counsel,the INSURED agrees that counsel will timely respond to the Company's requests for information regarding the CLAIM. Furthermore,the INSURED may at any time,by its signed consent, freely and fully waive its right to select independent counsel. 11. Inspection and Audit: Any of the Company's authorized representatives shall have the right and opportunity, but not the obligation,when the Company so desires, to interview persons employed by the INSURED and to inspect at any reasonable time, during the POLICY PERIOD or thereafter, the INSURED'S premises, equipment, operations,COVERED LOCATIONS and all improvements,structures,products,ways,works, machinery and appliances thereon;but neither the Company not its representatives shall assume any responsibility or duty to the INSURED or to any other party,person or entity,by reason of such right or inspection. Neither the Company's right to make inspections,not the actual undertaking thereof nor any report thereon shall constitute an undertaking on behalf of the INSURED or others,to determine or warrant that property or operations are safe,healthful or conform to acceptable engineering practices or are in compliance with any law,rule or regulation.The NAMED INSURED agrees to provide access to appropriate personnel to assist the Company's representatives during any inspection. The Company shall also have the right to examine or audit any financial records of the NAMED INSURED to inspect for accuracy in reporting income or revenue as represented and warranted in the Application. Premium audits maybe processed as a result of such inspection, after any policy expires or is terminated. Premium adjustment calculations shall determine additional premiums due,if any,and shall not result in any raid-term downward adjustment of premium. 12. Material Change in Risk: The INSURED must endeavor to notify the Company,in writing,of any change in operations which materially increases the risk from that originally assumed by the Company at Policy inception. Any failure by the INSURED to notify,-the Company may void all additional risk presented to the Company,if that failure to notify the Company presents additional exposure that the company has not had the opportunity to assess or receive due consideration for. The Company reserves the right to rescind all coverage offered under this policy,accordingly. 13. Mediation and Deductible Credit: If the INSURED and the Company agree to use Mediation to resolve a covered CLAIM,and is completely resolved by such Mediation,the INSURED's Deductible obligation will be reduced by 75%, subject to a maximum monetary reduction of$35,000. For the purpose of thvs paragraph, Mediation means a non-binding process where a neutral panel of individuals assist the parties to reach their own settlement.When this occurs,we will reimburse the NAMED INSURED as soon as practical for any qualif Ting deductible amount which was already paid by the NAMED INSURED prior to the Mediation. 14. Minimum Earned Premium: If this Policy is cancelled at the request of any NAMED INSURED, the total retained by the Company shall not be less than 25.00% 15. Nonrenewal: The Company may non-renew this Policy by mailing or delivering to the NAMED INSURED at the address stated on the Declarations Page,or any endorsement amending the Declarations Page,written notice of nonrenewal at least sixty (60)days before the expiration date of this Policy. The offer of Policy terms, conditions or premium different than those in effect prior to renewal, shall not constitute non-renewal. 16. Other Insurance: Conunercial General LiabihZT Coverage Only a. PrimanT Insurance:This insurance is primat-�% except when b. below applies. b. Excess Insurance: (1) This insurance is excess over any other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's 1Zisk, Installation Risk or similar coverage for "your work"; (b) That is Fire insurance for premises rented to �Tou or temporarily occupied by you with permission of the owner; NIP E 201(5/15) Page 7 of 9 (0 2015 Virtue Risk Partners,LLC (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (d) If the loss arises out of the maintenance or use of aircraft, "auto" or watercraft to the extent not subject to Exclusion g. of Coverage A (SECTION 1);or (e) That is valid and collectible insurance available to you under any other policy. (2)When this insurance is excess,we will have no duty under Coverages A or B to defend the insured against any"suit"if any other insurer has a duty to defend the insured against that"suit."If no other insurer defends,we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3) When this insurance is excess over other insurance, we will pay only the amount of the loss, if any, that exceeds the sum of- (a) f(a) The total amount that all such other insurance would pay for the loss in the absence of this insurance;and (b) The total of all deductible and self-insured amounts under all other insurance. If a loss occurs involving two or more policies,each of which states that its insurance will be excess, then our policy will contribute on a pro rata basis. All Other Coverage Parts except the Environmental Impairment Liability Coverage Part:If any part of either LOSS or CLAIMS EXPENSE are covered under this Policy and any other valid and collectible current,prior or subsequent Policy(les) issued by any other insurer,this Policy shall provide coverage for such LOSS or CLAIMS EXPENSE on a pro rata basis with such other policy according to the applicable Limits of Liability of the applicable Coverage Part and such other policy. This coverage shall apply on an excess basis over any and all Project Specific Policies. This insurance shall in no wa�T be increased or expanded as a result of the receivership,insolvency, or inability to pay of any insurer with respect to both the duty to indemnify and the duty to defend.'Phis also applies to the INSURED while acting as a self-insured for any coverage.The INSURED shall promptly upon the request of the Company provide the Company with copies of all policies potentially applicable against the liability to which this Policy applies. The Company's obligation to make any payment for TRANSPORTATION shall be on an excess and non- contributory basis over any other primarS7 and excess insurance available to the INSURED, whether collectible or not. 17. Primary Non-Contributory: Except as otherwise specified herein,this Policy shall be considered primary to any similar insurance held by third parties with respect to"your work,"YOUR SERVICES and PROFESSIONAL SERVICES performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which person(s)or organizations(s) as referenced above may have,is excess and non-contributory to this insurance. 18. Severability: Except with respect to the Limits of Liability,and any rights or dude s specifically assigned in this Policy to the NAMED INSURED, this insurance applies as if each NAMED INSURED were the only NAMED INSURED and separately to each INSURED against whom a CLAIM is made. 19. Sole Agent: The NAMED INSURED first listed in the Declarations shall be deemed agent of,and act on behalf of,all other INSUREDS,if any,with respect to all matters involving this policy,including the payment or return of premium,payment of all deductibles,receipt and acceptance of any endorsement issued to form a part of the Policy,giving and receiving notification of cancellation or non-renewal,and the exercise the Policy of the rights provided in the Extended Reporting Period clause,if applicable.The Company shall have the right to seek indemnification from any INSURED or any other person who may be legally liable for the debts of the NAMED INSURED. 20. Transfer or Recovery Rights: If the Company pays any amount or incurs CLAIM EXPENSE under this Policy, the Company shall be subrogated to the rights of recovery of each INSURED,against any person, firm or organization. :All INSUREDS shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights,including without limitation,assignment of the INSURED rights against anN7 VP E 201(5/15) Page 8 of 9 ,c 2015 Virtue Risk Partners,LLC person or organization on account of which the Company made payment or incurred coverage expense under this Policy. The INSURED shall do nothing to waive or prejudice such rights either prior or subsequent to any CLAIM. 21.Transfer of the NAMED INSURED'S Rights and Duties: The NAMED INSURED'S rights and duties under this policy may not be transferred without the Company's written consent except in the case of death of an individual NAMED INSURED. If an individual NAMED INSURED dies,their rights and duties will be transferred to the NAMED INSURED'S legal representative,but only while acting within the scope of duties as the NAMED INSURED'S legal representative. Until the NAMED INSURED'S legal representatl%7e is appointed,anyone having proper temporary custody of the NAMED INSURED'S property will have the NAMED INSURED'S rights and duties,but only with respect to that property. 22.Waiver of Subrogation:The Company waives any right of recovery it may have against any person(s)or organizations) to whom the NAMED INSURED agrees, in a written contract, to provide a waiver of subrogation because of payments the Company makes for injury or damage arising out of the YOUR SERVICES done under a contract with that person or organization. This status exists only for the project specified in that contract. Under no circumstances shall this provision act to extend the policy period, change the scope of coverage, or increase the Aggregate Limits of Insurance scheduled in the VIRTUE PACK Service Business Package Policy Declarations or in any Supplemental Declarations. This paragraph shall not apply to the Environmental Impairment Liability Coverage Part. All other policy terms and conditions shall remain the same. PLEASE READ THIS ENDORSEMENT CAREFULLY AND COMPLETELY. THIS ENDORSEMENT CHANGES THE POLICY. ALL OTHER TEI�-MS AND CONDITIONS REMAIN THE SAME. PrP E 201(5/15 Page 9 of 9 ©2015 Virtue Risk Partners,LLC COMMERCIAL GENERAL LIABILITY C. With respect to the insurance afforded by this endorsement;exclusion I.Damage To Your Work of CG 85 83 01 14 Paragraph 2.Exclusions under Section I—Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. 1, Damage To Your Work BLANKET ADDITIONAL INSURED "Property damage"to"your work"arising out of it or any part of it and included in the"products- CONTRACTORS-PRODUCTS/COMPLETED OPERATIONS completed operations hazard'. D. With respect to the insurance afforded to these additional insureds,the following is added to Section II— This endorsement modifies insurance provided under the following: Limits of Insurance: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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: A. Paragraph 2.under Section 11—Who Is An Insured is amended to include as an insured any person or 1. Required by contract or agreement;or organization whom you have agreed to add as an additional insured in a written contract or written agreement.Such person or organization is an additional insured but only with respect to liability for 2. Available under the applicable Limits of Insurance shown in the Declaration. "bodily injury"or"property damage": whichever is less. 1. Caused by"your work"performed for that additional insured that is the subject of the written This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. contract or written agreement;and E. With respect to the insurance afforded by this endorsement.Section IV—Commercial General Liability 2. Included in the"products-completed operations hazard`. Conditions is amended as follows: However: 1. The following is added to Paragraph 2.Duties In The Event Of Occurrence,Offense,Claims Or Suit: a) The insurance afforded to such additional insured only applies to the extent permitted by An additional insured under this endorsement will as soon as practicable: law;and a. Give written notice of an"occurrence"or an offense that may result in a claim or"suit" b) If coverage provided to the additional insured is required by a contract or agreement,the under this insurance to us; insurance afforded to such additional insured will not be broader than that which you are b. Tender the defense and indemnity of any claim or"suit"to all insurers whom also have required by the contract or agreement to provide for such additional insured insurance available to the additional insured;and The insurance provided by this endorsement applies only if the written contract or written agreement is C. Agree to make available any other insurance which the additional insured has for a loss signed prior to the"bodily injury"or"property damage". we cover under this Coverage Part. We have no duty to defend an additional insured under this endorsement until we receive written notice of d. We have no duty to defend or indemnify an additional insured under this endorsement a"suit"by the additional insured as required in Paragraph b.of Condition 2.Duties In The Event Of until we receive written notice of a"suit"by the additional insured. Occurrence,Offense,Claim Or Suit under Section IV—Commercial General Liability Conditions. 2. Paragraph 4.of Section IV—Commercial General Liability Conditions is amended as follows: B. With respect to the insurance provided by this endorsement,the following are added to Paragraph 2. a. The following is added to Paragraph a.Primary Insurance: Exclusions under Section I—Coverage A—Bodily Injury And Property Damage Liability: If an additional insured's policy has an Other Insurance provision making its policy This insurance does not apply to: excess,and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis,this policy shall be primary and we will not seek contribution from the additional insured's policy for damages 1. "Bodily injury"or"property damage"that occurs prior to you commencing operations at the we cover. location where such"bodily injury"or"property damage"occurs. b. The following is added to Paragraph b.Excess Insurance: 2. "Bodily injury"or"property damage"arising out of the rendering of,or the failure to render,any professional architectural,engineering or surveying services including: When a written contract or written agreement,other than a premises lease,facilities rental contract or agreement;an equipment rental or lease contract or agreement,or a. The preparing,approving or failure to prepare or approve,maps,shop drawings, permit issued by a state or political subdivision between you and an additional insured opinions,reports,surveys;field orders,change orders or drawing and specifications:and does not require this insurance to be primary or primary and non-contributory.this insurance is excess over any other insurance for which the additional insured is b. Supervisory,inspection,architectural or engineering activities. designated as a Named Insured. Regardless of the written agreement between you and an additional insured,this insurance is excess over any other insurance whether primary,excess.contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ©2013 Liberty Mutual Insurance ©2014 Liberty Mutual Insurance CG 85 83 01 14 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 2 CG 85 83 01 14 Includes copyrighted material of Insurance Services Office,Inc.,Wth its permission. Page 2 of 2 Frontier COMMUNICATIONS May 12, 2016 Right-of-Way Permit Specialist Governing Agency Re: Authorization for Vac-X to apply for and procure Work-in-Right-of-Way permits to perform vacuum excavation potholes as a Frontier Communications vendor. With this letter we are providing notice to public agencies that our vendor, Vac-X, is authorized to apply for and procure Work-in-Right-of-Way permits for vacuum excavation potholing of Frontier Communications telecommunication facilities and other underground utilities, for the purpose of acquiring subsurface utility exploration information requested by Frontier Communications for an upcoming telecommunications project or when information is requested by a public works agency. This authorization for Vac-X to apply for and procure Work-in-Right-of-Way permits is valid as long as Vac-X is authorized as a Frontier Communications vendor. If you have questions or concerns about this authorization for Vac-X please contact beavertonengineering@ftr.com. elY► r s Pete M. Calo Manager, Engineering and Construction Department CrM � a � � N rr •f ro ————————————————————————1 N cnN c"'i+ocAii o vWioc�'ico mw I I O 3a Q Single Flaggger Operation i toM for Low Volumes (Optional) �►` N) ch w N (ADT<400)di o' o 0 0 > C I BE D :; FLAOWA s s c I PREPARED ROAD z I T' Ia 10, 30 k► 1 TO STOP � AH 0 (n o W m 42— l- -' Q— r ROAD ro I 0# ei 4t 4 � tltl I WORK I c a 6 A l--i I AHEAD �d Vt Cf1 4 arm can v' o 0 o n m to 1 / �^ I M , N N_ ,� FCL OMb r J Ch A B M (ova 1 r B .. ------------------------� m UQd ® � � `� � i mile max. a 0 0 ° pin 0 a r) tea 'CD Cts c B B A LA w w a CJ Buffer M N 00 Ln UT LMw M 3 Protection Vehicle ROAD w/TMA(both Optional) WORK See Chapter 4 D AHEAD BE to C} ONE ROAD E PREPARED Two Fla er Operation � AHEAD TO STOP 99 p m CD Cn (Optional) co Co Cnn UTILITY CONFLICT LIST Utility: Frontier ProjectName: OR99W Pedestrian improvements Highway: Babur vd/Pacific Hwy (99W)/Commerclal St County: Multnomah/Washington Key : 18838 List of Existing Uglify Conflicts- Revised 4/05/2M ,o Iter: . ,- Con l n From o. tstace,j Sheet. escr6 t n of Ut�l t TGonfl t "y..... Yt ...a .... r. : .. .. :.. - .. q No. Site 1 None noted Site 2 None noted Site 3 1 Frontier "C" 22+83 "C" 22+83 15' to 18' Lt. City Sht C038, Nt 2 Potential Conflict: Frontier buried cable within proposed inlet 2 Frontier "C" 26+68 "C" 26+69 11,3'to 2.3' Lt. City Sht C04B Potential Conflict: Underground Frontier conduit under proposed curb and sidewalk. Site 4 None noted Site 5 None noted Review the project plans and perform site visits to determine the exact impact to facilities, The Utility is to notify the Utility Coordinator of discrepancies or conflicts that are not listed. Buried conflicts may be resolved by providing accurate horizontal &vertical location information Utility Coordinator Contact Information Peter Coffman, PE, HHPR PeterC@hhpr.com (503) 221-1131 Raga I of I L "' LINE Sec. 2,T,SITE 3W 1 , W.M. S I V—0 7 6 Underground Frontier line Adjust w,7ter meter box to finished grade within proposed inlet, curb, and sidewalk. See next page "C" STA 22-i-79,38,17.60'LtConst conc. inlet, Type D for section view of area. F.L. Out=159.55(F) < PIL Inst 12"Storm 5M - 7.2' Connect:onnect to ext-9. storm sewer j —f 2 7.2' 0 (See drq. nos. RD365&RD370) U I. z 2 LINE —Catchline 03 See sht, C04B for notes Ln 'q/W Prop. L R.,W Prop ------ 2% S 7: 7 SW COMMERCIAL ST 64-06'19" RIW RIW 110 + 11` �001�_ 1-57'08"C-R• Il to rn, 3*30134" RIW T51 205.40' cn Ts2 105.915' :0 P 263'SPJ 11 N\ General Notes: StalOflsets for inlets are to the center of the structure. Harper Houf Peterson VIE 1.VARr... Righellis Inc. CIIIIIIIEE115♦PLANNERS I LAII.SCAPE � 69) OR99W:SW LANE ST(PORTLAND)- SW NAEVE ST(TIGARD)PROJECT OryPACIFIC HIGHWAY WEST MULTNOMAH/WASHINGTON COUNTIES 9 Designer.Daniel E Cicerthi Review*Aaron J.Isenhart ISO W Drafter-, HHPR Checker.Peter G.Coffman SHEU NO. EXPIRES: 06/30/ DRAINAGE AND UTILITIES C038B 1883_ 3,d(i C 0 3 B RA I I'] I\!Q U T 1 L. 5/d/2018 10:26:50 AM Dontel c7ce.[-Ch'i Rotation: 328.6180,' Scole: 1---50' J'G. 2; T. 2S, R. 1 W, W.M. (D Relocate extg. utility pole(Sy Frontrer) 5 1 V-0 7 6 SITE 3 Q)0 "C" STA 26-,92.98, 19.75'Lt. Relocate fire hydrant(By City of Tigard) Inst. 72"storm sewpipe -57.S' i' Connect to extg. storm sesv. I2"- 21./71-- 03 Remove extg. storm sew.pipe Field verify locations of extg.pipes �. Frontier conduit �� 04 Protect extg. inlet and match finished grade it "C" STA 271.50.72, 21.81' Lt. -z' under proposed curb �` Const cone. inlet, type G-2 with 18"5ump 12"-_i?.2'_ �� '� jfi :� end sidewalk //r^ � �i � "C" STA 24.1-b'3.39 28.35'Lt. f=ield verify locations of extg.pipes STM-2A LINE STM-2 LINE ,. (See drg. no. RD364) O \ Const. large precast manhole- 7.. ' ¢� i Ca tchhrre -Catchline Install 12"storm seiv,pipe -21.7' .�- ,� 11 Install 18"storm segs,pipe -5.6' 7 5 �, ? 8"-24.4' o� /4 10 ,: _ Connect to extg. storm sew. -2 9 r-1 L 57.8' (See drg. no. RD346) r P �TC ? �' 3 Fleld verify locations of extg.pipes r -;�.. r,- , �M� _ Pilop. TSE_----- - r 2 �1 ._ ___ :a �= ._a I ! ! I I I I ! I i I ! I I I !I I 1 fr--- _ r "C" STA 24.1-89.01, 28.15'Lt. -_ � - 1 I hi t7/ - -- _ I '! �� F'�YI f I_t I- .L i-( F 1 l�-!_I I i I I I I ?,' _ - ---- `� �!3 Remove extg. inlet _ I-"F r 1-1=1=J ___ --_,�_ ,� --`_# -,/ `'' Connect to extg. storm sew. Fleld verify locations of extg.pipes N, ra __ , - - ----- - Q 'C" STA 24461.79, 29.70'Lt. SW COMMERCIAL ST; _ ' ----- -------- _ C;=C�_ - __ ------------ _ .. Const. cone. inlet, type D r\j Install 72"storm sew.pip e 32.2' Rfw _ 5'depth 3 // `+' r ' _; �� Rotate frame and grate to match proposed fill slope R , Field verify locations of extg.pipes v � N a "C" STA 24--36.35, 76.71'Lt. LINE b Connect to extg, starm sew, "C / Field verify locations of ext9.pipes "C" STA 24 -94.23,25.42'Lt. to "C" STA 25-, 77 76, 19.05'L t. Inst. 8"Culvert Pipe -24.4' General Notes: 5'Depth 0 Sta/Uffsets for inlets are to the center of the structure. Inst.sloped end sections -2 2)Rim elevations for G-2 inlets are at gutter line grade. • „ST —2Q" LI E 4 ,oExrg.Het „�TM— ! g ;, INE 165' i :165 165 - _ ! 165 ------- _- - --- -- xr5}�r n rour7 d sir pe - - -�--- - --— --` -- —-- I I I I Proposed Gro.e @ Pipe I Exisf►' g Groun Cts Pipe QIS/a.„0, �±4+36.35. ---- ----1-. — _- 24+89,01,28.1 'L t,-O 16,71'Lt, 1 -�xsfng.wst --- -- - - _ __ _ _- - -----1---- i --__ _----------�---- � � -- --- — -i- - ---- - - Ext 9•stor sew. � Y8" Storm Sewer- 5. rm�.-- •7 _ �' Sewer 160Extg.. 1 1160 160 18" S "� _-. for ewer 12" Srb — --- � I _.__ j-- 160 _ 4- 9%f0. nom. r 12 Storm Taller orm EIi � fli "r- s'xtg. 'Inlet 0*58 � I _ �no1»� _0,889; T j I155 155 155 �L.Out 16O,616"5(NW)NW) om. _ i(. 1 _ j 155 _-.�--��it�r3t175(SE) + 1.79,29.7 'L r. 1-- -- � -- - 4 FL.In 155JWJ ' ` A� FL.Out Fxtq.36 Storm S w.I ► ` --_ — - - Harper Houf Peterson °r""r� ili hellis Inc. z�':�,, 150 _ _ .Ste "24+83 9.28.35'L . - 150 - �C. I v \ ENOIHE Efts �LxMN EtiS LAN D5CAPE AR CFIItECfS VSURVEYDRSkA holo- 4 t l — V J5! 7055T.3p.+E�nt S,recf.Sm:r,'.h0 P-L-1,OR-?",102 PHONE AV:' wx�w- I IM hh,rmm FAX 557 171 F.L, n 157.06 1 —I /CXZ G w F,L.,n 157A6t 1 F.L, n (ME) + 01199Wo SW LANE ST(PORTLAND)- F.L.,n (Swl SW NAEVE ST(TIGARD)PROJECT � PACIFIC HIGHWAY WEST MULTNOMAH/WASHINGTON COUNTIES 2 145 I _ 145 fn7��y/- g Designer.Daniel E.Clcerchi Review:Aaron J.isenhart 1 +00 1 +50 2+00 1 +00 1 +50 �•.,� J. I � DraFtDrafter., HHPR Checker. Peter G.Coffman ---- - i SHEET ND. ExPtHes: os/3o,' � DRAINAGE AND UTILITIES C04B 18858_C0 .:�gn .. C048 - DRAIN AMC I_IT!!_ 5/4/2,018 10:2o:53 At,i Garsiel c iCer,;hi Rotation: � ;rel i' S•n189 e: =50'