HomeMy WebLinkAboutPortola Systems 2014-06-10 CONTRACT#1314234 I
AGREEMENT FOR
PROFESSIONAL CONSULTING SERVICES
This Agreement, made and entered into this 10th day of June, 2014 ("Effective Date"),
by and between CITY OF UKIAH, CALIFORNIA, hereinafter referred to as "City" and Portola '
Systems, a corporation organized and in good standing under the laws of the state of California,
hereinafter referred to as "ConsultanY'.
RECITALS
This Agreement is predicated on the following facts:
a. City requires consulting services related to providing information technology services
consisting of software, system, and/or network maintenance support on an on-call, as-
needed basis.
b. Consultant represents that it has the qualifications, skills, experience and properly
licensed to provide these services, and is willing to provide them according to the terms
of this Agreement.
c. City and Consultant agree upon the Scope-of-Work and Work Schedule attached hereto
as Attachment "A", describing contract provisions for the project and setting forth the
completion dates for the various services to be provided pursuant to this Agreement. I
TERMS OF AGREEMENT
1.0 DESCRIPTION OF PROJECT
1.01 The Project is described in detail in the attached Scope-of-Work (Attachment "A").
2.0 SCOPE OF SERVICES
2.01 As set forth in Attachment"A".
2.02 Additional Services. Additional services, if any, shall only proceed upon written
agreement between City and Consultant. The written Agreement shall be in the form of
an Amendment to this Agreement.
3.0 CONDUCT OF WORK
3.01 Term. The term of this agreement begins on the Effective Date and shall continue for an
indefinite term and until terminated in accordance with paragraph 7.09.
3.02 Time of Completion. Consultant shall commence pertormance of services as required
by the Scope-of-Work upon receipt of a Notice to Proceed from City. Consultant shall
complete each task to the City's reasonable satisfaction, even if contract disputes arise
or Consultant contends it is entitled to further compensation.
sa-r�rs��:n�.am.m-No.<mx�zo,zooe
PAGEIOFI
I
CONTRACT #1314234
4.0 COMPENSATION FOR SERVICES
4.01 Basis for Comoensation. For the pertormance of the professional services of this
Agreement, Consultant shall be compensated on a time and expense basis. Labor
charges shall be based upon hourly billing rates for the various classifications of
personnel employed by Consultant to perform the Scope of Work as set forth in the
attached Attachment B, which shall include all indirect costs and expenses of every kind
or nature, except direct expenses. The direct expenses and the fees to be charged for I
same shall be as set forth in Attachment B. The specifics of the requested services,
time frame, and costs will be established with each service requested by the City under
the Scope of Work identified in Attachment "A". II
4.02 Chanqes. Should changes in compensation be required because of changes to the I
Scope-of-Work of this Agreement, the parties shall agree in writing to any changes in '
compensation. "Changes to the Scope-of-Work" means different activities than those
described in Attachment "A" and not additional time to complete those activities than the
parties anticipated on the date they entered this Agreement.
4.03 Sub-contractor Pavment. The use of sub-consultants or other services to perform a
portion of the work of this Agreement shall be approved by City prior to commencement �I
of work. The cost of sub-consultants shall be included within guaranteed not-to-exceed
amount set forth in Section 4.1. '
4.04 Terms of Pavment. Payment to Consultant for services rendered in accordance with this
contract shall be based upon submission of weekly invoices for the work satisfactorily
performed prior to the date of the invoice less any amount already paid to Consultant,
which amounts shall be due and payable thirty (30) days after receipt by City. The
invoices shall provide a description of each item of work performed, the time expended
to perform each task, the fees charged for that task, and the direct expenses incurred ,
and billed for. Invoices shall be accompanied by documentation sufficient to enable City j
to determine progress made and to support the expenses claimed. II
5.0 ASSURANCES OF CONSULTANT �
5.01 Independent Contractor. Consultant is an independent contractor and is solely
responsible for its acts or omissions. Consultant (including its agents, servants, and
employees) is not the City's agent, employee, or representative for any purpose.
It is the express intention of the parties hereto that Consultant is an independent
' contractor and not an employee, joint venturer, or partner of City for any purpose '
whatsoever. City shall have no right to, and shall not control the manner or prescribe the
method of accomplishing those services contracted to and performed by Consultant
under this Agreement, and the general public and all govemmental agencies regulating
such activity shall be so informed.
' Those provisions of this Agreement that reserve ultimate authority in City have been
inserted solely to achieve compliance with federal and state laws, rules, regulations, and
interpretations thereof. No such provisions and no other provisions of this Agreement
shall be interpreted or construed as creating or establishing the relationship of employer
and employee between Consultant and City.
Consultant shall pay all estimated and actual federal and state income and self-
employment taxes that are due the state and federal government and shall furnish and
SW-PmSvcsf�yreemeni-Novembct?0,2008
PTGF.20F)
I _ ._ —
CONTRACT#1314234
pay worker's compensation insurance, unemployment insurance and any other benefits
required by law for himself and his employees, if any. Consultant agrees to indemnify
and hold City and its officers, agents and employees harmless from and against any
claims or demands by federal, state or local govemment agencies for any such taxes or i
benefits due but not paid by Consultant, including the legal costs associated with
defending against any audit, claim, demand or law suit.
Consultant warrants and represents that it is a properly licensed professional or
professional organization with a substantial investment in its business and that it
maintains its own offices and staff which it will use in performing under this Agreement.
5.02 Conflict of Interest. Consultant understands that its professional responsibility is solely
to City. Consultant has no interest and will not acquire any direct or indirect interest that
would conflict with its performance of the Agreement. Consultant shall not in the
performance of this Agreement employ a person having such an interest. If the City
Manager determines that the Consultant has a disclosure obligation under the City's
local conflict of interest code, the Consultant shall file the required disclosure form with
the City Clerk within 10 days of being notified of the City Manager's determination.
6.0 INDEMNIFICATION
6.01 Insurance Liabilitv. Without limiting ConsultanYs obligations arising under Paragraph 6.2
Consultant shall not begin work under this Agreement until it procures and maintains for
the full period of time allowed by law, surviving the termination of this Agreement
insurance against claims for injuries to persons or damages to property, which may arise i
from or in connection with its pertormance under this Agreement.
A. Minimum Scope of Insurance
Coverage shall be at least as broad as:
1. Insurance Services Office ("ISO) Commercial General Liability Coverage
Form No. CG 20 10 10 01 and Commercial General Liability Coverage —
Completed Operations Form No. CG 20 37 10 01.
2. ISO Form No. CA 0001 (Ed. 1/87) covering Automobile Liability, Code 1
"any auto" or Code 8, 9 if no owned autos and endorsement CA 0025.
3. Worker's Compensation Insurance as required by the Labor Code of the
State of California and Employers Liability Insurance.
4. Errors and Omissions liability insurance appropriate to the consultanYs
profession. Architects' and engineers' coverage is to be endorsed to
include contractual liability.
B. Minimum Limits of Insurance
Consultant shall maintain limits no less than:
1. General Liabilitv: $1,000,000 combined single limit per occurrence for
bodily injury, personal injury and property damage including operations,
products and completed operations. If Commercial General Liability
Insurance or other form with a general aggregate limit is used, the
sie-rmrs.c:ns«�m.ni-�o�.mn.�zo.zooe �
YAGE30F�
CONTRACT#1314234
general aggregate limit shall apply separately to the work performed
under this Agreement, or the aggregate limit shall be twice the prescribed
per occurrence limit.
2. Automobile Liabilitv: $1,000,000 combined single limit per accident for
bodily injury and property damage.
3. Worker's Compensation and Emplovers Liabilitv: Worker's compensation
limits as required by the Labor Code of the State of California and
Employers Liability limits of$1,000,000 per accident.
4. Errors and Omissions liabilitv: $1,000,000 per occurrence.
C. Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by
the City. At the option of the City, either the insurer shall reduce or eliminate
such deductibles or self-insured retentions as respects to the City, its officers,
officials, employees and volunteers; or the Consultant shall procure a bond
guaranteeing payment of losses and related investigations, claim administration
and defense expenses.
D. Other Insurance Provisions
The policies are to contain, or be endorsed to contain, the following provisions:
1. General Liabilitv and Automobile Liabilitv Coveraaes
a. The City, it officers, officials, employees and volunteers are to be
covered as additional insureds as respects; liability arising out of
activities performed by or on behalf of the Consultant, products
and completed operations of the Consultant, premises owned,
occupied or used by the Consultant, or automobiles owned, hired
or borrowed by the Consultant for the full period of time allowed by
law, surviving the termination of this Agreement. The coverage
shall contain no special limitations on the scope-of-protection
afforded to the City, its officers, officials, employees or volunteers.
b. The ConsultanYs insurance coverage shall be primary insurance
as respects to the City, its officers, officials, employees and
volunteers. Any insurance or self-insurance maintained by the
City, its officers, officials, employees or volunteers shall be in
excess of the ConsultanYs insurance and shall not contribute with
it.
c. Any failure to comply with reporting provisions of the policies shall
not affect coverage provided to the City, its officers, officials,
employees or volunteers.
d. The ConsultanYs insurance shall apply separately to each insured
against whom claim is made or suit is brought, except with respect i
to the limits of the insurer's liability.
9d-RofSV<sAgreemem-➢'ovembn?0,2008 �
PAGE C OF 9
I — _ —_. — _- .___ ____ —
CONTRACT#1314234 ,
2. Worker's Compensation and Emplovers Liabilitv Coveraqe
The insurer shall agree to waive all rights of subrogation against the City,
its officers, officials, employees and volunteers for losses arising from
ConsultanYs performance of the work, pursuant to this Agreement.
3. Professional Liabilitv Coverape
If written on a claims-made basis, the retroactivity date shall be the
effective date of this Agreement. The policy period shall extend from the
Effective Date to one year after the termination of this Agreement. i
4. All Coveraaes
Each Insurance policy required by this clause shall be endorsed to state
that coverage shall not be suspended, voided, canceled by either party,
reduced in coverage or in limits except after thirty (30) days prior written
notice by certified mail, return receipt requested, has been given to the
City.
E. Acceptabilitv of Insurers
I
Insurance is to be placed with admitted Califomia insurers with an A.M. Best's I
rating of no less than A- for financial strength, AA for long-term credit rating and
AMB-1 for short-term credit rating.
F. Verification of Coveraae
Consultant shall furnish the City with Certificates of Insurance and with original
Endorsements effecting coverage required by this Agreement. The Certificates
and Endorsements for each insurance policy are to be signed by a person
authorized by that insurer to bind coverage on its behalf. The Certificates and
Endorsements are to be on forms provided or approved by the City. Where by
statute, the City's Workers' Compensation - related forms cannot be used,
equivalent forms approved by the Insurance Commissioner are to be substituted.
All Certificates and Endorsements are to be received and approved by the City
before Consultant begins the work of this Agreement. The City reserves the right
to require complete, certified copies of all required insurance policies, at any
time. If Consultant fails to provide the coverages required herein, the City shall
have the right, but not the obligation, to purchase any or all of them. In that
event, the cost of insurance becomes part of the compensation due the
contractor after notice to Consultant that City has paid the premium.
G. Subcontractors
Consultant shall include all subcontractors or sub-consultants as insured under
its policies or shall furnish separate certificates and endorsements for each sub-
contractor or sub-consultant. All coverage for sub-contractors or sub-consultants
shall be subject to all insurance requirements set forth in this Paragraph 6.1.
6.02 Indemnification. Notwithstanding the foregoing insurance requirements, and in addition ,
thereto, Consultant agrees, for the full period of time allowed by law, surviving the
termination of this Agreement, to indemnify the City for any claim, cost or liability that
ISIE-PoISvc5.4grecmeni-\ovembe�d0.3008 I
PAGE 5 OF]
I l
CONTRACT#1314234
� arises out of, or pertains to, or relates to any negligent act or omission or the willful
misconduct of Consultant in the performance of services under this contract by I
Consultant, but this indemnity does not apply to liability for damages for death or bodily
injury to persons, injury to property, or other loss, arising from the sole negligence or
willful misconduct of the City.
"Indemnify," as used herein includes the expenses of defending against a claim and the
payment of any settlement or judgment arising out of the claim. Defense costs include
all costs associated with defending the claim, including, but not limited to, the fees of
attorneys, investigators, consultants, experts and expert witnesses, and litigation
expenses.
References in this paragraph to City or Consultant, include their officers, employees,
agents, and subcontractors. li
7.0 CONTRACT PROVISIONS '
7.01 Ownership of Work. All documents furnished to Consultant by City and all documents or
reports and supportive data prepared by Consultant under this Agreement are owned
and become the property of the City upon their creation and shall be given to City '
immediately upon demand and at the completion of ConsultanYs services at no
additional cost to City. Deliverables are identified in the Scope-of-Work, Attachment "A".
All documents produced by Consultant shall be furnished to City in digital format and
hardcopy. Consultant shall produce the digital format, using software and media
approved by City.
7.02 Non-Disclosure of Citv data. In the course of performing IT consulting services to City,
Consultant may have access to data maintained on the City's computer systems. While
information in the City's system may be subject to disclosure under the California Public
Records Act or other laws, there are numerous exemptions to public disclosure,
including City data about individuals and businesses. For this reason, the City must have
strict control over the disclosure of any information on its computer systems. To insure
that Consultant will not disclose information it may access in the course of performing I
consulting services to the City ("City data"), Consultant agrees that it will not disclose
City data and will only use any such data to perform its consulting services for City.
Consultant represents, warrants, and covenants that it:
A. Shall process, use, maintain and disclose City data only as necessary to
perform its consulting services under this Agreement and only in accordance
with this Agreement;
B. Shall not disclose any City data to any third party (including to the subject of
such information) or any employee or agent of Consultant ("Representative")
who does not have a need the City data to pertorm ConsultanYs services
under this Agreement;
C. Shall implement and maintain an appropriate written information security
program, the terms of which shall meet or exceed the requirements for
financial institutions under state and federal laws, to (i) ensure the security
and confidentiality of all information provided by City, including City data
' (collectively, the "information"), (ii) protect against any threats or hazards to
the security or integrity of information, including unlawful destruction or
sd-rrors�ansrcemen�-rvo�.mner za,iaaa .
PAGE 6 OF]
.
i
CONTRACT #1314234
accidental loss, alteration and any other form of unlawful processing, and (iii) I
prevent unauthorized access to, use, or disclosure of the information;
D. Shall immediately notify City in writing if it becomes aware of (i) any
disclosure or use of any information by it or its Representatives in breach of
this Section, (ii) any disclosure of any information to it or its Representatives
where the purpose of such disclosure is not known, (iii) any request for
disclosure or inquiry regarding the information from a third party, and (iv) any
, change in applicable law that is likely to have a substantial adverse effect on
Vendor's ability to comply with this Article;
E. Shall cooperate with City in the event of litigation or a regulatory inquiry
concerning the information and shall abide by the advice of City with regard
to the processing of such information;
F. At City's direction at any time, and in any event upon any termination or
expiration of the Agreement, shall immediately return to City any or all
information and shall destroy all records of such information;
G. Upon completion of any Task Order, shall return to City any or all applicable
information which is not necessary for the performance of another pending
Task Order or destroy all records of such information; and
City reserves the right to review ConsultanYs policies and procedures used to maintain
the security and confidentiality of information, including auditing Consultant and its
Representatives concerning such policies and procedures. The provisions of this
Section, are in addition to, and shall not limit any other confidentiality obligations under
the Agreement. Vendor also agrees that it shall cause its Representatives to act in
accordance with this Section 7.2.
7.03 Governinq Law. Consultant shall comply with the laws and regulations of the United
States, the State of California, and all local governments having jurisdiction over this
Agreement. The interpretation and enforcement of this Agreement shall be governed by
California law and any action arising under or in connection with this Agreement must be
filed in a Court of competentjurisdiction in Mendocino County.
7.04 Entire Aqreement. This Agreement plus its Attachment(s) and executed Amendments
set forth the entire understanding between the parties.
7.05 Severabilitv. If any term of this Agreement is held invalid by a court of competent
jurisdiction, the remainder of this Agreement shall remain in effect.
7.06 Modification. No modification of this Agreement is valid unless made with the agreement
of both parties in writing.
7.07 Assiqnment. ConsultanYs services are considered unique and personal. Consultant I
shall not assign, transfer, or sub-contract its interest or obligation under all or any portion
of this Agreement without City's prior written consent.
7.08 Waiver. No waiver of a breach of any covenant, term, or condition of this Agreement ,
shall be a waiver of any other or subsequent breach of the same or any other covenant, i
term or condition or a waiver of the covenant, term or condition itself. I
i�a-NaRr<zAgroemem-November E0,]008 �
PdGE"IOF"/ '
I,
CONTRACT #1314234
7.09 Termination. This Agreement may only be terminated by either party: 1) for breach of
the Agreement; 2) because funds are no longer available to pay Consultant for services
provided under this Agreement; 3) City has abandoned and does not wish to complete
the project for which Consultant was retained; or 4) by either party without cause on
thirty (30) days prior written notice to the other party. A party shall notify the other party I
of any alleged breach of the Agreement and of the action required to cure the breach. If j
the breaching party fails to cure the breach within the time specified in the notice, the I
contract shall be terminated as of that time. If terminated for lack of funds, abandonment
of the project or without cause, the contract shall terminate as provided in the notice.
� City shall pay the Consultant only for services performed and expenses incurred as of
the effective termination date. In such event, as a condition to payment, Consultant shall I
provide to City all finished or unfinished documents, data, studies, surveys, drawings,
maps, models, photographs and reports prepared by the Consultant under this
Agreement. Consultant shall be entitled to receive just and equitable compensation for
any work satisfactorily completed hereunder, subject to off-set for any direct or
consequential damages City may incur as a result of ConsultanYs breach of contract.
8.0 Duolicate Oriqinals. This Agreement may be executed in duplicate originals, each
bearing the original signature of the parties. When so signed, each such document shall
be admissible in administrative or judicial proceedings as proof of the terms of the '
Agreement between the parties.
8.01 NOTICES
Any notice given under this Agreement shall be in writing and deemed given when
personally delivered or deposited in the mail (ceRified or registered) addressed to the
parties as follows:
CITY OF UKIAH PORTOLA SYSTEMS, INC.
ATTN: SAGE SANGIACOMO ATTN: RYAN T. MILLER
300 SEMINARY AVENUE 7064 CORLINE COURT, SUITE 65
UKIAH, CALIFORNIA 95482-5400 SEBASTOPOL, CA 95472
9.0 SIGNATURES
IN WITNESS WHEREOF, the parties have executed this Agreement the Effective Date:
PORTOLA SYSTEP✓1S, INC.
BY: ` - ' � 06/23/2014
� % � Date
PRINT NAME: Ryan T. Miller 94-3294395
IRS IDN Number
CITY O UKIAH
B : �P ��l I
CITY MANAGER Date
, EST i
iVl�;��'�'�• �I,G�GG-C�L-� (�/�� l i 1 �
CITY CLERK Date
Std-Pro6vw�gmemem-November 30.200H
PAGF.8 OF]
I
-
i _
I
« „
I ATTACHMENT A - SCOPE OF WORK
Consultant is to provide information technology services consisting of software,
system, and/or network maintenance support on an as needed basis.
Emergency Response
Emergency suppoR requests will be logged with a 20 minute response during and
afier standard business hours. Emergency support requests can be submitted via phone
call or via [icket submission. The nearest available Engineer will be dispatched to
address the incident if onsite suppoR is required. Every possible measure will be taken to
respond to and address the emergency incident in a timely manner. Onsite support will
be provided within a 2 hour minimum meantime to arrival, from initial time of
ticket/request submission. I
I
i - _
II I
,
ATTACHMENT "B"
� Section 8.0 Hourly Rates and Reimbursable Costs eage 1 of 2
� — — — - - —
a.) Services Non Contracted Standard Rates
• Partner/ Executive Account Manager $ 195/hour
' . Senior Engineer/ Tech. Account Manager $ 175/hour
� Mid-Tier Engineer
$ 165/hour
• Staff Engineer/ Help Desk Engineer $ 105/hour
• Administrative Support $ 85/hour
b.) Block Hour Rates
i For block hour contracts greater than S hours per month, but less than 40 hours per month
Portola Systems will provitle a $10 per hour discount for alI service levels.
For block hour contracts over 40 hours per month Portola Systems will provide a $10 per hour I
discount for Staff Engineer and $20 per hour discount for all other service levels.
C.) Managed Services
i.) Service Desk Advanced - PC Maintenance, Monitoring, Triage and Unlimited Remote User
Support
125 PCs and up g 35/PC/montfi i
ii.) Service Desk Essentials - PC Maintenance, Triage and Monitoring
125 PCs and up $ 10/PC/month
iii.) Portola Secure - Managed Security Firewall, Mai�tenance and Monitoring, Web-fil[ering
*3 Firewall Nodes $ 250/node/month
i *If firewall is already in place no uplift fee will be required. Firewall must have active support
contrect with manufacturer i.e. Smar[NeC maintenance on Cisco Firewall would be required.
� iv.) Portola NOC - Fixed Fee Managed Server & Storage Maintenance, Moni[oring and Support �
for Microsoft Systems, includes remote troubleshooting and triage.
30 Instances and up $ 155/fnstance/month �
v.) Portola Core Care - LAN/WAN infrastructure monitoring, maintenance and configuration j
backups '
SO nodes and up $ 20/node/month
8.0 Hourly Rates and Reimbursable Fees I 23
� — --�— — --- -- — -- — �� -- -- �
�
ATTACHMENT "B"
Page 2 of 2
Section 8.0 Hourly Rates and Reimbursable Costs (continued)
I d.) Blended Contrects and Discounts
Portola Systems offers blended contracts including a mix of managed services and block onsite i
support hours In effort to meet Client budgets, Portola Systems will be happy to negotiate
mixed rates and inclusion of onsite hours with managed service contracts.
I.E. if Client subscribes to Service Desk and NOC, Portola Systems may offer included block
onsite support hours at no additional fee. Number of hours included depends on volume of
managed service contract and negotia[ed rates.
Portola Systems will make every effort possible to help achieve a blended contract tha[ equitably
meets both Client's and Portola Systems' operational and fiscal budgetary goals.
e.) Support Contract
Upon request, Portola Systems will provide a standard support agreement for CIIenYs review. ,
Portola Systems will require direction as to the quantity and type of service Client requires
outlined in the service contract. I.E. Managed services and quantities, block hours and schedules
etc.
Portola Systems will be happy to discuss the benefits and terms of the service offering to assist
Client with selection of appropeiately suited services,
Legal terms and conditions of the standard support agreement may be modified before
acceptance to mee[ Client's specific needs.
f.) Mileage and Drive time
Mileage is charged round-trip, por[al-to-portal, from Portola Systems office, Iocated at 7064
Corline Court, Suite BS Sebastopoi, CA 95472, to City location where services are to be provided.
Mileage fees are based on Internal Revenue Standard Mileage Rates applicable during the time of
travel.
Drive time is billed one-way, portal-[o-portal, from Portola Systems office, located at 7064 ;
Corline Court, Suite BS Sebastopol, CA 95472, to City location where services are to be provided. ���
Drive time rates are based on the standard hourly rate of the individual performing the task.
g.) Miscellaneous Materials Costs
All materials purchases are to be approved by City Purchase Order. Materials fees will be detailed
within the [erms of Portola Systems Sales Quote and City's Purchase Order. No other materials
fees shall be incurred, by either party, unless otherwise approved through written consent, by an .
Authorized Manager.
I
8.0 Hourly Rates and Reimbursable Fees I 24 '
�
I . —. _ . .- _ . _
i ,
Wells Fe�go Ineurance Secvicee USA,Ine. I �,
CA DOI#OD08508 I
1039A Nor[h McDowell Boule.vard �
Petaluma,CA 9 49 54-117 3 � '�
Tel:(7D7)769-2900
F'az: (707)769-2929
,lunc 5, 2014
i
City of Ukiah
300 Seminaiy Ave.
Ukiah, CA 95482
1 o Wtrom It May Coucern:
Your insurunce ccrtificate requirements include a 30 day w��ittcn notice of cancellation.
Reeent national changes to the Certificate of Ins�n•ance Acord form preclude this
fanguage and asserl lhe policy provisions governiug Chis malter. Pursuant to Tlte
Department of Insuia�ice �nd Lhe provisions of the policy, caucellation notices are to be i
senc to the policy holder.
IIowever, in lhe event of a mid-term cai�cellation, Wells Far�o lnsurance Seivices USA,
lnc. will advise you in writing within 30 days ofconlinned I<nowlcdgc ofthe policy '
cancellation.
This lettcr does not extend, alter und/or change the provisions of the Certiticate oY I
Tnsurunce. Plelsc note that a CertilicaLe of'Insurance is not an insurance policy and does I
uot serve to provide, endorse, amend, extend or alter in any way the terms of�n insw•ancc
policy.
Snicerely, �
�-���'�/�'. ���v�(,��'~IJL�
Robyu Nichols �
Sml/Rolc I
'
� ,
Together we'll go far
.�c,>c:>— ---'— �._ .,
��� � . _ __ � �I I
. _-_�. .__ _ _ .. _ - . _ _
I
r WORKERS COMPENSATION AND EMPLOYERS LIABILIN INSURANCE POLICY WC 99 04 026 (Ed i-o7)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
� right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
I perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall bP 5.00 % of the total policy premium otherwise due on such
remuneration subject to a policy maximum charge for all such wafvers of 5.00 % of total policy premium.
The minimum premium for this endorsement is$ 350.00 '
Schedule ��
' Person or Organization Job Description
City of Ukiah IT Services
300 Seminary Ave
Ukiah, CA 95482
i
, ,
�I
I
I
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherv�nse stated.
(The information below is required only when this entlorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 04/0�/2014 Policy No.2200058749-141 Endorsement No. 1
. Insured PORTOLA SYSTEMS, INC. Premium $
IInsurance Company Countersigned by
. Oak River Insurance Company .
WC 99 04 02B
(Ed 7-07) — �
I
�y
I]95�1 I
l� �
� ��Rn'� CERTIFICATE OF LIABILITY INSURANCE ���6I5/2014rrn f
� THIS CERTIFICATE IS ISSUEO AS A MATTER OF WFORMA710N ONLY ANO CONFERS NO RIGHTS UPON 7HE CERTIFICATE HOI.DER. THIS F
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTENO OR ALTER THE COVERAGE AFPORDEO 8Y THE POLICIES g �
BELOW. Tf{IS CER7IFICATE OF INSl1RANCE DOES NOT CONSTITUTE A CONTRACT 6E7WEEN THE ISSUING INSURER(S), AUTHORIZED y
REPRESENTA7IVE OR PRODl10ER,AND 7HE CERTIFICATE HOLDER.
IMPOR7ANi: H lhe cerfificate holtler is an ADDITIONAL IN5URE�, ihe policy�les� must Uo entlorsed. I(SUBROGATION IS WAIVED, subject to ��
the terms and conditions ot the policy,certaln pollcles may requlre an endorsoment A statement on this certificate Aoes not confer righls to the
cer[iflcata holdar in lieu of such andorsement(s�. �
�� aeooucEa coNrncr �,
NnmE: _
I CORIRIEfCIBILIfI@5-707-7ES-ZJOO PHONE � .FA%
� d9.e�u: ___ mm.a4,:(�o>> n3-,ase w
Wells Fare�o Insurance Services USA,Inc,-CA Licfl:OD08A08 e-mni� � �� �
aooaess .. ___ _.. . . '
1039�N,McDOwell Blvtl � - f
INSURER(S)AFFORDINGCOVERAGE NAICM
Pelaluma,CA�J4954 iNSUqEp p: I-lartford Casualty Insurance Company �29424
wsuaeo iHSUaea e: Sentlnel Insurance Campany Lld. 11000 �'
Podola Systems.Ina ir�sunee c�, Oak River Insurance Company 34fi30
7064 Corline Court,Suite e-5 iNSURER�:� Admirel Insurence Company 248GFi .
— _—______ . ..__"_'— �
INSUFEF E: _ __ . I
$Eb25IOP01. Cf�9$472 INSUFEP 1�,
COVERAGES CERTIFICATE NUM6ER: 7007196 REVISION NUMBER: Seo 6elow �� �
THIS IS TO CERTIFY THAT THE POLIGES OF INSURANCE LISTED BELOW HAVE 6EEN ISSUE�TO THE INSURED NAMED ABOVE FOR TIIE POLIC� PLIt100
IN[11CATF0. NOTWITHSTANDING ANY REQUIREMF.NT,TE.RM OR CON�ITION OF ANV CONTRACT OR OTHER DOCUMENT WITII RESPECT TO WHICH THIS �
CERTIFICATF MAY BE ISSUED OR MAY PERTAIN, THE fNSl1RARCE AFPORDEO BY THE POLIpES DESCRIBED HEftEIN IS SUBJECT TO ALL TH[ TLRMS, �
EXCLUSIONS ANO CONOITIONS OF SUCH POLICIFS.1 IMf�S SHOWN MAY HAVE BEEN REDUCE�BY PAID CLAIMS. r
INSR TYPE OF INSURlNLE >ouL slLiNi POLICY EFF POLICY E%P LIMITS E
LTq I POLICYNUMBER (MMID�lYYYV MM/ODIYYYV �
n X I��MMENCIALGENEPALLIp51LITY 5�SeAAZ31II4 07/3�/13 �7/3�/20�4 EACNOCCLIftftENCE 5 24�'�� - `� I
DRMAGETORENYEO
CLAIMSMAOE a OCCUR P CMISHE(Eaoecuemnee� 5 10U],000_ '[
_ , ME�EXP(Nnyone enonl 5 Ia,Wp "' �
I IPERSONAI.SA�VIN111RY $ ?��A�� � I
GBMI AGGRCG�T[11MIT�PP4E5 P[R: GENERAL qGGREGATE 5 4 COO,OCO�
POLICV�j�P � LOC � . PRO�UCTS-COMPIOPAGG I 5 <�OO,OCO �
E
OTHER: i S
f} AUiOMOBILELIABILITY 57UECU0337A 713U2013 7l3112014 � t°aa�aeosixci[unnr ' s i,000,aao
g �Ny�117O BooILYINJUNV(Paroa�son) 5
AIIGWNED SCHF.DUI.FD BopILYIN,IUHY(PwncelGenq 5
AVfUS AVi05 �
K IIIR[DAUTOS % NONOWNE❑ PROPEft�e�4lMGE 5
AUi05 �
5
UM9ftELL�LIAB OCCUR , EpCH OCCIIRRENCE 5 �� '
e%r,esSilAH CL�IMS-MA�[ I AGGRCGATC 5 � �
OEO I RETENTION � 5 �
� woaKeascorndeusalioN I pp00058749141 4l1/2D74 ��� 41112015 x IsTnrure EaH �
�Na EMPLUYEHS'LIA¢ILITY y�N I � "
FNY PROPRILTO�tIPRRTNER/IXECUTIVE � � GL EACH ACCIULNT 5 �OO�,OCO �
OfFICEWMCM�ERF.%CLODE�) �',�N1A� i
(MenJatory in NI1� '� � C1.�ISENS[�G[MPLOYG 5 _ _'���W.f%10 f;
1/yc tl.scihoimdu �.plp.Wp �
OLSCRIPTION 0!'OPERATIONS hclaw ' E L.OISEASE�POLICY LIMIT 6 i
D ProFesslonalLiability ; F000000012216 07/31/2013 D7l3V2014 stoco,000 �
g
DFSCRIPTION OF OPERATION51 LOCATIONS I VEHICLES (ACOFO 11H,Atldillonal Remn�kt Schedule,m.ry ha allaehntl il maw xpaeo Is m0uireEj �
SS 00 OB 04 OS,SS 00 OB 04 OS,HA 99 16 03�2 RE�, Operafions or services o(Ihe Naine,d InsureU(or the Cetlilicate Holder �
The City,ils officcrs,oKcials,empioyees and volunteers are included as atlditional insured under the general liability entl aulo liahillly per endorsemenls �
listetl eoove.General Liabiliry and Auto Liabilily covorago is pnmary per ondotsements listed above.Walver of subrogation is Induded untler fhe workers' � i'
compensalion per entlorsemert to follow from carrier. I�
"30 day Notico o(Cancellation applies per attached form^'
I
CERTIFlCATEHOL�ER CANCELLATION � I
Clly Of Uklah SHOULD ANY OF THEABOVE DESCRI�ED POLICICS RE CANCELLED BEFORE I
THE E%PIRATION �ATE THEREOF, NOTICE WII.L BE OEf.IVER[� IN
300 Seminary AVC, pCCOR�ANCE WITH THE POLICY PROVISIONS. j
' Uklah,GA &5482 i�
AULHORI2EOXEFftESENTATIVE �r��`
.�
�
� The ACORD name and l090 are registered marks of ACORD OO 1986-2014 ACORD CORPORATION. All�ights�eserved. � ���
i
ACORD 25(2014(01) p
r
m,�.�=,un=.m��wFa.a�an�mnrwviae�.:�aamaeimi.i �
��
I �
SUSINESS LIAI31LIi Y COVERAGE FORM
F, OP710NAL ADDI710NHL INSUREL�
COVERAGES
II li�led nr shoWn as a���,�licuble In the Declarilious,
onu ur moru al Il��e I�.,II��vAng Optionai Flddilion;+l
Insuiud Cnvr,r:i{�s�s.ilsu appP/. When any ol thcsa
Opiion,al AdJiliu��:;i Insurcd Uovcr�ges apply.
I';�r,�griph 6. (/�tldiliu��sl In�;urods N/l�,uii Requirocl
by Wrillen Gonlri�.:l. NAitlen Ai)«•emr.nl or Pennil)
o( �ecliori C.. VVho Ls An Insuied. dne's nol ap�?ly
lu llie pyr3on r�r �iryanlz.dion Sho1•m in Ihn
Ur,olarnllone. l ha� �:uverzq�es �vu �ubjec', tc� lhe
Irnni. and t:onditiw�s .ipplir.able fo Buslnosa
Llabilit5' Covor'iyn i�.i Ihle �Sullcy, ��xcepl r+s
provided beloiv:
i �ddillonal Insurcd - pcsign�ted Person Or
Orq�nlzatiim
VVI Ip R: �1'J IP;SIIR[D un�Juf 5ecllon C. is
arnendor� u� inclu�lc ,�s an n�lditiun:d ir�suretl
ihe persoiqsj nr nrg;�ni;:aliunf,::) sho�mn in lnr.
U�:�;larcuions, L��,1 only �viih reupecl lo liabilily
lor "bodily rllury.� .�r�p[:�1y d�ina�3e�� ��r
"par�son.�l :inil ��J��ciCrlup Injnry" cauded. in
�,vi��olr or in p�u;, Iry ,�o�.n ncl5 of unll55iun:; or
lhe „u.:ls r.rt on�iir,:,ums uf lhosc� acling on ynur
beh:iil:
a. h: fl-�r ��aiiimnance of your unyoin��
uperehonP'.; ��r
U. In connecllori wili� Voui pfCriVSas owned
by oi'rcnterJ to you.
2, Additionrl Insiucd - Man��ors Or Lessors
Of Prumisos
d. �NI-I(7 1:3 AN 1145CIiED UndUr Gertion C. is
urnondr:d lo includ��! as a�n eddiUnnal msurcu
Ii1C pu�.ann(ti)pi r_+q::ini78U0i1(sJ 5hoWn In Ih(r
I)eclan"ii,m.; �... .�.n /�ddi�ional InSUr��d
UesignnlcJ Par;�n Or OrgEinizollnn�, InA nnly
v+ilh rospocl in li�biliry �uisln{� oul ol Ihc
q�a�r,ersl�l��.iii>iii iten�mCC or use ol thal p<lii ul
Ihr, prcrnc;cr� loased lo you 2nd shU�!�n iii lho
Ucclar.i!ions
b. Wlth respoct to [ha lnsuranco afford�3�i fn
Iliese ��idJllini::il insureds, tl�e Followin��
:iddiliun:N e.:cii:slu�ls a�>ply.
l.hia in•�,ui;�r��::�:: �locs nul apply lo�.
(1) Any 'uacuf«.nGri' which I�ikes pi3ce
ailer ;�;ni ';ee;:.e In Uc a lr,nun'. iu Ih:il
pie"niser„ nr
(2) 5Uur.l�nul elleraliuns, nem
cuu.�lrwdi�.in or deniolilion opera�.ions
per�oiui!��I by or un bel'iedt nf si:cYi
pinson nr oryanizatlnn.
9. AdUitional hisin�ed - Grantor Ui Fr�nchis�
WHO IS AN INSUh6Ll undsr Section i:. e.
�aincn�.led 1(, incluJe as ai� additinn;ai Insur�d
Ihv persnn(s� or oryanizatiqn(s) Shown In Ihu
Ucclxiralioiie a5 an Addiliai;il liisure�i
Grnntor Of Fmnchiso. bu� unlV wilh rr;spocl :u
Ihcir Iieibliily a;grtinlor uf frarn:,hw��, lo yuu.
d. Additional Insw'erl - L.essor Of Leased
Equipmont
a. VJHO IS AN IMSUREU uncfcr E+cr.Uon C, ic�;
nni��nJotl lu inclurJe .as aut addiU��nal
insured the �iersun(,) oi or�aanlzeliun(s1
;hnwn in Ihe Declzualions;i,,�n Additiona!
Insured - I.ossor of Lenscd I-yuipmr.nl.
bW only wilh respeol lu linl.�ilily lor 'burlily
injwy'� ���iruperty dtimagr." or "penonal
uild advr-.ilislnq lnjwy" a�usr•,d. In wh�ul�� oi
in p:arl, by yuur niainlcnan�-e. ��per�lion or
une oi r.quipmen; IcaseU lu pou by r,u�h
person(s) or nn�uniz�iUnn(:s;.
b. IMIh re:spL'cl In Ihe iic,.uiaincc :illiadcd lo
thqNr. atlddipntil InSwY;(h:, Ihis in&uiance
dOOS not :iNply In any "nCC.Ufrunr.:c" v��hich
Lekus plrir,c H0.cr ',/�.,u cuosn to Ie.SC Ih�l
eyuipmenl.
5. Additlonal Insured - Owners Or OCher
Interests From Whom Land H�as Seun
Leused
a. �A�FfOIS NN ItJtiUREU un�li9r 3r:r.liun G. ia
emendEd lo IncluCu ais .ui �idililiunal
insur�d Ihe prrsun(s) or uryaniza!ion(sj
sl�ineon in lhe Uoclamlir,iu ucs xin nidhitianal
Ins.ued -Ownr.r.: Or Olh�.a Inbn�usls I o.im
Whan �am'I lins k3[:e;i I �,osud. bUl only
�•dlh R>spenl lo li.ibility zwsirip '�ul pl Ihc
owners'hip, nlainlenancc ur usU ol Ih,al pai�
ol lhe IanrJ leasod lo you anJ ;;huwn iri Ihn
Der.ler�alion:��.
b. Wi�h rc::pecl !o Ihr. insur,�nce ;�funf�ad lu
Ihi:si: �ddilional insurec',s, Ihe Inhnviin�;i
addltiontil CxclUC;ions upply:
This insu�ewr.0�Ices nul a�iply!p:
('I) Airy "ocGUnence" Ihnl Inko& {�dace
aller yuu ce;ise tu Iripsc Ih.�1 land: or
(2J Strucluf%!I al�ertiUons, nc!�,
c:oiistrur.lion nr dem<�hliori upuialinn•,
perfr�fined 6y nr nn 6ch.ili n; .,iii:h
pnrsun or on�nni�,�liun.
f. Addltlonal If15111'P(I - S18I0 Or Pollticol
Subdlvislon -Permlls
a VVFIO IS AIJ INSURED unJr.r ie�:lion C.is
amiendud lo I��cllide a:�� 2ri :u1di11unE?I
insured thr, slafc or politir.�l su6dlvisicn
shc�wn in tl�r. Ilr.cl.vutions [+s 2ri i�[Itlillon>il
pagc 16 ot ?4 Forn�SS 00 US U4 U5
�
(3USWESS I.IABILITY COVGRAGF FOR�4
Insi,ucd - Sta�e Or Pulitical 9ubdivision - (e) F�ny Giilure lu makc �uch �
?armitc, bUl nnly with ruspocl lo insperli0n5, .djU�ltnonls. lub�l.� Ur �
�p�i3linn periuitned b'd you or w� youY sorvi�inq � IPicveu�lnrhi ii�we�J ` I
br,h:Nf lu, whiCll lh? siale ui (iolilicnl lm m�kt oi nurnl.11y wldFritk�', lo
' sulidiw iu-� h;i>is:�urd t permit. mahr, m thc u. u-J �nur � nl �
U. VVilli i�.;pad lo Iha Insur�ince effhide�i �o businc� In cu�n� [tlnn � AI Ihe
� Ihesr: :v-lclitiun;al insur�e�is, Ih� fnllowing disLibu6on ur stde n�Ih�,pri�ducle�:
oddilionalcacl�isionsa�y��ily: (� UenWnstretlon, ire;(nll:dipn, �
fhc; In::uranr.o dou:; nal apply(o� scrvlclny or rcpaii nprrnlinns-.
cr.o^PI ::;uch operal��ous �mi(nnned
(1J 'Bndlly injwy" "proPeily damage" nr at lhc vendnr's preinises in
„�icfsonal and t'�tiVGflisiny Injlify" Conneclion wilh �f�e ralc ut th�
'. tnisii�,rl o�.it of npc�ations perfor�ned tor product:
!li��:si❑le r.�r m�.�n',ciPalify: or I
(g) Produd: ',•:hiGii. ,�Il�ff (lislrll'�nllun
, (2) "Rorllly Ir.jury° or "Prop�rPl daina:lu" M calr_ by you, P��.svu he��n lal,eled
iiidude�l In Il�e "produCt-r,omplclrid pi' ii�la6siec4 nr �.ised a�s ri
uParalion;;"h�;tinJ. conl;ainr,,r. Pa�l�.x in(u�:dlu:d �>I any i
L AddlUoned Insin�od-Vondors olhcr lhin� cr suDSlance+ by or G�,r � .
� a. bVl�i(� 18 i1P! IFiSUk2GD untler Seclion C.Ir. lhe Vund�.x:i?r �
i
:m�ernlnd to includ� a;; �n Uddifionel (h) "Lio[lily inJury" nr "��ro��F�rly t
inswul IhE:� nurson(s) or oic��dni/dliUn(5) dainti�� 'uisinp � i I ol lhr; ,�,ol�� � �
(releii�.l lo uc�lnsv ns vendor) .,hovrn�n Ilic negli9enc,e nf U�e vendor [o; iL'� �' I
C)ur,l n iti�n-� :i>; an Addilion�il In,.urail - o�vn acl oi ��inie�:icn oi Ihu�;r. ol �
\/endni I ut �id; wifh io-spr ( Io "borlily il� innploycus ui �anyunc cls�, f
injUry ��i � ir.p�:rt, ]dm2gc" insulcl ��!�< <�I 'iCting on itt beh�dl. Huwevel. lhi5 I
"your ��fr.dur:ie" w�hiuh afe (115[nb�ned ur OxCIUSiUn tlo�s nnl apply In�. �
sol�l In Iln: ir.siula� r,nursc o( fhc ven6G(s �
(i) �Ine, cznaplium containe�l n� I
Imsine;s an�l niilV i( liiis Covera(;e PLjn Subpnf��n'uphs(d)Ur(t)I �n . �
pfUVi(lo �-r��rfiiqr In� "UOi;ily m�Ury�• Of � ,
..�irup<i � . .un;igr inrluaed vilhin lhe (il) �uch in �ic:CUuni. [
,.�.modwi 4��nnplcl�dni�crelfonslidz:vrl,, edjusUncnla IC-1-�u �mvi�:inq '
as Il�e vcndo� ha�x a{�;ucd io ;
b- Ihn iivunnco a�luiderJ lo t!u; vC.�.cV�� is ntake of nui9w+qy unilart�l;tr:�,
,id?j�r,:l l��Uir.(r,llow'my ri[i�lltiunal�;xGiusione� lu�n:ike in Ih�� usu�i r�+nsr o'
(i) Tlii!:visefaiicedou; notap�ilytu� I�usinesz:, in �;.)nneclion entli ��
Ihe r.11s'tfibutiun oi sF,lc ol !h�� �
(�� "Eoilly injufy" of 'propoity i
cl�,imagr." lur which ihe von<lor is prodw�::.
rihlil�alorl lo pday daiY12�.Jee 6V (2) This Inswniu:u Joos nnl epply lo :inv �
rr;n;,on oi Ihe �ssumptiun ul 6�swecl parson or r�ipanlzntion troin i
Iia.Uilil, in;: conU:ici oi eigre�:nicnL whoin you havc ur,r�uhed sucli i
lld;� �u;Clusion does nol rapply lo prodUrls� or any In��fuillent. parl or - �i
IiabilitY Iqr tl+lma�cs Ih:d ILc conl2int�r, unlr.iing inlo. �.
vonrioi woulrl havo iri Iliu u�sencc accomp:wyinq or r,unleilning �tiith �
ol �he cntllrn�;l br�grernnonl: P�oducl�s. ,
(b) P,ny cxprusa wa�ranly S. Adclllional Insw�eJ -Coniralling Interest : II
unauthnn ��d by you: 1NI10 IS Ald IIJSUhL❑ uuUur �r.ion C. b.�. ,
(c) An� ;,hvsi al or ct�amical ch�n�r, an�encled tu inr,lud� is an cuhidioria� :nsur^.n '
in Ih:� pralucl inade hd�ntionelly lh�a pe.rson(Sj or orq�ni_-tlion(s) -liuwr� in ihr: ,
t
bv II��r-veridor_ Der,lai'aLOns 2e nn �ddltlnnsd Insufrii I
(d) IL.rF�.i�lcailin�.�, unlCS: un{iackeU
Conliolllny Inturus�, but rnly will� ris:.pect lo �I
siiely i�ir Ihe ��ur��use ul Inspociion. theli liahillly arisln��pui nt�
' :la�monslr.tir�,ii, testing, [�r ll�ie a. lliuir linaiici;,l cun�.rol af yuu:or
� ,:u!�sulullon oi p�rls unUE:r b, Prcinises lhny rnvii, inainlaiu c�r cbnlfol �� i
In:zl�ucGon:; iroin lila inbnUf[�clunn, m�hlle you iieas(i nr occuVy IhUSe Preuiiscy. t .
t��id Ihcn iep�iCka�ed iu ih!� uriginal
r,cnlai i iui�, '
I
Forni 55 (la OS Oa OS Pa(�e 19 of 24 � j �
�
I i
, I
,
L�USINE55 LIABILITY COV[F2AGt FORM
. Tl�is insws��cc r,c.r.s not �:pply :c st:�.�clutal TLC iirnits ol in;ur�ncv 1h21 a��ply to adNition.;. ? �
. allmnliGns. n�dw' co��c`Anir.lion and demolltir,ii inBUreds nrr, d�scrihetl in Seclion D. - LiYnil�� OI 1
opeialions perfonned by or for Ihr�( prrsnn or IusuranCe. = ,
i
On).7ni?;iliqn. liow Ihis insur2nr,e 2���phes when ulhm insurdnco ���
9. Addltional Insunad - Ownors, Lessees Or is nvailablc lu an addilion�l insurr.d is dce�;cribed iii
Contractors - ScheduleA Person Or the Olher lusur�nr,e Cuudilinn in Snr,iion r. �
Or�anizalion I_iabillly Hnd Me<Iical f.-apunsus Gor�r.ra� � �
a. bVI1U IS i\N INSURLD under SecUnn C. is i%ondilions. '
antendurl In include �s an 2ddition:,l G. UAESI!_ITY AND MEDICAI. EXPENuF_5 F
insu«il ihc. p��rnm(5) ur uryiniz�tion(s) pEFI�I710N5 �
sliown n ih� Decl ralions�s an Additioncil
IntinHd t> dnvfL�aSeusOfC.Oniflc.'ore, �� 'AclVertlsemenC' mc��n_ Ihowirle � icd� pil-�li�
bul ortl�. �dl�h iosp ct IU Ilablhfy for bodil;� �1�5:•emination r.�l in(unnatinn nr im�gns Ihc!I
injur%'. "lxopnny tl;anxay&" ui 'paison�.l ha:; th<:purpose o(inducing U�ie ��le of ynr��fs. '
and advurllrsiny injiiry�� c:w.^,r.d, in�,vhulu or I�reducls ur s�rvroes Ihrouglr. � I
ui part, by your acU or ornissions oi Ihe a. (1) IZ�dio�, ' i
�aCl> iir nmL;siuns oI Ihunu �u�.tiny ori your (2) Tnlovision; �
t�onal'r: � (3) BillboarJ; f
(1) In ;he periurn�ancci n� your ongoing (4) Ma,yazine, �q .
o��,cro(inns fu! llie 2ddilionel ! ��,
insurrd(sj; ol' (S) �ovrspapF.r; 4
(2) In r.plin�ir,li0i7 wilh "VOUr wo:l:.' b, 1'he Inleniet, bW unlq thal p,irl of a tveb
perfn:ined !ui lhel 2ddition9l insUred sii[: fhal is alioUl �oncis, prndUr.t.: or j
fln::i incluJ�J wilhin Ihe "products- �mvicus for Ihe purpo,es nl inducing ihu ( �
cnmplci!•�:I OP��'�lions haz.artl", U�,:! s21e ot gootls,P���dur.ls nr<r:nicus:ur i
only ��f II'is i:oven�n Part pinvid�-n c. Arry nlhcr ��ublir.alion Ih.; is :liven �.
covc�agc foi "licd:ly injury" ar ividespread publir,di::lriGu�;on.
"prupi:rly �IZiniape" inr,lu�led �,Vilhin I,'�F Howrver,"��dverlis'�niunl°dUm:nol�nclud�.:; i
•��iNdUCl5�cp0�(7i�lCd p�Cfdl:OnP. `
a, ifm d�siqn. I�rinlaJ m;�h:n;tl. infunn[ilwn
heiear�s" � .
a iniag�s r.nntainr,A �n. ��n or upoi� th�- �
b. +Nilh resp:��;l lo tl�ie insur;vnce a1lor�ud I�, par,f:ayin�l or lohc:ling ol any y;onrls rn �
thr.se ad;lih�,nal insufr,ds, thi5 in5uran::e pcoducls; or '
r.in,;g nol n�Spl-�i lo "bodllY injury" '.proporly '�
dam��e" oi "p��isonal an advartislny 4. An in�craclivC convor;2tlon belwc+:n u�
an�pngpeisonslhrouyh.icwu�iulaneivnrk. '
In�ury" :�ii�in,i oul of Iho rundoring nl_ ai �
ihe tailuii+ lo rc-niicr. any p�o(esslonsl 2. "AJverosiny Ir.leaf rn�ans uny !JCa Irn �in E
nrahlter-lura: enc�inr.r.flny oi sw�ro}�in{; "�civnrliocrn�nl"
scrvlco:s. inr,llu.ling� 7. "A:;I�cstos ha<<irU" nic.nis zo �.y;�p�sur�� or r
(�) fh[ prn�r.,rinc. �pprnviny� ur fadiur, tu throal nl c>:pusure to Ihu s.�r;w;il or all�,{;ar: � �
p�epera ur ;ipprovc, maps, shop �nouoilius of as�i�stos �nd Inr.!udes tl�e mf:rr. a� ,i
:II?i.Nn1y5, pPiniong. Id�iGi15, SUNG%6. NletltlnUC Uf dE�C5lO5111 fllly(tillll
fe!J ordu:s. r.l�c,nq,� uiclera, do.=,iyns ur 4. "Hut<i' me�ns r� I.mA mnlur �d��hielr,, ir3ilr� ui �
drava:nqs:in�l ,peCiiir,atiom,::or seini-trailcr desi�nud for tr;roel on �>ublic �
(Z) Su���r.rvi:.,-�ry. inspeclion. aichiteclural roJds. ii�Cluding any atlachr.d rtiar.hinuiq oi i
oi r_m)irier,int�activilies. e�:iuipnienl. Bui ";mlo" �i��es nol includr. �
f0. Additional InsurcU - Co-Owner Of Insurod °�»��Lile r�nuipmem". �
Premisos 5. "L'odilV inji�ry" n,.�anti physir.a' ;
VVIIU i5 .'1hl V�:SURED ,in;fvr Ser.lipn C. is a. InJury, f
2nv;nded In :rnJwin .i� nn addilior.al uisurFd b. tiir.kness:oi j
Ihc p�;�:rsnn(s) ni (.rryanizz+liun�s) shuwn in lhc c.� piscase
I�E,r,lar2tions .��. .�n A�IUitinn.{I Insured - C:o- ��
Otvur,�r O( lu•au�crl Prnmis��s. bul only with sus4�IneU 6y a pers��n rmd. If aiiz,inq uul of;ii�:•
respecl lu thuii habili(y ,s Co-owner of the ��uv�, nienleJ an{�liish ci dr,�ll;at ouy lim�a. � �
i�fr71T115P.ti::P�ovan in lhe Duclaralions. 6. "Cuveiage t«:rrilorj'muans�, . ,
i
P
Pagr. 20 0} 2d Form 55 I)0 U&OA 05
� II
�
i; i
I _ . _ _ — _ _ _ — _. _ .
� ! . . _ _ _ . _ _ . _. .. I
l I
�
1
' fi I'7 : � 9: :dicJ
i ',fr MO EO P;�!L ���":.�
3
r
� .,. ._. . '�r i .^.i:i,. �, i� i� �. ... .� � .
ln i , r
� � .„1 . .. �Ii. ..�. � I
` �� . �.� � 7. ' � �il I ,�p`.r , ..
�:�.in:u. C ' i..
; � �. i � .. . V y:i I .. � ��t
�� 1 I U� :�� .::q' .i_:u` I � .i u. . i�I
:� 1 m�J� i , i ..:a� :i.. II 1 . ,b�'.'.', q� f i .- . .. . .
1
i au �L:r� nu,i �;n �:
�;in�iv,ul7iposll 'Ol��.��udinb.j A.rl��•,l • If i 1,' � Us�
= p:;ronim{� r�� a6inucfl d�r.�rinid i_.� nirnu��u„yn•d:;yi ,i
� x:d i ur..� �f, _i.�.��� � i i � �:. V .. }.i��.. i ' .
k �J )I ��L: 1 c'.� �...����I: �LI�.11 q. - ..y. �. . '1 I � d,li`.I. i�.y, . �Q /. �I til�...i: ''1
3 ... i ..i:.:e�� : „ �'q�u'.. Iluc��,i•ic.r�n y, .
; ...� � u 4��::: Vi :.. i �',':il '.';: I: � ..�:n� .ipi
. ..pe�� uy .i �a i� nir q � � y v u
1 q��. �ai�,.r q)�iln�,. •}I�.l�nV (i) ..�.��pi h .ru�.•�:�.
i
h ii�:�n.�i.�l ��i iv_��n�u.:C-Illf: ql '�?.'�n..inli, i.o-�.lnei, .. �q . +qre� ..i. ,
�1I�. . � � . . : .i. I �b, . � . �' 1 .
a � .�.�.�� I �� . � �
1
� �.. �. i . �� , ol bi i ��� SV Jn���,1 .i ,,n, q 1�� '. I �I'.:�, iy� � � � ,
U.��� � i � � tli i n.�. i
� � ,,.u11f� �nlli nd:i;._ .
j ii� ., �, I..:���p:�n _ .nin[:u� i n�
. �,;µ i ��p9 ,inri i .�„i i
� .� 5�i�lrpi�lwuil (Ci . �� . . .
i .•u ��
iu � I I i n. � �..�, i �:i i i
❑✓�_ �i i.y-I 1. iq i i i�.� - n i� i i I i i ,.
� ' I I �:� � . .I oo ,� : . i ( � . . i u .�,r.
j irn I� , iluWll�'I ,in�� !:i ❑ �..i .�.i:.,: . �., n ny� � � 1 �:. , i . .���:iiq�.
fnpj, °I. Ppluo2l `n!..uiri�! �[:� :o� r.��.jp P>n �„L; �i ..L..�.i� i 1 .i.:-P.•�
; � •.�r. i._ �'r a:.�... .:':nw:. ;i::i�i.lq�n�: i irl :� i6. r �.� ��yil.�,. �.. ii.: .�.� i:,..
. i ' : .. : . ... . i � , . . . �. . .
�. I '-.li � - A.1'. „I iqlL.'� . .F�
I , ......_ .. .. .,.. �.
� . .. 1 � I .1:1•!II'�..,� .,...I�:1 :-..I.:�:I 1".�
' .�I• ..�.. �.iil:. i � 'i ' .I i � .'��:1'.
� .. ... . �:.� . :.I . ...�.�
�
� 1�IOAl11pU� �i.J 1 1�1• . , . :i I .
y �..J�:r,. u_ , ;Il .:�. ,i . ., rl. ; ��I ,
; � .rnl .P i�r � .i.u��. ui 1111 l..i'�,1�
� .. .. ll.� fl'Ir
.c�n�i J'�i V �ot�� I� U .Id�ll��
� 'qll il � 11• InM1C l. - l I Y.:IIC11 :I11 '.11l; I' �I�:tl 11 �i �1 l I'.. �O�f. t.U!�
..II �.II'.1 'i.l:'�i�.� I � 1��1� : :I 11.� ' 1:
� oouvmsu��:su�.q �q '
� ,._ i:..-��i.�•.,�-:'.'p
� :.i ��...u�. �. � . :•.� i . �, 'I�c� i . . � �.q.;
.� r' �. �, �i .i i :iill !q n ��� u�
� I�,�..,. , . ii 1- m.i:�i i�q-.l' Iriiu-1 �
i i � �'.� �.� u � .� IP;;, .� i ni ..in
g v, �mr:iu i y II �.:?q I h � P:. il.nc� . .'�'iq
{ ��.
� q .. � � 6� c Ai ii i .��.wi i �r� .� i-i. :���1 i .,i.i ,wl I _I ,� . _ LI-
A� :19�II:.IIP 4� <II i 11Ir1 . ...I .� . 1 � ... � li'.I� I . '
,� .. . .� . 11 '�: ' I I I � ': U; I � '
y I.i � I ...0 I i .�, ���
�d� .� U�III � '.iJl I I I�i II9— �n � ii :i'. ,'� �.i v i:bh: li , q a tl aiiq•
� .u.l q m .v„�. _ - :n� i i � ..�t:D�'�'�' .i ni: i .. ;q"..I �Ui. '-) � .�I � ill�.i 1. il
-:i „ .n. :ep..i:.n�.�i�� ;-.uc n�x ;-.itr•' li � �
,�;� 1;��� .� r ni�l!,.� �.•.irJm,:i
:.�uc�ln:u� �oyiU �, , :;�iuq ::i:c .�"u.�..�n:r.: :: ;� �r ;. ;�.,i n�i
. u pi�l �.{.nl^ It�m..in:,.��� .: t.�.tq •I J a.�in�:i :.uJ .:q im ��,:lu,U'>
. G;.; �d•q�::u�". ::r..11 it�p'm (�1�1'u.Cn�� ��I:n ,Qn,:n:�I1 ,;:�hCiur:. pi..n:l.�i�l, 'n�r 4iUt�••l.
... I . h:l! .�i..� .�,. 'Pail 'IT�..ecy, . �dU iU.ii.. 'y !. r� "li "-I P�i��Ltu.i
� , t� n-�i i .i lli }t �.�.r.:l �iuci.0 � Ul vi:�l/ppqc. . bn -u�.u.;
� �..�. p i u n:. ; � il iq��C+i F�r i i �P: I.i , i �nu .�u� I .. i. �n, u� I i;� i
j . q IP�'ll'�.�� , iia.� (,���unilt'�Pinn �l, I. '�..�t n�� �.j p�i - i � �UC '.� II,
j ,pA:�try� i . li .;il�.y� � ..y • �� i
A.�.u��.'i i� �m�ir� �cu>t� �i u� �q .n e� /Iip t u 1� I lu ,unq.�
� ..ic:l; �d.. .9,i i.t �i `.0 i I i � . � . '
j .. ,u �u , •:r.i i r,i• ;i '�� .� r , (`:) . '.�:q . � .ii:�„ � .�li_. '.; .iJ ' .�
�
i :'�1`I�'� I I:;V:Ii.9lY.` A.LI-I,;;lVll ^•._r!;dlSll.�i i
I
{
� I
I
Potlola Syslems,Ina 57UECU03374 COMMERGfAL ALITOMOBILE ,
HA 99 16 03 12 ' �
� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
I COMMERCIAL AUTOMOBILE BROAD FORM ;
iENDORSEMENT �
This enclorsement modifies Insurance provitled unticr thc following: ' �
BUSfNE55 AUTO COVERAGE FORM
To the extenl that fhe provrsions of this endorserttent provide broader benefils lo (he "insureB" than other '
provislons of Ihe Coverac�e Funn, the provislons of this endorsemenl apply. I
1. BROAD FORM INSURED tl. Any "employee" of yours while using a g
A. Subsidiaries and Newly Acquired or covered "aulo" you doiit own, hire or (
FormedOr anlzations bOfrow in i '
g your business or your
The Named Insured shown in the personal affairs. �
Declarations is amended to include: C. Lessors as Insureds i I
(1) Any legal business enlity other than a Paragraph A.1. -WHO IS AN INSURED -of
partnersbip or joint vanWre, formed as a Secfion II - Liability Coverage is amended to
subsidiary In which you have an add: � i
ownership interesf ot more [han 50% on � i
e, The lessor of a covered "auto" whilc the
the eFfeclive tlate of thc Coverage Form. "aulo" is leasetl to you under a writlen '�',
However, the Named Insured does not a�reement if: � �'
include any subslcliary thai is an (1) The agreement reqWres ou
"insured" under any other autoinobile Y to �
policy or would be an "insurotl" unde.r provide direcl primary 'rnsurance for � ,
such a policy but for its terminaliun or the lessor and
the exhaustion of ils Limit of insuranco, (2) The"auto"Is leased wlthout a Urivar.
(2) nny orgauizalion that is acquired or Such a leased "auto" will be consitlered a '�
formetl by you and over which you covered "auto" you own and not a covered �
maintain majority ownership. However, "auto"you hire. �i �
lhe Named Insured does not include any D. Additlonal Insured if Required by Contract
nowly formed or acyuired orr�anizaiion:
(a) That is a partnership or joint (7) Paragraphl�.1. -WHO IS AN INSURED 1;
- of Section II - Liability Coverage is �
venture, amended to add:
(b) That is an "insured" under�ny other f. When you have agreeci, in a written
policy, confract or wr'�tfen agreemer.t, tha! a �
(c) That has ozhaus[ed its Limil ot person or organization be aclrl�A as '.
Insurance under any other policy, or an aAditional insuretl o� your �
(d) 180 days or more after ils business auto policy, such person or .
acquisition or formaUOn by you, organization is an "insuretl", but oitly � �I
unless you have given us notice of to the exlent such person or � �.
the acquisition or formation, organization is liable for "bodily �. �
Coverage does noi apply to "boclily injury" or "property damage" caused �.
injury" or "propeiiy damage^ that results by the conduct of an "insured° under �
from an "accident" that occurred beFore paragraphs a. or b. of Who Is An ��
you formed or acc7ulred Ihe organization. Insured wlth regard to the ��
B. Employees as Insureds owrlership, maintenance or use of a '
covered "aulo." �
Paragraph A.1. - WHO IS AN INSURED - of - '
SECTION II - LIABILITY COVERAGE is
amended to adtl: �
�
=O 2011, The Hartford Qndudes copyri9hted material �,
Form HA 99 16 03 12 of ISO Properties, Inc.,with its permission.) Page 'I of 5 '� �
I
�
i
, s
�
t
F
F
i
I
I
a
a
' The insurence a(forded lo any such E. Primary and Non-Contrihu[ory if ii �
ddditional insured applies only if the Requlred by Contract e
"bodily injury" or "property damaye" Only with r�spect to insurance provided lo '
occurs: �
an additional insured in 9.D, - Additianal g
� (t) Durin,y the policy penod, and Insured if Required by Contract, Uie ��
(2) Subsequent[o the execution of such following provisions apply: � ,
written conlract, and (3) Primary Insurance When Required By i '
(3) Prior to the expiretion of the period Contract � �
of time lhat the written contract This insurance is primary if you have �
reGuires such insurance be provided agreod in a written coniracl or written �
to Ihe additional insuretl. agreement lhat Ihls insurance be �
(2) How�imils npply prim2iy. If other insurance Is also � I
If ou have ayreed in e written contract primary, we will share wlth all lha[ othor
Y insurance by ihe methnd described in �.
or wntlen agreement that anolher Other Insurance 5.d. �
person or oryanizalion be added as an '
additional insured on your policy, the (4) Primary And NomContributory To Other (
most we wlll pay on behalf of such Insurance When Roquired 8y Contract [� .
additional insured is th� lesser ot If you have ayr�ed In a wrltton conlracl ,
(a) The limits of insurance specified in or written agreement that this insurance
the written contract or written is primary and non-contributory with the �
agreeinent; or additional insured's own insurance, this
Insurance Is prim2ry 2nd we will not ;
(b) The Limits of Insurance shown in seel< contribution from tha! other I '
the Declarations. insurance, i
Such amounl shall be a part of and not Paragrephs (3J and (4) do not apply to other Ij
in addition to Limits ot Insurance shoevn insurance to which the additional insured
in lhe Oeclarations and describetl in this t
has heen added as an additional InsureU. d
Section. ��
When this Insurance Is ezcess, we will have no y �
(3) Additional Insureds Othor Insurance �iity to defend the� insured against any "suiP' if p
If we cover a claim or "suiP' under lhis any other Insurer has a duty lo defend the ?
Coverac�e Part th�t m2y also be covcred insured against that�"suit". If. no olher insurer �
by olher insurancc available to an defends, v✓e will underteke lo do so, �ut we will �
additional insured, such additional be en!itled to the insured's rights against :�II )
insured must submit such clainl or "suiP' thosc othcr insurers. '
to Ihe other insurer for tlefense and W��en this insurance is excess over o(her '�
F
indemnity, insurance, we will pay only our share of the "
However, Ihls provision does not apply amounl oi the loss, i} any, thai exceeds the sum �
i
to the extent Ihat you have agreed in a of: �
writtan contract or wrltten agreament (�) The total amount thet all such other �'
Ihal this insurance is primary and non- insurance would pay for tho loss in the ��.
contriGutory with the additional Insured's absence o(thls insur8nce; and
owninsurance. �
(2) The total of all deductible and seli-insured
(4) Du�ies in The Evr.nt Of Accitlent, Claim, amounts undor all that other insurance.
Suit or Loss
VVe will sharc the remaining loss, if any, by the F
If you have ac�reed in a written r,oniract melhod described in Other Insurance S.d.
or wri;len agrec:ment that another 2 qUTOS RENTED BY EMPLOYEES '
person or organizalion be added �s an �
�dditlonal insured on your policy, Ihe Any "auto" liired or rented by your "employee" (.
�dditional insured shall be required to on your behalf and a[ your dlrection will be �
comply with the provisions in �OSS considered 2n "auto" you hire. �
CON�ITIONS 2. - DUTIES IN TI1E The OTHER INSURANCE Condition is amended
EVENT OF ACCIDENT, CLAIM , SUIT by addinc� the (ollowing: �
OR LOSS - OF SECTION IV —
BUSINESS AUTO CONDITIONS, In [he
same manner as the Named Insuretl. `
�O 20'11.The Flartford(Includes copyrighted malerial � I
Fofm HA�J�J 1G 03 12 of ISO Properties, Inc., wilh ils permission.) Page 2 of 5 �
I!
��
'i
e
E
is
i+
I
i
,
' I( an "employee's" personal insurance aiso 5. PHYSICAL DAMAGE - ADDITIONAL '
applics on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE .
' hired or rented by your "employee" on your COVERAGE
, behalf antl ai your direction, this insurance wiil paragraph A.4.a. of SECTION III - PHYSICAL �
� be primary to Ihe "employee's" personal DAMAGE COVERAGE is amended to provide a i
insurance. limit of $50 per day and a maximum limil of
3. AMEN�ED FELLOW EMPLOYEE EXCLUSION $1.DOD.
� GXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOAN/LEASE GAP COVERAGE ;
�, SEC�I"ION II - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE �
� apply if you have workers' compensation COVERAGE, in the evenl of a total "loss" to a
insurance in-force covering all of your covered "auto", we will pay your atlditional legal
"employees", obligation for 2ny differonce belween the actual '
Coverage is excoss over any other collectible cash value of the "auto" at the [ime of the "loss" �
insurance.. and tt!e 'bulstanding balance" of Ihe loan/lease.
4. HIRED AUTO PHYSICAL DAMAGE COVERAGE "Oulstanding balanco" means the amounl you
If hired "autos" are coverad "autos" for Liability oWe on the IoaNlease at the time of "loss" Icss .
� Coverege and if Comprehensive, Specified any amounts representing tazes; overdue .,
Gauses of Loss, or Collision coverages are P�Y�rAnts; penaifies, interest or chargos ,
provided under this Coverage Form for 2ny resulting (rom overdue payments additional
"auto" you own, then lhe Physical Damayo mlle2ge r,harges;axcess wear and lear charges: i,
lease terminalion fees; security deposi[s nol
Coverac�es provided aro extended to "autos"you �� �,
hire or borrow, suhject to the(oilowing limi!. returned by the lessor, costs for extended ; i
warranties, credit li(e Insurance, health. accident k,
Th� most we will pay (or "loss" to any hired or disabllity InsUrance purchased v✓i�h the loan or �
"aulo" is: lease; and carry-over balances from previous i
(1) $'100,000; � loans orleases.
(2) The actual cash value of the damaged or 7, AIRBAG COVERAGE p
stolen propoiiy at the lime oF Ihe"loss";or Under Paragraph B. EXCWSIONS - of � �
(3) Th� cost of repairinc� or replacinc� Ihe SECTION III - PHYSICAL DAMAGH p
damaged or slolen property, COVERAGE, the following is added: t
whichever is smallest, minus a deductible. The The ezdusion relating to mechanical brealcdown
doductiblo will be equal to lhe larc�est deduc�ible does not apply to the acciden[al dischar�e of an ���
applicable lo any owned "auto" for lhal alrbag. '
coverage. No deductible applies lo "loss" caused g, ELECTRONIC EQUIPMENT - BROADENED
by fire or liyhtning. Hired Auto Physical Damage COVERAGE �I'
coverac�e is excess over any other collectible �
insurance. Subject to the 2bove limit, deductible a. The exr.eptions to Par��raphs B.4 - � I
� and excess provisions, we will provide covere�e EXCWSIONS - of SECTION III - PHYSICAL
equal to the broadesl coverage applicable tn any DAMAGE COVERAGE are replaced by ihe j i
covered "auto" you own. following: E
We will also cover loss of use of the hired "aulo" Exdusions 4.c. and 4.d. Uo not appry to �
if it results from an "accidenC', you are legalty ?quipment designed to be oper2ted solely �
liable �nd lhe lessor incurs an acWal financial bY use of Ihe power from the "aulo's" �
loss, subject to a maximurn of $1000 per e�ectrical system that, at fhe time of'9oss",
� "accident". is: � �
This ex�ension oF coverage does rtol apply to (�) Pennanently installed in or upon
"a i o" ou hire or borrow from an of our the covered "auto"; ` ,
anY tt y Y Y �
"employees", U�rtners Qf you are a partnership), (2) Removable from a houslnc� unit �
memUers (if you are a timited liability company), which is permanently installed in � �
, or members oi their househotds. or upon the covered"auto", �
� (3) An integral part of lhe same unit ! �
' housing any eleclronlc �
oquipment described in
'i Paragraphs (1)and (2)above; or
{[;
�O 2011, The Hertford(Indudes Copyrighted material f �
Form HA 99 16 03 12 of ISO Properlies, Inc., wlth ils permission J Page 3 of 5 6
II
i
I
I�
I I
_ _ . — _ __ _ _. - -
(4) Necessary for :he normal If another Hartford Finarcial Services Group, '. I
operation of the covered "auto"or Inc. wmpany policy or coverage form Ihal is no! ,
the monitoring of the covered an automobile policy or coverag2 form applies to :
� "auto's"operating system. the same "accidenP', the following applles: '
f
b.Section III – Version Cn 00 01 03 10 of the (1) If lhe deductible under this Business Auto
8usiness Auto Coverage Porm, Physical Covorage Form is Ihe smaller (or smallest) �
Damage Coverage, Limit of Insurance, detluctible, it wlll be waivetl; �
Parayraph C2 and Version CA 00 01 10 01 of (p) I{ the deductible under ihis Business Aulo
lhe Business Auto Cov�rage Form, Physical - Coverage Form is nol [he smaller (or �
Damage Coverage, Limit of Inswance, smallest) deductlble, It wlll be retluced by � .
Paragraph C are oach amended l0 2dd the the amount of the smaller (or sm�lle,^,t) � 'I
following: deductible. �
51,500 is the most we wlll pay far "loss" in 12. AMENDED DUTIES W THE EVENT OF ��
any one "accident" to all eleclronic qCCIDENT, CLAIM, SUIT OR LOSS
. equipment (o�her then equipmen� designod The requirement in LOSS CONDITIONS 2.a. - ,
solely for the reproduction of sound, and DUTIES IN THE EVENT OF ACCIDENT,CLAIM, C
accessories usetl with such equipment) SUIT OR LOSS - of SECTION IV - BUSWESS ��.
that reproduces, receives or transmits . i
audio, visual or data signals which, at [he AUTO CONDITIONS that you must notify us nf
an "accidenP' �pplies only when ih� "accidenP' is �
11111A O(��IO65", I5:
Imown to:
(1) Permanently installed in or upon �
Ihe covered "auto" in a housing, (1) You, if you are an individual; � '
opening or other location that is not (2) A partner, if you are a parMership; , �
normalry usod by the "aulo" (3) q member, if you are a limitetl liability I
manufacWrer for the installation of company;oi'
such equipment; (q) An executive officer or Insurence rnanager, iF
(7) Rernoval�le from a permanently you are a corporation. e
installed housing unil as described i
in Par2yraph 2.a. abovo or is an 13. UNIN7ENTIONAL FAILURE TO DISCLOSE
HAZARDS �
intogral part of that equipment;or `•
(3)An in;ogral part of such equipmenl. If you �nintentlonally fail to disclose any hatards
ezisling at the mception date uf yvur policy, we ','��
c.For oar.h covered "auto", should loss be limi:ed vdlll not derry coverage undr.r lhis Covcrac�e �
to electronle equipment only, our o6liyation io Porm because of such failure.
pay fnr, repair, retum ❑r repiace Uamac�ecl or �q. HIRED AUTO -COVERAGE TERRITORY €
stolen electronic equipment wiil be reduced by
lhe applicable tleductible shown in the Paragraph e. of GENGRAL CONDITIONS 7. - ��.
Der,laralions, or $25D, vahichever deductible is POLICY PERIO�, COVERl1GE TERRITORY -
less. of SECTION IV - BUSINESS AUTO
9. EXTRA EXPENSE - BROAOENED CONDITIONS is replaced by the following:
COVERAGE e. For shorl-term hired "autos", fhe cover2ge E
Under Paragraph A. -COVERAGE -of SECTION lerritory with respect to Liabllily Coverac�e is 6
Itl - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if (he F ,
"insured's" responsibility to pay damages for G,
pay for the expense of retuminc� a Slolen covered "bodily injury" or "proper�y damage" is
"auto" to you. determinetl in a "suit," the "sui[" is brouyh� in �
10. GLASS REPAIR-WAIVER OF DEDUCTIB�E the United Slates of America, the territories F
Under Parat�raph D.-DEDUCTIBLE -of SECTION and possessions of the Uniled Stales of t.
III - PHYSICAL DAMAGF COVERAGE, tl:e America, PuerW Rico or Canada or i� a �
following is addetl: se[llement we a�ree to. p
No deductible applir.s to glass damage if the 15, WAIVER OF SUBROGATION 4,
glass is repaired rather Ihen replaced. TRANSFFR OF RIGHTS OF RECOVERY j'�
11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - af SECTION IV - �
Undc;r Paragraph D.-DEDUCTIBLE -of SECTION BUSW ESS AUTO CONDITIONS is 2mendetl by ;
III - PHYSICAL DAMAGE COVERHGE, the addiny the following: � I
following is added: � I
Cc>2011, The Hartford(Includes copyrighted materiel � ,
Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page A of 5 �l
I
�t
f I
_ _ . .. . _ __ _ _ . _ .
i _ _ — _ . _ ._- _
��
,
We waive any right of recovery we may have c.Regardless of the number of autos deemed a �
aqainsl any person or organization with whom total loss, the most we wiil pay under this
you have a written contrac� that reyuires such HybrW, Electric, or Natural Ges Vehicle
� waiver because of payments we make for Payment Coverage provision for any one ;
damac�es under this Coverage Form. "loss" is $10,000. i
16. RESULTANT MENTAL ANGUISH COVERAGE For ihe purposes of fhe covc�rage provision, �
The definition of "bodily injury" in SECTION V- a.A "nornhybrid" auto is defined as an auto tfiat ; I
�EFINITIONS is replaced by the following uses only an internal combustion enc�ine to i I
"BOdily injury" means bodily injury, sickness or move the auto but does nol include .autos
disease sustained by any person, including powered solely by electriciiy or nalural c�as. I
mental anguish or death resultinc� from eny of 6.A "hybrid" auto is defined as an auto with an I
these. internal combustion en�ine antl one or more
17. EXTENDED CANCELLATION CONDITION electrlc motors; and that uses the intemal ��
coml�ustion engine and one or more olectric '
Parac�raph 2. of the COMMON POLICY motors lo move the auto, or Ihe intemat
CONDITIONS - CANCEL.LATION - applies combustion engine to char�je one or more �
ezcept as follows: eleclric molors, which move the auto. !�
I( we c2ncel for any reason olher than �g, VEHICLE WRAP COVEftAGE �
nonpayment af premium, we will mai! or tleliver
lo !he first Named Insured written notice o! �n the event of a total loss to an "auto" (or which � I
cancellation at Icast 6U days be(ore the effective Comprehensivc, Specifed Causes of �nss, or '- �.
date o(cancell2tion, Collision coverages are providetl under this I��
Coverage Form, ihen such Physical Damagc
18. HYBRID, ELECTRIC, OR NATLIRAL GAS Coverages are ainended to acid lhe following: �
VEHICLE PAYMENT COVERAGE �
in addition to the actual cash value of the "auto",
In the event of a total loss to a "non-hybrid" aulo �,ye will pay up ro $1,000 for vinyl vehicle wraps �
for which Comprehensive, Specified Causes of �,vhich are displayed on the covered "auto" at the j
Loss, or Collision coveraqes are provided untler Urne of total loss. Rec�ardless of lhe number of N
this Coveraye Form, then such Physical k'
Dama�e Coverages are amended as follows� autos tleemed a lolel loss, the most we will pay
k:
under lhis Vehicle Wrap Coverage provision fa� �,
a.lf Ihe auto Is replacetl with a "hybrid" auto or any one "loss" is $5,000. For purposes of this �;
an auto powered solely by electricity or natural cover:�ye provision, sic�ns or othcr graphics 1
gas, we will pay an additional 10%, lo a pain[ed or mac�netically affixed to the vehicle are �
maximum of$2,500, of the "non-hybrid" auto's not consldefed vehlcle Wraps.
actual cash value or replacement cosi,
whichever is loss, �
b.The euto must be replaced and a eepy of a Uil� €
of sale or new lease ac�feement rocoivetl by us t ',
wilhin 60 calendar days of�he dale of"loss," j
!
�
�
�
!
(
t
!
!
�
OO 2011, The Hartfortl(Includes copyiighled maleri2l �
Form HA 99 16 03 12 of I50 Properlies, Inc., with iIS permission.) Page 5 of 5
�
4 I
�
i I