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Vest Concrete ContractorsCITY OF OKEECHOBEE INVITATION TO BID OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS No. PW 03-11-08-20 OPENING DATE AND TIME: September 1, 2020 at 3:00 PM Prepared by David Allen, Public Works Director Dated: Aug 12, 2020 CITY OF OKEECHOBEE CITY COUNCIL Bid No. PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS DOWLING R. WATFORD, JR., MAYOR WES ABNEY MONICA CLARK BOB JARRIEL BOBBY KEEFE MARCOS MONTES DE OCA, CITY ADMINISTRATOR TABLE OF CONTENTS PW 03-11-08-20 Invitation to Bid Advertisement Form 1 Section I General Information 2 Section II Submission Requirements 3 Section III Bid Documentation 4-5 Section IV Minimum Qualification for Bidders 6 Section V Bonding and Insurance Requirements 7 - 23 Section VI Rejection of Bid 24 Section VII Agreement for Services 25 - 56 Section Vill Miscellaneous 57 - 58 Attachments: A No Lobbying Affidavit 59 B Anti -Collusion Statement and No Gift Statement 60 C Proposer's Certification 61 D Sworn Statement Pursuant to Section 287.133(3)(a), FL § on Public Entity Crimes 62 - 63 E Conflict of Interest Disclosure Form 64 F Immigration Law Certification 65 G Drug -Free Workplace Certification 66 H Reference Form 67 INVITATION TO BID NO. PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS Opening Date and Time: September 1, 2020, 3:00 PM The City of Okeechobee, Florida is currently soliciting bids to provide construction services needed to install various concrete projects located within the City including: • 8-inch-thick roadway slab work. • Removal of existing sidewalk and installation of new ADA ramps. • Removal and replacement of existing sidewalk and/or curb and gutter. • Installation of new sidewalk and/or curb and gutter. Sealed bids must be received within the General Services Department at City Hall, 55 SE V Avenue, Rm 101, Okeechobee, FL 34974, no later than 3:00 PM EST on or before Tuesday, September 1, 2020. All responses received by the deadline will be opened and recorded in the presence of one or more witnesses within the Council Chambers, Rm 200, at the address listed above. Any bids received after the above noted date and time will not be opened or considered. Facsimile or emailed bids will not be accepted. Product specifications are available in the Bid Packets that may be obtained on the City's website: www.cityofokeechobee.com/contracting-opportunities.htm1, or from the General Services Department at City Hall during normal office hours, Mon -Fri, 8 AM-4:30 PM, except holidays, or by contacting Patty Burnette, 863- 763-3372 x 9820, or via email at pburnette@cityofokeechobee.com. Questions concerning the scope of work are to be directed to Public Works Director David Allen, 863-763-9790, or dallenocityofokeechobee.com NOTE: Bonding Requirements Apply to this Bid Opportunity. Bid submittals must be within a sealed envelope and contain two (2) clearly identified originals and one (1) copy of the bid, with the outside of the envelope clearly labeled "BID NO. PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK _ AND ROADWAY CONCRETE IMPROVEMENTS, 9-1-20 3:00 PM" with the submitting Company Name, and Return Address. Bids may be mailed, hand delivered and/or express mailed to the address listed above. Firms properly registered in the State of Florida are encouraged to submit their bid for consideration. It is the sole responsibility of the Bidder to deliver personally or by mail, their bid to the General Services Department on or before the closing hour and date for the receipt of bids as noted above. This solicitation does not commit the City of Okeechobee to award any contracts, to pay any costs incurred in the preparation of a response to this bid, or to contract for any services. The City Council reserves the right to reject any or all bids, to waive informalities and to accept or reject all or part of any bid, as they may deem to be in the best interests of the City of Okeechobee. Responses to this bid, upon receipt by the General Services Department, will become public records subject to provisions of Florida Statute Chapter 119 Florida Public Records Law. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 1 SECTION I PW 03-11-08-20 GENERAL INFORMATION All responses which comply with the requirements of this Bid will be considered Submittals must be made in the official name of the Firm or Individual under which business is conducted (showing official business address) and must be signed in ink by a person duly authorized to legally bind the person, Partnership, Company, or Corporation submitting the response to this Bid. Two clearly identified originals and one copy of your bid submittal are required. Bid submittals will be received by the General Services Department until 3:00 p.m. on September 1, 2020. Bid submittals are to be mailed, hand -delivered, and/or Express Mail to City of Okeechobee General Services Department 55 S.E. 3rd Avenue, Room 101 Okeechobee, FL 34974 The submitting offeror is required to have printed on the sealed envelope or wrapping containing their submission their Company name and return address, the Bid Number, Title, Opening Date and Time. Bids received after the date and time specified above shall be returned to the sender unopened. Facsimile or emailed bids will not be accepted. All bids shall remain in effect for a period of ninety (90) days after the last day on which bids must be submitted. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 2 SECTION II PW 03-11-08-20 SUBMISSION REQUIREMENTS The bidder shall submit two (2) original clearly identified originals and one copy of the following: 1. Bid Documentation Form (Section III) 2. Minimum Qualifications for Bidders Form (Section IV) and three (3) references (Attachment H) 3. Bid Bond 4. Bid Unit Price Schedule (Section VII, Exhibit B) In addition to the above, please complete the following forms that must be returned with your bid: Attachment A — No Lobbying Affidavit Attachment B — Anti Collusion Statement and No Gifts Statement Attachment C — Proposer's Certification Attachment D — Sworn Statement Pursuant to Section 287.133(3)(a), FL Statutes on Public Entity Crimes Attachment E — Conflict of Interest Disclosure Attachment F — Immigration Law Certification Attachment G — Drug Free Workplace Certification City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 3 SECTION III PW 03-11-08-20 BID DOCUMENTATION City Council City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 �e3S G.-rkrefr' (U ltTOC%rS, )V7(. (BIDDER'S COMPANY NAME) I have received the documents titled OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS, Project No. PW 03-11-08-20. 1 have also received addendum number_ through and have included these provisions in my Bid. I have examined both the Bid documents and the construction site and submit the following Bid in which I agree: To hold my Bid open until an agreement has been executed between the City of Okeechobee and accepted Bidder, or until ninety (90) days after Bids are opened, whichever is longer. 2. Regarding the Disposition of Bid Security: to accept the provisions of the Instructions to the Bidders. 3. To accomplish the work included in, and in accordance with the Contract Documents, if this Bid is accepted. 4. To start work on the first day of the month following the date of the Notice to Proceed. This contract will be in force for a period of one (1) year. This contract may be extended beyond the initial one (1) year. Each extension period will be for an additional one (1) year and may be renewed thereafter on an annual basis. It may be under the same or superior terms and conditions as this bid. This shall be accomplished by mutual written agreement/acceptance between the vendor and the City. 5. Payment will be made on a monthly cycle after work has been completed. A monthly invoice will be submitted on or before the 9th day of each month for payment. The invoice will be processed through our regular cycle with payment usually made by the end of the following month. Example: Work performed from September 1' through September 30". The bill is to be received by the City no later than October 9th, and payment should be made by October 30th. NOTE: The City shall not be liable to pay interest on any unpaid balance. Vendor is solely responsible for all taxes, withholding, or social security obligations. 6. Regarding the Award of the Contract: if I am awarded a contract for this project, I understand that the award may be for all or any portion thereof, of the items listed under the Bid Unit Price Schedule. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 4 Bidder: �&S �y�1 � ��� �u►1 �ruCFo�S� � N �- Date: (Company Name) By: Title: PRIESiSEN (Signature) CF rr -i E s (Printed Name) Email �4JF-STC� Ne�cr�wG►�.ec�v� Mailing Address: k366 -TF-ARAc-s= QRf-EcN,..>$EE FL-. 349-Iy Office Number: 3- 7 3 -- 3 % D 0 Fax Number: City of Okeechobee Public Works Department Project No. PW 03-11-08-20 SECTION IV PW 03-11-08-20 MINIMUM QUALIFICATIONS FOR BIDDERS Minimum Qualifications: 1.0 Experience 1.1 Bidder must have at least 3 years of experience in providing commercial concrete services including sidewalks and other flat work, roadway curbing, and roadway concrete pavement. 1.2 Bidder has successfully completed at least 12 concrete projects including at least one project in each of the following categories: 1.2.1 Sidewalk installation 1.2.2 Roadway curbing 1.2.3 Roadway concrete pavement 2.0 References 2.1 Bidder must provide at least 3 verifiable references of similar prior concrete services including sidewalks and other flat work, roadway curbing, and roadway concrete pavement 2.2 For each reference, Bidder shall submit a completed Reference Form provided in Attachment H. provide the client name, client phone number, and client e- mail address. 2.3 Bidder shall provide a written description of the services performed in sufficient detail as they directly relate to the work of this Request for Bid. The description shall include the dates of the period that the Bidder provided the services as well as the contractual amount of the services provided. 2.4 The City, in its sole discretion, may reject any and all bids if the City is not able to verify the references provided. 3.0 Bidder certifies that 3.1 Bidder meets the qualifications listed in Section IV, 1.0 above. 3.2 Bidder has never failed to complete work awarded under a contract due to circumstances that were under Bidder's control. 1 Bidder: 'e`) f c:nc it- iz� COD i NL- Date: (Company Name) By: Lxl�-Title: 01R ESi N t-- (Signature) j ,Q--4 Email: r,1?cr, l _c (Printed Name) Mailing Address: i 3� U S:' i '`� j ,- Office Number: � (, I " 1 L % 3 - 3 7 :� 0 Fax Number: City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 6 SECTION V PW 03-11-08-20 BONDING AND INSURANCE REQUIREMENTS 5.01 Bid Guaranty A. Bid Bond Form. Each Bid must be accompanied by the CITY's Bid Bond form meeting the standards specified in this Article 5, including those applicable to the sureties for the Statutory Payment Bond and Common Law Performance Bond specified in the General Terms & Conditions. The bond shall be on the Bid Guaranty form provided by the CITY, with Power of Attorney Affidavit attached, in an amount not less than five percent (5%) of the amount of the bid. The Bid Bond shall be in the Prime Contractor's name. The Bidder is required to use the CITY forms provided in this Request for Bid (RFB). Alternate bond forms will not be accepted. Failure to provide the CITY's bond forms will deem the Bid non- responsive. B. Alternate Security. In lieu of the Bid Bond, the Bid may be accompanied by an alternate form of security in the form of cash, a money order, certified check of any national or state bank made payable to the CITY, or an irrevocable letter of credit, in an amount not less than five percent (5%) of the amount of the Bid. Any such alternative form of security shall be for the same purpose and be subject to the same conditions as those applicable to the bond for which the alternative form of security is being substituted. The determination of the value of an alternative form of security shall be made by the CITY. C. Conditions. The Bid Bond or alternate security shall be conditioned upon the Bidder's: 1. Not withdrawing said bid within one hundred twenty (120) days after date of opening of the same, and 2. Within seven (7) business days after posting of Bid tab: a. executing a written CONTRACT with the CITY, in accordance with the bid as accepted; b. providing evidence of insurance in the manner specified by the CITY; and c. if the Bid exceeds $200,000.00, providing a Statutory Payment Bond and a Common Law Performance Bond as specified in the General Terms & Conditions (or, in lieu of the Statutory Payment Bond or Common Law Performance Bond, having provided an alternate form of security as specified in the General Terms & Conditions); d. or in the event to fully comply with all of the foregoing, if the Bidder shall have paid the CITY the difference between the amount specified in said bid and the amount for which the CITY may procure the required work and/or supplies, if the latter amount be in excess of the former. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 7 D. Return of Bid Guaranty. Funds of any money order or check that may be received will be returned to all Bidders, except for the two (2) apparent low Bidders, within thirty (30) days after the opening of the Bids. Bid bonds will not be returned to the bidders, unless specifically requested by a Bidder. The Bid Security of the bidders shall be retained until such Bidder has executed the CONTRACT, furnished the Insurance Certificate and endorsements, and furnished a valid and acceptable Statutory Payment Bond and a Common Law Performance Bond (or, in lieu of the Statutory Payment Bond or Common Law Performance Bond, having provided an alternate form of security as specified in the General Terms & Conditions) as required under the provisions of the CONTRACT. Any money order or check from the apparent low bidder shall be deposited upon receipt. Any money order or certified check from the second apparent low bidder may be deposited. Failure of the CITY to execute the CONTRACT within one hundred twenty (120) days after the date of the bid opening shall initiate release of the Bid Bond, certified check or cash of the lowest and second lowest bidders unless mutually agreed otherwise or specified in the Supplemental Conditions. 5.02 Performance and Payment Bond: Bonds must be in compliance with Florida Law. If the CONTRACT price is in excess of $200,000.00, the CONTRACTOR shall, within seven (7) business days of date of the Notice of Award from CITY, provide CITY with a Common Law Performance Bond and a Statutory Payment Bond meeting the standards specified herein, on the forms provided by the CITY with Power of Attorney Affidavit attached, each in an amount not less than the CONTRACT Price. The bonds shall also be accompanied by the CITY's Affidavit for Surety Form. The Performance and Payment Bonds shall be in the Prime Contractor's name. Failure to provide the bond(s) within the seven (7) business day period shall be sufficient cause for the CITY to deem the Bidder non -responsive and nullify the CONTRACT award. The Contractor shall provide a Performance Bond which guarantees the performance of the Work as well as any applicable extended warranty. 5.03 All Bonds Sureties Qualifications: All bonds required under this CONTRACT, including, but not by way of limitation, any Bid Bond, Common Law Performance Bond or Statutory Payment Bond shall be written through a reputable and responsible surety bond agency licensed to do business in the State of Florida and with a surety which holds a certificate of authority authorizing it to write surety bonds in Florida meeting the following requirements: City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 8 BOND AND INSURANCE REQUIREMENTS FOR CONSTRUCTION CONTRACTS CONTRACT SUM BEST'S RATING CLASSIFICATION FOR BEST'S FINANCIAL SURETY AND INSURANCE FIRMS, & SIZE CATEGORY OTHER REQUIREMENTS FOR SURETY AND INSURANCE FIRMS. From: $0.00 Bid Bond and Insurance Required. No Minimum To: $200,000.00 Required. Performance and Payment Bond Not Required (unless specified in Contract Not Applicable. Documents From: $200,000.01 All Bonds and Insurance Required: No Minimum To: $500,000.00 See requirements under paragraph 3 below Required. From: $500,000.01 All Bonds and Insurance Required: IV or larger. To: $2,500,000.00 A- or better Circular 570 requirements (paragraph 2 below From: $2,500,000.01 and All Bonds and Insurance Required: V or larger. more A- or better Circular 570 requirements (paragraph 2 below CONTRACTORs must use the CITY bond forms enclosed herein. Failure to use the CITY forms shall deem the bidder as non -responsive. 1. Ratings by A.M. Best: The surety and insurance company or corporation shall have a minimum A.M. Best Company rating as indicated above in addition to the surety qualifying pursuant to paragraph (3) below: 2. Circular 570, CONTRACT Price of $500,000.01 or More: If the CONTRACT Price is $500,000.01 or greater, the surety shall also comply with the Circular 570 requirements as set forth in this paragraph 2. The surety shall maintain a current certificate of authority as an acceptable surety on Federal Bonds in accordance with U.S. Department of Treasury Circular 570, current revision. If the amount of the bond exceeds the underwriting limitations set forth in the Circular, in order to qualify, the net retention of the surety company shall not exceed the underwriting limitation in the Circular and the excess risk must be protected by co- insurance, reinsurance, or other methods in accordance with Treasury Circular 297, revised September 1, 1978 CFR Section 223.10 - Section 223.111. Further the surety company shall provide the CITY with evidence satisfactory to the CITY, that such excess risk has been protected in an acceptable manner. 3. CONTRACT Price of $500,000 or Less: Notwithstanding the foregoing paragraphs 1. and 2., in the event the CONTRACT price is $500,000.00 or less, in accordance with Section 287.0935, Florida Statutes, bonds with a surety company in compliance with the following requirements shall be acceptable: City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 9 a. The surety company is licensed to do business in the State of Florida; and b. The surety company holds a certificate of authority authorizing it to write surety bonds in Florida; and c. The surety company has twice the minimum surplus and capital required by the Florida Insurance code at the time this Request for Bids is issued; and d. The surety company is otherwise in compliance with the provisions of the Florida Insurance Code; and e. The surety company holds a currently valid certificate of authority issued by the United States Department of the Treasury under 31 U.S.C. ss.9304 to 9308. In order to qualify as an acceptable surety company under this paragraph 3, an Affidavit for the Surety Company shall be executed by an Officer of the surety bond insurer as evidence that a surety company is in compliance with the foregoing requirements. A. Additional or replacement bond: It is further mutually agreed between the parties hereto that if, at any time, the CITY shall deem the surety or sureties upon any bond to be unsatisfactory, or if, for any reason, such bond ceases to be adequate, the CONTRACTOR shall, at its expense within seven (7) business days after the receipt of notice from the CITY to do so, furnish an additional or replacement bond or bonds on the CITY'S standard form, with the same amount, and with such surety or sureties as shall be satisfactory to the CITY. In such event, no further payments to the CONTRACTOR shall be deemed to be due under this CONTRACT until such new or additional security for the faithful performance of the work shall be furnished in the manner and form satisfactory to the CITY. In addition, the CONTRACTOR shall for any increases in the CONTRACT amount automatically increase the amount of the performance and payment bonds to equal the revised amount of the contract and shall provide the CITY with evidence of same. B. The surety company shall provide a Florida address for service of process in the prescribed space on the forms provided by the CITY for all bonds required by the CITY. C. Alternate form of security: In lieu of the Common Law Performance Bond or Statutory Payment Bond, CONTRACTOR may, pursuant to Section 255.051, Florida Statutes, provide an alternate form of security in the form of cash, a money order, a certified check, or an irrevocable letter of credit. Any such alternative form of security shall be for the same purpose and be subject to the same conditions as those applicable to the bond for which the alternative form of security is being substituted. The determination of the value of an alternative form of security shall be made by the CITY. 5.04 Insurance City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 10 A. Certificate of Insurance. The CONTRACTOR shall deliver to CITY and maintain insurance coverage reflecting, at a minimum, the amounts and conditions as specified within the CITY'S Insurance Requirements Checklist, attached herein. All insurance required under this CONTRACT shall meet the requirements listed in the Table found in 5.03 above. In addition, at the direction of the CITY, the CONTRACTOR shall for any increases in the CONTRACT amount automatically increase the amount of the insurance to equal the revised amount of the contract and shall provide the CITY with evidence of same. The CONTRACTOR shall provide the certificate within seven (7) business days from the date of the Notice of Award. The CONTRACTOR shall have thirty (30) business days after CONTRACT execution, to produce the required Insurance Declaration Page of Policy, additional insured endorsement forms, and a waiver of subrogation endorsement as set forth in the General Terms & Conditions, and the Insurance Requirements Checklist included herein. CONTRACTOR shall provide an insurance policy that provides the City, as additional insured, a separate defense in the event of a claim filed by a third party against the City, regardless of whether an allegation of negligence is alleged against the CONTRACTOR. B. Qualifications to Do Business in Florida. All insurers must be qualified to lawfully conduct business in the State of Florida. Failure of the CITY to notify the CONTRACTOR that the Certificate of Insurance provided does not meet the CONTRACT requirements, shall not constitute a waiver of the CONTRACTOR's responsibility to meet the stated requirements. In addition, receipt and acceptance of the certificate of insurance by the CITY shall not constitute approval of the amounts, conditions or types of coverage listed on the certificate. Misrepresentation of any material fact, whether intentional or not, regarding the CONTRACTOR's insurance coverage, policies or capabilities, may be grounds for rejection of the response and recision of any ensuing contract. C. Self -insured Provisions. If the CONTRACTOR is a self -insured entity, the CONTRACTOR may contact the CITY'S CONTRACT Administrator, identified on the cover page, and request the CITY'S self-insurance package. It shall be the responsibility of the CONTRACTOR to ensure that all Subcontractors are adequately insured or covered under their policies. The CITY may at its discretion, require the CONTRACTOR to provide a complete certified copy of its insurance policy(s). City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 11 D. Workers' Compensation: 1. Workers' Compensation insurance shall comply with Chapter 440, Florida Statute, including Employer's Liability. If work is performed in/over navigable waters, an endorsement covering the U.S. Longshore and Harbor Workers' Compensation Act (LHWCA) 33 U.S.C. Section 901, et seq. and Jones Act, 46 App U.S.C. Section 861, et seq. shall be included. 2. If CONTRACTOR claims an exemption from coverage, it must attach proof of same for consideration in the form of a certified copy of your state exemption form. The CITY reserves the right to require said coverage regardless of the state exemption. E. Commercial Liability Insurance 1. Coverage shall be no more restrictive than that identified by the Insurance Services Office, Inc. (ISO). 2. Coverage shall be written on an Occurrence Basis Form. 3. Coverage shall provide as a minimum those limits identified within the CITY's Insurance Requirements Checklist. Coverage shall be "first dollar" coverage. If CONTRACTOR's policy includes a Self -Insured Retention (SIR) CONTRACTOR may, at the CITY's option, be required to meet established financial security requirements. 4. Coverage shall include as a minimum the following coverage endorsement: Premises/Operations, Products/Completed Operations, Contractual Liability, Independent CONTRACTORS, Broad Form Property Damage, Underground Explosion/Collapse (XCU) and Personal Injury. Additional endorsements may be required as the CONTRACT dictates. Refer to the CITY's Insurance Requirements Checklist attached herein. 5. The CITY shall be added by endorsement as an Additional Insured. An endorsement shall also be included which specifies that the inclusion of an additional insured does not exclude any pollution liability coverage otherwise afforded by said policy. F. Business Auto Liability Insurance 1. Coverage shall be no more restrictive than that identified by the ISO. 2. Coverage shall provide as a minimum those limits identified within the CITY's Insurance Requirements Checklist. Coverage shall be "first dollar" coverage. If CONTRACTOR's policy includes an SIR CONTRACTOR may, at the CITY's option, be required to meet established financial security requirements. 3. Coverage shall be "Any Auto" - Symbol 1. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 12 G. Builders Risk Insurance/Installation Floater 1. The insurance policy shall be "broad form," "all risk" covering all equipment and machinery; or a special Installation Floater may be included to ensure the required coverage for this exposure. The policy form shall be no more restrictive than the "inland marine type form." The CITY shall be allowed to occupy the property in question without voiding any of the provided coverages. 2. The policy(s) shall state, "on behalf of all parties to the contract." The CONTRACTOR, the CITY and all other applicable subcontractors are to be included as "insureds" on the policy(s). 3. At a minimum, the "covered property" will include the building or structure being constructed, including all fixtures, materials, supplies, machinery and equipment to be used in, or incidental to the construction. This will extend coverage to underground works. Coverage shall also be afforded to the property of others through a "care, custody or control" endorsement, as well as property off -site or in transit. The following coverages shall also be included by endorsement, unless excluded by the CITY: Boiler & Machinery, Testing, Mechanical Breakdown, Earthquake, and Flood. 4. Coverage shall be valued on a Replacement Cost (100%) basis. A maximum (SIR) of $5,000 is allowed. If multiple limits of liability are proposed for the construction site, property in transit, off -site storage, etc., the same value requirement shall be used for each. 5. All coverages afforded under this policy(s) shall remain in effect and not be excluded by a "Force Majeure Clause" found elsewhere in these Bidding Documents. 6. Coverage shall cease when the entire project covered by said policy is accepted by the CITY. In the event testing by the CONTRACTOR is conducted after acceptance by the CITY, coverage shall remain in full force and effect until all testing is complete and accepted by the CITY, and final payment is made. INSURANCE [CONTRACTOR] shall, at its sole cost and expense, procure and maintain throughout the term of this contract, Comprehensive General Liability, Worker's Compensation, and Commercial Automobile Liability insurance, including Employer Liability insurance, with minimum policy limits specified below Combined Single Limits, or to the extent and in such amounts as required and authorized by Florida Law, and will provide endorsed certificates of insurance generated and executed by a licensed insurance broker, brokerage or similar licensed insurance professional evidencing such coverage, and naming the City of Okeechobee as a named additional insured, as well as furnishing the City of Okeechobee with a certified copy, or copies, of said insurance policies. Certificates of insurance and certified copies of these insurance policies must accompany this signed contract. Said insurance coverages procured by [CONTRACTOR] as required herein shall be considered, and [CONTRACTOR] agrees that said insurance coverages it procures as required herein shall be considered, as primary insurance over and above any other insurance, or self-insurance, available to the City of Okeechobee, and that any other City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 13 insurance, or self-insurance available to the City of Okeechobee shall be considered secondary to, or in excess of, the insurance coverage(s) procured by [CONTRACTOR] as required herein. Worker's' Compensation - Coverage is to apply for all employees for statutory limits in compliance with the applicable state and federal laws. The policy must include Employers' Liability with a limit of $500,000.00 each accident, $500,000.00 each employee, $500,000.00 policy limit for disease. Commercial General Liability (Occurrence Form Required) (Contractor/Vendor) shall maintain commercial general liability (CGL) insurance with a limit of not less than $500,000.00 each occurrence. If such CGL insurance contains a general aggregate limit, it shall apply separately to this location/project in the amount of $1,000,000.00. Products and completed operations aggregate shall be $1,000,000.00. CGL insurance shall be written on an occurrence form and shall include bodily injury and property damage liability for premises, operations, independent Contractors, products and completed operations, contractual liability, broad form property damage and property damage resulting from explosion, collapse or underground (x, c, u) exposures, personal injury and advertising injury. Damage to rented premises shall be included at $100,000.00. Commercial Automobile Liability Insurance (Contractor/Vendor) shall maintain automobile liability insurance with a limit of not less than $1,000,000.00 each accident for bodily injury and property damage liability. Such insurance shall cover liability arising out of any auto (including owned, hired and non -owned autos). The policy shall be endorsed to provide contractual liability coverage. Nothing herein shall be construed to extend the City of Okeechobee's liability beyond that provided in F.S. 768.28, Florida Statutes. Will need to be completed. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 14 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, vest Concrete Contractors, Inc. as Principal and Auto Owners Insurance Company , as Surety, are held and firmly bound unto the City of Okeechobee (the "City"), in the penal sum of $ 5% of attached bid lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THE OBLIGATION IS SUCH, that whereas the Principal has submitted the accompanying bid, dated September 1 12020 for the Contract Documents: Contract Title: OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS Contract Number: PW 03-11-08-20 NOW, THEREFORE, 1. If the Principal, a. Within seven (7) business days after the date of the Notice of Apparent Low Bidder, provides a Statutory Payment Bond and a Common Law Performance Bond as specified in the General Terms & Conditions or, in lieu of the Statutory Payment Bond or Common Law Performance Bond, provides an alternate form of security as specified in the Contract Documents; and provides the insurance certificate required under the Contract Documents, completed by a lawfully authorized insurance agent; and b. Within seven (7) business days of receipt of the Contract Documents, enters into a written contract with the City, in accordance with the Bid, as accepted, then the above obligations of the Principal and Surety shall be null and void. 2. However, should the Principal fail to fully comply with the conditions of paragraph 1 above, then the Principal and Surety, jointly and severally, shall be liable to the City for the full penal sum of this Bond which shall be forfeited to the City as liquidated damage, but not a penalty, as a result of the Principal's failure to comply with the bid instructions and conditions, regardless of whether the City ultimately decides to change the project requirements or resolicit bids. 3. The remedies provided herein are not to be construed as the City's exclusive remedies for the Principal's failure to enter into a contract with the City but shall be deemed supplemental to all remedies available to the City at law or otherwise. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 15 DATED ON 1SN �ecY,�.Q t , 20 ,-1) . FOR NON -CORPORATE BIDDERS: (Witness) (Print Name) (Witness) (Print Name) FOR CORPORATE BIDDERS: ATTEST: Secretary SURETY: ATTEST: (Corporate Seal) Secretary By: (Signature of Principal) (Print Name and Title) Business Address -, " y_ ( g re of Corporate Principal) (Print Name and Title) 13(;le, 5w 0' Tee, CUK.�,�O- F 3`4CiT`1 Business Address f� (Corpor Surety) 1pn4(� S-x&WLw` I frco,C-e ,- (Print Name and Title) !` be SE Business Address Florida Address for Service of Process Telephone Number (Surety shall provide evidence of signature authority such as a certified copy of Power of Attorney. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 16 DATE AND ATTACH TO ORIGINAL BOND AUTO -OWNERS INSURANCE COMPANY LANSING, MICHIGAN POWER OF ATTORNEY NO. BD153756 KNOW ALL MEN BY THESE PRESENTS: That the AUTO -OWNERS INSURANCE COMPANY AT LANSING, MICHIGAN, a Michigan Corporation, having its principal office at Lansing, County of Eaton, State of Michigan, adopted the following Resolution by the directors of the Company on January 27, 1971, to wit: "RESOLVED, That the President or any Vice President or Secretary or Assistant Secretary of the Company shall have the power and authority to appoint Attorneys -in -fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity, and other writings obligatory in the nature thereof. Signatures of officers and seal of Company imprinted on such powers of attorney by facsimile shall have same force and effect as if manually affixed. Said officers may at any time remove and revoke the authority of any such appointee." Does hereby constitute and appoint MILTON O CARPENTER its true and lawful attorney(s)-in-fact, to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof, and the execution of such instrument(s) shall be as binding upon the AUTO -OWNERS INSURANCE COMPANY AT LANSING, MICHIGAN as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal office. IN WITNESS WHEREOF, the AUTO -OWNERS INSURANCE COMPANY AT LANSING, MICHIGAN, has caused this to be signed by its authorized officer this 1 st day of August, 2016. Denise Williams Senior Vice President STATE OF MICHIGANiss. COUNTY OF EATON ff On this 1 st day of August, 2016, before me personally came Denise Williams, to me known, who being duly sworn, did depose and say that they are Denise Williams, Senior Vice President of AUTO -OWNERS INSURANCE COMPANY, the corporation described in and which executed the above instrument, that they know the seal of said corporation, that the seal affixed to said instrument is such Corporate Seal, and that they received said instrument on behalf of the corporation by authority of their office pursuant to a Resolution of the Board of Directors of said corporation. n My commission expires March 10, 2022 STATE OF MICHIGAN lss. COUNTY OF EATON f Susan E. Theisen Cr Z4N E.`t/� Zr'4 NOTARYPUBLIC y- COUNN OF ICEM MYCommurbn B4*w MARCH 10. 2022 : Acling In the l ,h119%t� p.. M..... hl Notary Public I, the undersigned First Vice President, Secretary and General Counsel of AUTO -OWNERS INSURANCE COMPANY, do hereby certify that the authority to issue a power of attorney as outlined in the above board of directors resolution remains in full force and effect as written and has not been revoked and the resolution as set forth is now in force. Signed and sealed at Lansing, Michigan. Dated this 31st day of August 2020 s•= oviNERS�!ys j CORPORATE ey - c its �9,y- ...OQ.,=a a"a M16%% ' .1104 William F. Woodbury, First Vice Pr ident, Secretary and General Counsel 2940 (10-17) Print Date: 08/31/2020 Print Time: 01:23:18 PM COMMON LAW PERFORMANCE BOND BY THIS BOND, know that as Principal, herewith called CONTRACTOR, Business Address , Business Phone , and as hereinafter called SURETY, Surety Address Surety Phone Number are bound to City of Okeechobee, as Obligee, herein called CITY, in the amount of Dollars ($ ) for payment of which CONTRACTOR and SURETY bind themselves, their heirs, personal representatives, executors, administrators, successors and assigns, jointly and severally, with reference to a written CONTRACT entered into by CONTRACTOR and CITY, for the following: Contract Number: PW 03-11-08-20 Contract Title: 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS General Description of Project: Provide construction services needed to install various concrete projects located within the City of Okeechobee Directions: THE CONDITION OF THIS BOND is that if the CONTRACTOR: 1. Performs said contract in accordance with its terms and conditions; and 2. Pays CITY all losses, damages (direct and consequential including delay or liquidated damages), expenses, costs, and attorney's fees, including appellate proceedings, that CITY sustains because of a default by CONTRACTOR under the CONTRACT; and 3. Pays CITY any and all other amounts due CITY by CONTRACTOR because of a default by CONTRACTOR under the CONTRACT; and 4. Performs the warranty, extended warranty and guarantee of all work and materials furnished under the CONTRACT for the time specified in the CONTRACT; THEN THIS BOND IS VOID, OTHERWISE, IT REMAINS IN FULL FORCE. If there is no CITY default, the SURETY's OBLIGATIONS UNDER THIS BOND shall arise after SURETY has received notice of CITY's declaration of default of CONTRACTOR in accordance with the terms and conditions of the CONTRACT (including notice and cure periods), so that within 20 days of CITY's declaration of CONTRACTOR's default, SURETY shall either (1) arrange for the CONTRACTOR, with the written consent of the CITY, to timely perform and complete the contract or (2) undertake to timely perform and complete the contract either by retaining another contractor approved by the CITY or undertaking to do the contract itself. SURETY shall be liable for any and all delays caused by the CONTRACTOR, SURETY, and/or the replacement contractor(s) provided by the SURETY. SURETY's failure to take such action shall be deemed to be a default on this Bond, thus entitling the CITY to complete the contract with another contractor and recover all resulting damages, including, but not limited to, all direct and consequential damages including delay or liquidated damages, engineering and architectural fees, as well as, any and all legal costs and attorney's fees. Any changes in or under the Contract Documents do not affect the Surety's obligation under this bond. Surety hereby waives notice of any alteration or extension of time made by the Owner. Any suit under this bond must be initiated before the expiration of the limitation period applicable under Florida Statutes. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 17 IN WITNESS WHEREOF, this instrument is executed this _day of WHEN THE PRINCIPAL IS AN INDIVIDUAL: Signed and delivered in the presence of: Bv: (Witness) WHEN THE PRINCIPAL OPERATES UNDER A TRADE NAME: Signed and delivered in the presence of: By: By: (Witness) om (Witness) WHEN A PARTNERSHIP: Signed and delivered in the presence of: By: (Witness) By: (Witness) WHEN THE PRINCIPAL IS A CORPORATION: ATTEST: (Type Corporate Principal Name) By: SURETY: ATTEST: (Surety Seal) By: (Secretary) .20 Individual Principal Signature of Individual By: Partner By: President (Type Corporate Surety Name) (Secretary) ATTORNEY -IN -FACT By: City of Okeechobee Public Works Department 18 SURETY Name Project No. PW 03-11-08-20 NOTE 1: Surety shall provide evidence of signature authority, i.e., a certified copy of Power of Attorney. IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the State of Florida. ATTACH a certified copy of Power -of -Attorney appointing individual Attorney -in -Fact for execution of Performance Bond on behalf of Surety. The Common Law Performance Bond and the Payment Bond and the covered amounts of each are separate and distinct from each other. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 19 STATUTORY PAYMENT BOND BY THIS BOND, know that as Principal, herewith called CONTRACTOR, Business Address Business Phone and , as hereinafter called SURETY, Surety Address Surety Phone Number , are bound to City of Okeechobee, as Obligee, herein called CITY, in the amount of Dollars ($ ) for payment of which CONTRACTOR and SURETY bind themselves, their heirs, personal representatives, executors, administrators, successors and assigns, jointly and severally, with reference to a written CONTRACT entered into by CONTRACTOR and CITY, for the following: Contract Number: PW 03-11-08-20 Contract Title: 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS General Description of Project: Provide construction services needed to install various concrete projects located within the City of Okeechobee Directions: THE CONDITION OF THIS BOND is that if the CONTRACTOR: Promptly makes payments to all claimants as defined in Section 255.05(1), Florida Statutes, supplying CONTRACTOR with labor, material, or supplies, used directly or indirectly by CONTRACTOR in the prosecution of the work provided for in the contract; THEN THIS BOND IS VOID, OTHERWISE, IT REMAINS IN FULL FORCE. Any changes in or under the Contract Documents and compliance or noncompliance with formalities, connected with the CONTRACT or with the changes, do not affect Surety's obligation under this bond. Surety hereby waives notice of any alteration or extension of time made by the CITY. Claimants must comply with notice requirements set forth in Section 255.05(2), Florida Statutes. No action shall be instituted against the CONTRACTOR or Surety under this bond after one (1) year from the performance of the labor or completion of the delivery of the materials or supplies. IN WITNESS WHEREOF, this instrument is executed this the WHEN THE PRINCIPAL IS AN INDIVIDUAL: Signed and delivered in the presence of: By: By: (Witness) WHEN THE PRINCIPAL OPERATES UNDER A TRADE NAME: Signed and delivered in the presence of: By: By: (Witness) 93 (Witness) day of 20 (Individual Principal) Signature of Individual City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 20 WHEN A PARTNERSHIP: Signed and delivered in the presence of: By: (Witness) 0 (Witness) WHEN THE PRINCIPAL IS A CORPORATION: ATTEST: (Type Corporate Principal Name) By: (Secretary) SURETY: ATTEST: (Surety Seal) As ATTORNEY -IN -FACT By: (Type Corporate Surety Name) Partner By: President SURETY (Secretary) (Type Florida Address for Service of Process) Name NOTE 1: Surety shall provide evidence of signature authority, i.e., a certified copy of Power of Attorney. IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the State of Florida. ATTACH a certified copy of Power -of -Attorney appointing individual Attorney -in -Fact for execution of Performance Bond on behalf of Surety. The Common Law Performance Bond and the Statutory Payment Bond and the covered amounts of each are separate and distinct from each other. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 21 AFFIDAVIT FOR SURETY COMPANY To be submitted with Performance & Payment Bond TO: City of Okeechobee RE: CONTRACT NUMBER CONTRACT TITLE: CONTRACTOR: Name: Address: Telephone: AMOUNT OF BOND: SURETY COMPANY: Name: Address: Telephone: Email address: PW 03-11-08-20 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS BEFORE ME, the undersigned authority, personally appeared the AFFIANT, who being duly sworn and says: (1) He/She is (Officership) of the Surety Company; (2) In accordance with Section 287.0935, Florida Statutes, the Surety Company fulfills each of the following provisions: a) The Surety Company is licensed to do business in the State of Florida; b) The Surety Company holds a certificate of authority authorizing it to write surety bonds in Florida; c) The Surety Company has twice the minimum surplus and capital required by the Florida Insurance code at the time the invitation to bid is issued; d) The Surety Company is otherwise in compliance with the provisions of the Florida Insurance Code; and e) The Surety Company holds a currently valid certificate of authority issued by the United Stated Department of Treasury under 31 U.S.C. ss. 9304 to 9308. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 22 FURTHER AFFIANT SAYETH NOT. Dated Signed Signature of AFFIANT (Officer of Surety Company) Title of AFFIANT STATE OF COUNTY OF Before me this day personally appeared , who, being duly sworn, executed this Affidavit and acknowledged to and before me the truthfulness and accuracy of the statements in the Affidavit. SWORN TO AND SUBSCRIBED before me this day of 20 by AFFIANT, who is personally known to me. M Name: NOTARY PUBLIC Commission Expiration Date: City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 23 SECTION VI PW 03-11-08-20 REJECTION OF BID The City may reject a Bid if: a. The Bidder conceals any material fact in the bid. b. The Bid does not strictly conform to the law or requirements of this solicitation. C. The City may, however, reject any or all Bids, whenever it is deemed in the best interest of the City to do so and may reject any part of a Bid. The City may also waive any minor informalities or irregularities in any Bid. 2. Bid Protest Procedure: a. Any Bidder that has submitted a formal bid to City of Okeechobee, and who is adversely affected by the decision with respect to the award of the formal bid, may file with the City Administrator's Office, City of Okeechobee, 55 S.E. 3rd Avenue, Okeechobee, FL 34974, a written Protest no later than forty-eight (48) hours (excluding Saturdays, Sundays and Legal Holidays) of the decision of the City of Okeechobee City Council to award the bid. b. The "Notice of Intent to File a Protest" document shall be in the form of a letter stating all grounds claimed for the Protest. Failure to do so shall constitute a waiver of all rights to seek any further remedies provided for under this Protest Procedure. The City Administrator shall submit the protest statement and affidavits along with his or her own statement and affidavits in support of the award of the formal bid to the City Council for a final determination of the protest. City of Okeechobee Public Works Department 24 Project No. PW 03-11-08-20 NOTICE OF AWARD PW 03-11-08-20, OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS September 22, 2020 Vest Concrete Contractors, Inc. Attn: Mr. Jeff Vest 1366 SW 18th Terrace Okeechobee, FL 34974 Dear Mr. Vest, The City Council awarded the PW 03-11-08-20, OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS bid to your company, Vest Concrete Contractors, Inc., at the September 21, 2020 City Council Meeting in the amount of $86,337.50. In order to proceed with the project, you will need to provide the City of Okeechobee with the following by Friday, October 2, 2020: • A certified copy of the insurance policies with the declaration pages for the General Liability and Commercial Auto Insurance. The insurance agent can use a stamp and state that it is a true and original copy and then sign and date it or they can write something to the fact on their letterhead listing the policy numbers, signing and dating it. The City of Okeechobee also needs to be listed as additional insured with the limits specified per Section V of the bid packet, pages 7 - 23. �• Workers Compensation Insurance certificate with the limits specified per Section V of the bid packet, pages 7 - 23. ✓• Copy of City and County of Okeechobee Business Tax Receipt. ✓• Copy of State License or Competency Card. ✓• W-9. ✓• Exhibit B Bid Unit Price Schedule Page 56 of the bid document needs to be filled out and signed. `�• Attachment F of the bid document needs to be notarized. ✓• Two original executed sets of the attached Agreement. One set will be returned to you after executed by the City. We look forward to working with you on this project. Should you have any questions please feel free to contact me per my contact information below. Sincerely�,�_ �Davi Allen Public Works Director City of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 Tele: 863-763-9790 Fax: 863-763-1686 dallen(a)cityofokeechobee.com SECTION VII PW 03-11-08-20 AGREEMENT FOR SERVICES This AGREEMENT is dated as of the 21st day of September in the year 2020, between the City of Okeechobee (CITY) and Vest Concrete Contractors, Inc. (CONTRACTOR). CITY and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: ARTICLE 1. SCOPE OF WORK The following Exhibits are attached and are a part of this Agreement. Exhibit A — Governing Specifications Exhibit B — Bid Unit Price Schedule The work is described as follows: provide construction services needed to install various concrete projects located within the CITY including: • 8-inch-thick roadway slab work. Removal of existing sidewalk and installation of new ADA ramps. Removal and replacement of existing sidewalk and/or curb and gutter. Installation of new sidewalk and/or curb and gutter. The selected Contractors will be responsible for the entire scope of work, hiring licensed Subcontractors, and paying for all plans and permits from the CITY and/or other agencies. ARTICLE 2. PUBLIC WORKS DIRECTOR 2.1. PUBLIC WORKS DIRECTOR as named in the Contract Documents shall mean: City of Okeechobee Public Works Director 55 S.E. 3rd Avenue Okeechobee, FL 34974 ARTICLE 3. CONTRACT TIME 3.1 This contract will be in force for a period of one (1) year. 3.2 Renewal: This contract may be extended beyond the initial one (1) year. Each extension period will be for an additional one (1) year and may be renewed thereafter on an annual basis. It may be under the same or superior terms and conditions as this bid. This shall be accomplished by mutual written agreement/acceptance between the vendor and the CITY. ARTICLE 4. CONTRACT PRICE 4.1 CITY shall pay CONTRACTOR for performance of the work in accordance with the unit prices listed in Exhibit B. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 25 4.2 CITY shall pay the CONTRACTOR, or receive as credit, for changes or adjustments in the work made in accordance with the General Conditions, based on the unit prices indicated on the Bid form. ARTICLE 5. MEASUREMENT AND PAYMENT 5.1 The CITY will not pay for any item that is not specifically set forth in the Bid Schedule. 5.2 The total Unit Bid Price for each project shall cover all work required by the Contract Documents. All costs in connection with the proper and successful completion of the work, including furnishings all materials, equipment, supplies, and appurtenances; providing all construction equipment, and tools; and performing all necessary labor and supervision to fully complete the Work, shall be included in the Unit Bid prices. All related and necessary work not specifically set forth as a pay item in the Bid shall be considered a subsidiary obligation of CONTRACTOR and all costs in connection therewith shall be included. 5.3 Payment for all work done in compliance with the Contract Documents, inclusive of furnishings all manpower, equipment, materials, and performance of all operations relative to construction of this project, will be made under the Unit Bid Price. 5.4 Contractor shall submit Applications for Payment monthly after work has been completed. A monthly invoice shall be submitted on or before the 9th day of each month for payment. The invoice will be processed through our regular cycle with payment usually made by the end of the following month. Example: Work performed from September 1st through September 30th. The invoice is to be received by the CITY no later than October 91h, and payment should be made by October 30th. The CITY shall not be liable to pay interest on any unpaid balance. Vendor is solely responsible for all taxes, withholding, or social security obligations. 5.5 Quantities necessary to complete the work as shown on the Drawings or as specified herein shall govern over those shown in the Bid Documents. The CONTRACTOR shall take no advantage of any apparent error or omission in the Drawings or Specifications, and the Public Works Director shall be permitted to make corrections and interpretations as may be deemed necessary for fulfillment of the intent of the Contract Documents. 5.6 The quantities for payment, other than Final Payment, under this Contract shall be determined for actual measurement of the completed items, in place, ready for service and accepted by the CITY, in accordance with the applicable method of measurement therefore contained herein. A representative of the CONTRACTOR shall witness all field measurements. 5.7 All estimated quantities stipulated in the Bid Form or other Contract Documents are approximate and supplied for the sole purpose of providing Bidder with a basis which will be used to determine the Base Bid and to obtain unit prices for approvals of progress payments for the Work done. Actual quantities which will be ordered by CITY may vary from those on the Bid Form(s). The CONTRACTOR'S attention is directed to the items of work for which no unit price is set. All work shown on the drawings as outlined in the specifications is to be completed in all respects, and the cost of all miscellaneous and associated work to au specific items shall be included in the Unit Prices. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 0 5.8 All quantities, for the submittal of payments, shall be measured and tabulated by both the Public Works Director, or representative, and CONTRACTOR. Requests for payment and supporting data shall be prepared by the CONTRACTOR and given to the Public Works Director sufficiently in advance of payment date to permit thorough checking of all quantities. 5.9 The CONTRACTOR shall furnish the Public Works Director whatever assistance is required, laborers, clerks and records that will enable the Public Works Director to expeditiously check all estimates and especially the final quantities of the project. ARTICLE 6. CONTRACTOR'S REPRESENTATIONS In order to induce CITY to enter into this Agreement, CONTRACTOR makes the following representations: 6.1 CONTRACTOR has familiarized himself with the nature and extent of the Contract Documents. Work locality, weather, and with all local conditions and federal, state, and local laws ordinances, rules, policies, and regulations that in any manner affect cost, progress, or performance of the work. 6.2 CONTRACTOR has studied carefully all reports of investigations and tests of subsurface and latent physical conditions of the site or otherwise affecting cost, progress, or performance of the work which were relied upon by the Public Works Director in the preparation of the Drawings and Specifications. 6.3 CONTRACTOR has made or caused to be made examinations, investigations, and tests, and studies of such reports and related data, in addition to those referred to in Paragraph 6.2 above as he deems necessary for the performance of the work at the contract price, within the contract time, and in accordance with the other terms and conditions of the contract documents, and no additional examinations, investigations, tests, reports or similar data are/or will be required by the CONTRACTOR for such purposes. 6.4 CONTRACTOR has correlated results of such observations, examinations, investigations, tests, reports, and data with the terms and conditions of the contract documents. 6.5 CONTRACTOR has given Public Works Director written notice of all conflicts, errors, or discrepancies that he has discovered in the contract documents, and the written resolution thereof by Public Works Director is acceptable to the contract. ARTICLE 7. EARLY TERMINATION 7.1 Should CONTRACTOR violate any provision of this contract, or if the level of service and performance being provided by CONTRACTOR does not meet the expectations of the CITY after providing attempts at curing such defects, the CITY may cancel this contract upon thirty (30) days written notice to CONTRACTOR without further liability therefore. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 27 ARTICLE 8. CONTRACT DOCUMENTS The contract documents which comprise the entire agreement between the CITY and the CONTRACTOR are made a part hereof and consist of the following: • This Agreement • Certificates of Insurance • Payment Bond and Performance Bond • Notice of Award • Notices to Proceed • General Conditions • Governing Specifications attached as Exhibit Addenda numbers to , inclusive. • CONTRACTOR'S Bid Forms (including documentation accompanying the Bid and documentation prior to Notice of Award). • Documentation submitted by CONTRACTOR prior to Notice of Award. • Any modification, including Change Orders and Field Orders, duly delivered after execution of Agreement. • Call for Bids, Instructions to Bidders, Bid Forms, Payment and Performance Bonds, and Application for Payment. There are no contract documents other than those listed above in this Article 8. The contract documents may only be altered, amended, or replaced by a modification (as defined in Section 1 of the general conditions). ARTICLE 9. GENERAL PROVISIONS 9.1 Compliance with Laws The Contractor, its employees, subcontractors or assigns, shall comply with all applicable federal, state, and local laws, regulations, and requirements relating to the performance of this Contract. 9.2 Applicable Laws and Venue The laws of the State of Florida shall govern all aspects of this Contract. In the event it is necessary for either party to initiate legal action regarding this Contract, venue shall be in the Nineteenth Judicial Circuit for claims under state law and in the Southern District of Florida for any claims which are justiciable in federal court. 9.3 Indemnification. Contractor shall defend, indemnify and hold harmless the CITY and all of the CITY's officers, agents, and employees from and against all claims, liability, loss and expense, including reasonable costs, collection expenses, attorneys' fees, and court costs which may arise because of the negligence (whether active or passive), misconduct, or other fault, in whole or in part (whether joint, concurrent, or contributing), of Contractor, its officers, agents or employees in performance or non-performance of its obligations under the Agreement. Contractor recognizes the broad nature of this indemnification and hold harmless clause, as well as the provision of a legal defense to the CITY when necessary, and voluntarily makes this covenant and expressly acknowledges the receipt of such good and valuable consideration provided by the CITY in support of these indemnification, legal defense and hold harmless contractual obligations in accordance with the laws of the State of Florida. This clause shall survive the termination of this Agreement. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 28 Compliance with any insurance requirements required elsewhere within this Agreement shall not relieve Contractor of its liability and obligation to defend, hold harmless and indemnify the CITY as set forth in this article of the Agreement. Nothing herein, shall be construed to extend the CITY's liability beyond that provided in Section 768.28, Florida Statutes. 9.4 Waiver of Jury Trial Each party, to the extent permitted by law, knowingly, voluntarily, and intentionally waives its right to a trial by jury in any action or other legal proceeding arising out of or relating to this Contract and the transactions it contemplates. This waiver applies to an action or legal proceeding, whether sounding in contract, tort or otherwise. 9.5 No Discrimination Contractor and its agents will not discriminate against any person on the grounds of race, color, creed, national origin, handicap, age, or sex, in any activity under this Contract. 9.6 No Lobbying Pursuant to Chapter 216.347, F.S., the Contractor is prohibited from the expenditure of any funds under this Contract to lobby the Legislature, the judicial branch or another state agency. 9.7 E-Verify CONTRACTOR has verified that its employees are authorized to work in the U.S. and certifies that a good faith effort has been made to properly identify employees by timely reviewing and completing appropriate documentation, including but not limited to the Department of Homeland Security, U.S. Citizenship, and Immigration Services Form 1-9. Answers to questions regarding E-Verify as well as instructions on enrollment may be found at the E-Verify website: www.uscis.aov/e-verify. CONTRACTOR shall expressly require any subcontractors performing work or providing services pursuant to this contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term. 9.8 Contractor's Duties Regarding Public Records A. Compliance with Florida Laws Contractor must provide public access to all records concerning this Contract according to applicable Florida laws including Chapter 119, Florida Statutes. If Contractor asserts any exemptions to Florida's public records laws, Contractor has the burden of establishing and defending the exemption. Contractor's failure to comply with this section is a breach of this Contract. The records subject to Chapter 119 may include, in addition to prepared documents, such communication as e-mails, text messages, inter -office memorandums, social media, and photographs or images; a person or entity may request public records via e-mail, or by oral or written request, and a response to such a request must be prompt; it is the responsibility of the CONTRACTOR to establish an in-house policy in reference to such records, and to identify and retain such communications in the normal course of business in the event a request is made to produce these records. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 29 B. If the Contractor has questions regarding the application of Chapter 119, Florida Statutes, to the Contractor's duty to provide public records relating to this contract, contact the custodian of public records at telephone number: (863) 763-3372, ext. 9814, email address: Igamiotea@citvofokeechobee.com, and mailing address: 55 SE THIRD AVE, OKEECHOBEE FL, 34974. 9.9 No Third -Party Beneficiaries This Contract is solely for the benefit of the Contractor and the City. No person or entity other than the Contractor or the CITY shall have any rights or privileges under this Contract in any capacity whatsoever, either as third -party beneficiary or otherwise. 9.10 Assignment Contractor shall not assign, delegate, sublease or otherwise transfer any portion of its rights and obligations as set forth in this Contract without prior written consent of the City. Any attempted assignment in violation of this provision shall be void. 9.11 Waiver No waiver of any term of this Contract constitutes a waiver of any other provision, whether similar or dissimilar. No waiver of any term constitutes a continuing waiver. No waiver is binding unless signed in writing by the waiving party. 9.12 Severability If any term of this Contract is for any reason invalid or unenforceable, the rest of the Contract remains fully valid and enforceable. 9.13 Entire Contract This Contract constitutes the entire agreement between the parties and supersedes all prior and contemporaneous agreement, representations, and undertaking. No supplement, modification, or amendment of this agreement will be binding unless it is in writing and signed by both parties. 9.14 Interpretation Unless the context requires otherwise: The term "including" contemplates "including but not limited to." 9.15 Survival All provisions of this Contract which by their terms bind either party after the expiration or termination of this Contract shall survive the expiration or termination of this Contract. 9.16 Force Majeure Notwithstanding any provisions of this Contract to the contrary, the Parties shall not be held liable for any failure or delay in the performance of this Contract that arises from fires, floods, strikes, embargoes, acts of the public enemy, unusually severe weather, outbreak of war, restraint of Government, riots, civil commotion, force majeure, act of God, or for any other cause of the same character which is unavoidable through the exercise of due care and beyond the control of the Parties. Failure to perform shall be excused during the continuance or as a result of such circumstances, but this Contract shall otherwise remain in effect. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 30 This provision shall not apply if the "Statement of Work" of this Contract specifies that performance by the Contractor is specifically required during the occurrence of any of the events herein mentioned. ARTICLE 10. PUNCHLIST PROCEDURES Further to Florida Statutes §218.735(7)(a)(1), Punchlist procedures to render the Work complete, satisfactory and acceptable are established as follows: 10.1 Within five (5) days of Substantial Completion of the construction services purchased as defined in the Contract, CONTRACTOR shall schedule a walkthrough with CITY ("Initial Walkthrough" a/k/a "IW"). The purpose of the IW is to develop a preliminary checklist ("Checklist") of items to be performed by the CONTRACTOR, based upon observations made jointly between the CONTRACTOR and CITY during the IW. The IW is to occur within ten (10) days of Substantial Completion of the Work as defined by the Contract, again predicated upon the CONTRACTOR'S timely initiation of a request for the IW. At its option, CITY may conduct the IW with its Field Inspector. 10.2 CONTRACTOR shall endeavor to address and complete as many items as possible noted on the Checklist either during the IW itself, or thereafter for a period of fifteen (15) days from the date of the IW. 10.3 No later than fifteen (15) days following the scheduled IW, CONTRACTOR shall again initiate and request a second walkthrough of the Project with the CITY. The purpose of this second walkthrough is to identify which items remain to be performed from the IW Checklist and to supplement that list as necessary (based, for example, upon work which may have been damaged as a result of the CONTRACTOR'S performance of completion of items contained on the IW Checklist) and for the purpose of developing a joint Final Punchlist. 10.4 The intent of this section is for the CITY and the CONTRACTOR to cooperate to develop a Final Punchlist to be completed no later than five (5) days from the date of reaching Substantial Completion of the construction services purchase as defined in the Contract. 10.5 In no event may the CONTRACTOR request payment of final retainage under Florida Statutes §218.735(7)(d) until the CONTRACTOR considers the Final Punch list to be one hundred percent (100%) complete. 10.6 CONTRACTOR agrees to complete the Final Punchlist items within fifteen (15) days of the date of its issuance by the CITY. 10.7 CONTRACTOR acknowledges and agrees that no item contained on the Final Punchlist shall be considered a warranty item until such time as (a) the Final Punch list is one hundred percent (100%) complete, and (b) the CITY has been able to operate or utilize the affected Punchlist item for an additional period of fifteen (15) days. 10.9 CONTRACTOR acknowledges and agrees that the CITY may, at its option, during performance of the Work and prior to Substantial Completion, issue lists of identified non -conforming or corrective work for the CONTRACTOR to address. The intent of any such the CITY generated lists prior to Substantial Completion is to attempt to streamline the Punchlist process upon achieving Substantial Completion, and to allow for the CONTRACTOR to address needed areas of corrective work as they may be observed by the CITY during performance of the Work. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 31 10.10 CONTRACTOR acknowledges and agrees that in calculating one hundred fifty percent (150%) of the amount which may be withheld by the CITY as to any Final Punchlist item for which a good faith basis exists as to it being complete, as provided for by Florida Statutes §218.735(7)(d), the CITY may include within such percentage calculation its total costs for completing such item of work, including its administrative costs as well as costs to address other services needed or areas of work which may be affected in order to achieve full completion of the Final Punchlist item. Such percentage shall in no event relate to the schedule of value associated with such Work activity, but rather total costs are based upon the value (i.e. cost) of completing such Work activity based upon market conditions at the time of Final Punchlist completion. IN WITNESS WHEREOF, the parties hereto have signed two (2) copies of this agreement. At least one counterpart each has been delivered to the CITY and CONTRACTOR. All portions of the contract documents have been signed or identified by CITY and CONTRACTOR or by Public Works Director on their behalf. This Agreement will be effective on W-1"ab CITY By: Z" mg . Watford, Jr. ayor Lane Gamiotea, IMC, CITY Clerk Addresses for giving notices: CITY City of Okeechobee 55 SE 3rd Avenue Okeechobee, FL 34974 CONTRACTOR Nam :� V �5 Title: ecQ 1 CUr\ c Attest: -�-� V!,-T Title: ibel� Corporate Seal CONTRACTOR \12--,r Conch Con av!r5' /wc. / 3 0.0 S i$'+" Te r 0'zGGho(o "- ,, FL 3L/617`f O C 5 k- c" " /g- L�q Florida State Contractors License No Approved as to form and legaln for the use and reliance of the CITY only. Carlyn H. Kowalsky, Attorn City of Okeechobee Public Works Department Project No. PW 03-11-08-20 32 NOTICE TO PROCEED PW 03-11-08-20 Date: October 7, 2020 To: Vest Concrete Contractors, Inc. Contractor. SUBJECT PROJECT: PW 03-11-08-20 Okeechobee 2020 Sidewalk and Roadway Concrete Improvements You are hereby notified to proceed with the Work on the subject Project on or after October 7, 2020. OWNER: BY: CITY OF OKEECHOBEE ��� 55 SE THIRD AVENUE TDVad Allen OKEECHOBEE, FL 34974 Public Works Director CONTRACTOR'S ACKNOWLEDGMENT OF RECEIPT OF NOTICE CONTRACTOR: Name: V +C�v�cr�lzC���rGc,� s, IivL Date: 0 Address: 13LA: Signature: cx'�-'e�WL fit- 3'l�i�y Title: Vlc�. EXHIBIT A PW 03-11-08-20 GOVERNING SPECIFICATIONS 1.0 Roadway Concrete Slab — Bid items 1 and 2 NW 10th Street: The scope of this item of the contract consists of the installation of a 150' of 24' wide, 8" thick reinforced concrete roadway in the 300 block of NW 10th Street. The City will be responsible for removal of the existing roadway and preparation of the base. The contractor will be responsible for forming, reinforcing, pouring, and form removal. The specification for the project is per the attached detail drawing. In order to maintain access to the apartment complex located on the North side of North West loth Street, the project will need to be completed in two phases per the following diagram: City of Okeechobee Public Works Department 33 Project No. PW 03-11-08-20 PROVIDE %" EXPANSION JOINTS WHERE CONC. PAVEMMENT ABUTTS CURBS, BLDG, DRIVES OR OTHER SIMULAR CONC. STRUCTURES CONCRETE APRON (3,000 PSI MIN.) Wf 6"x6" — W1.4 x W1.4 WWF SEALANT MATERIAL Yt " BELOW SURFACE A 2" DEPTH INITIAL SAW CUT OR INSERTED STRIP 8" STABILIZED SUBGREADE COMPACTED TO A MIN DENSITY OF 98% ASHTO T-180 F.D..O.T. (LBR 40) CONCRETE PAVEMENT NE 5th Avenue: The scope of this item of the contract consists of the installation of a 450 Square Yard, 8" thick reinforced concrete roadway in the 600 block of NE 5th Avenue. The City will be responsible for removal of the existing roadway and preparation of the base. The contractor will be responsible for forming, reinforcing, pouring, and form removal. The specification for the project is per the attached detail drawing. In order to maintain access to the apartment complex located on the North side of North West loth Street, the project will need to be completed in two phases per the following diagram: City of Okeechobee Public Works Department 34 Project No. PW 03-11-08-20 w THSi �' Phase #1 Phase #Z bA F. r . _4. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 35 PROVIDE X2" EXPANSION JOINTS WHERE CONC. PAVEMMENT ABUTTS CURBS, BLDG, DRIVES OR OTHER SIMULAR CONC. STRUCTURES CONCRETE APRON (3,000 PSI MIN.) W/G"xG"—W1.4xW1.4WWF SEALANT MATERIAL " BELOW SURFACE v . `a v a 4 • 2" DEPTH INITIAL v SAW CUT OR INSERTED STRIP 8" STABILIZED SUBGREADE COMPACTED TO A MIN DENSITY OF 98% ASHTO T-180 F.D.O.T. (LBR 40) CONCRETE PAVEMENT City of Okeechobee Public Works Department 36 Project No. PW 03-11-08-20 2.0 ADA Ramp Installation The scope of this item of the contract is to install ten (10) ADA sidewalk curb ramps on SW Park Street in the downtown area of Okeechobee. Minimizing impact to the existing business owners and customers is of highest priority. The maximum allowable time for removal, forming and pouring any single ramp located adjacent to businesses located on the south side of south park street is three (3) calendar days. The contractor is responsible for providing appropriate barricades, signage and other traffic control devices to assure pedestrian safety always. All curb ramps will be installed per FDOT indexes 300 - Curb & Curb and Gutter, and 304 — Detectable Warnings and Sidewalk Curb Ramps. Concrete shall be 3,000 PSI with fiber of other appropriate reinforcement material. Detectable warning mat color shall be brick red. The locations of the new ramps are as follows: Number Location Ramp T e 1 100 block of SE Park St, midblock south side C 2 100 block of SW Park St, midblock south side C 3 200 block of SW Park St, midblock south side C 4 300 block of SW Park St, midblock south side C 5 400 block of SW Park St, midblock south side C 6 500 block of SW Park St, midblock south side C 7 600 block of SW Park St, midblock south side C 8 100 block SW Park Street, mid block in Veterans park B 9 100 block SW Park Street, SW corner of Veterans park L 10 200 block SW Park St, SE corner of Park 2 L City of Okeechobee Public Works Department 37 Project No. PW 03-11-08-20 17AAl am ■ jJA� Ramp 1, 100 Block SE Park Street I? Ile All City of Okeechobee Public Works Department Ramps 2, 7,8 100 Block SW Park Street 38 Project No. PW 03-11-08-20 IJ .. ,N. IM 00 �*i Ramp 3, 200 Block SW Park Street City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 9% tA At MIR -,-�--�Ad City of Okeechobee Public Works Department Ramp 4, 300 Block SW Park Street Ramp 5, 400 Block SW Park Street WE Project No. PW 03-11-08-20 ` SW PARK Sf is M070 Ramp 6, 500 Block SW Park Street City of Okeechobee Public Works Department Ramp 7, 600 Block SW Park Street 41 Project No. PW 03-11-08-20 I 0 Future Curb And Gutter Construction 20' R Or As Shown On Plans ^� Exp. Joint Valley Gutter Curb And Gutter PLAN P-2" 9 a. ` �1a 3'-0" SECTION AA 6" P-6" 1'-10" F-2" 8„ 5'-0" SECTION BB SECTION CC VALLEY GUTTER V-2" g„ 1'-6- 2'-3" TYPE E 6„ V 6„ 8„ 2' -0" TYPE F 10" 1'-2" Scope To Fit Driveway I a ko / 2 -0 Note: To be paid for as parent curb. DROP CURB Standard Shoulder Line Earth Berm F 6" 1 2' v 3-6 f� io r'• SHOULDER GUTTER When used on high side of roadways, the cross slope of the gutter shall match the cross slope of the adjacent pavement. The thickness of the lip shall be 6", unless otherwise shown on plans. p Rotate entire section so that gutter cross slope matches slope of adjacent circulating roadway pavement. For use adjacent to concrete or flexible pavement. For details depicting usage adjacent to flexible pavement, see Sheet 2. Expansion joint, preformed joint filler and joint seal are required between curb & gutter and concrete pavement only, see Sheet 2. Shoulder Pavement Truck Apron Surface Specified In The Plans - I{..�i Q' r' Circulating —- Roadway Pavement ^ ❑ � � n1 p Ql 2 3' TRAFFIC BEARING SECTION FOR USE IN ROUNDABOUT CENTRAL ISLAND CONSTRUCTION TYPE RA 16 Same Slope As 9„ 7„ Adjacent Pavement Joint Seal +t M %2" Exp. Joint And Preformed Joint Filler Concrete Pavement For details depicting usage adjacent to flexible pavement, see Sheet 2. TYPE A 4e" R 91, /Ei oint Seal Conc. Pavt. %z' Exp. Joint And Preformed Joint Filler TYPE B C 8" r— Joint Seat L -------- �— Conc. Pavt. %z' Exp. Joint And Preformed Joint Filler TYPE D Note: For use adjacent to concrete or flexible pavement, concrete shown. Expansion joint, preformed joint filler and joint seal are required between curbs and concrete pavement only, see Sheet 2. CONCRETE CURB CONCRETE CURB AND GUTTER LAST Z DESCRIPTION: ION: o FY 2020-21 INDEX SHEET REVISION FDOTT CURB AND GUTTER 520-001 1 of 2 11101117 W � STANDARD PLANS 8.5' End Of Curb 0 N Edge Of Pavt. PLAN Edge Of Pavt. PLAN 3' 3' Top Of Curb -� 5.5' Trans Top Of Curb --� Trans. Gutter Gutte, PROFILE FLARED END CURB TYPE A Depth Of Sawcut 2W" Min. 3Vz' Max. Depth Of Sawcut 0" Min. //1 �LLLGJ / G GL1 �-/ —7' � GGLLLL111 5" Max. T � 0"' Min. SHOULDER GUTTER TYPE E 3V2' Max. // Depth Of Sawcut 0" Min. - GLLL1111 5„ Max. j� 0" Min. I TYPE F Sawcuts should be avoided within valley gutter and within curb and gutter endings. CONTRACTION JOINT IN CURB AND GUTTER Depth Of Sawcut / Depth Of Sawcut Depth Of Sawcut // / 3V2' Min. /�/ 3VZ' Min. 3W' Min. GZ- �L // LLL/ L TYPE A TYPE B TYPE D CONTRACTION JOINT IN CURB 4" Min., 5" Max. -� i 6'-0" 7B" Or %" Holes 2" Min., >< 3" Max. III £ Z I,i to e Pitch Optional 8" Min., R=2" / 9" Max. Cast Or Rubbed ---/// 72� #4 Bars, 18" Long (Two Per Guard) - CONCRETE BUMPER GUARD PROFILE STRAIGHT END 6' N � End Of Curb A +i Edge Of Pavt. Edge Of Pavt. PLAN PLAN 3' 3' Top Of Curb -� 3' Trans. Top Of Curb -� Trans.---{ Gutter Gutter CURB AND GUTTER ENDINGS 17z' PROFILE PROFILE FLARED END STRAIGHT END CURB AND GUTTER TYPES E & F Surface On Low Side Of Pavement to Be %4" Above Lip Of Gutter. Surface On High Side To Be Flush With Lip Of Curb Or Curb & Gutter. r Slope Varies Flexible Pavt. p Applies to both high and low sides of pavement, low side shown. Applies to shoulder gutter only where adjoining traffic lanes. CURB AND GUTTER AND TYPE A CURB ADJACENT TO FLEXIBLE PAVEMENT 2"' Min., 3" Max. 9" ASPHALTIC CONCRETE CURB Joint Seal m � Concrete Gutter Concrete Pavement Vz" Exp. Joint And Preformed Joint Filler 1 I - Applies to both high and low sides of pavement, low side shown. EXPANSION JOINT BETWEEN GUTTER AND CONCRETE PAVEMENT GENERAL NOTES 1. For curb, gutter and curb & gutter provide V8' - V4' contraction joints at 10' centers (max.). Contraction joints adjacent to concrete pavement on tangents and flat curves are to match the pavement joints, with intermediate joints not to exceed 10' centers. Curb, gutter and curb & gutter expansion joints shall be located in accordance with Specification 520. 2. Ends of Curbs Types B and D shall transition from full to zero heights in 3'. LAST DESCRIPTION: FY 2020-21 INDEX SHEET REVISION FDOTT CURB AND GUTTER 520-001 2 of 2 11101117 W �" STANDARD PLANS Cr GENERAL NOTES: I. Cross Slopes and Grades: A. Sidewalk, ramp, and landing slopes (i.e. 0.02, 0.05, and 1:12) shown in this Index are maximums. With approval of the Engineer, provide the minimum feasible slope where the requirements cannot be met. B. Landings must have cross -slopes less than or equal to 0.02 in any direction. C. Maintain a single longitudinal slope along each side of the curb ramp. Ramp slopes are not required to exceed 15 feet in length. D. Joints permitted at the location of Slope Breaks. Otherwise locate joints in accordance with Index 522-001. No joints are permitted within the ramp portion of the Curb Ramp. 2. Curb, Curb and Gutter and/or Sidewalk: A. Refer to Index 522-001 for concrete thickness and sidewalk details. B. Remove any existing curb, curb and gutter, or sidewalk to the nearest joint beyond the curb transition or to the extent that no remaining section is less than 5 feet long. 3. Curb Ramp Alpha -Identification: A. Sidewalk curb ramp alpha -identifications (e.g. CR-A) are provided for reference purposes in the Plans. B. Alpha -identifications CR-I and CR-J are intentionally omitted. 4. Detectable Warnings: A. Install detectable warnings in accordance with Specification 527. B. Place detectable warnings across the full width of the ramp or landing, to a minimum depth of 2 feet measured perpendicular to the curb line and no greater than 5 feet from the back of the curb or edge of pavement. C. If detectable warnings are shown in the Plans on slopes greater than 5%, align the truncated domes with the centerline of the ramp; otherwise, the truncated domes are not required to be aligned. 5. Detectable Warnings - Acceptance Criteria: A. Color and texture shall be complete and uniform. B. 90% of individual truncated domes shall be in accordance with the Americans with Disabilities Act Standards for Transportation Facilities, Section 705. C. There shall be no more than 4 non -compliant domes in any one square foot. D. Non -compliant domes shall not be adjacent to other non -compliant domes. E. Surfaces shall not deviate more than 0.10" from a true plane. URB RAMP NOMENCLATURE LAST DESCRIPTION: FY 2021-22 INDEX SHEET REVISION FDOT� D]ETE CTAB LE WARNINGS AND SIDEWALK CURB RAMPS 11101119 W -VAPP01" STANDARD PLANS 522-002 ]of 7 N N 2'-0" 0 O lV Utility Strip (Grass Or / Pavement) J ISOMETRIC VIEW 7'-0" 4'-0" T-O" Min. PLAN VIEW NOTE: For Example of CR-A used in Radial Curb Returns, See Sheet 8. CR-A 8" For Type F Curb 9" For Type E Curb (Type F Curb Shown) Gutter Line Rdwy. Pavt. 2'-0" c 3 �c � v ji U) Utility Strip (Grass Or Pavement) Varies Varies - 7'-0" (5td.) 4'-0" Min. Ramp Landing 0.02 /- Sidewalk 0.02 SECTION A -A Ramp ISOMETRIC VIEW -Al T-O" I 4'-0" 7'-0" Min. PLAN VIEW CR-8 SIDEWALK CURB RAMPS CR-A AND CR-B LAST Z DESCRIPTION: FY 2021-22 INDEX SHEET REVISION FDDETECTABLE WARNINGS AND SIDEWALK CURB RAMPS 11101118 W --Jpo�— STANDARD PLANS 522-002 2 of 7 cX Sidewalk Curb (Where Necessary) 8 3 0 � Ramp c ='o o Ramp -i I:I2 to Rdwy. Pavt. J 4'-0" Min. PLAN VIEW 6'-0" (Shown) Sidewalk — — — n o2 Land Sidewalk Curb (Where Necessary) (See Note) NOTE: For additional information on sidewalk curb construction, see SIDEWALK CURB OPTIONS details. SECTION B-B Transition (Where Necessary) f f et 6.0 / ti a i I / Drop (H) �i � 6" x H Monolithic Cast Curb Or i 6" x 12" Separately Cast Curb Back Of Sidewalk CONSTRUCTION OF SIDEWALK CURB IN CUT SECTIONS 6" 3/4' R H (Varies) Ramp, Sidewalk Or Landing 0.02 MONOLITHIC CAST CURB 31, ' R H (Varies) \ Ramp, Sidewalk Or Landing 0.02 0 f-�-i SEPARATELY CAST CURB SIDEWALK CURB OPTIONS SIDEWALK CURB RAMPS CR-C AND SIDEWALK CURB LAST Q DESCRIPTION: REVISION FY 2021-22 INDEX SHEET 11101118 VREVISION W F,r Tr) STANDARD PLANS ]DETECTABLE WARNINGS AND SIDEWALK CURB RAMPS CC 522-002 3 of 7 J�\ Sidewalk �aM 2'-0" Detectable Warnings 2'-0" Detectable Warnings OPTION A OPTION A �\Q 5` 2'-0" Detectable Warnings 2'-0" Detectable Warnings J OPTION A VDetectable ISOMETRIC VIEW Sidewalk 2'-0" Detectable Warnings 2'-0" Warnings OPTION B OPTION B kv �a ISOMETRIC VIEW ISOMETRIC VIEW �ShownJ Sid P'Na/k 00 2'-0" Detectable Warnings 6-0" (Shown) '3: 2'-0" Sidewalk as 6-0" (Shown) Sidewalk OPTION B 0.02 0.02 Sidewalk Curb ISOMETRIC VIEW Q 1 5-0" (Shown) Sidewalk Sidewalk Curb E ^� y Sidewalk Curb or, Sidewalk Curb c 0 o�, o 0� 1 ,p o„ 5-0" Min. 4'-0" Min. 4'-6" Min. Landing Ramp Ramp Ramp PLAN VIEW PLAN VIEW PLAN VIEW PLAN VIEW CR-D CR-E CR-F CR-G SIDEWALK CURB RAMPS CR-D, CR-E, CR-F & CR-G LAST R EV I SION REVISION 20 v DESCRIPTION: FY 2021-22 INDEX SHEET FD��TI,� D ET EC'] ABLE WARNINGS AND SIDEWALK CURB RAMPS 111 W STANDARD PLANS 522-002 4 of 7 Sidewal ISOMETRIC VIEW 6'-0" (Shown) Sidewalk 4'-0" Min. Ramp PLAN VIEW CR-H 8" For Type F Curb 9" For Type E Curb (Type F Curb Shown) Gutter Line Rdwy. Pavt. 2'-0" De 3 Y � v a o in i tp Q C tv g Utility Strip (Grass Or Pavement) Varies ISOMETRIC VIEW 2'-B„ 7-0" 4'-0" 7-0„ Min. PLAN VIEW CR-K Varies - T-O" (Std.) 3'-0" Min. 4'-0" Min. J, Sidewalk Curb Landing (Where Necessary) Ramp Landing (See Note 3) 0.02 Sidewalk a 0.02 Rdwy. Pavt. _ 0.02 0.02 _ Ramp H (Varies) SECTION D-D SECTION E-E OPTION B ISOMETRIC VIEW 4 � Z Y Ln L R1 ,,0 3 = V) _ v v a Ln „ 0.02 omc 4'-0" Min. rE) Sidewalk Curb (Where Necessary) _ Ramp 1:12 Crosswalk Sidewalk i 0 A� \ v O Utility Strip (Grass Or Pavt.) Y_ 3 NOTES: 1. Crosswalk Width and Configuration Vary, Must Conform to Index 711-001. PLAN VIEW 2. 15' Radius Curve Shown for CR-L. 3. For additional information on sidewalk curb construction, see SIDEWALK CURB CR-L OPTIONS details, on Sheet 3. SIDEWALK CURB RAMPS CR-H, CR-K & CR-L LAST Z DESCRIPTION: FY 2021-22 INDEX SHEET REVISION 1 FDDT� E'T]E D CTAB LE bi�t�]f NI NGS AND S IID E WA LK CURB RAMPS11/01/I8 W �— STANDARD PLANS 522-002 5 of 7 cc Transition Slc Pavement Relief (If (See Sect, 5'-n^ mi. ISOMETRIC VIEW (CR-C Shown, Other S+n,dar) Varies (P-6" Max.) Pavement Relief Initial Surface of Pavement 0.05 Max. tea. Final Surface of Pavement Relief Lip Of Curb Varies (1'-6" Max.) Varies 5'� 5'. f LANDINGS FOR CURB RAMPS WITHOUT SIDEWALKS (See CR-F, CR-G & CR-K Respectively For Detectable Warning Details/Options) Ramp Or Landing NOTE: Remove Elevated Pavement By Spading And Rolling, Smooth Milling, or Grinding. SECTION C-C PAVEMENT RELIEF DETAILS OPTION A OPTION B DETECTABLE WARNING ON FLUSH SHOULDER SIDEWALKS CURB RAMPS WITHOUT SIDEWALKS AND FLUSH SHOULDER SIDEWALKS LAST Q DESCRIPTION: FY 2021-22 INDEX SHEET REVISION EV I SI N W FAOT STANDARD PLANS DBE T E C�'AB L E WAIF NIINGS AND S IIDE WAILK CURB RA PS 522-002 6 of 7 NOTES: I. Where crosswalk markings are used, ramps must fall within the crosswalk lime A clear space of 48" minimum is required at the bottom of the ramp within a marked crosswalk. If crosswalk markings are not present, a clear space of 4 minimum is required at the bottom of the ramp outside of active travel lanes. 2. Crosswalk widths and configurations vary; must conform to Index 711-001. 3. Flangeway Gap may be up to 3" for Freight -only Railways. Rail C, 2'-( RAILROAD CROSSING 2'-0" Detectat L� C tabh RADIAL SIDEWALK RAMPS 3-0" Curb Transition From Full to Zero Height Full Height Curb, 2'-0" Min. ` 2'-0" Detectable Warnings �, \ 1:12 Utility Strip LINEAR SIDEWALK RAMPS Crosswalk PLACEMENT OF SIDEWALK CURB RAMPS AT CURBED RETURNS (TYP.) gs RAILROAD CROSSING AND CURB RAMPS AT CURBED RETURNS LAST Z, DESCRIPTION: FY 2021-22 INDEX SHEET REVISION W �- FDOT� D]GTECTAB L]E WARNINGS AND SIDEWA][ K CURB RAMPS SZZ-��2 7 of 7 11101117 STANDARD PLANS Fl 2'-0" Detectable Warnings Face Of Curb 0 5'-0" (Show Median Concrete Al / ewalk 2'-0" Detectable Warnings DEPRESSED SIDEWALK NOTES: 1. Cross Slope of the median crossing not to exceed 0.02. 2. Running Slopes: A. Slopes :s 0.05: For roadway cross sections were the Edge of Pavement elevation is the same for both directions of traffic, the median cross'. running slopes (0.02 Typ.) should meet at the centerline of the me n. For roadway cross sections with variable Edge of Pavement el ations, or to accommodate other construction in the median, the si es may intersect off the centerline of the median. B. Slopes > 0.05: Provide a median refuge area nding, 0.02 slope) for crossings with running slopes > 0.05. The fuge area must extend the full width of the crossing and have minimum length of 5 feet. 3. On existing facilities, remove and r nstruct curb transition for raised sidewalk with ramp. Face Of Curb Median Face Of Curb DIAN CROSS) Median Crossing Surface (Concrete Sidewalk) Edge Of Pavement Curb Transition (See eNNote 3) rl 2'-0" Detectable Warnings co ' Median Al DELETED SHEET Transition Slope 2'-0" Qeectable Warnings Of Curb t ransition Slope 5'-0" (Shown) Concrete Median Side k Zj RAISED SIDEWALK Face Of Curb -u" KerU a Area ded, 0.02 Slope) (See to 2B) Slope Varies (0.02 Std., 0.05 Max.) 4 than Curb Transition (Curb &Gutter Type E Shown) Edge Of Pavement SECTION F-F MEDIA CROSSING LAST p DESCRIPTION: FY 2020-21 INDEX HEET REVI N FDOf(� DETECTABLE WARNINGS AND SIDEWALK CURB RAMPS 522-002 7 0 1 Ol/17 W �- STANDARD PLANS GENERAL NOTES: 1. Construct sidewalks in accordance with Specification Section 522. 2. Include detectable warnings on sidewalk curb ramps in accordance with Index 304. 3. For TURNOUTS see Index 515. 4. Bond breaker material can be any impermeable coated or sheet membrane or preformed material having a thickness of not less than 6 mils nor more than VZ'. 5. Construct sidewalks with Edge Beam through the limits of any surface mounted Pedestrian/Bicycle Railing or Pipe Guiderail shown in the plans. (See RAILING DETAIL) 6. When roadways or driveways are newly constructed, reconstructed or altered, construct the cross slopes for crosswalks and discontinuous sidewalks as follows: A. Cross Slope = 0.02 for roadways or driveway controlled by "STOP" Sign or "YIELD" sign- B. Cross Slope = 0.05 for roadways or driveways controlled by traffic signal. A 8 C B C 8 C B C 8 A 5' 5' 5' 5' 5' 5' 1 5' 5' S' a Return Curb Rigid Structure; 6" Min. For Turnouts Or Curb Ramps OPEN JOINTS 120' Max. 120' Max. 30' Max. 30' Max. 30' Max. IAI D D D D D E D D F D D A V�l _5_ I _5' I _5-I _5' I _5' 15'_I _5-I n 5 5 Return Curb Rigid Structure; 6" Min. For Turnouts Or Curb Ramps SAWED JOINTS LONGITUDINAL SECTION LEGEND: A- VZ' Expansion Joints (Preformed Joint Filler) 8- V8' Dummy Joints, Tooled C- 1/s- Formed Open Joints D- 3/16' Saw Cut Joints, 1 Vz' Deep (within 96 hours) Max. 5' Centers E- 3/16' Saw Cut Joints, 1 Vz' Deep (within 12 hours) Max. 30' Centers Joint(s) Required When Length Exceeds 30' F- Vz' Expansion Joint When Run Of Sidewalk Exceeds 120'. Intermediate locations when called for in the plans or at locations as directed by the Engineer. G- Cold Joint With Bond Breaker, Tooled SIDEWALK JOINTS o A (Utility Pole, Ex.) A A A c / Tur \ / Tur— out Back Of Sidewalk Variations Omit Joints On Curb ramps A (signal Pole Or Controller Base. Ex.) A A A A J ) A J A Curb Or Curb And Gutter —� PLAN SIDEWALK WITH UTILITY STRIP LEGEND: O 4" Thick Sidewalk 6" Thick Sidewalk Utility Strip o A (Utility Pole, Ex.) A — `r A � A b a r Turnout A y tq / A Turnout Or Side Road (Full Return Shown) A — Back Of Sidewalk Variations -�-- ,/ Omit Joints On Curb ramps / A (signal Pole Or Controller Base. Ex.) A A G A J "- G / A J B I G Curb Or Curb And Gutter J �- Utility Strip Sidewalk Varies Varies (5' Min.) _,0.02 Max. SECTION A -A PLAN SIDEWALK WITHOUT UTILITY STRIP Sidewalk Varies (6' Min.) G „0.02 Max. SECTION B-B G A Turnout Or Side Road (Full Return Shown) Railing (See Index 852, 862, 870 Or 880) Clear Width (5' or 6' Std., 4' Min) „0.02 Max. 45" 9„ Sidewalk Varies Based on Railing Used RAILING DETAIL GENERAL NOTES AND CONCRETE SIDEWALK ON CURBED ROADWAYS LAST zFY Z017-18 0 DESCRIPTION: _ INDEX SHEET REVISION �, FDOT,) CONCRETE SIDEWALK NO. NO, 11/O1116 W c �- DESIGN STANDARDS 310 1 of 2 8 C 8 C Flexible Pavt. �]u� Graded Turnout A 8 C 8 C 8 C 8 C 8 A 8 C 8 C A Rigid Pavt. �ll OPEN JOINTS 30' Max. D D D D D E D 5' S' S' Flexible Pavt. — v _ J 120' Max. 30' Max. 30' Max Graded Turnout 120' Max. 1 30' Max. 30' Max. 30' Max. II w A D D D D D E D D F D D A D D E D D A 5 5 I _5'_ I 5 I 5 5 I 5 I 5 5 I I Az Rigid Pavt. SAWED JOINTS LONGITUDINAL SECTION LEGEND: A- Vz' Expansion Joints (Preformed Joint Filler) 8- V8' Dummy Joints, Tooled C- Ve" Formed Open Joints D- 3176' Saw Cut Joints, 1 Vz' Deep (within 96 hours) Max. 5' Centers E- -j7e' Saw Cut Joints, 1Vz' Deep (within 12 hours) Max. 30' Centers Joint(s) Required When Length Exceeds 30' F- Vz' Expansion Joint When Run Of Sidewalk Exceeds 120'. Intermediate locations when called for in the plans or at locations as directed by the Engineer. SIDEWALK JOINTS 2' Detectable —0001 Warning Surface C / \ � \ Border i i Driveway Side Road Shoulder Line --——————————————————— -----------�� LEGEND: 7-1 4" Thick Sidewalk Edge Of Trave Way PLAN CONTINUOUS SIDEWALK See GENERAL NOTE #6 2' Detectable —0001 Warning Surface C \ Border Driveway i Side Road � Shoulder Line i/ "----------------------� �"/ Edge Of Trave Way PLAN DISCONTINUOUS SIDEWALK Sidewalk Varies (5' Min.) 0.02 Max. SECTION C-C CONCRETE SIDEWALK ON FLUSH SHOULDER ROADWAYS LAST DESCRIPTION: INDEX SHEET ON REVISI� �"� FY 2017-18 NO. NO. 11/01116 w FAT'' DESIGN STANDARDS ®NCRETE SIDEWALK 310 2 of 2 EXHIBIT B BID UNIT PRICE SCHEDULE PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS sss1.900.00 EST. ITEM UNIT UNIT DESCRIPTION QTY AMOUNT NO MEASURE PRICE POUR EIGHT (8) INCH CONCRETE ROADWAY SLAB TWENTY-FOUR (24) FEETX ONE HUNDRED -FIFTY (150) FEET, 3,000 PSI MINIMUM W/6 INCHES X 6 INCHES-1.4 X 1.4 WWF REINFORCEMENT ON NW 10TH STREET. CITY 1 TO REMOVE EXISTING ASPHALT AND EXCAVATE EACH 1 EXISTING ROAD BASE AND PROVIDE NEW SUBBASE. $17,100.00 $17,100.00 WORK TO BE PERFORMED IN TWO SEGMENTS TO MAINTAIN ACCESS TO APARTMENT COMPLEX ON NORTH SIDE OF 10TH STREET. POUR EIGHT (8) INCH CONCRETE ROADWAY SLAB TWENTY-FOUR (24) FEET X ONE HUNDRED -FIFTY (150) FEET, 3,000 PSI MINIMUM W/6 INCHES X 6INCHES —1.4 X 1.4 WWF REINFORCEMENT ON NW 10TH STREET. CITY $19,237.50 $19,237.50 2 EACH 1 TO REMOVE EXISTING ASPHALT AND EXCAVATE EXISTING ROAD BASE AND PROVIDE NEW SUBBASE. WORKTO BE PERFORMED IN TWO SEGMENTSTO MAINTAIN ACCESS TO DIAMOND R FERTILIZER. REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-B PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND 3 SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 EACH 1 $1,900.,00 $1,900.00 PSI WITH FIBER OF OTHER APPROPRIATE REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-C PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 PSI WITH FIBER OF OTHER APPROPRIATE 4 REINFORCEMENT MATERIAL. DETECTABLE WARNING EACH 7 $1,900.00 $13,300.00 MAT COLOR SHALL BE BRICK RED. WIDTH TO VARY FROM 6 FEET TO 8 FEET DEPENDING ON LOCATION. RAMP WIDTH TO MATCH WIDTH OF EXISTING PAVER SIDEWALK. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 54 REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-L PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND 5 SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 EACH 2 PSI WITH FIBER OF OTHER APPROPRIATE $1,900.00 $3,800.00 REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. REMOVE AND REPLACE EXISTING FIVE (5) FOOT WIDE LINEAR 6 CONCRETE SIDEWALK. TEN (10) YARD TOTAL. FOOT 100 $30.00 $300000 . REMOVE AND REPLACE EXISTING FIVE -FOOT -WIDE LINEAR 7 CONCRETE SIDEWALK. LESS THAN TEN (10) YARD TOTAL FOOT 50 $35.00 $1,750.00 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LINEAR $28.00 $2,800.00 8 TEN (10) YARD TOTAL FOOT 100 9 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LINEAR $28.00 $2,800.00 LESS THAN TEN (10) YARD TOTAL FOOT 100 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE LINEAR 10 500 $16.25 $8,125.00 SIDEWALK. TEN (10) YARD TOTAL FOOT INSTALL NEW FIVE (5) FOOT WIDE CONCRETE LINEAR 11 SIDEWALK. LESS THAN TEN (10) YARD TOTAL FOOT 100 $z1.25 $2,125.00 INSTALL NEW CONCRETE "D" CURB. TEN (10) YARD OR LINEAR 12 100 $18.00 $1,800.00 GREATER TOTAL FOOT INSTALL NEW CONCRETE "D" CURB. LESS THAN TEN LINEAR 13 (10) YARD TOTAL FOOT 50 $30.00 $1,500.00 INSTALL NEW CONCRETE "F" CURB. TEN (10) YARD OR LINEAR 14 GREATER TOTAL FOOT 100 $2s.00 $2,soo.00 INSTALL NEW CONCRETE "F" CURB. LESS THAN TEN (10) LINEAR 15 YARD TOTAL FOOT 50 $35.00 $1,750.00 16 INSTALL NEW 4-INCH-THICK CONCRETE SLAB SQUARE 500 $4.00 FOOT $2000.00 17 INSTALL NEW 6-INCH-THICK CONCRETE SLAB SQUARE 500 $4.70 $2,350.00 FOOT TOTAL BID AMOUNT (Based on Bid Unit Prices & Estimated Quantities) $88 137.50 City of Okeechobee Public Works Department Project No. PW 03-11-08-20 55 Bidders Company Name \v (L ` i C"-) i-\ c' ft4-e- ec 11 NOTE: This Bid is on a unit price basis. The total estimated amount is for Bid comparison purposes only. The Contractor should field verify the actual site conditions prior to time of bidding and before submitting the Bid proposal. The Contractor should read the special conditions and the requirements for insurance before submitting a Bid proposal. The Contractor should verify the quantities to be included in the construction contract. The Contractor shall furnish the City of Okeechobee with a Payment and Performance Bond in 100 percent (100%) of the total estimated amount of the contract. The Payment and Performance Bond shall continue in effect for one (1) year after completion and acceptance of the work as guarantee against construction defects. The Contractor in his Bid shall include the cost of said bond. I have attached the required 5 percent (5%) Bid Security to this Bid. Bidder: % �L'66, ((CCompany Name) By: . , ? 1 (Signature) (Printed Name) Date: `1 4 )' - 'q C�; Title: Email: jtC,JIr — Mailing Address:I.3 u • �:�-= ► K ck�,r� I rL `i -7 -1 Office Number: Fax Number: City of Okeechobee Public Works Department Project No. PW 03-11-08-20 56 SECTION VIII PW 03-11-08-20 MISCELLANEOUS A. No Lobbying: All respondents are hereby placed on notice that any communication, whether written or oral, with City of Okeechobee elected officials or any City staff or outside Individuals working with the City in respect to this request (with the exception of the General Services personnel designated to receive requests for interpretation or corrections or technical questions), is prohibited. These persons shall not be lobbied, either individually or collectively, regarding any request for Bid, qualifications and/or any other solicitations released by the City. To do so is grounds for immediate disqualification from the selection process. All respondents must submit the attached No Lobbying Affidavit with their submittal stating that they and their Subcontractor, sub - consultants and agents agree to abide by the no lobbying restrictions in order to be considered for this request. Any respondent that does not submit the required No Lobbying Affidavit will be automatically disqualified from further consideration. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment A B. Collusion, Gratuities and Kickbacks: It shall be unethical for any respondent to collude with any other respondent or offer, give or agree to give any City Council member, City employee or City representative (including selection committee members) a gift, gratuity or an offer of employment in connection with any decision, approval, disapproval, recommendation or preparation of any part of the procurement process. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment B C. Modifications: The City reserves the right to modify, alter or change the scope or other aspects of this solicitation. D. Level Playing Field: The contents of this solicitation are intended to provide a level playing field on which Firms or Individuals may base their responses. E. Public Entity Crime Affidavit: As requested by Florida Statute 287.133(2)(a), a person or affiliate who has been placed on the convicted vendor list following a conviction for a Public Entity Crime may not submit a Bid on a contract with a Public Entity for the construction or repair of a public building or a public work, may not submit Bids on leases of real property to a Public Entity, may not be awarded or perform work as a Contractor, supplier, Subcontractor, or consultant under a contract with any Public Entity, and may not transact business with any Public Entity in excess of the threshold amount provided in F.S. 287.017 for Category Two for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. Any person must notify the City within thirty (30) days after a conviction of a Public Entity crime applicable to that person or to an affiliate of that person. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment D Cliy ui Gkeechubee Public Works Department rrvjeci 110. i-VV U3-11-U?55-w 57 F. Conflict of Interest: The award hereunder is subject to the provisions of Chapter 112, Florida Statutes. All respondents must disclose with their submission the name of any officer, director, employee or agent who is also a public officer, employee or an agent of the City of Okeechobee City Council, or any of its agencies. Furthermore, all respondents must disclose the name of any City officer, employee or agent who owns, directly or indirectly, an interest of five percent (5 %) or more in the Firm or any of its parent companies or subsidiaries. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment E G. Immigration Laws: Respondents must comply with all applicable immigration laws in their employment practices. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment F H. Tie Bids: Preference shall be given to businesses with drug -free workplace programs. Whenever two or more bids which are equal with respect to quality and service are received by the City for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug -free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied vendors has a drug -free workplace program. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 58 ATTACHMENT A PW 03-11-08-20 NO LOBBYING AFFIDAVIT STATE OF FLORIDA COUNTY OF C4) This Ai day of - , 201t , (:: �( Vc'`,i being first duly swom, deposes and s ys that he/she is the authorized representative of 4e�' I coa (,P- t�-- I iy L (Name of Contractor, Firm or Individual) respondent to the attached request for Bid, or qualifications and/or any other solicitation released by City of Okeechobee, and that the Bidder and any of its agents agrees to abide by the City of Okeechobee no lobbying restrictions in regard to this solicitation. VLiT Affint j The foregoing instrument was acknowledged before me by means of ephysical presence or online notarization, this 11-l' day of Sr-ke,rbc,- , 20; (_, by i) Vems} , who is personally known to me or produced as identification. Mo ERR Notary Pu nature Commission # GG 157439 Expires November 2.2021 00F F�PBonded rf-&-19A Notary serim Commission No. City of Okeechobee Public Works Department 59 Project No. PW 03-11-08-20 ATTACHMENT B PW 03-11-08-20 ANTI -COLLUSION STATEMENT AND NO GIFTS STATEMENT Date: , _ j 1 - ;�C, Anti -collusion statement: The below -signed Bidder has not divulged to, discussed, or compared his/her Bid with other Bidders and has not colluded with any other Bidder or parties to a Bid whatsoever. No gifts statement: No premiums, rebates, gifts or gratuities are permitted with, prior to, or after submission of the Bid. Any such violation will result in rejection of the Bid and removal from the Bid list(s). Firm Name: Cof\c Con- mcAor 5+ / r\i C_ By (printed/typed): ale 5 By (signature): Title: d,,� \ r Mailing Address: S I Ter City, State, Zip: hL; u�i FL �3q�1 q Telephone No.: L-3 1 C- 3- 3 7 3y City of Okeechobee Public Works Department 60 Project No. PW 03-11-08-20 ATTACHMENT C PW 03-11-08-20 PROPOSER'S CERTIFICATION have carefully examined this Request for Bid (BID)/Request for Proposals (RFP)/ Request for Qualifications (RFQ), which includes scope, requirements for submission, general information and the evaluation and award process. I acknowledge receipt of the following addenda. Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: 1 hereby propose to provide the services requested in the City's BID/RFP/RFQ and, if awarded, to enter into the attached draft contract. I agree that the terms and conditions of the City's BID/RFP/RFQ shall take precedence over any conflicting terms and conditions submitted with my proposal and agree to abide by all conditions of the BID/RFP/RFQ, unless a properly completed Exceptions to BID/RFP/RFQ form is submitted. I acknowledge that the City may not accept the proposal due to any exceptions. I certify that all information contained in my proposal is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this proposal on behalf of the Company as its agent and that the Company is ready, willing and able to perform if awarded a contract. further certify, under oath, that this proposal is made without prior understanding, agreement, connection, discussion or collusion with any other person, Company or Corporation submitting a proposal for the same product or service; no gratuities, gifts or kick -backs were offered or given by the Bidder or anyone on its behalf to gain favorable treatment concerning this procurement; no City Council member, employee or agent of City of Okeechobee or of any other Company is interested in said Bid; and that the undersigned executed this Proposer's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so. �QS�CE+1Ct� etct. C- Name of Business Aut on Signature .� ��� Vz5 ► res;d�Y� r Name & Title, Ty ed STATE OF FLORIDA COUNTY OF Q I)Ljh t �(IL S- -`- 1$11" TQC Mailing Address City, State & Zip Code Telephonee' Number/Fax Number Email Address The foregoing instrument was acknowledged before me by means of ephysical presence or ❑ online notarization, this Vkr day of :,, e , 20)-j,-, by V a it , who is personally known tome or produced as identification. MARALANA R T}�lC1 • •.. Notary gna lure commissim#GGlsra3tCommission No. C IS ?J Ll3Cj >r o� Expires November 2, 2021 FaFFt�¢ awwedThuBOW NWM8W*W City of Okeechobee Public Works Department 61 Project No_ PW 03-11-08-20 ATTACHMENT D PW 03-11-08-20 SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted to CITY OF OKEECHOBEE, FLORIDA by: (print individual's name and title) for: /NC - (print name of entity submitting sworn statement) whose business address is t Ic SW i S +- Te.f , gt} , P—Oxc V)e-C,-1 F ! 3 y cI -1 -I and (if applicable) its Federal Employer Identification Number (FEIN) is: 5'-t (If the entity has no FEIN, include the Social Security Number of the Individual signing this sworn statement: 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including but not limited to, any Bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentations. 3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means: a. A predecessor or successor of a person convicted of a public entity crime; or b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. City of Okeechobee Public Works Department 62 Project No. PW 03-11-08-20 5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which Bids or applies to Bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies). X Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. ❑ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. ❑ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list (attach a copy of the final order). I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. 11 Signature � 1 / r STATE OF FLORIDA COUNTY OF Kt e-c.-llc1�_ The foregoing instrument was acknowledged before me by means of physical presence or i-] online notarization, this sl -� day of , 20aQ , by who is personally known to me or produced ��; , ,,, 11J►;,o ��= as identification. MAR UMARTNAcKER Notary c Signature commission # GG 1574W Expires November 2,2M Commission No. G (� is tALA 3"t lF pr �`OQ' Emded Rn WON Notary Smkea City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 63 ATTACHMENT E PW 03-11-08-20 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all Bidders must disclose if any City of Okeechobee employee(s), elected official(s), or any of its agents is also an owner, corporate officer, director, agent, employee, etc., of their business. Indicate either "yes" (a City employee, elected official or agent is associated with your business), or "no". If yes, give person(s) name(s) and position(s) with your business. YES NO Name(s) Position(s) Firm Name: \i E S 1 CC, N C 9 F- Co N I RNe-za RS , t N L- By (Printed): S t n- \1 V-5 r By (Signature): Title: Address: t-3 b IG 5 -v J 1'%-1 h T C 2 Phone Number: ' S Va - -� �- 3 3-1 DC� City of Okeechobee Public Works Department 64 Project No. PW 03-11-08-20 ATTACHMENT F PW 03-11-08-20 IMMIGRATION LAW CERTIFICATION City of Okeechobee will not intentionally award City contracts to any Contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324 a(e) (Section 274a(e) of the immigration and nationality act ("INA")). City of Okeechobee may consider the employment by any Contractor of unauthorized aliens a violation of Section 274A(e) of the INA. Such violation by the recipient of the employment provisions contained in Section 274A(e) of the INA shall be grounds for unilateral cancellation of the contract by City of Okeechobee. Respondent attests that it is fully compliant with all applicable immigration laws, specifically relating to the 1986 immigration act and subsequent amendments. �-- C ny, Nae og RE,) i ure Iy N N i Title Date STATE OF FLORIDA COUNTY OF L The foregoing instrument was acknowledged before me by means of i 1 physical presence or ❑ online notarization, this�day of AyG-taST, 2020 , by -gam who is personally known to me or produced as iden ' ' ation. Commission No. "t"�� VARY E. PURMS reca`'f CommiLsion # GG 156187 N'�vc Expims October 30, 2021 FIG fly' fi�Mibd TIN W�dgt Mrtf%Sf11C!! City of Okeechobee Public Works Department 65 Project No. PW 03-11-08-20 ATTACHMENT G PW 03-11-08-20 DRUG -FREE WORKPLACE CERTIFICATION THE BELOW SIGNED Bidder/proposer CERTIFIES that it has implemented a drug -free workplace program. In order to have a drug -free workplace program, a business shall: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violation of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under quote a copy of the statement specified in subsection 1. 4. In the statement specified in subsection 1, notify the employees that, as a condition of working on the commodities or contractual services that are under quote, the employee will abide by the terms of the statement and will notify the employer of any conviction or plea of guilty or nolo contendere to any violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in, drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign this statement, I certify that this Firm complies fully with the above requirements. Signature: - ��,�-t Date: Company: VP.Y(_c s����+� (�: ��}r�.� fo r-,, I wc. Name: -r�� Address: 1.3 b ky S 'vJ Ins I, \ c (- Title: (31 P ,5 ► is L OKCk,vt3 ��� f 3Q'i-14 Phone Number: - � L, 3 " 3 1 City of Okeechobee Public Works Department 66 Project No. PW 03-11-08-20 CITY OF OKEECHOBEE OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS PW 03-11-08-20 REFERENCE Client Name: D► CA e T sc> ,►J r 1 o i d et Client Phone Number: 1 1 :� - Client E-mail: (' .S h y, I --f cc'k C-' (a Service Dates: Beginning 53 ` I - i ce End S � ► ► ► �� <-= k. ��� +� P� ��� -t Estimated Annual Contract Amount: $ s5 7 , Sci`t � a c7 Description of the services performed as they directly relate to the work of this Request for Bid: ���•� � (.c��c.i� +� S ,c� �..:.:, �1 iK �:,�.� � � � J � w <�v :� `I �� i It ► cK c, r<ti �. ' i i-+� c K City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 67 ATTACHMENT H CITY OF OKEECHOBEE OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS PW 03-11-08-20 REFERENCE Client Name: i C0tNJ-ruc4,c)jJ LL C, Client Phone Number: Client E-mail: Iy Ail,(-,�na� v�am� r is :nc>,� �t rv.�-t �.►� �. �� ,-. Service Dates: Beginning I u- J- I ct End 3 S Estimated Annual Contract Amount: 0 1 +1(, Iss SU Description of the services performed as they directly relate to the work of this Request for Bid: rerC ��.� �1� F- �. �� s►d'p- = 1Ks City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 67 ATTACHMENT H CITY OF OKEECHOBEE OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS PW 03-11-08-20 REFERENCE Client Name: C_ W I ` C & fv i R A (. T) N (_ , / �; C_ Client Phone Number: 'is b 3 .1 C- 3 - -) 3,7 3 y�c;1 Q Cvj i ui� LtC T I NCB Client E-mail: � rr, � � � -� T� tC, �^ Service Dates: Beginning i - 10 - 1 ci End 3 - 3 - 19 Estimated Annual Contract Amount: _T I b v i C:,) . < Description of the services performed as they directly relate to the work of this Request for Bid: >O-T F - Cyr b-_�> ' s 1- .!S City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 67 ,4co o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) O8l31 /2020 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 Milton Carpenter Insurance, Inc. 135 S. E. Avenue C P.O. BOX 1270 Belle Glade FL 33430 CONTACT Tonya Stamm NAME: PHONE 863 824-0885 FAX (561)996-2601 AIC No Ext : ( ) A/c, No : E-MAIL tnya@miltoncarpenterins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Southern -Owners Insurance Company 10190 INSURED Vest Concrete Contractors Inc 1366 SW 18th Terrace Okeechobee FL 34974-4801 INSURER B : Owners Insurance Company 32700 INSURER C : Lanser Indemnity Company INSURER D : INSURER E : INSURERF: nn�r�on2�c r'T=PTI;3r'ATF All IMRFR• CL2041401994 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. TR TYPE OF INSURANCE INS❑ WVD POLICY NUMBER MMIDDY/YYW EXP MM/FF DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE N PREMISES Ea occurrence 300,000 $ X MED EXP (Any one person) $ 10,000 Hired Auto Liability A X Non Owned Auto Liability Y Y 72684185 03/30/2020 03/30/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY ❑X JEC ❑ LOC JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANYAUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y Y 4275305200 03/30/2020 03/30/2021 PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE 4275305201 03/30/2020 03/30/2021 AGGREGATE $ 1,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 10021 09/01/2020 09/01/2021 X STATUTE X ER I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Inland Marine Floater 72684185 03l30/2020 03/30/2021 Tools &Equipment DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Okeechobee is listed as an additional insured in regards to the General Liability and the Commercial Auto Liability. Waiver of Subrogation applies to both policies in favor of the City of Okeechobee. Okeechobee 2020 Sidewalk and Roadway Concrete Improvements r ;:PTlFlr-ATF Hnl r1FR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Okeechobee ACCORDANCE WITH THE POLICY PROVISIONS. 55 SE Third Avenue AUTHORIZED REPRESENTATIVE Okeechobee FL 34974 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ® ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 o/osl2o2o 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 Milton Carpenter Insurance, Inc. 135 S. E. Avenue C P.O. BOX 1270 Belle Glade FL 33430 CONTACT Tonya Stamm NAME: PHONE (863) 824-0885 FAX (561) 996-2601 A/C No AIC, No Ext : E-MAIL tnya@miltoncarpenterins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Southern -Owners Insurance Company 10190 INSURED Vest Concrete Contractors Inc 1366 SW 18th Terrace Okeechobee FL 34974-4801 INSURER B : Owners Insurance Company 32700 INSURER C : Lanser Indemnity Company INSURER D : INSURER E : 1INSURERF: COVERAGES CFRTIFICATF NUMBER: CL2041401994 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX] OCCUR UAMAUE I U REN I LU PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 Hired Auto Liability A X Non Owned Auto Liability Y Y 72684185 03/30/2020 03/30/2021 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 2,000,000 PRO POLICY JECT❑LOC -PRODUCTS- OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1.000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y Y 4275305200 03/30/2020 03/30/2021 PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE 4275305201 03/30/2020 03/30/2021 AGGREGATE $ 1,000,000 DED I I RETENTION $ $ O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 10021 09/01/2020 09/01/2021 H X STATUTE X ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Inland Marine Floater 72684185 03/30l2020 03/30/2021 Tools &Equipment DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Okeechobee is listed as an additional insured in regards to the General Liability and the Commercial Auto Liability. Waiver of Subrogation applies to both policies in favor of the City of Okeechobee. Okeechobee 2020 Sidewalk and Roadway Concrete Improvements rCMT!Clr ATM uni ncD CANCFI I ATICIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Okeechobee ACCORDANCE WITH THE POLICY PROVISIONS. 55 SE Third Avenue AUTHORIZED REPRESENTATIVE Okeechobee FL 34974 r @ 1988-2015 ACORD CORPORATION. All ngnts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA OKEECHOBEE COUNTY BUSINESS LICENSE PENALTY ADDED: OCT lst, 10%; NOV 1st, 15%; DEC 1st, 20%; JAN lst 25% THIS LICENSE IS FURNISHED IN PURSUANCE OF CHAPTER 205,FLORIDA STATUTES AND COUNTY ORDINANCE NO.79-2 VEST CONCRETE CONTRACTOR INC (MOBILE) 1366 SW 18TH TER OKEECHOBEE FL 34974 BUSINESS # 03164 2020 2021 CONTRACTOR CONCRETE 1 THIS LICENSE IS VALID ONLY IF NO OTHER LAW OR ORDINANCE IS VIOLATED. ESPECIALLY ZONING PRIOR COUNTY $18.00 PENALTY AMOUNT DUE LICENSE # DATE PAID $18.00 01601 9/30/2020 CELESTE WATFORD, TAX COLLECTOR OKEECHOBEE COUNTY 307 NW 5TH AVE STE B OKEECHOBEE, FL 34972 ORIGINAL CUSTOMER COPY �-X �3 W- Cityof Okeechobee VEST, RICHA REGULATORY PERMIT (863)634462 55S FL 3497 E 3rd Avenue, Okeechobee, 4 October 1, 2020 September 30, 2021 RECEIPT q. Address: 16 0 6 Sw 18TH TERRACE K Z PENALTY t OKEECHOBEE, FL 34974 APP1,TRAN", Act REG mbig iNSP FIREJNSP Toth ft" id 1Z, 'Issued to: VEST CONCRETE CONTRACTORS IN VEST RICHARD R I'D p 366'$* I 8TH TE)RRACE' ' OKEECHOBEE,F34974 7 A Business -A Tax Receipt Official -W: OKEECHOBEE COUNTY CONSTRUCTION INDUSTRY LICENSING BOARD Contractor License Number: OCSL0044-01 This CERTIFICATE. OF COMPETENCY certifies that Vest Concrete Construction Inc Richard Vest, Qualifier has complied xlk ith requirements of this Board as a Concrete & Masonry specialty Contractor Expires: 9/30/2021 Building Official: c- Request for Taxpayer Dive loan to the Form (Rev. Qctober2018) Identification Number and Certification requester. Do not Department of the Treasury send 'to -the IRS. Internal Revenue Service I► Go to vsewwJrs.gov1 brmM for instructions and 'tile latest information. 1 Name (as shown on your 'income tax return). Name is required on this line; do not leave this fine blank. VEST CONCRETE CONTRACTORS, INC 2 Business namaldisregarded entity name, If different from above m 0 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to C following seven boxes. certain entities, not individuals; see a o ❑ lndvidual/sols proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate instructions on page 3): to single -member LLC Exempt payee code (if any) CL , 52 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)1► o Mote. Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting = an LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is •federa'a code {if any) ts9 another LLC that is not disregarded from the owner for U.S. tax purposes. Otherwise, a single -member LLC than is disregarded from the owner should check the appropriate box for the tax classification of its owner. Other (see instructions) ® WPPries to ecceunls mairfsined outside the U.S.) W 5 Address (number, street, and apt. or suRe no.) See instructions. Requester's name and address (eptionai) 1366 SIN 18th TER 8 City, state, and ZIP code OKEECHOBEE, FL. 34974 7 List account number(s) here (optional) • Te�epeyei Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid 7 Socisl security number backup withholding. For individuals, this is generally your social security number (SS". However, for a l resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other I ®I entities, it is your employer identification number (EIN). If you do not have a number, see flow to get a iii iii III I TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also ssa Vfhat Name and Employer identification number Number To give the Paquester for guidelines on whose number to enter. 51,9 - 2 1 6 1 1 1 9 1 1 7 1 z Certification Under penalties of perjury, 1 certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject 'to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA codes) entered on this form (if any) indicating that I air+, exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the iRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments Other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. i 9'Cgn signature of iter'e �. U.S. parson ► _ `-x-�.r \ Y Q�C oats 0. General Instructions Section references are to the Internal Revenue Code unless otherwise notad. Futura devel:opinetats. For the latest information about developments rMated io Farm W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov1FannW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the iRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITiN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-€ (student ioan intterest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured prcparty) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. dependem Insurance Apenl MIL MAIN OFFICE 135 S.E. AVENUE C P.O. DRAWER 1270 BELLE GLADE, FLORIDA 33430 Toll Free: 1-800-472-5434 Telephone: (561) 996-7211 Fax: (561) 996-2601 MILTON O. CARPENTER, President October 5, 2020 City of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 RE: Vest Concrete Contractors, Inc. Policy # 4275305200 — Business Auto Policy # 72684185 — General Liability To Whom It May Concern: RPENTER ctytc� PI, PROFESSIONAL INSURANCE AGENTS BRANCH OFFICE CARPENTER INSURANCE 3960 S.E. 18 TERRACE OKEECHOBEE, FLORIDA 34974 Telephone: (863) 824-0885 peggy@miltoncarpenterins.com PEGGY CARPENTER-BRADY, Vice President Attached are certified copies of the Business Auto Policy and Commercial General Liability policy for Vest Concrete Contractors, Inc. If you have any questions, please feel free to contact me. Sincerely, Tonya Stamm Commercial Lines Manager/Agent Milton Carpenter Insurance, Inc. 59511 (10-19) 12-0422-00 MILTON CARPENTER INSURANCE INC 135 SE AVENUE C BELLE GLADE FL 33430-3527 09-15-2020 VEST CONCRETE CONTRACTORS INC 1366 SW 18TH TER OKEECHOBEE FL 34974-4801 auto -Owners INSURANCE LIFE • HOME • CAR • BUSINESS PO Box 30660 • Lansing, MI 48909-8160 517,323.1200 Southern -Owners Insurance Company You can view your policy, pay your bill, or change your paperless options at any time online at www.auto-owners.com. ADDITIONAL WAYS TO PAY YOUR BILL Pay Online www.auto-owners.com Pay by Mail Pay My Bill AUTO -OWNERS INSURANCE PO BOX 740312 Pay by Phone CINCINNATI, OH 45274-0312 1-800-288-8740 Your agency's phone number is 561-996-7211. RE: Policy 014682-72684185-20 Billing Account 014309304 Thank you for selecting Auto -Owners Insurance Group to serve your insurance needs! Feel free to contact your independent Auto -Owners agent with questions you may have. Auto -Owners and its affiliate companies offer a full complement of policies, each of which has its own eligibility requirements, coverages and rates. In addition, Auto -Owners also offers many billing options. Please take this opportunity to review your insurance needs with your Auto -Owners agent, and discuss which company, program, and billing option may be most appropriate for you. Auto -Owners Insurance Company was formed in 1916. Our A++ (Superior) rating by A.M. Best Company signifies that we have the financial strength to provide the insurance protection you need. The Auto -Owners Insurance Group is comprised of six property and casualty companies and a life insurance company. Serving Our Policyholders and Agents Since 1916 e'outhern-Owners Page 1 Issued 09-15-2020 INSURANCE COMPANY 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 MKT TERR 114 561-996-7211 INSURED VEST CONCRETE CONTRACTORS INC ADDRESS 1366 SW 18TH TER OKEECHOBEE FL 34974-4801 Description of Change LIABILITY COVERAGE PART ADDITIONAL INSURED IS ADDED TO: TAILORED PROTECTION POLICY DECLARATIONS Change Endorsement Effective 08-31-2020 POLICY NUMBER 014682-72684185-20 Company Use 72-46-FL-0603 Company Policy Term Bill 12:01 a.m. 12:01 a.m. to 03-30-2020 03-30-2021 55205 ADDITIONAL INSURED - INCLUDING PRODUCTS COMPLETED OPERATIONS NAME OF PERSON OR ORGANIZATION: CITY OF OKEECHOBEE Transaction Number: 003 Endorsement Premium: $55.05 ADDITIONAL (THIS IS NOT A BILL) Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55205 (12-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization (Additional Insured): OKEECHOBEE COUNTY BOCC / THE SEMINOLE TRIBE OF FLORIDA / LAWRENCE-LYNCH CORP / DICKERSON FLORIDA INC / NATIVE AMERICAN CONSTRUCTION LLC / LIFESTYLES & HEALTHCARE LTD / CITY OF OKEECHOBEE / (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Under SECTION II - WHO IS AN INSURED, the following is added: The person or organization shown in the above Schedule is an Additional Insured, but only with re- spect to liability arising out of "your work' for that insured by or for you. B. Under SECTION III - LIMITS OF INSURANCE, the following is added: The limits of liability for the Additional Insured are those specified in the written contract or agreement between the insured and the owner, lessee or con- tractor, not to exceed the limits provided in this policy. These limits are inclusive of and not in addition to the limits of insurance shown in the Declarations. C. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, the following is added: This insurance is primary for the person or organi- zation shown in the Schedule, but only with respect to liability arising out of "your work' for that person or organization by or for you. Other insurance available to the person or organization shown in the Schedule will apply as excess insurance and not contribute as primary insurance to the insurance provided by this endorsement. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55205 (12-04) Copyright, Insurance Services office, Inc., 1984, 2003. Page 1 of 1 59511 (7-15) 12-0422-00 MILTON CARPENTER INSURANCE INC 135 SE AVENUE C BELLE GLADE FL 33430-3527 02-07-2020 VEST CONCRETE CONTRACTORS INC 1366 SW 18TH TER OKEECHOBEE FL 34974-4801 RE: Policy 014682-72684185-20 t.Auto-Owners INSURANCE LIFE • HOME - CAR • BUSINESS P.O. BOX 30660 • LANSING, MICHIGAN 48909-8160 Southern -Owners Insurance Company Remember, you can view your policy, pay your bill or change your paperless options any time online, at www.auto-owners.com. If you have not already enrolled your policy, you may do so using policy number 014682-72684185-20 and Personal ID Code (PID) 9V1 K8V 29N. Your agency's phone number is 561-996-7211. Thank you for selecting Auto -Owners Insurance Group to serve your insurance needs! Feel free to contact your independent Auto -Owners agent with questions you may have. Auto -Owners and its affiliate companies offer a variety of programs, each of which has its own eligibility requirements, coverages and rates. In addition, Auto -Owners also offers many billing options. Please take this opportunity to review your insurance needs with your Auto -Owners agent, and discuss which company, program, and billing option may be most appropriate for you. Auto -Owners Insurance Company was formed in 1916. The Auto -Owners Insurance Group is comprised of five property and casualty companies and a life insurance company. Our A++ (Superior) rating by A.M. Best Company signifies that we have the financial strength to provide the insurance protection you need. - Serving Our Policyholders and Agents Since 1916 Agency Code 12-0422-00 Policy Number 014682-72684185 Dear Policyholder, NOTICE OF CHANGE IN POLICY TERMS FLORIDA INSUFFICIENT FUNDS FEE AMENDATORY 16827 (4-18) Effective with this renewal, endorsement 16757 (12-17) FLORIDA INSUFFICIENT FUNDS FEE AMENDATORY is included with the policy. This may constitute a reduction in coverage. Per Florida statute 627.4035(1)(b), this form allows for a fee of up to $15 per occurrence if your payment of premium by debit card, credit card, electronic funds transfer or electronic check is returned, declined or cannot be processed. Additionally, we may not charge you an insufficient funds fee if the failure in payment resulted from fraud or misuse of your account from which the payment was made and such fraud or misuse was not attributed to you. This notice is for informational purposes only. Your policy contains the specific terms and conditions of coverage. Please review the endorsement and your policy carefully. If you have any questions regarding your policy or this notice, please contact your Auto -Owners Insurance agency. 16827 (4-18) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55081 (5-18) AVAILABILITY OF RISK MANAGEMENT PLAN - FLORIDA The Florida Tort Reform and Insurance Act of 1986 requires insurance companies to make available to commercial casualty and commercial property policyholders guidelines for risk management plans. Risk management guidelines include the following: A. Safety measures, including, as applicable, the following areas: 1. Pollution and environmental hazards; 2. Disease hazards; 3. Accidental occurrences; 4. Fire hazards and fire prevention and detection; 5. Liability for acts from the course of business; 6. Slip and fall hazards; 7. Product injury; and 8. Hazards unique to a particular class or category of insureds. B. Training to insureds in safety management techniques. C. Safety management counseling services. Risk Management Plan guidelines are available at your request. If you desire this service, please contact your agent or our Loss Control Services department by e-mail at losscontrolsupport@aoins.com or by phone (855) 586-5388. 55081 (5-18) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55531 (6-11) NOTICE OF CHANGE IN POLICY TERMS YOUR SUBCONTRACTED WORK Dear Policyholder, Your policy has a subcontracted work classification. The subcontracted work classification requires that your sub- contractors are "adequately insured contractors". We define an "adequately insured subcontractor" to be a subcontractor who carries commercial general liability insurance. If your subcontractors are not "adequately insured subcontractors", they will be classified and rated as your employees and charged a premium which best describes their work. This classification procedure will result in a substantial additional premium charge to you at final audit. We suggest that you take immediate steps to qualify your subcontractors as "adequately insured subcontractors" to avoid any additional premium charges at final audit. If you have any questions, please contact your Auto -Owners Insurance agency. 55531 (6-11) Page 1 of 1 59243(6-00) Florida POLICYHOLDER INFORMATION AND ASSISTANCE We are here to serve you and as our policyholder your satisfaction is very important to us. Should you have any questions or a complaint regarding your policy that cannot be resolved by your agent, you may contact our Lakeland Regional Office for information and assistance by calling 863-687-4505. Auto -Owners Insurance Company Owners Insurance Company Southern -Owners Insurance Company 59243 (6-00) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 64816 (4-18) NOTICE OF CHANGE IN POLICY TERMS FLORIDA CHANGES Dear Policyholder, Effective with this renewal, endorsement 55881 (12-17) FLORIDA CHANGES — INSUFFICIENT FUNDS FEE is included with the policy. This may constitute a reduction in coverage. Per Florida statute 627.4035(1)(b), this form allows for a fee of up to $15 per occurrence if your payment of premium by debit card, credit card, electronic funds transfer or electronic check is returned, declined or cannot be processed. Additionally, we may not charge you an insufficient funds fee if the failure in payment resulted from fraud or misuse of your account from which the payment was made and such fraud or misuse was not attributed to you. This notice is for informational purposes only. Your policy contains the specific terms and conditions of coverage. Please review the endorsement and your policy carefully. If you have any questions regarding your policy or this notice, please contact your Auto -Owners Insurance agency. 64816 (4-18) Page 1 of 1 Tailored Protection Insurance Policy e outhern-Owners Insurance Company In witness whereof, we, the Southern -Owners Insurance Company, have caused this policy to be issued and to be duly signed by our President and Secretary. Secretary 55156 (7-12) President Jouthern-Owners Page , Issued 02-07-2020 INSURANCE COMPANY TAILORED PROTECTION POLICY DECLARATIONS 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 AGENCY MILTON CARPENTER INSURANCE INC Renewal Effective 03-30-2020 12-0422-00 MKT TERR 114 561-996-7211 POLICY NUMBER 014682-72684185-20 INSURED VEST CONCRETE CONTRACTORS INC Company Use 72-46-FL-0603 Company Policy Term ADDRESS 1366 SW 18TH TER Bill 12:01 a.m. 12:01 a.m. to OKEECHOBEE FL 34974-4801 03-30-2020 03-30-2021 Inconsideration of payment of the premium shown below, this policy is renewed. Please attach this Declarations and attachments to your policy. If you have any questions, please consult with your agent. 55039 (11-87) COMMON POLICY INFORMATION Business Description: Concrete Contractor Entity: Corporation Program: Premier Subcontractors THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PART(S): COMMERCIAL GENERAL LIABILITY COVERAGE COMMERCIAL INLAND MARINE COVERAGE SURTAX FLORIDA EMERGENCY TRUST FUND SURCHARGE TOTAL PAID IN FULL DISCOUNT TOTAL POLICY PREMIUM IF PAID IN FULL THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. The Paid in Full Discount does not apply to fixed fees, statutory charges or minimum premiums. PREMIUM $4,579.00 $759.00 $4.57 $4.00 $5,346.57 $504.42 $4,842.15 Premium shown above for commercial general liability coverage is an advanced premium deposit and may be subject to audit. Forms that apply to all coverage part(s) shown above (except garage liability, dealer's blanket, commercial automobile, if applicable): IL0017 (11-85) 59495 (08-11) 55156 (07-12) A 09% Cumulative Multi -Policy Discount applies. Supporting policies are marked with an (X): Comm Umb(X) Comm Auto(X) WC() Life() Personal() Farm(). A merit rating plan factor of 0.90 applies. Countersigned By: MILTON CARPENTER INSURANCE INC Page 2 Southern -Owners Ins. Co. AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 MKT TERR 114 INSURED VEST CONCRETE CONTRACTORS INC Issued 02-07-2020 Company POLICY NUMBER 014682-72684185-20 Bill 72-46-FL-0603 Term 03-30-2020 to 03-30-2021 55040 (11-87) COMMERCIAL GENERAL LIABILITY COVERAGE COVERAGE LIMITS OF INSURANCE General Aggregate $2,000,000 (Other Than Products -Completed Operations) Products -Completed Operations Aggregate $2,000,000 Personal Injury and Advertising Injury $1,000,000 Each Occurrence $1,000,000 Voluntary Damage to Property of Others Aggregate $25,000 Voluntary Damage to Property of Others Occurrence $5,000 COMMERCIAL GENERAL LIABILITY PLUS ENDORSEMENT Damage to Premises Rented to You $300,000 Any One Premises (Fire, Lightning, Explosion, Smoke or Water Damage) Medical Payments $10,000 Any One Person Hired Auto & Non -Owned Auto $1,000,000 Each Occurrence Expanded Coverage Details See Form: Extended Watercraft Personal Injury Extension Broadened Supplementary Payments Broadened Knowledge Of Occurrence Additional Products -Completed Operations Aggregate Blanket Additional Insured - Lessor of Leased Equipment Blanket Additional Insured - Managers or Lessors of Premises Newly Formed or Acquired Organizations Extension Blanket Waiver of Subrogation Twice the "General Aggregate Limit", shown above, is provided at no additional charge for each 12 month period in accordance with form 55300. AUDIT TYPE: Annual Audit Forms that apply to this coverage: 59351 (01-15) 55200 (06-96) IL0017 (11-85) 55146 (06-04) 55188 (09-04) 55238 (06-04) 55006 (12-04) 55300 (07-05) 55371 (01-07) 55205 (12-04) 55296 (09-09) 55531 (06-11) 55091 (10-08) CG0220 (03-12) 55513 (11-11) IL0021 (07-02) 55592 (02-14) 55637 (09-14) 55719 (11-15) 55718 (11-15) 55881 (12-17) Page 3 Southern -Owners Ins. Co. AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 MKT TERR 114 INSURED VEST CONCRETE CONTRACTORS INC LOCATION 0001 - BUILDING 0001 Location: 2975 Sw 3Rd Ter, Okeechobee, FL 34974-5966 Territory: 006 County: Okeechobee Issued 02-07-2020 Company POLICY NUMBER 014682-72684185-20 Bill 72-46-FL-0603 Term 03-30-2020 to 03-30-2021 CLASSIFICATION CODE SUBLINE PREMIUM BASIS RATE PREMIUM Commercial General Liability Plus Endorsement 00501 Prem/Op Prem Included At 7.5% Of The Premises Operation Premium Prem/Op Included Included Included Amendment Of Location & Project Aggregate Limits Of 00502 Prem/Op Prem Insurance Endorsement Included At 2% Of The Premises Operations Premium Premier Subcontractors Class Amendment Of Location 30502 Payroll Each 1000 & Project Aggregate Limts Of Insurance Prem/Op Included Included Included Premier Subcontractors Class Voluntary Property 31555 Payroll Each 1000 Damage Contracting Or Servicing Prem/Op Included Included Included Premier Subcontractors Class Voluntary Property 31556 Total Costs Each 1000 Damage Subcontractors Prem/Op Included Included Included Premier Subcontractors Class Concrete Construction 31560 Payroll Each 1000 Prem/Op $170,511 13.973 $2,383.00 Prod/Comp Op $170,511 11.265 $1,921.00 Premier Subcontractors Class Subcontracted Work 31585 Total Costs Each 1000 Prem/Op If Any 1.663 Included Prod/Comp Op If Any 3.853 Included Additional Interests 49950 55205 Add'L Insured - O/L/C 1. Okeechobee Co Bocc Prod/Comp Op Flat Charge $55.00 2. The Seminole Tribe Prod/Comp Op Flat Charge $55.00 3. Lawrence -Lynch Corp Prod/Comp Op Flat Charge $55.00 4. Dickerson Florida In Prod/Comp Op Flat Charge $55.00 S. Native American Cons Prod/Comp Op Flat Charge $55.00 COMMERCIAL GENERAL LIABILITY COVERAGE - LOCATION 0001 SUMMARY PREMIUM TERRORISM - CERTIFIED ACTS SEE FORM: 59351 EXCLUDED LOCATION 0001 $4,579.00 Page 4 Southern -Owners Ins. Co. AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 MKT TERR 114 INSURED VEST CONCRETE CONTRACTORS INC Issued 02-07-2020 Company POLICY NUMBER 014682-72684185-20 Bill 72-46-FL-0603 Term 03-30-2020 to 03-30-2021 16198 (07-87) COMMERCIAL INLAND MARINE COVERAGE COVERAGES PROVIDED Insurance applies to covered property for which a limit of insurance is shown. Forms that apply to Inland Marine: 16080 (08-86) 59351 (01-15) 16566 (12-14) 55081 (05-18) 16757 (12-17) LOCATION 0001 - BUILDING 0001 Location: 2975 Sw 3Rd Ter, Okeechobee, FL 34974-5966 Rating Information for TOOLS AND EQUIPMENT (TE)- ACTUAL CASH VALUE Territory: 047 County: Okeechobee Program: Premier Subcontractors COVERAGE COINSURANCE DEDUCTIBLE LIMIT RATE PREMIUM TOOLS AND EQUIPMENT (TE)- ACTUAL CASH VALUE INSURED'S EQUIPMENT - SPECIAL FORM Unscheduled Items Up To $2,500 Each $500 $9,700 Variable $210.00 TOTAL FOR THIS COVERAGE: $210.00 Rating Information for CONTRACTORS EQUIPMENT Territory: 047 County: Okeechobee Program: Premier Subcontractors Rate Class: 3 COVERAGE COINSURANCE DEDUCTIBLE LIMIT RATE PREMIUM CONTRACTORS EQUIPMENT CONTRACTORS EQUIPMENT - SPECIAL FORM 1. 2001 MILLER CURB BUILDER $500 $2,000 Variable $24.00 Serial #: J12649 Valuation: Actual Cash Value 2. 2018 JOHN DEERE TRACTOR $500 $27,550 Variable $331.00 Serial #: 1 LV4052RJHH101184 Valuation: Replacement Cost coverage until 03-30-2024 3. 2018 JOHN DEERE LOADER $500 $6,250 Variable $75.00 Attachment Serial #: 1 P0440RXTJC050572 Valuation: Replacement Cost coverage until 03-30-2024 Page 5 Southern -Owners Ins. Co. AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 MKT TERR 114 INSURED VEST CONCRETE CONTRACTORS INC Issued 02-07-2020 Company POLICY NUMBER 014682-72684185-20 Bill 72-46-FL-0603 Term 03-30-2020 to 03-30-2021 COVERAGE COINSURANCE DEDUCTIBLE LIMIT RATE PREMIUM 4. 2018 JOHN DEERE BACKHOE 500 9,900 Variable $119.00 Attachment Serial #: 1 LV0485AP110040831 Valuation: Replacement Cost coverage until 03-30-2024 TOTAL FOR THIS COVERAGE: $549.00 Forms that apply to this location: 16010 (04-15) 16241 (05-94) 16071 (07-09) COMMERCIAL INLAND MARINE COVERAGE - LOCATION 0001 SUMMARY PREMIUM TERRORISM - CERTIFIED ACTS SEE FORM: 59351 EXCLUDED LOCATION 0001 $759.00 A single deductible applies per claim. If more than one item is involved in a claim, the single highest applicable deductible amount is used. PREMIUM TOOLS AND EQUIPMENT SUBTOTAL $210.00 TOOLS AND EQUIPMENT BALANCE TO MINIMUM $0.00 Agency Code 12-0422-00 Policy Number 014682-72684185 59495 (8-11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION OR NONRENEWAL DESIGNATED PERSON(S) OR ORGANIZATION(S) OTHER THAN THE NAMED INSURED It is agreed: This policy is subject to the following condition: If this policy is canceled or nonrenewed, the designated person(s) or organization(s) shown in the SCHEDULE below shall be notified at least: 1. 10 days prior to the effective date of cancellation if we cancel for nonpayment of premium; or 2. The number of days shown in the SCHEDULE prior to the effective date if we cancel for any other reason. If the law of the state in which notice is mailed to requires a longer notice period, we will comply with those requirements. SCHEDULE Number of Days Notice 030 Name Of Designated Person(s) Or Organization(s) Mailing Address NATIVE AMERICAN CONSTRUCTION LLC 2971 SW 3RD TER OKEECHOBEE FL 34974-5966 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) All other policy terms and conditions apply. 59495 (8-11) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 59495 (8-11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION OR NONRENEWAL DESIGNATED PERSON(S) OR ORGANIZATION(S) OTHER THAN THE NAMED INSURED It is agreed: This policy is subject to the following condition: If this policy is canceled or nonrenewed, the designated person(s) or organization(s) shown in the SCHEDULE below shall be notified at least: 1. 10 days prior to the effective date of cancellation if we cancel for nonpayment of premium; or 2. The number of days shown in the SCHEDULE prior to the effective date if we cancel for any other reason. If the law of the state in which notice is mailed to requires a longer notice period, we will comply with those requirements. SCHEDULE Number of Days Notice 030 Name Of Designated Person(s) Or Organization(s) Mailing Address DICKERSON FLORIDA INC PO BOX 910 FORT PIERCE FL 34954-0910 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) All other policy terms and conditions apply. 59495 (8-11) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55188 (9-04) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTERIOR FINISHING SYSTEM AND STUCCO EXCLUSION - FORM B This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement applies only if the construc- tion which includes "your work" commenced on or after: 03/30/2007 (If no entry appears above, information required to complete this endorsement will be shown in the Supplemental Declarations as applicable to this endorsement.) A. Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions and COVERAGE B. PERSONAL INJURY AND ADVERTISING INJURY LIABILITY, 2. Exclusions, the following exclusion is added: Exterior Finishing System and Stucco This insurance does not apply to any claim, "suit", action or proceeding for "bodily injury", "property damage", "personal injury" or "advertising injury" which is in any way related to or arising out of an "exterior finishing system" or exterior "stucco" application. This exclusion does not apply to any claim, "suit", action or proceeding for "bodily injury" which occurs before completion of "your work". "Your work" is deemed completed: 1. When all of the work called for in your contract has been completed. 2. When all of the work to be done at the site has been completed if your contract calls for work at more than one site. 3. When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. B. The following definitions are added to SECTION V - DEFINITIONS: "Exterior finishing system", is an exterior insulating and finishing system applied to the exterior of a structure which incorporates any synthetic stucco or material similar in substance or purpose, and which may also include: insulating board or other material; adhesive or mechanical fasteners; and the application of flashings, coatings, caulking or sealants. "Stucco", is a material made of portland cement, sand, cement, lime, and/or plaster, or any combination thereof, applied as a hard covering for exterior walls. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55188 (9-04) Copyright, Insurance Services Office, 1982, 1988, 1997, 2000, 2002. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55205 (12-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. �Y�l.r�1771�� Name of Person or Organization (Additional Insured): OKEECHOBEE COUNTY BOCC / THE SEMINOLE TRIBE OF FLORIDA / LAWRENCE-LYNCH CORP / DICKERSON FLORIDA INC / NATIVE AMERICAN CONSTRUCTION LLC (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Under SECTION II - WHO IS AN INSURED, the following is added: The person or organization shown in the above Schedule is an Additional Insured, but only with re- spect to liability arising out of "your work" for that insured by or for you. B. Under SECTION III - LIMITS OF INSURANCE, the following is added: The limits of liability for the Additional Insured are those specified in the written contract or agreement between the insured and the owner, lessee or con- tractor, not to exceed the limits provided in this policy. These limits are inclusive of and not in addition to the limits of insurance shown in the Declarations. C. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, the following is added: This insurance is primary for the person or organi- zation shown in the Schedule, but only with respect to liability arising out of "your work" for that person or organization by or for you. Other insurance available to the person or organization shown in the Schedule will apply as excess insurance and not contribute as primary insurance to the insurance provided by this endorsement. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55205 (12-04) Copyright, Insurance Services office, Inc., 1984, 2003. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55371 (1-07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - PROJECTS AND OPERATIONS COVERED BY A CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. The following exclusion is added to paragraph This exclusion applies whether or not the consolidated SECTION I - COVERAGES, COVERAGE A. BODILY (wrap-up) insurance program: INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: (1) Provides coverage identical to that provided by this Coverage Part; This insurance does not apply to: Projects And Operations Covered By a Consolidated (Wrap-up) Insurance Program "Bodily injury" or "property damage" arising out of your ongoing operations or completed operations including those within the "products -completed operations hazard" for which a consolidated (wrap-up) insurance program has been provided by the prime contractor/project manager or owner of the construction project in which you are involved. (2) Has limits adequate to cover all claims; or (3) Remains in effect. This exclusion shall not apply at the location described in the Schedule of this endorsement. All other policy terms and conditions apply. SCHEDULE Description and Location of Projects and Operation(s): (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55371 (1-07) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002 Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55200 (6-96) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF LOCATION AND PROJECT AGGREGATE LIMITS OF INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. 1. The General Aggregate Limit under LIMITS OF INSURANCE (Section III) applies separately to each of your "loca- tions" owned by or rented to you. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 2. The General Aggregate Limit under LIMITS OF INSURANCE (SECTION III) applies separately to each of your pro- jects away from premises owned by or rented to you. Includes copyrighted material of Insurance Services Office, Inc., with its permission 55200 (6-96) Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55238 (6-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. A. Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, the following exclusions are added: Bodily injury" or "property damage" arising out of, in whole or in part, the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, any "fungi" or bacteria, whether air -borne or not, on or within a building or structure, including its contents. This exclusion applies whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. 2. Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person, entity or governmental authority. These exclusions do not apply to any "fungi" or bacteria that are on, or are contained in, a good or product intended for human consumption. B. Under SECTION I - COVERAGES, COVERAGE B. PERSONAL INJURY AND ADVERTISING INJURY LIABILITY, 2. Exclusions, the following exclusions are added: 1. Arising out of, in whole or in part, the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, any "fungi" or bacteria, whether airborne or not, on or within a building or structure, including its contents. This exclusion applies whether any other cause, event, material or product contributed concurrently or in any sequence to such injury. 2. For any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person, entity or governmental authority. C. The following definition is added to SECTION V - DEFINITIONS: "Fungi" means any type or form of fungus, including but not limited to, any mold, mildew, mycotoxins, spores, scents or byproducts produced or released by any type or form of fungus. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55238 (6-04) Copyright Insurance Services Office, Inc., 1982, 1988, 2001, 2002. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55296 (9-09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RECORDING AND DISTRIBUTION OF MATERIAL OR INFORMATION IN VIOLATION OF LAW EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following exclusion is added to SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclu- sions: Recording And Distribution Of Material Or Infor- mation In Violation Of Law "Bodily injury" or "property damage" arising directly or indirectly out of any action or omission that violates or is alleged to violate: a. The Telephone Consumer Protection Act (TCPA), including any amendment of or addi- tion to such law; b. The CAN-SPAM Act of 2003, including any amendment of or addition to such law; c. The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or d. Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. 2. The following exclusion is added to SECTION I - COVERAGES, COVERAGE B. PERSONAL INJURY AND ADVERTISING INJURY LIABILITY, 2. Exclusions: Recording And Distribution Of Material Or Infor- mation In Violation Of Law "Personal injury" or "advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: a. The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; b. The CAN-SPAM Act of 2003, including any amendment of or addition to such law; c. The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or d. Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. All other policy terms and conditions apply. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55296 (9-09) © Insurance Services Office, Inc., 2008 Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55592 (2-14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA -RELATED LIABILITY - WITH LIMITED BODILY INJURY EXCEPTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to Paragraph 2. Exclusion Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: Access Or Disclosure Of Confidential Or Personal Information And Data -related Liability Damages arising out of: (1) Any access to or disclosure of any person's or organization's confidential or personal in- formation, including patents, trade secrets, processing methods, customer lists, finan- cial information, credit card information, health information or any other type of non- public information; or (2) The loss of, loss of use of, damage to, cor- ruption of, inability to access, or inability to manipulate electronic data. 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 in- curred by you or others arising out of that which is described in Paragraph (1) or (2) above. However, unless Paragraph (1) above applies, this exclusion does not apply to damages be- cause of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. B. The following is added to Paragraph 2. Exclusions of Section I - Coverage B - Personal Injury And Advertising Injury Liability: 2. Exclusions This insurance does not apply to: Access Or Disclosure Of Confidential Or Personal Information "Personal injury" and "advertising injury" arising out of any access to or disclosure of any per- son's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health infor- mation or any other type of nonpublic informa- tion. 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 ac- cess to or disclosure of any person's or organi- zation's confidential or personal information. All other policy terms and conditions apply. 55592 (2-14) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55637 (9-14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRODUCTS -COMPLETED OPERATIONS HAZARD AMENDATORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Under SECTION V- DEFINITIONS, 17. "Products -completed operations hazard" is deleted and replaced by the following. 17. "Products -completed operations hazard": a. Includes all "bodily injury" and "property dam- age" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1) Products that are still in your physical pos- session; or (2) Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the fol- lowing times: (a) When all of the work called for in your contract has been completed. (b) When all of the work to be done at the job site has been completed if your con- tract calls for work at more than one job site. (c) When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b. Does not include "bodily injury" or "property damage" arising out of: (1) The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; or (2) The existence of tools, uninstalled equip- ment or abandoned or unused materials. All other policy terms and conditions apply. 55637 (9-14) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55719 (11-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA AMENDATORY ENDORSEMENT SUPPLEMENTARY PAYMENTS - COVERAGES A AND B This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Under SUPPLEMENTARY PAYMENTS — COVER- the insured unless the attorneys' fees or attorneys' AGES A AND B, S. is deleted and replaced by the expenses were taxed against the insured as a result following. of our rejection of an offer of judgment at or below the applicable limit of insurance while providing a 5. All costs taxed against the insured in the "suit" we defense for that insured. defend. However, such costs shall not include attorneys' fees or attorneys' expenses taxed against All other policy terms and conditions apply. 55719 (11-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 55881 (12-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA CHANGES - INSUFFICIENT FUNDS FEE This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CYBER LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART MANUFACTURERS ERRORS AND OMISSIONS LIABILITY COVERAGE PART MISCELLANEOUS PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART Common Policy Conditions are amended. The following condition is added. INSUFFICIENT FUNDS FEE We may impose an insufficient funds fee of up to $15 per occurrence, if, because of insufficient funds, your payment of premium by debit card, credit card, electronic funds transfer or electronic check is returned, declined or cannot be processed. However, we may not charge you an insufficient funds fee if the failure in payment resulted from fraud or misuse on your account from which the payment was made and such fraud or misuse was not attributed to you. All other policy terms and conditions apply. 55881 (12-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55006 (12-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VOLUNTARY DAMAGE TO PROPERTY OF OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. A. Under SECTION I - COVERAGES, the following coverage is added: 1. Insuring Agreement We agree to pay, at your request, for "loss" to property of others: a. Which is caused by any insured; or b. While in the insured's possession; and c. Arising out of operations: 1) Away from the insured's premises; and 2) Incidental to your business covered by the policy. 2. Exclusions This coverage does not apply to: a. "Loss" to property: 1) Held by any insured for servicing, repair, storage or sale at premises or the ways immediately adjoining which are: a) Owned; 2) While being transported by, caused by or which occurs during the loading or unloading of any: a) "Auto"; or b) Watercraft or aircraft owned, hired, used by or on behalf of any insured. 3) Owned, rented to, leased to, borrowed by or used by any insured. b. The cost of repairing or replacing any: 1) Product manufactured, sold or supplied by or work completed by any insured or his or her sub contractor, unless such damage or destruction: a) Is caused directly by any insured after the product is delivered or the work completed; and b) Results from a subsequent undertaking; 2) Property because of liability of others assumed by any insured under a contract or agreement; 3) Product manufactured, sold, handled or b) Rented or leased; or distributed by any insured or a conces- sionaire because of a warranty of such c) Operated or used product; or by any insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55006 (12-04) Copyright, Insurance Services Office, Inc., 1982, 1988, 2000, 2002. Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 4) Work completed by the insured or his sub contractor because of warranty of such work. c. "Loss" to property caused by or resulting from: 1) Blasting; 2) Excavation or related filling or back - filling; 3) Drilling, tunneling, pile driving, cofferdam or caisson work; or 4) Moving, shoring, underpinning, raising or demolition of any building or structure or rebuilding of the structural support of any such structure. d. "Loss" to property caused by or resulting from the operations of an independent contractor for any insured, but this exclusion does not apply to such contractors if coverage for "property damage" is provided by the policy. e. Loss to property caused by or arising out of the "products - completed operations haz- ard" as defined in the policy. f. The disappearance or abstraction of grop- e rty. g. The cost of labor and materials which are a part of the original operations being per- formed by you or a subconstractor. 3. Deductible The amount of $250 shall be deducted from the amount of each 'occurrence" covered by this endorsement. B. As it applies to this endorsement only, SECTION III - LIMITS OF INSURANCE, is deleted and replaced by the following: SECTION III - LIMITS OF INSURANCE Our liability under this endorsement for "loss" is lim- ited to $5,000 of any one 'occurrence", subject to a total aggregate limit of $25,000 for any one policy period. C. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: 1. As it applies to this endorsement only, 4. Other Insurance is deleted and replaced by the follow- ing: 4. Other Insurance If there is other valid and collectible insur- ance available to the insured for a loss cov- ered under this endorsement, this insurance is excess over such other insurance. 2. The following is added: REPAIR OR REPLACEMENT OF DAMAGED PROPERTY If we request it, the insured shall replace the damaged or destroyed property or furnish the labor or materials necessary to repair such property at actual cost to the insured excluding any profit or overhead. D. Under SECTION V - DEFINITIONS, the following definition is added: "Loss" means unintentional damage or destruction, including loss of use, but does not include disap- pearance or abstraction. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55006 (12-04) Copyright, Insurance Services Office, Inc., 1982, 1988, 2000, 2002. Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55091 (10-08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. 1. EXTENDED WATERCRAFT LIABILITY Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, g., exclusion (2) is deleted and is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 50 feet long; and (b) Not being used to carry persons or property for a charge; 2. HIRED AUTO AND NON -OWNED AUTO LIABILITY Coverage for "bodily injury" and "property damage" liability provided under SECTION I COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, is extended as follows under this item, but only if you do not have any other insurance available to you which affords the same or similar coverage. Coverage We will pay those sums the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" arising out of the main- tenance or use of an "auto": a. You do not own; b. Which is not registered in your name; or c. Which is not leased or rented to you for more than ninety consecutive days Exclusions With respect to only HIRED AUTO AND NON - OWNED AUTO LIABILITY, the exclusions which apply to SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, other than the Nuclear Energy Liability Exclusion Endorsement, do not apply. The following exclusions apply to this coverage: This coverage does not apply to: a. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b. Any obligation of the insured under a workers compensation, disability benefits or unemploy- ment compensation law or any similar law. c. (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a) That are, or are contained in any property that is: 1) Being transported or towed by, handled or prepared for placement into or upon, or taken from the "auto"; 2) Otherwise in the course of transit by and which is used in your business. you or on your behalf; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 1 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 3) Being disposed of, stored, treated or processed into or upon the "auto"; (b) Before such "pollutants" or property con- taining "pollutants" are moved from the place they are accepted by you or anyone acting on your behalf for placement into or onto the "auto"; or (c) After such "pollutants" or property containing "pollutants" are removed from the "auto" to where they are delivered, disposed of or abandoned by you or anyone acting in your behalf. c. (1) (a) above does not apply to "pollu- tants" that are needed or result from the normal mechanical, electrical or hydraulic functioning of the "auto" or its parts, if the discharge, release, escape, seepage, migration or dispersal of such "pollutants" is directly from a part of the "auto" designed to hold, store, receive or dispose of such "pollutants" by the "auto" manufacturer. c. (1) (b) and c. (1) (c) above do not apply, if as a direct result of maintenance or use of the "auto", "pollutants" or property contain- ing "pollutants" which are not in or upon the "auto", are upset, overturned or damaged at any premises not owned by or leased to you. The discharge, release, escape, seepage, migration or dispersal of the "pollutants" must be directly caused by such upset, overturn or damage. (2) Any loss, cost or expense arising out of any: (a) Request, demand or order that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or (b) Claim or "suit" by or on behalf of a gov- ernmental authority for damages be- cause of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of "pollutants". (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any govern- ment, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. e. "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages: (1) Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subse- quent to the execution of the contract or agreement. However, if the insurance under this policy does not apply to the liability of the insured, it also does not apply to such liability assumed by the insured under an "insured contract". (2) That the insured would have in the absence of the contract or agreement. f. "Property damage" to: (1) Property owned or being transported by, or rented or loaned to any insured; or (2) Property in the care, custody or control of any insured other than "property damage" to a residence or a private garage by a private passenger "auto" covered by this coverage. g. "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of employment by the insured; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. d. "Bodily injury" or "property damage" however This exclusion applies: caused, arising directly or indirectly, out of: Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 2 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 (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 dam- ages because of the injury. This exclusion does not apply to: (1) Liability assumed by the insured under an "insured contract". (2) "Bodily injury" to any "employee" of the in- sured arising out of and in the course of his domestic employment by the insured unless benefits for such injury are in whole or in part either payable or required to be pro- vided under any workers compensation law. Who Is An Insured With respect to only this coverage, SECTION II - WHO IS AN INSURED, is deleted and replaced by the following: SECTION II - WHO IS AN INSURED Each of the following is an insured with respect to this coverage: a. You. b. Your partners if you are designated in the Declarations as a partnership or a joint venture. c. Your members if you are designated in the Declarations as a limited liability company. d. Your "executive officers" if you are designated in the Declarations as an organization other than a partnership, joint venture or limited liability company. e. Any person using the "auto" and any person or organization legally responsible for the use of an "auto" not owned by such person or organiza- tion, provided the actual use is with your permis- sion. None of the following is an insured: b. Any person using the "auto" and any person other than you, legally responsible for its use with respect to an "auto" owned or registered in the name of: (1) Such person; or (2) Any partner or "executive officer" of yours or a member of his or her household; or (3) Any "employee" or agent of yours who is granted an operating allowance of any sort for the use of such "auto". c. Any person while employed in or otherwise engaged in duties in connection with an "auto business", other than an "auto business" you operate. d. The owner or lessee (of whom you are a sub- lessee) of a hired "auto" or the owner of an "auto" you do not own or which is not registered in your name which is used in your business or any agent or employee of any such owner or lessee. e. Any person or organization with respect to the conduct of any current or past partnership or joint venture that is not shown as a Named Insured in the Declarations. Additional Definitions The following definition applies to only this coverage: "Auto business" means the business or occupation of selling, repairing, servicing, storing or parking "autos". Limits of Insurance With respect to only this coverage, SECTION III - LIMITS OF INSURANCE, is deleted and replaced by the following: SECTION III - LIMITS OF INSURANCE a. The Limits of Insurance shown in the Declara- tions and the rules below fix the most we will pay regardless of the number of: a. Any person engaged in the business of his or (1) Insureds; her employer with respect to "bodily injury" to any co -"employee" of such person injured in the (2) Claims made or "suits" brought; or course of employment. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 3 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 (3) Persons or organizations making claims or bringing "suits". b. We will pay damages for "bodily injury" or "property damage" up to the limits of liability stated in the Declarations for this coverage. Such damages shall be paid as follows: (1) When Hired Auto and Non -Owned Auto Each Occurrence Limit is shown in the Declarations, such limit is the total amount of coverage and the most we will pay for all damages because of or arising out of all "bodily injury" and "property damage" in any one "occurrence". (2) When Bodily Injury Hired Auto and Non - Owned Auto Each Occurrence Limit and Property Damage Hired Auto and Non - Owned Auto Each Occurrence Limit are shown in the Declarations: (a) The limit shown for Bodily Injury Hired Auto and Non -Owned Auto Each Occur- rence is the total amount of coverage and the most we will pay for all dam- ages because of or arising out of all "bodily injury" in any one "occurrence". (b) The limit shown for Property Damage Hired Auto and Non -Owned Auto Each Occurrence is the total amount of cover- age and the most we will pay for all damages because of or arising out of all "property damage" in any one "occur- rence". 3. BROADENED SUPPLEMENTARY PAYMENTS Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, COVERAGE B. PERSONAL INJURY AND ADVERTISING INJURY LIABILITY and SUPPLEMENTARY PAYMENTS - COVERAGES A AND B: Paragraph 4., the amount we will pay for the actual loss of earnings is increased from $250 per day to $400 per day. 4. ADDITIONAL PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT is not attached to this policy, then the following is added to SECTION III - LIMITS OF INSURANCE: Commencing with the effective date of this policy, we will provide one additional Products -Completed Operations Aggregate Limit, for each annual period, equal to the amount of the Products -Completed Operations Aggregate Limit shown in the Declara- tions. The maximum Products -Completed Opera- tions Aggregate Limit for any annual period will be no more than two times the original Products - Completed Operations Aggregate Limit. 5. PERSONAL INJURY EXTENSION a. If the endorsement EXCLUSION - PERSONAL INJURY AND ADVERTISING INJURY, 55350, is attached to this policy, then this provision, 5. PERSONAL INJURY EXTENSION, does not apply. b. If the endorsement EXCLUSION - PERSONAL INJURY AND ADVERTISING INJURY, 55350, is not attached to this policy, then under SEC- TION V - DEFINITIONS, 15. "Personal injury" is deleted and replaced by the following: 15. "Personal injury" means, other than "bodily injury", arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution; c. 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 by or on behalf of its owner, landlord or lessor; d. Oral or written publication of material that slanders or libels a person or or- ganization or disparages a person's or organization's goods, products or services; e. Oral or written publication of material that violates a person's right of privacy; or f. Discrimination, humiliation, sexual If the endorsement, EXCLUSION - PRODUCTS harassment and any violation of civil COMPLETED OPERATIONS HAZARD, CG 21 04, rights caused by such discrimination, humiliation or sexual harassment. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 4 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 6. BROADENED KNOWLEDGE OF OCCURRENCE Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit, the follow- ing paragraph is added: Paragraphs a. and b. of this condition will not serve to deny any claim for failure to provide us with notice as soon as practicable after an 'occurrence" or an offense which may result in a claim: a. If the notice of a new claim is given to your "employee"; and b. That "employee" fails to provide us with notice as soon as practicable. This exception shall not apply: a. To you; or b. To any officer, director, partner, risk manager or insurance manager of yours. 7. DAMAGE TO PREMISES RENTED TO YOU Under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIA- BILITY, the last paragraph is deleted and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or water damage to premises rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in 7. DAMAGE TO PREMISES RENTED TO YOU, a. Limits of Insurance. The following additional exclusions apply to "pro- perty damage" arising out of Water Damage to premises rented to you or temporarily occupied by you with permission of the owner: (1) "Property damage" to: (a) The interior of the premises caused by or resulting from rain or snow, whether driven by wind or not; or (2) "Property damage" caused by or resulting from any of the following: (a) Mechanical breakdown, including bursting or rupture caused by cen- trifugal force; (b) Cracking, settling, expansion or shrinking; (c) Smoke or smog; (d) Birds, insects, rodents or other ani- mals; (e) Wear and tear; (f) Corrosion, rust, decay, fungus, dete- rioration, hidden or latent defect or any quality in property that causes such property to destroy or damage itself; or (g) Water that flows or leaks from any heating, air conditioning, plumbing or fire protection system caused by or resulting from freezing, unless: 1) You make a reasonable effort to maintain heat in the building or structure; or 2) You drain the equipment and shut off the water supply if the heat is not maintained. (3) "Property damage" caused directly or indirectly by any of the following: (a) Water that backs up from a drain or sewer; (b) Mud flow or mudslide; (c) Volcanic eruption, explosion or effusion; (d) Any earth movement, such as earth- quake, landslide, mine subsidence, earth sinking, earth rising or earth shifting; (e) Regardless of the cause, flood, surface (b) Heating, air conditioning, plumbing or water, waves, tides, tidal waves, storm fire protection systems, or other equip- surge, overflow of any body of water, or ment or appliances. their spray, all whether wind driven or not; Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 5 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 (f) Water under the ground surface pressing on, or seeping or flowing through: 1) Walls, foundations, floors or paved surfaces; 2) Basements, whether paved or not; or 3) Doors, windows or other openings. (4) "Property damage" for which the insured is obligated to pay as damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of this contract or agreement. a. Limits of Insurance With respect to this coverage only, under SECTION III - LIMITS OF INSURANCE, paragraph 6. is deleted and replaced by the following: 6. The most we will pay under Coverage A for damages because of "property damage" to premises rented to you or temporarily occupied by you with permission of the owner arising out of or caused by fire, lightning, explosion, smoke and water damage is the amount shown in the Declarations under Damage to Premises Rented to You. b. Under SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 4. Other Insurance, paragraph b., the word fire is amended to include fire, lightning, explosion, smoke or water damage. 8. BLANKET ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT a. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization with whom you have agreed: (1) In a written contract or agreement, executed prior to loss, to name as an additional insured; or (2) In an oral contract or agreement, executed prior to loss, to name as an additional insured only if a Certificate of Insurance was issued prior to loss indicating that the person or organization was an additional insured but only with respect to liability for: (1) "Bodily injury"; (2) "Property damage"; (3) "Personal injury"; or (4) "Advertising injury" caused in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. b. With respect to the insurance afforded to an additional insured, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. c. The following is added to SECTION III - LIMITS OF INSURANCE: The Limits of Insurance for the additional in- sured are those specified in the written contract or agreement between the insured and the lessor, not to exceed the limits provided in this policy. These limits are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. 9. BLANKET ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES a. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization with whom you have agreed: (1) In a written contract or agreement, executed prior to loss, to name as an additional insured; or (2) In an oral contract or agreement, executed prior to loss, to name as an additional insured only if a Certificate of Insurance was issued prior to loss indicating that the person or organization was an additional insured but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 6 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 b. This provision is subject to the following addi- tional exclusions, applicable to this provision only: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new constructions or demolition operations performed by or on behalf of the additional insured. c. The following is added to SECTION III - LIMITS OF INSURANCE: The Limits of Insurance for the additional in- sured are those specified in the written contract or agreement between the insured and the manager or lessor of the premises, not to exceed the limits provided in this policy. These limits are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. 10. NEWLY FORMED OR ACQUIRED ORGANIZA- TIONS Under SECTION II - WHO IS AN INSURED, Para- graph 4. is deleted and replaced by the following: 4. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal injury" or "advertising injury" arising out of an offense committed before you acquired or formed the organization. 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. 11. BLANKET WAIVER OF SUBROGATION The following is added to SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights of Recovery Against Others To Us. When you have agreed to waive your right of subro- gation in a written contract, executed prior to loss, with any person or organization, we waive any right to recovery we may have against such person or organization because of payments we make for injury or damage arising out of your ongoing opera tions or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". All other policy terms and conditions apply. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 7 of 7 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55146 (6-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UPSET AND OVERSPRAY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is agreed the coverage for "property damage" liability with respect to your operations is extended as follows: 1. COVERAGE We will pay those sums which you become legally obligated to pay for "property damage" caused directly by immediate, abrupt and accidental: a. Upset, overturn or collision of your "mobile equipment" while transporting; or b. "Overspray" during your application or dispersal of "pollutants" which are intended for and normally used in your operations. The operations must be in compliance with local, state, and federal ordinances and laws. This is not an additional amount of insurance and does not increase the Limits of Insurance stated in the Decla- rations. 2. EXCLUSIONS a. With regard only to the coverage provided by this endorsement, Exclusion f. of Section I - Coverage A - Bodily Injury And Property Damage Liability is deleted and replaced by the following: f. Pollution Any loss, cost or expense arising out of any: (1) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or (2) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of "pollutants". However, this paragraph does not apply to liability for damages because of covered "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55146 (6-04) Copyright, Insurance Services Office, Inc., 2000 Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 b. The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: This coverage does not apply to "overspray" resulting from aerial application or dispersal of "pollutants". 3. DEDUCTIBLE Any deductible provision of the policy which is applicable to Property Damage Liability coverage applies to this coverage extension. 4. DEFINITIONS The following definition applies in addition to those in the policy. "Overspray" means spray, from a device specifically designed for spray application or dispersal, that goes beyond the entire area of intended application or dispersal. All other policy terms and conditions apply. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55146 (6-04) Copyright, Insurance Services Office, Inc., 2000 Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 55300 (7-05) COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II - Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V - Definitions. SECTION I - COVERAGES (1) The "bodily injury" or "property damage" is caused by an "occurrence" that takes place COVERAGE A. BODILY INJURY AND PROPERTY in the "coverage territory"; DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured be- comes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. We may at our discretion investigate any claim or "occur- rence" and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III - Limits of Insurance; and (2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverage A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments - Coverages A and B. b. This insurance applies to "bodily injury" and "property damage" only if: (2) The "bodily injury" or "property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1. of Section II - Who Is An Insured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. "Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section II - Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim: (1) Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 1 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or (3) Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. d. Damages because of "bodily injury" include damages claimed by any person or organiza- tion for care, loss of services or death resulting at any time from the "bodily injury". 2. Exclusions This insurance does not apply to: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b. Contractual Liability "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a con- tract or agreement. This exclusion does not apply to liability for damages: (1) Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subse- quent to the execution of the contract or agreement. However, if the insurance under this policy does not apply to the liability of the insured, it also does not apply to such liability assumed by the insured under an "insured contract". (2) That the insured would have in the absence of the contract or agreement. c. Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. d. Workers Compensation And Similar Laws Any obligation of the insured under a workers compensation, disability benefits or unemploy- ment compensation law or any similar law. e. Employer's Liability "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of employment by the insured; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. 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. This exclusion does not apply to liability assumed by the insured under an "insured contract". f. Pollution (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a) At or from any premises, site or location (1) Causing or contributing to the intoxication of which is or was at any time owned or any person; occupied by, or rented or loaned to, any insured. However, this subparagraph does not apply to: Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 2 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 (i) "Bodily injury" if sustained within a building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use by the building's occupants or their guests; (ii) "Bodily injury" or "property damage" for which you may be held liable, if you are a contractor and the owner or lessee of such premises, site or location has been added to your policy as an additional insured with respect to your ongoing operations performed for that additional insured at that premises, site or location and such premises, site or location is not and never was owned or occupied by, or rented or loaned to, any insured, other than that additional insured; or (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (b) At or from any premises, site or location which is or was at any time used by or for any insured or others for the han- dling, storage, disposal, processing or treatment of waste; (c) Which are or were at any time trans- ported, handled, stored, treated, dis- posed of, or processed as waste by or for: (i) Any insured; or (ii) Any person or organization for whom you may be legally respon- sible; (d) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the "pollutants" are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. However, this subparagraph does not apply to: (i) "Bodily injury" or "property damage" arising out of the escape of fuels, lubricants or other operating fluids which are needed to perform the normal electrical, hydraulic or mech- anical functions necessary for the operation of "mobile equipment" or its parts, if such fuels, lubricants or other operating fluids escape from a vehicle part designed to hold, store or receive them. This exception does not apply if the "bodily injury" or "property damage" arises out of the intentional discharge, dispersal or release of the fuels, lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on or to the premises, site or location with the intent that they be discharged, dispersed or released as part of the operations being performed by such insured, contractor or subcontractor; (i i) "Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connec- tion with operations being performed by you or on your behalf by a contractor or subcontractor; or (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; or (e) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 3 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 (b) Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for damages because of covered "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrust- ment to others of any aircraft, "auto" or water- craft owned or operated by or rented or loaned to any insured. Use includes operation and "loading and unloading". This exclusion applies even if the claims against any insured allege negligence or other wrong- doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily in- jury" or "property damage" involved the owner- ship, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 26 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured con- tract" for the ownership, maintenance or use of aircraft or watercraft; or (5) "Bodily injury" or "property damage" arising out of the operation of any of the equipment listed in paragraph f.(2) or f.(3) of the definition of "mobile equipment". h. Mobile Equipment "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. i. War "Bodily injury" or "property damage", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any govern- ment, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. Damage To Property "Property damage" to: (1) Property you own, rent, occupy or use, in- cluding any cost or expense incurred by you, or any other person, organization or entity, for repair, replacement, enhance- ment, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 4 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 (2) Property that any of your: (a) "Employees"; (b) "Volunteer workers"; (c) Partners or members (if you are a partnership or joint venture); or (d) Members (if you are a limited liability company) own, rent, occupy or use. However, this exclusion j.(2), shall not apply to your liability for damage to such property; (3) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (4) Property loaned to you; (5) Personal property in the care, custody or control of, or over which physical control is being exercised for any purpose by any insured; (6) That particular part of real property on which any insured or any contractors or subcon- tractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (7) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs (1), (2), (4) and (5) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits Of Insurance. Paragraph (7) of this exclusion does not apply to "property damage" included in the "products - completed operations hazard". k. Damage To Your Product "Property damage" to "your product" arising out of it or any part of it. I. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard". m. Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1) A defect, deficiency, inadequacy or danger- ous condition in "your product" or "your work"; or (2) A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use. In. Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replace- ment, adjustment, removal or disposal of: (1) "Your product "; (2) "Your work"; or Paragraph (3) of this exclusion does not apply if (3) "Impaired property" the premises are "your work" and were never occupied, rented or held for rental by you. if such product, work or property is withdrawn or recalled from the market or from use by any Paragraphs (4), (5), (6) and (7) of this exclusion person or organization because of a known or do not apply to liability assumed under a side- suspected defect, deficiency, inadequacy or track agreement. dangerous condition in it. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003, Page 5 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 o. Personal Injury And Advertising Injury "Bodily injury" arising out of "personal injury" or "advertising injury". p. Employment -Related Practices "Bodily injury" to: (1) A person arising out of any: (a) Refusal to employ a person; (b) Termination of a person's employment; (c) Employment -related practice, policy, act or omission, including but not limited to coercion, demotion, evaluation, re- assignment, discipline, defamation, harassment, humiliation or discrimina- tion directed at a person; or (d) Criminal or civil action brought against a person by or at the direction of the insured directly or indirectly related to any offense described in (a), (b), or (c) above; or (2) Anyone as a consequence of "bodily injury" to a person at whom any of the employ- ment -related practices described in Para- graphs (a), (b), (c), or (d) above is directed. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; (2) Whether the offense is alleged to arise out of the employment during the course or scope of employment, outside the course or scope of employment or after termination of employment; (3) Whether directly or indirectly related to a person's prospective, current or past em- ployment; and (4) To any obligation to share damages with or repay someone else who must pay damages because of the injury. q. Asbestos dispersal, release, escape or inhalation of any asbestos -related particles, dust, irritants, contaminants, "pollutants", toxic elements or materials. r. Communicable Disease "Bodily Injury" arising out of or resulting from the transmission of any communicable disease by any insured. s. Silica Or Silica -Related Dust Any claim, "suit", action or proceeding against any insured arising out of the discharge, disper- sal, release, escape or inhalation of any "silica" or "silica -related dust". Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance. COVERAGE B. PERSONAL INJURY AND ADVER- TISING INJURY LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured be- comes legally obligated to pay as damages because of "personal injury" or "advertising injury" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. We may at our discretion investigate any claim or offense and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III - Limits Of Insurance; and (2) Our right and duty to defend end when we have used up the applicable limit of insur- ance in the payment of judgments or set- tlements under Coverage A or B or medi- cal expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments - Coverages A and B. Any claim, "suit", action or proceeding against b. This insurance applies to "personal injury" and any insured arising out of the discharge, "advertising injury" only if: Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003, Page 6 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 (1) The "personal injury" or "advertising injury" is caused by an offense arising out of your business; and (2) The offense causing the "personal injury" or "advertising injury" was committed in the "coverage territory" during the policy period. 2. Exclusions This insurance does not apply to "personal injury" or "advertising injury": a. Knowing Violation Of Rights Of Another Or Expected Or Intended Injury (1) Caused by or at the direction of any insured with the knowledge that the act would vio- late the rights of another and would inflict "personal injury" or "advertising injury"; or (2) Expected or intended by any insured. This exclusion a.(2), does not apply to "personal injury". b. Material Published With Knowledge Of Falsity Arising out of oral or written publication of material, if done by or at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period Arising out of oral or written publication of material whose first publication took place before the beginning of the policy period. d. Criminal Acts Arising out of a criminal act or violation of a penal statute or ordinance committed by or at the direction of the insured. e. Contractual Liability Arising out of a breach of contract, except an implied contract to use another's advertising idea in your "advertisement". g. Quality Or Performance Of Goods - Failure To Conform To Statements Or Representa- tions Arising out of the failure of goods, products or services to conform with any statement or repre- sentation of quality or performance made in your "advertisement". h. Wrong Description Of Prices Arising out of the wrong description of the price of goods, products or services. i. Infringement Of Copyright, Patent, Trademark Or Trade Secret Arising out of the infringement of copyright, patent, "trademark", trade secret or other intellectual property rights. However, this exclusion does not apply to in- fringement, in your "advertisement" of copy- right, "trade dress" or slogan. j. Insureds In Media And Internet Type Businesses Committed by an insured whose business is: (1) Advertising, broadcasting, publishing or telecasting; (2) Designing or determining content of websites for others; or (3) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs 15. a., b. and c. of "personal injury" under Section V - Definitions. For which the insured has assumed liability in a contract or agreement. This exclusion does not For the purposes of j.(1) of this exclusion, the apply to liability for damages that the insured placing of frames, borders, links, or advertising, would have in the absence of the contract or for you or others anywhere on the Internet, is agreement. not by itself, considered the business of adver- tising, broadcasting, publishing or telecasting. f. Breach of Contract Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 7 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 k. Electronic Chatrooms Or Bulletin Boards Arising out of an electronic chatroom or bulletin board the insured hosts, owns, or over which the insured exercises control for any purpose. I. Unauthorized Use Of Another's Name Or Product Arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatag, or any other similar tactics to mislead another's potential customers. m. Pollution (1) Arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. (2) For any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". n. Employment -Related Practices (1) Arising out of any: 55300 (7-05) (a) Refusal to employ a person; (b) Termination of a person's employment; (c) Employment -related practice, policy, act insured directly or indirectly related to any offense described in (a), (b), or (c) above; or (2) To anyone as a consequence of "personal injury" or "advertising injury" to a person at whom any of the employment -related practices described in Paragraphs (a), (b), (c), or (d) above is directed. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; (2) Whether the offense is alleged to arise out of the employment during the course or scope of employment, outside the course or scope of employment or after termination of employment; (3) Whether directly or indirectly related to a person's prospective, current or past em- ployment; and (4) To any obligation to share damages with or repay someone else who must pay dam- ages because of the injury. o. Asbestos For any claim, "suit", action or proceeding against any insured arising out of the discharge, dispersal, release, escape or inhalation of any asbestos -related particles, dust, irritants, con- taminants, "pollutants", toxic elements or materials. p. Communicable Disease Arising out of or resulting from the transmission of any communicable disease by any insured. q. War However, caused, arising directly or indirectly, out of: or omission, including but not limited to (1) War, including undeclared or civil war; coercion, demotion, evaluation, reas- signment, discipline, defamation, (2) Warlike action by a military force, including harassment, humiliation or discrimina- action in hindering or defending against an tion directed at a person; or actual or expected attack, by any govern- ment, sovereign or other authority using (d) Criminal or civil action brought against a military personnel or other agents; or person by or at the direction of the Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 8 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. r. Silica Or Silica -Related Dust Any claim, "suit", action or proceeding against any insured arising out of the discharge, disper- sal, release, escape or inhalation of any "silica" or "silica -related dust". COVERAGE C. MEDICAL PAYMENTS 1. Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; or (3) Because of your operations; provided that: (1) The accident takes place in the "coverage territory" and during the policy period; (2) The expenses are incurred and reported to us within one year of the date of the accident; and (3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. b. We will make these payments regardless of fault. These payments will not exceed the ap- plicable limit of insurance. We will pay reason- able expenses for: (1) First aid administered at the time of an accident; (2) Necessary medical, surgical, x-ray and dental services, including prosthetic devices; and 2. Exclusions We will not pay expenses for "bodily injury": a. Any Insured To any insured, except "volunteer workers". b. Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers compensation or disability benefit law or a similar law. e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports or athletics contests. f. Products -Completed Operations Hazard Included within the "products -completed opera- tions hazard". g. Coverage A Exclusions Excluded under Coverage A. h. Asbestos For any claim, "suit", action or proceeding against any insured arising out of the discharge, dispersal, release, escape or inhalation of any asbestos related particle, dust, irritant, contami- nant, pollutant, toxic element or material. i. Communicable Disease (3) Necessary ambulance, hospital, profes- Arising out of or resulting from the transmission sional nursing and funeral services. of any communicable disease by any insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 9 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 SUPPLEMENTARY PAYMENTS - COVERAGES A AND B If Coverage A or B apply, we will pay, with respect to any claim we investigate or settle, or any "suit" against an insured we defend: 1. All expenses we incur. 2. Up to $2000 for premiums on bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We have no obligation to apply for or furnish these bonds. 3. Premiums on appeal bonds or bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We have no obligation to apply for or furnish these bonds. 4. All reasonable expenses incurred by the insured at our request including actual loss of earnings up to $250 a day because of time off from work. 5. All costs taxed against the insured in the "suit". 6. Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. 7. All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insurance. SECTION II - WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a busi- ness of which you are the sole owner. b. A partnership or joint venture, you are an in- sured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Your "employees", other than either your "exec- utive officers" (if you are an organization other than a partnership, joint venture or limited lia- bility company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business, or your "volunteer workers" only while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for "bodily injury", "personal injury" or "advertising injury": (1) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability com- pany), to a co -"employee" while in the course of his or her employment or perform- ing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (2) To the spouse, child, parent, brother or sis- ter of that co -"employee" or "volunteer worker" as a consequence of Paragraph (1) above; (3) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) or (2) above; or (4) Arising out of his or her providing or failing to provide professional health care services. c. A limited liability company, you are an insured. b. Any person (other than your "employee" or Your members are also insureds, but only with "volunteer worker"), or any organization while respect to the conduct of your business. Your acting as your real estate manager. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 10 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. 3. With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equip- ment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person driving the equipment; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 4. Any organization you newly acquire or form, other 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. SECTION III - LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay re- gardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products completed operations hazard"; and c. Damages under Coverage B. 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard". than a partnership, joint venture or limited liability 4. Subject to 2. above, the Personal Injury and Adver- company, and over which you maintain ownership or tising Injury Limit is the most we will pay under majority interest, will qualify as a Named Insured if Coverage B for the sum of all damages because of there is no other similar insurance available to that all "personal injury" and all "advertising injury" organization. However: sustained by any one person or organization. a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and 5. Subject to 2, or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" c. Coverage B does not apply to "personal injury" arising out of any one 'occurrence". or "advertising injury" arising out of an offense committed before you acquired or formed the 6. The Damage To Premises Rented To You Limit is organization. the most we will pay under Coverage A for damages because of "property damage" to any one premises, Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 11 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medi- cal expenses because of "bodily injury" sustained by any one person. 8. Beginning with the effective date of this policy, we will provide twice the General Aggregate Limit (other than Products -Completed Operations), shown in the Declarations. If this policy is written for more than one 12 month period, the General Aggregate Limit for each 12 month period shall never exceed twice the General Aggregate Limit shown in the Declarations. The General Aggregate Limit applies separately to each 12 month period starting with the beginning of the policy period shown in the Declarations. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declara- tions, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or the in- sured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If any claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of any claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written no- tice of any claim or "suit" as soon as practi- cable. c. You and any other involved insured must: (1) Immediately send us copies of any corre- spondence, demands, notices, summonses or papers in connection with any claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of any claim or defense of any "suit"; and (4) Assist us, upon our request, in the enforce- ment of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. (2) The names and addresses of any injured A person or organization may sue us to recover on persons and witnesses; and an agreed settlement or on a final judgment against Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 12 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 an insured obtained after an actual trial; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed set- tlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverage A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obliga- tions are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over: (1) Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (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; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I - Coverage A - Bodily Injury And Property Damage Liability. and completed operations, for which you have been added as an additional insured by attachment of an endorsement. When this insurance is excess, we will have no duty under Coverage 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. When this insurance is excess over other insur- ance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insur- ance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self -insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total appicable limits of insurance of all insurers. S. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. (2) Any other primary insurance available to an b. Premium shown in this Coverage Part as ad - insured, other than an additional insured, vance premium is a deposit premium only. At covering liability for damages arising out of the close of each audit period we will compute the premises or operations, or the products the earned premium for that period and send Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 13 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computa- tion, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representa- tions you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us b. Subject to all the terms and conditions of the policy to comply with any motor vehicle insurance law to the extent such law applies to the "mobile equip- ment" covered by this Coverage Part. However, this coverage only applies in the absence of any other applicable insurance. SECTION V - DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web -sites, only that part of a web - site that is about your goods, products or ser- vices for the purpose of attracting customers or supporters is considered an advertisement. 2. "Advertising injury" means injury arising out of one or more of the following offenses: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to 3. us and help us enforce them. 9. Motor Vehicle Laws a. Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or or- ganization's goods, products or services in your "advertisement"; b. Oral or written publication, in any manner, of material that violates a person's right of privacy in your "advertisement"; c. The use of another's advertising idea in your "advertisement"; or d. Infringing upon another's copyright, "trade dress" or slogan in your "advertisement". "Auto" means a land motor vehicle, trailer or semi- trailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment". We will provide coverage: 4. "Bodily injury" means bodily injury, bodily sickness or bodily disease sustained by a person, including a. Up to the minimum required limits; and death resulting from any of these at any time. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 14 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 5. "Coverage territory" means: a. 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 a. above; or c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in a. above; (2) The activities of a person whose home is in the territory described in a. above, but is away for a short time on your business; or (3) "Personal injury" or "advertising injury" of- fenses that take place through the Internet or similar electronic means of comunication provided the insured's responsibility to pay damages is determined in a "suit" on the merits, in the territory described in a. above or in a settlement we agree to. 6. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". 7. "Executive officer" means a person holding any of the officer positions created by your charter, con- stitution, by-laws or any other similar governing document. 8. "Hostile fire" means one which becomes uncontrol- lable or breaks out from where it was intended to be. 9. "Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because: a. It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b. You have failed to fulfill the terms of a contract or agreement a. The repair, replacement, adjustment or removal of "your product" or "your work"; or b. Your fulfilling the terms of the contractor agree- ment. 10. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of pre- mises that indemnifies any person or organiza- tion for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to in- demnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; or f. That part of any other contract or agreement pertaining to your business (including an indem- nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of con- struction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road- beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to pre - if such property can be restored to use by: pare or approve, maps, shop drawings, Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 15 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 opinions, reports, surveys, field orders, change orders or drawings and specifi- cations; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the in- sured's rendering or failure to render profes- sional services, including those listed in (2) above and supervisory, inspection, archi- tectural or engineering activities. 11. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". 12. "Loading or unloading" means the handling of pro- perty: a. After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b. While it is in or on an aircraft, watercraft or "auto"; or c. While it is being moved from an aircraft, water- craft or "auto" to the place where it is finally delivered but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or "auto". 13. "Mobile equipment" means any of the following types of land vehicles, including any attached ma- chinery or equipment: a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; d. Vehicles, whether self-propelled or not, main- tained primarily to provide mobility to perma- nently mounted: (1) Power cranes, shovels, loaders, diggers or drills; or (2) Road construction or resurfacing equipment such as graders, scrapers or rollers; e. Vehicles not described in a., b., c., or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1) Air compressors, pumps and generators, including spraying, welding, building clean- ing, geophysical exploration, lighting and well servicing equipment; or (2) Cherry pickers and similar devices used to raise or lower workers; or f. Vehicles not described in a., b., c., or d. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the follow- ing types of permanently attached equipment are not "mobile equipment" but will be consid- ered "autos": (1) Equipment designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; (2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; or (3) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. b. Vehicles maintained for use solely on or next to premises you own or rent; 14. "Occurrence" means an accident, including con- tinuous or repeated exposure to substantially the c. Vehicles that travel on crawler treads; same general harmful conditions. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003, Page 16 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 15. "Personal injury" means other than "bodily injury" arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution; c. 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; d. Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or organi- zation's goods, products or services; or e. Oral or written publication, in any manner, of material that violates a person's right of privacy. 16. "Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 17. "Products -completed operations hazard": a. Includes all "bodily injury" and "property dam- age" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1) Products that are still in your physical possession; or (2) Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: 55300 (7-05) (a) When all of the work called for in your contract has been completed. (b) When all of the work to be done at the job site has been completed if your con- tract calls for work at more than one job site. (c) When that part of the work done at a job Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b. Does not include "bodily injury" or "property damage" arising out of: (1) The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; (2) The existence of tools, uninstalled equip- ment or abandoned or unused materials; or (3) Products or operations for which the clas- sification, shown in the Declarations, states that products -completed operations are included. 18. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of use of tangible property that is not physi- cally injured. All such loss shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and appli- cations software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 19. "Silica" means silicon dioxide (occurring in crystal- line, amorphous and impure forms), silica particles, silica dust or silica compounds. site has been put to its intended use by 20. "Silica -related dust" means a mixture or combination any person or organization other than of silica and other dust or particles. another contractor or subcontractor working on the same project. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 17 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 21. "Suit" means a civil proceeding in which damages because of "bodily injury", "property damage", "personal injury" or "advertising injury" to which this insurance applies are alleged. "Suit" includes: a. An arbitration proceeding in which such dam- ages are claimed and to which the insured must submit or does submit with our consent; or b. Any other alternative dispute resolution proceed- ing in which such damages are claimed and to which the insured submits with our consent. 22. "Temporary worker" means a person who is fur- nished to you to substitute for a permanent "em- ployee" on leave or to meet seasonal or short-term workload conditions. 23. "Trademark" means any registered or unregistered word, name, symbol, sign, device or any combi- nation thereof used to identify or distinguish a person's or organization's goods, products or services from those of others and to indicate or identify the origin or source of such goods, prod- ucts or services, even if the origin or source is unknown. "Trademark" includes registered "trade dress" and "trade dress" which is used with or in- corporates any "trademark". 24. "Trade dress" means the unregistered and non- functional distinctive packaging, appearance, image, design, color scheme or shape or combination thereof used to identify or distinguish a person's or organization's goods, products or services from those of others and to indicate or identify the origin or source of such goods, products or services, even if the source is unknown. "Trade dress" does not include: a. Registered "trade dress"; b. "Trademark"; or c. "Trade dress" which is used with or incorporates any "trademark". 25. "Volunteer worker" means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. 26. "Your product": a. Means: (1) Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a) You; (b) Others trading under your name; or (c) A person or organization whose busi- ness or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your pro- duct"; and (2) The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. 27. "Your work": a. Means: (1) Work or operations performed by you or on your behalf; and (2) Materials, parts or equipment furnished in connection with such work or operations. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work"; and (2) The providing of or failure to provide warnings or instructions. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55300 (7-05) Copyright, Insurance Services Office, Inc., 1982, 1988, 1997, 2000, 2002, 2003. Page 18 of 18 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY 55513 (11-11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYER'S LIABILITY EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION I - COVERAGES is amended as follows. d. An organization other than a partnership, Under COVERAGE A. BODILY INJURY AND joint venture or limited liability company, you PROPERTY DAMAGE LIABILITY, 2. EXCLU- are an insured. Your "executive officers" SIONS, exclusion e. Employer's Liability is deleted and directors are insureds, but only with re - and replaced by the following exclusion. spect to their duties as your officers or direc- e. Employer's Liability tors. Your stockholders are also insureds, "Bodily injury" to: but only with respect to their liability as (1) An "employee" of any insured arising out of stockholders. and in the course of employment by any in- e. A trust, you are an insured. Your trustees sured; or are also insureds, but only with respect to (2) The spouse, child, parent, brother or sister their duties as trustees. of that "employee" as a consequence of However, with respect to paragraphs 1.a. Paragraph (1) above. through 1.e. above, no person is an insured for This exclusion applies: "bodily injury", "personal injury" or "advertising (1) Whether any insured may be liable as an injury": employer or in any other capacity; and a. To: (2) To any obligation to share damages with or (1) You and your spouse if the Named In - repay someone else who must pay dam- sured is an individual; ages because of the injury. (2) Your members, your partners and their This exclusion does not apply to liability as- spouses if the Named Insured is a part- sumed by any insured under an "insured con- nership or joint venture; tract". (3) Your members if the Named Insured is 2. SECTION II - WHO IS AN INSURED is amended as a Limited Liability Company; follows. (4) Your "executive officers" and directors if Paragraph 1. is deleted and replaced by the follow- the Named Insured is other than a part- ing. nership, joint venture or limited liability 1. If you are designated in the Declarations as: company; or a. An individual, you and your spouse are (5) Your trustees if the Named Insured is a insureds, but only with respect to the con- trust. duct of a business of which you are the sole b. To an "employee" of any insured while in the owner. course of his or her employment or perform- b. A partnership or joint venture, you are an in- ing duties related to the conduct of any in- sured. Your members, your partners, and sured's business. their spouses are also insureds, but only c. To any insured's "volunteer workers" while with respect to the conduct of your busi- performing duties related to the conduct of ness. any insured's business; c. A limited liability company, you are an in- d. To the spouse, child, parent, brother or sis- sured. Your members are also insureds, but ter of any "employee" or "volunteer worker" only with respect to the conduct of your as a consequence of Paragraphs b. or c. business. immediately above. 55513 (11-11) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 e. For which there is any obligation to share f. Arising out of his or her providing or failing damages with or repay someone else who to provide professional health care services. must pay damages because of the injury described in Paragraphs a., b. and c. imme- All other policy terms and conditions apply. diately above. 55513 (11-11) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 55718 (11-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - UNMANNED AIRCRAFT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Exclusion 2.g. Aircraft, Auto Or Watercraft under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIA- BILITY is deleted and replaced by the following. 2. Exclusions This insurance does not apply to: g. Aircraft, Auto Or Watercraft (1) Unmanned Aircraft "Bodily injury" or "property damage" arising out of the ownership, mainte- nance, use or entrustment to others of any aircraft that is an "unmanned air- craft". Use includes operation and "loading or unloading". This Paragraph g.(1) applies even if the claims against any insured allege negli- gence or other wrongdoing in the super- vision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any air- craft that is an "unmanned aircraft". (2) Aircraft (Other Than Unmanned Aircraft), Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, mainte- nance, use or entrustment to others of any aircraft (other than "unmanned air- craft"), "auto" or watercraft owned or op- erated by or rented or loaned to any in- sured. Use includes operation and "loading or unloading". This Paragraph g.(2) applies even if the claims against any insured allege negli- gence or other wrongdoing in the super- vision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any air- craft (other than "unmanned aircraft"), "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This Paragraph g.(2) does not apply to: (a) A watercraft while ashore on premises you own or rent; (b) A watercraft you do not own that is: (i) Less than 26 feet long; and (ii) Not being used to carry persons or property for a charge; (c) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (d) Liability assumed under any "in- sured contract" for the ownership, maintenance or use of aircraft or watercraft; or (e) "Bodily injury" or "property damage" arising out of the operation of any of the equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment". B. The following exclusion is added to Paragraph 2. Exclusions of COVERAGE B. PERSONAL IN- JURY AND ADVERTISING INJURY LIABILITY. 2. Exclusions This insurance does not apply to: Unmanned Aircraft "Personal injury" or "advertising injury" arising out of the ownership, maintenance, use or en- trustment to others of any aircraft that is an "un- manned aircraft". Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrong- doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the offense which caused the "personal injury" 55718 (11-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 or "advertising injury" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". This exclusion does not apply to: a. The use of another's advertising idea in your "advertisement"; or b. Infringing upon another's copyright, trade dress or slogan in your "advertisement". C. The following definition is added to SECTION V - DEFINITIONS. "Unmanned aircraft" means an aircraft that is not: 1. Designed; 2. Manufactured; or 3. Modified after manufacture to be controlled directly by a person from within or on the aircraft. All other policy terms and conditions apply. 55718 (11-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMERCIAL GENERAL LIABILITY CG 02 20 03 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART A. Paragraph 2. of the Cancellation Common Policy Condition is replaced by the following: 2. Cancellation Of Policies In Effect: a. For 90 Days Or Less If this policy has been in effect for 90 days or less, we may cancel this policy by mailing or delivering to the first Named Insured writ- ten notice of cancellation, accompanied by the reasons for cancellation, at least: (1) 10 days before the effective date of can- cellation if we cancel for non-payment of premium; or (2) 20 days before the effective date of can- cellation if we cancel for any other rea- son, except we may cancel immediately if there has been: (a) A material misstatement or misrep- resentation; or (b) A failure to comply with the under- writing requirements established by the insurer. b. For More Than 90 Days If this policy has been in effect for more than 90 days, we may cancel this policy only for one or more of the following reasons: (1) Nonpayment of premium; (2) The policy was obtained by a material misstatement; (3) Failure to comply with underwriting re- quirements established by the insurer within 90 days of the effective date of coverage; (4) A substantial change in the risk covered by the policy; or (5) The cancellation is for all insureds under such policies for a given class of in- sureds. If we cancel this policy for any of these rea- sons, we will mail or deliver to the first Named Insured written notice of cancella- tion, accompanied by the reasons for can- cellation, at least: (a) 10 days before the effective date of can- cellation if we cancel for non-payment of premium; (b) 45 days before the effective date of can- cellation if we cancel for any of the other reasons stated in paragraph 2.b. B. Paragraph 3. of the Cancellation Common Policy Condition is replaced by the following: 3. We will mail or deliver our notice to the first Named Insured at the last mailing address known to us. C. Paragraph 5. of the Cancellation Common Policy Condition is replaced by the following: 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. If the return premium is not re- funded with the notice of cancellation or when this policy is returned to us, we will mail the re- fund within 15 working days after the date can- cellation takes effect, unless this is an audit policy. If this is an audit policy, then, subject to your full cooperation with us or our agent in securing the necessary data for audit, we will return any pre- CG 02 20 03 12 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 mium refund due within 90 days of the date can- cellation takes effect. If our audit is not com- pleted within this time limitation, then we shall accept your own audit, and any premium refund due shall be mailed within 10 working days of receipt of your audit. The cancellation will be effective even if we have not made or offered a refund. D. The following is added and supersedes any other provision to the contrary: Nonrenewal 1. If we decide not to renew this policy we will mail or deliver to the first Named Insured written no- tice of nonrenewal, accompanied by the reason for nonrenewal, at least 45 days prior to the ex- piration of this policy. 2. Any notice of nonrenewal will be mailed or deliv- ered to the first Named Insured's last mailing ad- dress known to us. If notice is mailed, proof of mailing will be sufficient proof of notice. CG 02 20 03 12 Copyright, Insurance Services Office, Inc., 1992 Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 16010 (4-15) COINSURANCE CONTRACT TOOLS AND EQUIPMENT FLOATER PROPERTY COVERED We cover the property which is: 1. described for this coverage in the Declarations; and 2. owned by: a. you; or b. your employees; while the property is on the insured premise or else- where in the course of your business. AMOUNT OF INSURANCE We will not pay more than: 1. the limit of insurance stated in the Declarations for any one loss occurrence; or 2. $2,500 ON ANY ONE ITEM UNLESS ANOTHER AMOUNT IS SPECIFICALLY SCHEDULED. PERILS WE INSURE AGAINST We cover risk of direct physical loss or damage, not ex- cluded in this form, to the property covered. EXCLUSIONS We do not cover under this form loss or damage caused directly or indirectly by any of the following, whether or not any other cause or happening contributes concur- rently or in any sequence to the loss or damage: 1. Seizure or destruction of property by order of gov- ernmental authority. But we will pay for such acts of destruction taken at the time of a fire to prevent its spread if the fire would be covered under this form. 2. Nuclear action meaning nuclear reaction, radiation, radioactive contamination, discharge of a nuclear weapon, however caused and whether controlled or uncontrolled, or any consequence of any of these. We will cover direct loss resulting from fire if caused by any of these, if fire is covered elsewhere in this form. 3. War (declared or undeclared), civil war, insurrection, rebellion or revolution. 4. Wear and tear; inherent vice; hidden or latent defect; gradual deterioration; mechanical break down; in- sects, vermin, rodents; depreciation; or by processing or any work on the property. We will cover direct loss from fire or explosion which is caused by any of these. 5. Corrosion, rusting, dampness of atmosphere, or extremes of temperature. 6. Misappropriation, secretion, conversion, infidelity or any dishonest act by you or others or the employees or agents of either to whom the covered property may be entrusted. This exclusion does not apply to carriers for hire. 7. Artificially generated electrical currents to electrical apparatus. We will cover loss or damage caused directly by ensuing fire or explosion. 8. The weight of a load exceeding the registered lifting or supporting capacity of any machine. 9. Strikes, lockouts, labor disturbances; riots and civil commotion; or the acts of any person or persons taking part in such occurrences or disorders. 10. Theft by an insured's employees or a person to whom the insured property is entrusted. 11. Loss or damage by an unexplainable or unaccount- able cause where there is no visible evidence that the loss or damage resulted from a peril insured against. ADDITIONAL CONDITIONS 1. Coinsurance Clause We will pay no more than the amount of loss or damage multiplied by the ratio of the amount of in- surance on the property covered to its actual cash value at the time of loss or damage. 2. Territory This policy applies only within the continental United States and Canada. 3. Special Condition Each item of the schedule is deemed to be sepa- rately insured. All other policy terms and conditions apply. 16010 (4-15) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 16241 (5-94) NEWLY ACQUIRED CONTRACTORS EQUIPMENT ENDORSEMENT It is agreed: PROPERTY COVERED includes contractors equipment of the type described in the Declarations, which is acquired 1. you report such newly acquired equipment to us within 30 days from the date acquired; and 2. you pay any required extra premium. For the purposes of this endorsement, PROPERTY COVERED does not include any contractors equipment you borrow or any contractors equipment you rent or lease for a period of time which is less than one year. All other terms and conditions of the policy apply. 16241 (5-94) Florida AMENDATORY ENDORSEMENT - COINSURANCE CONTRACT Commercial Inland Marine It is agreed: Page 1 of 1 16566 (12-14) The following provision is added when Coinsurance the coinsurance clause attached to this policy, with the applies. consent of the insured. Coinsurance contract: The rate charged in this policy is based upon the use of All other policy terms and conditions apply. 16566 (12-14) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 It is agreed: Florida INSUFFICIENT FUNDS FEE AMENDATORY Commercial Inland Marine Coverage COMMERCIAL INLAND MARINE CONDITIONS, SPECIAL CONDITIONS is amended. The following condition is added. INSUFFICIENT FUNDS We may impose an insufficient funds fee of up to $15 per occurrence, if, because of insufficient funds, your payment of premium by debit card, credit card, 16757 (12-17) electronic funds transfer or electronic check is returned, declined or cannot be processed. However, we may not charge you an insufficient funds fee if the failure in payment resulted from fraud or misuse on your account from which the payment was made and such fraud or misuse was not attributed to you. All other policy terms and conditions apply. 16757 (12-17) Page 1 of 1 Agency Code 12-0422-00 Policy Number 014682-72684185 COINSURANCE CONTRACT CONTRACTORS EQUIPMENT FORM COVERAGE 1. Property Covered We cover the property described in the Declarations under Contractors Equipment. 2. Property Not Covered We do not cover: a. automobiles or similar vehicles; b. plans, blue prints, designs or specifications; c. property while stored or operated underground in connection with any mining operations; and d. property which has become a permanent part of any structure. PERILS WE INSURE AGAINST We cover accidental direct physical loss or damage to covered property, except for losses excluded in this form. EXCLUSIONS 16071 (7-09) We do not cover under this form loss or damage caused directly or indirectly by any of the following, whether or not any other cause or happening contributes concurrently or in any sequence to the loss or damage: 1. Seizure or destruction of property by order of governmental authority. We will pay for such acts of destruction taken at the time of a fire to prevent its spread if the fire would be covered under this form. 2. Nuclear action meaning nuclear reaction, radiation, radioactive contamination, discharge of a nuclear weapon, however caused and whether controlled or uncontrolled, or any consequence of any of these. We will cover direct loss resulting from fire if caused by any of these, if fire is covered elsewhere in this form. 3. War (declared or undeclared), civil war, insurrection, rebellion or revolution. 4. Wear and tear; inherent vice; hidden or latent defect, gradual deterioration; mechanical break down; insects, vermin, rodents; or depreciation. We will cover direct loss from fire or explosion which is caused by any of these. 5. A process to repair, adjust, service or maintain the property covered. If a fire or explosion results, we will cover the loss caused by the fire or explosion. 6. Corrosion, rusting, dampness of atmosphere, or extremes of temperature. 7. Misappropriation, secretion, conversion, infidelity or any dishonest act by you or others or the employees or agents of either to whom the covered property may be entrusted. This exclusion does not apply to carriers for hire. 8. Artificially generated electrical currents to electrical apparatus. We will cover loss or damage caused directly by ensuing fire or explosion. 9. The weight of a load exceeding the registered lifting or supporting capacity of any machine. 10. While covered property is being supported or carried on water except loss or damage caused by fire. 11. Strikes, lockouts, labor disturbances, riots and civil commotion; or the acts of any person or persons taking part in such occurrences or disorders. LIMITS OF LIABILITY We shall not be liable for more than the limits shown in the Declarations under Contractors Equipment. 16071 (7-09) Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 ADDITIONAL CONDITIONS Coinsurance Clause We will pay no more than the amount of loss or damage multiplied by the ratio of the amount of insurance on the property covered to 100% of its actual cash value or replacement cost, as stated in the Declarations or Schedule, at the time of loss. Territory This policy applies only within the continental United States and Canada. Special Condition Each item of property described in the Declarations under Contractors Equipment is deemed to be separately insured. Under COMMERCIAL INLAND MARINE CONDITIONS, SPECIAL CONDITIONS, the condition VALUATION is de- leted and replaced by the following as it applies to this form only: VALUATION Loss of or damage to property covered shall be adjusted on the basis of: 1, actual cash value; or 2. replacement cost as stated in the Declarations or Schedule. Replacement cost is the value of the covered property based on the cost at the time of loss to repair or replace the covered property with like kind or quality without any deduction for depreciation and subject to the following: 1. Replacement cost valuation will not apply until actual repair or replacement of the damaged or destroyed covered property occurs. 2. If you decide not to repair or replace the damaged or destroyed covered property, we will settle on an actual cash value basis and deduct for depreciation. You may make a claim within 180 days after the loss for any additional payment on a replacement cost basis. All scheduled items valued on a Replacement Cost basis will automatically change to Actual Cash Value when the age of the item exceeds five years as determined by the original date of manufacture. 16071 (7-09) Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 16080 (8-86) COMMERCIAL INLAND MARINE CONDITIONS INSURING AGREEMENT We agree to provide insurance subject to all the terms of this coverage part. In return, you must pay the premium and comply with all the terms of this coverage part. This insurance applies to loss which occurs during the policy period as shown in the Declarations. The coverages provided, the limits of our liability and the premiums are also shown in the Declarations. DEFINITIONS To understand this coverage part, you must understand what we mean when we use these words: "You" and "Your" mean the insured named in the Decla- rations. "We", "us" and 'bur" mean the Company providing this insurance. WHAT TO DO IN CASE OF LOSS If covered loss occurs, you agree to: (3) actual cash value and amount of loss to the property; -a) Give us or our agent immediate written notice. In case of theft also notify the police. (b) Protect the property from further damage, making necessary and reasonable repairs to do so and keeping records of the cost. (c) Make a list of all damaged and destroyed property, showing in detail quantities, costs, actual cash value and amount of loss claimed. (d) Send to us, within 60 days of our request, proof of loss signed and sworn to by the insured person, including: (1) the time and cause of loss; (2) the interest of insured persons and all others in the property; (4) all encumbrances on the property; (5) other policies covering the loss; and (6) changes in the title, use or possession of the property. (e) Exhibit the damaged property to us or our representative as often as may be reasonably required. (f) Submit to examinations under oath by any person we name and sign the transcript of the examinations. (g) Produce for examination, with permission to copy, all books of account, bills, invoices, receipts and other vouchers as we may reasonably require. 6080 (8-86) Page 1 of 3 Agency Code 12-0422-00 SPECIAL CONDITIONS Policy Number 014682-72684185 ABANDONMENT We are not obligated to accept abandoned property. APPRAISAL If you and we fail to agree on the actual cash value or amount of loss, either party may make written demand for an appraisal. Each party will select an appraiser and notify the other of the appraiser's identity within 20 days after the demand is received. The appraisers will select a competent and impartial umpire. If the appraisers are unable to agree upon an umpire within 15 days, you or we can ask a judge of a court of record having jurisdiction where the appraisal is pending to select an umpire. The appraisers shall then appraise the loss, stating separately the actual cash value and the amount of loss to each item. If the appraisers submit a written report of an agreement to us, the amount agreed upon shall be the actual cash value or amount of loss. If they cannot agree, they will submit their differences to the umpire. A written award by two will determine the actual cash value or amount of loss. Each party will pay the appraiser it chooses, and equally pay the umpire and all other expenses of the appraisal. CONCEALMENT, MISREPRESENTATION OR FRAUD --his entire policy is void in any case of fraud by you or if you have intentionally concealed or misrepresented any material fact or circumstance relating to this insurance. OUR PAYMENT OF LOSS We will pay you or make good any loss covered by this policy, unless another payee is named in the policy. We will pay within 30 days after: (a) We receive your proof of loss; and (b) The amount of loss is finally determined by an agreement between you and us, a court judgement or an appraisal award. We will not pay or make good any loss which you have collected from others. OTHER INSURANCE If you have other insurance covering the same loss as this insurance, we will pay only the excess over what the other insurer should pay. We will pay the excess whether you can collect on the other insurance or not. PAIR OR SET In case of loss of or damage to any part of a pair or set, we may: (a) repair or replace any part of the pair or set to restore it to its value before the loss; or (b) pay the difference between the actual cash value of the property before and after the loss. PARTS In case of loss or damage to any part of property covered, consisting of several parts when complete, we shall pay only for the value of the part lost or damaged. RIGHT TO ADJUST LOSS WITH OWNER If a loss involved property of others in your care, custody or control, we may: (a) settle the loss with the owners; or (b) defend you against any claim or suit at our cost. The expense of the defense will not reduce the limit of this insurance. RECOVERIES Any recovery or salvage on a loss belongs to us until we recover what we have paid. LOSS CLAUSE The amount of insurance under this policy will not be reduced except for total loss of a scheduled item. Any unearned premium that applies to such item will be refunded. OUR RIGHT TO RECOVER PAYMENT After making payment under this policy, we will have the right to recover to the extent of our payment from anyone held responsible. You agree to do whatever is required to transfer this right to us. SUIT AGAINST US We may not be sued unless there is full compliance with all the terms of this policy. Suit must be brought within two years after you first know of the loss or damage. NO BENEFIT TO BAILEE This insurance will not, in any way, benefit any other person or organization who may be caring for or handling property for a fee. VALUATION We will not pay more than the least of: (a) The actual cash value of the damaged property at the time any loss or damage occurs. Actual cash value may include a deduction for depreciation; 6080 (8-86) Page 2 of 3 Agency Code 12-0422-00 Policy Number 014682-72684185 (b) the cost to repair or replace the damaged property with like kind or quality; or !c) the amount of insurance stated for the class of property. DEDUCTIBLE Each claim for loss or damage will be adjusted separately. We will deduct the amount stated in the Declarations (or in the form that applies) from each adjusted claim. ASSIGNMENT No interest in this policy may be assigned without our written consent. But if you are an individual named insured and die, we will cover: (a) your legal representative but only within the scope of his duties as such; and (b) anyone having proper temporary custody of your insured property, but only: 1. with respect to that property; and 2. until your representative is appointed. WHEN TWO OR MORE COVERAGES APPLY If two or more of this policy's coverages apply to the same loss or damage, we shall pay no more than the actual amount of such loss or damage. 16080 (8-86) Page 3 of 3 Agency Code 12-0422-00 Policy Number 014682-72684185 59351 (1-15) EXCLUSION OF CERTIFIED ACTS OF TERRORISM and IMPORTANT INFORMATION REGARDING TERRORISM RISK INSURANCE COVERAGE It is agreed: 1. The following definition applies: Certified act of terrorism means any act certified by the Secretary of the Treasury, in consultation with: a. the Secretary of Homeland Security; and b. the Attorney General of the United States to be an act of terrorism as defined and in accordance with the federal Terrorism Risk Insurance Act of 2002 (includ- ing ensuing Congressional actions pursuant to the Act). Under the federal Terrorism Risk Insurance Act of 2002 (including ensuing Congressional actions pursuant to the Act) a terrorist act may be certified: a. if the aggregate covered commercial property and casualty insurance losses resulting from the terrorist act ex- ceed $5 million; and b. (1) if the act of terrorism is: a) a violent act; or b) an act that is dangerous to human life, property or infrastructure; and (2) if the act is committed: a) by an individual or individuals as part of an effort to coerce the civilian population of the United States; or b) to influence the policy or affect the conduct of the United States government by coercion. 2. The following exclusion is added: We shall not pay: a. for any loss caused directly or indirectly by a certified act of terrorism, whether or not any other cause or event contributed concurrently or in any sequence to the loss. b. sums any insured becomes legally obligated to pay because of or arising out of bodily injury, property damage, personal injury or advertising injury, if covered by this insurance, caused by a certified act of terrorism. All other policy terms and conditions apply. :39351 (1-15) Page 1 of Agency Code 12-0422-00 Policy Number 014682-72684185 IMPORTANT INFORMATION REGARDING TERRORISM RISK INSURANCE COVERAGE Whe Terrorism Risk Insurance Act of 2002 was signed into law on November 26, 2002. The Act (including ensuing Con- gressional actions pursuant to the Act) defines an act of terrorism, to mean any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security and the Attorney General of the United States to be (i) an act of terrorism; (ii) to be a violent act or an act that is dangerous to human life, property or infrastructure; (iii) to have resulted in damage within the United States or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and (iv) to have been committed by an individual or individuals as part of an ef- fort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States government by coercion. At your request, this policy does not provide insurance coverage for certified acts of terrorism as defined in the Act. "Ex- cluded" is shown on the Declarations page under this coverage. In the event of a certified act of terrorism, future policies also may include a government assessed terrorism loss risk -spreading premium in accordance with the provisions of the Act. 59351 (1-15) Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. CANCELLATION 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. CHANGES This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is autho- rized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. IL00171185 C. EXAMINATIONS OF YOUR BOOKS AND RECORDS We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D. INSPECTIONS AND SURVEYS We have the right but are not obligated to: 1. Make inspections and surveys at any time; 2. Give you reports on the conditions we find; and 3. Recommend changes. Any inspections, surveys, reports or recommenda- tions relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: 1. Are safe or healthful; or 2. Comply with laws, regulations, codes or stan- dards. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. E. PREMIUMS The first Named Insured shown in the Declarations: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. 00 17 11 85 Copyright, Insurance Services Office, 1982, 1983 Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 F. TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 11 85 Copyright, Insurance Services Office, 1982, 1983 Page 2 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 IL 00 21 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: A. Under any Liability Coverage, to "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 in- sured under any such policy but for its term- ination upon exhaustion of its limit of liab- ility; 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, to ex- penses incurred with respect to "bodily injury" resulting from the "hazardous properties" of "nuclear material' and arising out of the oper- ation of a "nuclear facility" by any person or organization. C. Under any Liability Coverage, to"bodily injury" or "property damage" resulting from "hazardous properties" of "nuclear material', if: (1) The "nuclear material' (a) is at any "nuclear facility" owned by, or operated by or on behalf of, an "insured" or (b) has been discharged or dispersed therefrom; (2) The "nuclear material' is contained in "spent fuel' or "waste" at any time possessed, handled, used, processed, stored, trans- ported or disposed of, by or on behalf of an "insured"; or (3) The "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 IL 00 21 07 02 Copyright, Insurance Services Office, Inc., 1983, 1984 Page 1 of 2 Agency Code 12-0422-00 Policy Number 014682-72684185 within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2. As used in this endorsement: "Hazardous properties" include radioactive, toxic or explosive properties. "Nuclear material" means "source material', "Special nuclear material' or "by-product material'. "Source material", "special nuclear material', and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes 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 or or- ganization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". "Nuclear facility" means: (a) Any "nuclear reactor"; (b) Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel', or (3) handling, processing or packaging "waste"; (c) Any equipment or device used for the process- ing, fabricating or alloying of "special nuclear material' if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any com- bination thereof, or more than 250 grams of uranium 235; (d) Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. "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 fis- sionable material. "Property damage" includes all forms of radioactive contamination of property. IL 00 21 07 02 Copyright, Insurance Services Office, Inc., 1983, 1984 Page 2 of 2 59511 (10-19) 12-0422-00 MILTON CARPENTER INSURANCE INC 135 SE AVENUE C BELLE GLADE FL 33430 09-08-2020 VEST CONCRETE CONTRACTORS INC 1366 SW 18TH TER OKEECHOBEE FL 34974-4801 %4uto-Owners INSURANCE LIFE • HOME • CAR • BUSINESS PO Box 30660 • Lansing, MI 48909-8160 517.323.1200 OWNERS INSURANCE COMPANY You can view your policy, pay your bill, or change your paperless options at any time online at www.auto-owners.com. ADDITIONAL WAYS TO PAY YOUR BILL Pay Online www.auto-owners.com Pay by Mail Pay My Bill AUTO -OWNERS INSURANCE PO BOX 740312 Pay by Phone CINCINNATI, OH 45274-0312 1-800-288-8740 Your agency's phone number is (561) 996-7211. RE: Policy42-753-052-00 Billing Account 014309304 Thank you for selecting Auto -Owners Insurance Group to serve your insurance needs! Feel free to contact your independent Auto -Owners agent with questions you may have. Auto -Owners and its affiliate companies offer a full complement of policies, each of which has its own eligibility requirements, coverages and rates. In addition, Auto -Owners also offers many billing options. Please take this opportunity to review your insurance needs with your Auto -Owners agent, and discuss which company, program, and billing option may be most appropriate for you. Auto -Owners Insurance Company was formed in 1916. Our A++ (Superior) rating by A.M. Best Company signifies that we have the financial strength to provide the insurance protection you need. The Auto -Owners Insurance Group is comprised of six property and casualty companies and a life insurance company. Serving Our Policyholders and Agents Since 1916 Agency Code 12-0422-00 Policy Number 42-753-052-00 55081 (5-18) AVAILABILITY OF RISK MANAGEMENT PLAN - FLORIDA The Florida Tort Reform and Insurance Act of 1986 requires insurance companies to make available to commercial casualty and commercial property policyholders guidelines for risk management plans. Risk management guidelines include the following: A. Safety measures, including, as applicable, the following areas: 1. Pollution and environmental hazards; 2. Disease hazards; 3. Accidental occurrences; 4. Fire hazards and fire prevention and detection; 5. Liability for acts from the course of business; 6. Slip and fall hazards; 7. Product injury; and 8. Hazards unique to a particular class or category of insureds. B. Training to insureds in safety management techniques. C. Safety management counseling services. Risk Management Plan guidelines are available at your request. If you desire this service, please contact your agent or our Loss Control Services department by e-mail at losscontrolsupport@aoins.com or by phone (855) 586-5388. 55081 (5-18) Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58237 (1-17) POLICYHOLDER NOTICE USE OF MEDICAL FEE SCHEDULE FOR PERSONAL INJURY PROTECTION CLAIMS We will limit reimbursement of medical expenses under Personal Injury Protection coverage to 80 percent of the following schedule of maximum charges specified in the Florida Motor Vehicle No -Fault Law, section 627.736, Florida Statutes: a. For emergency transport and treatment by providers licensed under chapter 401, Florida Statutes, 200 percent of Medicare. b. For emergency services and care provided by a hospital licensed under chapter 395, Florida Statutes, 75 percent of the hospital's usual and customary charges. c. For emergency services and care as defined by s. 395.002, Florida Statutes, provided in a facility licensed under chapter 395, Florida Statutes, rendered by a physician or dentist, and related hospital inpatient services rendered by a physician or dentist, the usual and customary charges in the community. d. For hospital inpatient services, other than emergency services and care, 200 percent of the Medicare Part A prospec- tive payment applicable to the specific hospital providing the inpatient services. e. For hospital outpatient services, other than emergency services and care, 200 percent of the Medicare Part A Ambu- latory Payment Classification for the specific hospital providing the outpatient services. f. For all other medical services, supplies, and care, 200 percent of the allowable amount under: 1. The participating physicians fee schedule of Medicare Part B, except as provided in 2. and 3. below. 2. Medicare Part B, in the case of services, supplies, and care provided by ambulatory surgical centers and clinical laboratories. 3. The Durable Medical Equipment Prosthetics/Orthotics and Supplies fee schedule of Medicare Part B, in the case of durable medical equipment. However, if such services, supplies, or care is not reimbursable under Medicare Part B, as provided in f. above, we will limit reimbursement to 80 percent of the maximum reimbursable allowance under workers' compensation, as de- termined under s. 440.13, Florida Statutes, and rules adopted thereunder which are in effect at the time such ser- vices, supplies, or care is provided. Services, supplies, or care that is not reimbursable under Medicare or workers' compensation will not be reimbursed by us. For purposes of the above, the applicable fee schedule or payment limitation under Medicare is the fee schedule or pay- ment limitation in effect on March 1 of the service year in which the services, supplies, or care is rendered and for the area in which such services, supplies, or care is rendered, and the applicable fee schedule or payment limitation applies to services, supplies, or care rendered during that service year notwithstanding any subsequent change made to the fee schedule or payment limitation, except that it will not be less than the allowable amount under the applicable schedule of Medicare Part B for 2007 for medical services, supplies, and care subject to Medicare Part B. The term "service year" means the period from March 1 through the end of February of the following year. If you have elected Extended Personal Injury Protection, as shown in the Declarations, we will limit reimbursement for medical benefits to 100 percent of the schedule of maximum charges set forth by the above described fee schedule for the named insured and resident family members and 80 percent of the schedule of maximum charges set forth by the above described fee schedule for persons other than the named insured or resident family members. We shall use the Medicare coding policies and payment methodologies of the federal Centers for Medicare and Medicaid Services, including applicable modifiers, to determine the appropriate amount of reimbursement for medical services, supplies or care. Your policy contains the terms and conditions of this coverage. Should you have any questions about this or other issues related to your policy, please contact your agent for assistance. 58237 (1-17) Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58238 (1-17) OPTION TO MODIFY PERSONAL INJURY PROTECTION BENEFITS For Personal Injury Protection insurance, the named insured may elect a deductible and to exclude coverage for loss of gross income and loss of earning capacity ("lost wages"). These elections apply to the named insured alone, or to the named insured and all dependent resident family members. A premium reduction will result from these elections. The named insured is hereby advised not to elect the lost wage exclusion if the named insured or dependent resident family members are employed, since lost wages will not be payable in the event of an accident. If this is an existing or renewal policy, the option you previously selected for Personal Injury Protection will continue to apply, unless you make a different selection below. Please review carefully and indicate your selection(s) under one of the following options, if desired: Option 1: Standard Personal Injury Protection Benefits Limit Per Person Total Aggregate Limit for all Personal $10,000 (medical expenses limited to $2,500 non -emergency) Injury Protection Benefits, except Death Benefits Medical Expenses 80% of medical expenses subject to the Florida Motor Vehicle No -Fault Statute's fee schedule and subject to the total aggregate limit for Personal Injury Protection Benefits Wage Loss 60% of wage loss subject to the total aggregate limit Replacement Services Expenses subject to the total aggregate limit Death Benefits $5,000 ❑ Select deductible of ❑ No deductible ❑ $250 ❑ $500 ❑ $1,000 to apply to Personal Injury Protection Benefits for: ❑Named Insured Only ❑Named Insured and All Dependent Resident Family Members ❑ Exclude loss of gross income and loss of earning capacity ("lost wages") ❑Named Insured Only ❑Named Insured and All Dependent Resident Family Members Option 2: Extended Personal Injury Protection Benefits Limit Per Person Total Aggregate Limit for all Personal $10,000 (medical expenses limited to $2,500 non -emergency) Injury Protection Benefits, except Death Benefits Medical Expenses 100% of medical expenses subject to the Florida Motor Vehicle No -Fault Statute's fee schedule and subject to the total aggregate limit for Personal Injury Protection Benefits Wage Loss 80% of wage loss subject to the total aggregate limit Replacement Services Expenses subject to the total aggregate limit Death Benefits $5,000 ❑Select Extended Personal Injury Protection Coverage. No deductible options are available. ❑ Exclude loss of gross income and loss of earning capacity ("loss wages"). Excluded 'loss wages" must apply to named insured and all dependent resident family members. Signature Date Policy Number: 42-753-052-00 Agency: 12-0422-00 MILTON CARPENTER INSURANCE INC 58238 (1-17) Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 59243 (6-00) Florida POLICYHOLDER INFORMATION AND ASSISTANCE We are here to serve you and as our policyholder your satisfaction is very important to us. Should you have any questions or a complaint regarding your policy that cannot be resolved by your agent, you may contact our Lakeland Regional Office for information and assistance by calling 863-687-4505. Auto -Owners Insurance Company Owners Insurance Company Southern -Owners Insurance Company 59243 (6-00) Page 1 of 1 Owners Issued 09-08-2020 INSURANCE COMPANY 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 AGENCY MILTON CARPENTER INSURANCE INC Endorsement Effective 08-31-2020 12-0422-00 LP MKT TERR 114 (561) 996-7211 POLICY NUMBER 42-753-052-00 NAMED INSURED VEST CONCRETE CONTRACTORS INC Company Use 72-04-FL-0103 Company POLICY TERM Bill 12:01 a.m. 12:01 a.m. ADDRESS 1366 SW 18TH TER to 03-30-2020 03-30-2021 OKEECHOBEE FL 34974-4801 COMMERCIAL AUTO POLICY DESCRIPTION OF CHANGES EFFECTIVE 08-31-2020 (See Declarations Attached) ADDED WAIVER OF OUR RIGHT TO RECOVER PAYMENTS - BLANKET TERM ALL ITEMS ESTIMATED TOTAL PREMIUM $5,681.84 $50.00 (THIS IS NOT A BILL) Additional Owners Page 1 58974 (1-17) Issued 09-08-2020 INSURANCE COMPANY 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 LP MKT TERR 114 (561) 996-7211 ITEM ONE NAMED INSURED VEST CONCRETE CONTRACTORS INC ADDRESS 1366 SW 18TH TER OKEECHOBEE FL 34974-4801 COMMERCIAL AUTO POLICY DECLARATIONS PREFERRED PROGRAM Endorsement Effective 08-31-2020 POLICY NUMBER 42-753-052-00 Company Use 72-04-FL-0103 Company POLICY TERM Bill 12:01 a.m. 12:01 a.m. to 03-30-2020 03-30-2021 Entity: Corporation IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. ITEM TWO - SCHEDULE OF COVERED AUTOS AND COVERAGES This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those autos shown as covered autos. Autos are shown as covered autos for a particular coverage by the entry of one or more of the symbols from the COVERED AUTOS section of the Commercial Auto Policy next to the name of the coverage. COVERAGES COVERED AUTOS LIMIT OF INSURANCE PREMIUM SYMBOLS FOR ANY ONE ACCIDENT OR LOSS Combined Liability 1 $1 Million each accident $2,981.44 Uninsured Motorist 2 $300,000 each person/ $300,000 each accident $g09.39 Coverage (Non -stacked Uninsured Motorist Coverage selected.) Medical and Disability - $10,000 each person Personal Injury Protection 5 Medical limited to $2,500 non -emergency $192.59 Death Benefits - $5,000 each person Medical Payments 7 $5,000 each person $55.75 Comprehensive 7 $250 deductible applies for each covered auto unless a $464.94 rn deductible appears in ITEM THREE. m Collision 7 $500 deductible applies for each covered auto unless a $860.73 o deductible appears in ITEM THREE. •U Road Trouble Service No Coverage s IL Additional Expense No Coverage Premium for Endorsements $317.00 ESTIMATED TOTAL PREMIUM* $5,681.84 * This policy may be subject to final audit. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 58974 (1-17) OWNERS INS. CO. Issued 09-08-2020 AGENCY MILTON CARPENTER INSURANCE INC Company POLICY NUMBER 42-753-052-00 12-0422-00 LP MKT TERR 114 Bill Company Use 72-04-FL-0103 NAMED INSURED VEST CONCRETE CONTRACTORS INC Term 03-30-2020 to 03-30-2021 ITEM TWO (Continued) Endorsements That Apply To All Items: 59495 (08-11) 58001 (01-15) 58800 (04-18) 58000 (01-15) 58200 (01-15) 58550 (01-17) 58706 (01-17) 58524 (01-15) 58555 (01-16) 58558 (03-16) 58122 (01-15) 58583 (01-15) 58504 (01-15) QUICK REFERENCE FOR COVERED AUTO DESIGNATION SYMBOLS Refer to the Commercial Auto Policy 58001 Section I for a complete description of COVERED AUTOS and policy provisions that may apply. 1 = Any Auto 2 = Owned Autos Only 3 = Owned Private Passenger Autos Only 4 = Owned Autos Other Than Private Passenger Autos Only 5 = Owned Autos Subject to No-fault 6 = Owned Autos Subject To A Compulsory Uninsured Motorists Law 7 = Scheduled Autos Only 8 = Hired Autos Only 9 = Non -owned Autos Only 19 = Mobile Equipment Subject To Compulsory Or Financial Responsibility Or Other Motor Vehicle Insurance Law Only Includes copyrighted material of Insurance Services Office, Inc., with its permission. Owners Page 3 58974 (1-17) Issued 09-08-2020 INSURANCE COMPANY COMMERCIAL AUTO POLICY DECLARATIONS 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 PREFERRED PROGRAM AGENCY MILTON CARPENTER INSURANCE INC Endorsement Effective 08-31-2020 12-0422-00 LP MKT TERR 114 (561) 996-7211 POLICY NUMBER 42-753-052-00 NAMED INSURED VEST CONCRETE CONTRACTORS INC Company Use 72-04-FL-0103 Company POLICY TERM ADDRESS 1366 SW 18TH TER Bill 12:01 a.m. t0 12:01 a.m. 03-30-2020 03-30-2021 OKEECHOBEE FL 34974-4801 This policy is amended in consideration of the additional or return premium shown below. This Declarations voids and replaces all previously issued Declarations bearing the same policy number and premium term. ITEM THREE - SCHEDULE OF COVERED AUTOS, ADDITIONAL COVERAGES AND ENDORSEMENTS TERRITORY CLASS -fired Autos 058 SPL Okeechobee County, FL COVERAGES Combined Liability LIMITS $1 Million each accident TOTAL ITEM DETAILS: Estimated cost of hire - liability $ If Any (Subject to audit) Rate Effective Date 06-08-2019 150 0933 PREMIUM &n� nc y _ ' - CHANGE No Charge Ion -Owned Autos Liability 058 SPL Okeechobee County, FL COVERAGES Combined Liability Rate Effective Date 06-08-2019 150 0933 LIMITS $1 Million each accident TOTAL PREMIUM &CA nG y,-r. — CHANGE No Charge 1. 2001 TRLR ANDERSON 058 VIN: 4YNBN16271CO05651 Okeechobee County, FL COVERAGES Combined Liability LIMITS $1 Million each accident TOTAL Interested Parties: None ITEM DETAILS: Service or utility trailer operated within a 100 mile radius. USE CLASS (00727): Contractor - Miscellaneous. Vehicle Count Factor Applies. Rate Effective Date 06-08-2019 150 0933 PREMIUM 4' 1, ­ Uu CHANGE No Charge OWNERS INS. CO. AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 LP MKT TERR 114 NAMED INSURED VEST CONCRETE CONTRACTORS INC Page 4 58974 (1-17) Issued 09-08-2020 Company POLICY NUMBER 42-753-052-00 Bill Company Use 72-04-FL-0103 Term 03-30-2020 to 03-30-2021 TERRITORY CLASS 2. 2002 TRLR ANDERSON 058 VIN: 4YNBN18252CO07784 Okeechobee County, FL COVERAGES LIMITS PREMIUM CHANGE Combined Liability $1 Million each accident $ Included TOTAL $ Included No Charge Interested Parties: None ITEM DETAILS: Service or utility trailer operated within a 100 mile radius USE CLASS (00727): Contractor- Miscellaneous. Vehicle Count Factor Applies. Rate Effective Date 06-08-2019 150 0933 3. 2003 TRLR ANDERSON 058 VIN: 4YNBN20263CO12883 Okeechobee County, FL COVERAGES LIMITS PREMIUM Combined Liability $1 Million each accident $ Included TOTAL $ Included Interested Parties: None ITEM DETAILS: Service or utility trailer operated within a 100 mile radius. USE CLASS (00727): Contractor- Miscellaneous. Vehicle Count Factor Applies. Rate Effective Date 06-08-2019 150 0933 CHANGE No Charge 4. 2004 TRLR ANDERSON 058 VIN: 4YNGN25294CO19777 Okeechobee County, FL COVERAGES LIMITS Combined Liability $1 Million each accident TOTAL Interested Parties: None ITEM DETAILS: Service or utility trailer operated within a 100 mile radius. USE CLASS (00727): Contractor- Miscellaneous. Vehicle Count Factor Applies. Rate Effective Date 06-08-2019 150 0933 PREMIUM $ Included $ Included CHANGE No Charge Page 5 58974 (1-17) OWNERS INS. CO. Issued 09-08-2020 AGENCY MILTON CARPENTER INSURANCE INC Company POLICY NUMBER 42-753-052-00 12-0422-00 LP MKT TERR 114 Bill Company Use 72-04-FL-0103 NAMED INSURED VEST CONCRETE CONTRACTORS INC Term 03-30-2020 to 03-30-2021 TERRITORY CLASS 5. 2005 FORD F250SD 058 VIN: 1 FTSW21 P85EB24610 Okeechobee County, FL COVERAGES Combined Liability Uninsured Motorist Personal Injury Protection Medical Payments Comprehensive Collision LIMITS $1Million each accident $ 300,000 each person/$ 300,000 each accident Medical and Disability - $10,000 each person Medical limited to $2,500 non -emergency Death Benefits - $5,000 each person $ 5,000 each person ACV - $ 500 deductible ACV - $ 500 deductible TOTAL PREMIUM CHANGE $886.69 220.94 35.31 Interested Parties: Lienholder (Loss Payee): RIVERSIDE NATIONAL BANK, PO BOX 2109, FORT PIERCE, FL 34954-2109 Additional Endorsements For This Item: 58455 (01-17) 58308 (01-17) 58428 (01-17) 58903 (10-17) ITEM DETAILS: Light truck operated within a 100 mile radius - commercial use. USE CLASS (00727): Contractor - Miscellaneous. Commercial Auto Plus Coverage Package applies. A 5% discount has been applied to autos used in contracting business. Vehicle Count Factor Applies. Non -stacked Uninsured Motorist Coverage selected. Rate Effective Date 06-08-2019 150 0035000 0933 11.07 85.14 1 Q7 01 No Charge Page 6 58974 (1-17) OWNERS INS. CO. Issued 09-08-2020 AGENCY MILTON CARPENTER INSURANCE INC Company POLICY NUMBER 42-753-052-00 12-0422-00 LP MKT TERR 114 Bill Company Use 72-04-FL-0103 NAMED INSURED VEST CONCRETE CONTRACTORS INC Term 03-30-2020 to 03-30-2021 TERRITORY CLASS 6. 2006 FORD F350 SUPER DUTY 058 VIN: 1 FTWW31 P06EC93724 Okeechobee County, FL COVERAGES Combined Liability Uninsured Motorist Personal Injury Protection Medical Payments Comprehensive Collision LIMITS $1 Million each accident $ 300,000 each person/$ 300,000 each accident Medical and Disability - $10,000 each person Medical limited to $2,500 non -emergency Death Benefits - $5,000 each person $ 5,000 each person ACV - $ 500 deductible ACV - $ 500 deductible TOTAL PREMIUM CHANGE $574.00 196.15 52.08 14.84 100.28 19R fiS �) 1, 1.3o.UU No Charge Interested Parties: Lienholder (Loss Payee): FORD MOTOR CREDIT CO, C/O VAN WAGENEN FINANCIAL SERVICES, PO BOX 390910, MINNEAPOLIS, MN 55439-0910 Additional Endorsements For This Item: 58455 (01-17) 58308 (01-17) 58428 (01-17) 58903 (10-17) ITEM DETAILS: Auto is occasionally used for business duties by a 58 year old operator. Cost Symbol: 21-00-21-00-64. Commercial Auto Plus Coverage Package applies. Vehicle Count Factor Applies. 5% ABS Discount applies. Multi -Car Discount applies. Premier Credit applies. 30% Air Bag Discount applies. Non -stacked Uninsured Motorist Coverage selected. Rate Effective Date 06-08-2019 150 0933 7. 2008 TRLR HAULMARK 058 VIN: 16HGB24278GO93836 Okeechobee County, FL COVERAGES LIMITS Combined Liability $1 Million each accident Comprehensive ACV - $ 500 deductible Collision ACV - $ 500 deductible TOTAL Interested Parties: None ITEM DETAILS: Service or utility trailer operated within a 100 mile radius. USE CLASS (00727): Contractor- Miscellaneous. Vehicle Count Factor Applies. Rate Effective Date 06-08-2019 150 0016588 0933 PREMIUM $ Included 28.95 37.83 $66.78 CHANGE No Charge Page 7 58974 (1-17) OWNERS INS. CO. Issued 09-08-2020 AGENCY MILTON CARPENTER INSURANCE INC Company POLICY NUMBER 42-753-052-00 12-0422-00 LP MKT TERR 114 Bill Company Use 72-04-FL-0103 NAMED INSURED VEST CONCRETE CONTRACTORS INC Term 03-30-2020 to 03-30-2021 TERRITORY CLASS 8. 2015 CHEV C1500 SUBURBAN LT 058 VIN: 1GNSCJKC9FR288450 Okeechobee County, FL COVERAGES Combined Liability Uninsured Motorist Personal Injury Protection Medical Payments Comprehensive Collision LIMITS $1 Million each accident $ 300,000 each person/$ 300,000 each accident Medical and Disability - $10,000 each person Medical limited to $2,500 non -emergency Death Benefits - $5,000 each person $ 5,000 each person ACV - $ 500 deductible ACV - $ 500 deductible TOTAL PREMIUM CHANGE $662.72 196.15 52.28 15.30 102.42 ')i C; 7o .p 1 , 4--F•i. u u No Charge Interested Parties: Lienholder (Loss Payee): ALLY FINANCIAL, PO BOX 8110, COCKEYSVILLE, MD 21030-8110 Additional Endorsements For This Item: 58455 (01-17) 58308 (01-17) 58428 (01-17) 58903 (10-17) 58548 (01-15) ITEM DETAILS: Auto is occasionally used for business duties by a 58 year old operator. This vehicle rated on a cost new of $45,001.00, Cost Symbol: 23-7D-15-FD-64. Broadened Coverage for Named Individuals - Drive Other Cars endorsement applies for MARGARET ELLEN VEST Commercial Auto Plus Coverage Package applies. 10% Anti -Theft Device Discount applies. Vehicle Count Factor Applies. 5% ABS Discount applies. Multi -Car Discount applies. Premier Credit applies. 35% Air Bag Discount applies. Non -stacked Uninsured Motorist Coverage selected. Rate Effective Date 06-08-2019 150 0933 Page 8 58974 (1-17) OWNERS INS. CO. Issued 09-08-2020 AGENCY MILTON CARPENTER INSURANCE INC Company POLICY NUMBER 42-753-052-00 12-0422-00 LP MKT TERR 114 Bill Company Use 72-04-FL-0103 NAMED INSURED VEST CONCRETE CONTRACTORS INC Term 03-30-2020 to 03-30-2021 TERRITORY CLASS 9. 2019 FORD F350 Crew Cab SUPER DUTY 058 VIN: 1 FT8W3BT3KEG65880 Okeechobee County, FL COVERAGES Combined Liability Uninsured Motorist Personal Injury Protection Medical Payments Comprehensive Collision LIMITS $1 Million each accident $ 300,000 each person/$ 300,000 each accident Medical and Disability - $10,000 each person Medical limited to $2,500 non -emergency Death Benefits - $5,000 each person $ 5,000 each person ACV - $ 500 deductible ACV - $ 500 deductible TOTAL PREMIUM CHANGE $706.01 196.15 52.92 Interested Parties: None Additional Endorsements For This Item: 58455 (01-17) 58308 (01-17) 58428 (01-17) 58548 (01-15) ITEM DETAILS: Auto is principally used for business duties by a 58 year old operator. This vehicle rated on a cost new of $40,001.00, Cost Symbol: 40-8B-28-LB-66. Broadened Coverage for Named Individuals - Drive Other Cars endorsement applies for JEFFREY VEST Commercial Auto Plus Coverage Package applies. 5% Anti -Theft Device Discount applies. Vehicle Count Factor Applies. 5% ABS Discount applies. Multi -Car Discount applies. Premier Credit applies. 35% Air Bag Discount applies. Non -stacked Uninsured Motorist Coverage selected. Rate Effective Date 06-08-2019 150 0933 Endorsements That Apply To This Policy Additional Endorsements Waiver of Our Right to Recover Payments C.W. ROBERTS CONTRACTING, INC. NATIVE AMERICAN CONSTRUCTION, LLC DICKERSON FLORIDA, INC. Waiver of Our Right to Recover Payments - Blanket Designated Insured - Blanket Flat Charge Flat Charge Flat Charge 14.54 148.15 ?7n ss y I ,3t523.3L No Charge PREMIUM CHANGE $150.00 Flat Charge 50.00 50.00 Flat Charge 50.00 TOTAL $250.00 $50.00 Additional Page 9 58974 (1-17) OWNERS INS. CO. Issued 09-08-2020 AGENCY MILTON CARPENTER INSURANCE INC Company POLICY NUMBER 42-753-052-00 12-0422-00 LP MKT TERR 114 Bill Company Use 72-04-FL-0103 NAMED INSURED VEST CONCRETE CONTRACTORS INC Term 03-30-2020 to 03-30-2021 TERRITORY CLASS 058 Commercial Auto Plus Coverage Package Okeechobee County, FL COVERAGES PREMIUM CHANGE See form $67.00 TOTAL $67.00 Additional Endorsements For This Item: 58514 (09-17) No Charge ITEM DETAILS: 4 qualified item(s). Physical damage coverages apply under the Commercial Auto Plus Coverage Package to qualified items that have the applicable comprehensive and/or collision coverage(s). Liability coverages provided by this endorsement apply to covered autos insured for liability. Rate Effective Date 06-08-2019 150 0933 TERM ALL ITEMS ESTIMATED TOTAL PREMIUM $5,681.84 $50.00 (THIS IS NOT A BILL) Additional Policy Rate Code 0003 A 12% Cumulative Multi -Policy Discount applies. Supporting policies are marked with an (X): Comm Umb(X) Comm Prop/Comm Liab(X) WC() Life() Personal() Farm(). 00933 00960 Countersigned By: MILTON CARPENTER INSURANCE INC Owners 58974 (1-17) Issued 09-08-2020 INSURANCE COMPANY 6101 ANACAPRI BLVD., LANSING, MI 48917-3999 AGENCY MILTON CARPENTER INSURANCE INC 12-0422-00 LP MKT TERR 114 (561) 996-7211 NAMED INSURED VEST CONCRETE CONTRACTORS INC ADDRESS 1366 SW 18TH TER COMMERCIAL AUTO POLICY DECLARATIONS PREFERRED PROGRAM Endorsement Effective 08-31-2020 POLICY NUMBER 42-753-052-00 Company Use 72-04-FL-0103 Company POLICY TERM Bill 12:01 a.m. 12:01 a.m. t0 03-30-2020 03-30-2021 OKEECHOBEE FL 34974-4801 This policy is amended in consideration of the additional or return premium shown below. This Declarations voids and replaces all previously issued Declarations bearing the same policy number and premium term. 000099 / 000094 Scheduled Drivers List Listed below are drivers currently scheduled on this policy. Please compare the list with your current records and contact your agent with any changes that need to be made. We will update the list accordingly for the next renewal. Name: Last First Age Date of Birth MM-DD-CCYY State VEST JEFFREY 58 09-20-1961 FL SMITH WAYNE 58 03-05-1962 FL VEST MARGARET * 58 03-31-1961 FL VEST JEFFREY 31 08-12-1988 FL * DRIVER ASSIGNED TO PRIVATE PASSENGER VEHICLE FOR RATING PURPOSES Commercial Auto Policy Owners Insurance Company In witness whereof, we, the Owners Insurance Company, have caused this policy to be issued and to be duly signed by our President and Secretary. 411'1� . Secretary 58026 (1-15) President Agency Code 12-0422-00 Policy Number 42-753-052-00 58000 (1-15) QUICK REFERENCE THE DECLARATIONS PAGE SHOWS THE: NAMED INSURED SCHEDULE OF COVERED AUTOS AND COVERAGES LIMIT OF INSURANCE ENDORSEMENTS THAT APPLY TO THIS POLICY PREMIUM COMMERCIAL AUTO POLICY Beginning on Page SECTION I - COVERED AUTOS.................................................................................................................. 1 A. Covered Auto Designation Symbols.................................................................................................. 1 B. Newly Acquired Autos....................................................................................................................... 2 C. Trailers and Mobile Equipment.......................................................................................................... 2 D. Temporary Substitute Autos............................................................................................................. 3 E. Hired Autos...................................................................................................................................... 3 SECTION II - COVERED AUTOS LIABILITY COVERAGE.......................................................................... A. Coverage......................................................................................................................................... B. Exclusions....................................................................................................................................... C. Limit of Insurance............................................................................................................................ SECTION III - PHYSICAL DAMAGE COVERAGE....................................................................................... A. Coverage......................................................................................................................................... B. Exclusions....................................................................................................................................... C. Limit of Insurance............................................................................................................................ SECTION IV - INDIVIDUAL NAMED INSURED........................................................................................... SECTION V - CONDITIONS .................................................. A. Loss Conditions......................................................... Duties in the Event of Accident, Claim, Suit or Loss... Legal Action Against Us ............................................. Appraisal for Physical Damage Loss .......................... Loss Payment - Physical Damage Coverage ............. Our Right to Recover Payments ................................ Motor Carriers........................................................... B. General Conditions.................................................... Policy Term and Territory ........................................... Other Insurance......................................................... Assignment............................................................... Bankruptcy................................................................ Changes.................................................................... Concealment, Misrepresentation or Fraud .................. Duplication of Coverage ............................................. Examination of Your Books and Records ................... Inspections................................................................ Liberalization............................................................. No Benefit to Bailee - Physical Damage Coverage..... Premiums.................................................................. PremiumAudit........................................................... Severability................................................................ SECTION VI - DEFINITIONS ................................................. 58000 (1-15) 3 3 4 6 7 7 9 10 10 11 11 11 11 11 12 12 12 12 12 12 12 13 13 13 13 13 13 13 13 13 13 14 14 Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58001 (1-15) COMMERCIAL AUTO POLICY Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, words and phrases that appear in bold face type have special meaning. Refer to SECTION VI - DEFINITIONS. The descriptions in the headings of this policy and all applicable endorsements are solely for convenience and are not part of the terms and conditions of coverage. SECTION I - COVERED AUTOS A. COVERED AUTO DESIGNATION SYMBOLS the various coverages in the Declarations designate The following symbols describe the autos for which only those autos which shall be considered covered coverage may be provided. Symbols shown next to autos for each such coverage. Symbol Description Of Covered Auto Designation Symbols 1 Any Auto 2 Owned Autos Only Only those autos you own (and for Covered Autos Liability Coverage any trailer you do not own while connected to or accidentally disconnected from a power unit you own). This includes those autos you acquire ownership of after the policy begins. 3 Owned Private Only private passenger autos you own (and for Covered Autos Liability Coverage any Passenger Autos trailer while connected to or accidentally disconnected from a private passenger auto Only you own). This includes those private passenger autos you acquire ownership of after the policy begins. 4 Owned Autos Other Only those autos you own that are not private passenger autos (and for Covered Than Private Autos Liability Coverage any trailer while connected to or accidentally disconnected Passenger Autos from a power unit, other than a private passenger auto, you own). This includes Only those autos that are not private passenger autos you acquire ownership of after the policy begins. 5 Owned Autos Only those autos you own that are required by law to have no-fault benefits in the state Subject To No-fault in which they are licensed or principally garaged. This includes those autos you acquire ownership of after the policy begins provided they are required to have no-fault benefits in the state where they are licensed or principally garaged. 6 Owned Autos Only those autos you own that are required by law of the state in which they are Subject To A Com- licensed or principally garaged to have and cannot reject Uninsured Motorist Coverage. pulsory Uninsured This includes those autos you acquire ownership of after the policy begins provided Motorist Law they are subject to the same state uninsured motorist requirement. 7 Scheduled Autos Only those autos scheduled in the Declarations for which a premium charge is shown Only (and for Covered Autos Liability Coverage any trailer while connected to or accidentally disconnected from a power unit scheduled in the Declarations). 8 Hired Autos Only Only those autos you lease, hire, rent or borrow. This does not include any auto you lease, hire, rent or borrow from any of your employees, partners (if you are a partnership), members (if you are a limited liability company), executive officers (if you are a corporation), or members of their households. 9 Non -owned Autos Only those autos you do not own, lease, hire, rent or borrow that are used in Only connection with your business. This includes autos owned by your employees, partners (if you are a partnership), members (if you are a limited liability company), executive officers (if you are a corporation), or members of their households, but only while used in your business or your personal affairs. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 Symbol Description Of Covered Auto Designation Symbols 19 Mobile Equipment Only those autos that are land vehicles and that would qualify under the definition of Subject To Com- mobile equipment under this policy if they were not subject to a compulsory or pulsory Or Financial financial responsibility law or other motor vehicle insurance law where they are licensed Responsibility Or or principally garaged. Other Motor Vehicle Insurance Law Only B. NEWLY ACQUIRED AUTOS If Symbol 7 is entered next to a coverage in Item Two of the Declarations, then: 1. Coverage a. An auto you acquire ownership of shall be a covered auto provided: (1) The date you acquire ownership of the auto is during the policy term shown in the Declarations; (2) No other insurance policy provides cov- erage for the auto; and (3) We already cover all other autos you own, that are licensed for use on public roadways, except any that are out of service because of mechanical break- down or damage sustained in an acci- dent; and b. If such auto you acquire ownership of: (1) Replaces an auto you previously owned, it shall be provided only those coverages which applied to the replaced auto. (2) Is an additional auto (that is not a trailer), it shall be provided the following coverages: (a) For other than physical damage coverage, it shall be provided the broadest coverages applicable to any one covered auto (that is not a trailer). (b) For physical damage coverage, it shall be provided only those cover- ages (regardless of deductible) common to all of your other covered autos. The deductible shown in Item Two of the Declarations shall apply. (3) Is an additional auto (that is a trailer), it shall be provided only those physical damage coverages (regardless of de- ductible) common to all of your other covered autos. The deductible shown in Item Two of the Declarations shall apply. 2. Duration of Coverage Coverage for an auto you acquire ownership of shall apply for the remainder of the policy term or 30 days from the date you acquired ownership of the auto if this policy is renewed, whichever is longer. 3. Reporting You must report all autos you acquire owner- ship of to us by the expiration of the policy term during which the auto was acquired or 30 days from the date you acquired the auto if this policy is renewed, whichever is longer. 4. Premium You will be charged the premium for all autos you acquire ownership of that are provided coverage under this extension from the date you acquired the autos. S. Option to Purchase Physical Damage Coverage You may at any time during the first 30 days after you acquire ownership of the auto, pur- chase the broadest physical damage coverages applicable to any one auto already scheduled in the Declarations. C. TRAILERS AND MOBILE EQUIPMENT The Covered Autos Liability Coverage provided by this policy for an auto extends to: 1. A trailer that is not connected to an auto, pro- vided such trailer: a. Has a load capacity of 2,000 pounds or less; and b. Is owned by or is in the care, custody or control of: (1) You; (2) A family member, if you are an individ- ual, who owns an auto (that is not a trailer) scheduled in the Declarations for Covered Autos Liability Coverage or who only owns a trailer; or (3) Any other individual or organization who owns an auto (that is not a trailer) scheduled in the Declarations for Cov- ered Autos Liability Coverage. Coverage only applies for the ownership or use of the trailer by the individuals or organizations described in (1), (2) and (3) immediately above. 2. A trailer that is connected to an auto (that is not a trailer) to which Covered Autos Liability Cov- erage provided by this policy does not apply, provided such trailer: a. Has a load capacity of 2,000 pounds or less; and 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 b. Is owned by: (1) You; (2) A family member, if you are an individ- ual, who owns an auto (that is not a trailer) scheduled in the Declarations for Covered Autos Liability Coverage or who only owns a trailer; or (3) Any other individual or organization who owns an auto (that is not a trailer) scheduled in the Declarations for Cov- ered Autos Liability Coverage. Coverage only applies for the ownership of the trailer arising from the use of the trailer by an individual or organization other than the trailer owner. No coverage applies to the owner or op- erator of the auto (that is not a trailer) to which the trailer is connected. 3. Mobile equipment while being carried or towed by a covered auto. 4. Non -motorized farm machinery or farm wagons while connected to or accidentally disconnected from such covered auto. D. TEMPORARY SUBSTITUTE AUTOS Any auto you do not own while used with the per- mission of its owner as a temporary substitute for a covered auto you own that is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. Loss; or S. Destruction shall be provided only those coverages which apply to such covered auto that is out of service. E. HIRED AUTOS Any leased, hired, rented or borrowed auto sched- uled in the Declarations will be considered a covered auto you own and not a covered auto you lease, hire, rent or borrow. SECTION II - COVERED AUTOS LIABILITY COVERAGE A. COVERAGE We will pay all sums an insured legally must pay as damages because of bodily injury or property damage to which this insurance applies, caused by an accident and resulting from the ownership, main- tenance or use of a covered auto as an auto. We will also pay all sums an insured legally must pay as a covered pollution cost or expense to which this insurance applies, caused by an accident and resulting from the ownership, maintenance or use of a covered auto as an auto. However, we will only pay for the covered pollution cost or expense if there is either bodily injury or property damage to which this insurance applies that is caused by the same accident. We will investigate, settle or defend, as we consider appropriate, any claim or suit for damages or a cov- ered pollution cost or expense, covered by this policy. We will do this at our expense, using attor- neys of our choice. Our duty to defend or settle ends when the Limit of Insurance for Covered Autos Liability Coverage has been exhausted by payment of judgments or settlements. 1. Who Is An Insured The following are insureds: a. You for any covered auto. b. Anyone else while using, with your permis- sion, a covered auto (that is not a trailer) you own, lease, hire, rent or borrow except: (1) (a) The owner or anyone else, from whom such covered auto is leased, hired, rented or borrowed; or (b) Any employee, agent or driver of the owner or anyone else, from whom such covered auto is leased, hired, rented or borrowed. (2) Your employee, partner (if you are a partnership), member (if you are a lim- ited liability company) or executive of- ficer (if you are a corporation), if such covered auto is owned by him or her or a member of his or her household. (3) A person using such covered auto while working in a business of selling, leasing, servicing, repairing, parking, storing, delivering or testing autos, unless that business is yours. (4) A person, other than an employee, partner (if you are a partnership), mem- ber (if you are a limited liability com- pany) or executive officer (if you are a corporation), or a lessee or borrower or any of their employees, while moving property to or from such covered auto. c. The owner of a trailer, non -motorized farm machinery or farm wagon only when con- nected to or accidentally disconnected from a covered auto. d. A partner (if you are a partnership), a mem- ber (if you are a limited liability company) or an executive officer (if you are a corpora- tion) while someone, other than you, is using with your permission a covered auto 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 you do not own, lease, hire, rent or borrow, (4) Interest on damages owed by an in connection with your business. insured because of a judgment in a suit e. If you are an individual: we defend and accruing: (1) A family member who does not own an (a) After the judgment, and until we auto (that is not a trailer); and pay, offer or deposit in court, the (2) A family member who owns an auto amount for which we are liable un- scheduled in the Declarations der this policy; or while using a covered auto; and (b) Before the judgment, where owed (3) Anyone else while using, with the per- by law, but only on that part of the mission of a family member, a sched- judgment we pay. uled auto. (5) Expenses an insured incurs for first aid f. Anyone liable for the conduct of an insured to others at the time of an accident cov- described in 1.a. through 1.e. immediately ered by this policy. above, only to the extent of that liability. (6) All court costs taxed against an insured g. Any other individual or organization who in any suit against that insured which owns an auto (that is not a trailer) sched- we defend. uled in the Declarations while using a sched- (7) All reasonable expenses incurred by an uled auto. insured at our request, including actual h. Those individuals or organizations described loss of earnings up to $250 per day. in 1.e. and 1.g. immediately above for liabi- b. Out-of-state Coverage Extensions lity associated with ownership or use of a While a covered auto is away from the state trailer not scheduled in the Declarations where it is licensed, we will: which is owned by such individual or organi- (1) Increase the Limit of Insurance for Cov- zation only when such trailer: ered Autos Liability Coverage to meet (1) Has a load capacity of 2,000 pounds or the limits specified by a compulsory or less; and financial responsibility law of the juris- (2) Is not connected to an auto; or diction where the covered auto is being (3) Is connected to an auto (that is not a used. This extension does not apply to trailer) to which Covered Autos Liability the limit or limits specified by any law Coverage is not provided by this policy governing motor carriers of passengers while such trailer is being used by an or property. individual or organization other than the (2) Provide the minimum amounts and trailer owner. types of other coverages, such as no- i. While any covered auto scheduled in the fault, required of out-of-state vehicles by Declarations is rented or leased to you and the jurisdiction where the covered auto is being used by or for you, its owner or is being used. anyone else from whom you rent or lease it We will not duplicate payments available is an insured but only for that covered auto. under this or any other insurance for the 2. Coverage Extensions same elements of loss. a. Supplementary Payments In addition to our Limit of Insurance for B. EXCLUSIONS Covered Autos Liability Coverage, we will This insurance does not apply to any of the also pay: following: (1) Premiums on appeal bonds in any suit 1. Care, Custody or Control we defend. We will not apply for or fur- Property damage to or covered pollution cost nish such bonds. or expense involving property owned or trans- (2) Premiums on bonds to release attach- ported by the insured or in the insured's care, ments in any suit against an insured custody or control. This exclusion does not ap- we defend, but only for bond amounts ply to: that do not exceed the applicable Limit a. Liability assumed under a sidetrack agree - of Insurance. We will not apply for or ment; or furnish such bonds. b. Property damage to a residence or private (3) Up to $2,000 for the cost of bail bonds garage, caused by a covered private pas - (including bonds for related traffic law senger auto, when the residence or private violations) required because of an acci- garage is in the care, custody or control of dent we cover. We will not apply for or the insured. furnish such bonds. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 2. Contractual Liability for bodily injury or property damage assumed under any contract or agreement. This exclusion does not apply to liability for damages: a. Assumed in a contract or agreement that is an insured contract provided that the bodily injury or property damage occurs subsequent to the execution of such con- tract or agreement; b. That the insured would have in the absence of the contract or agreement; or c. Assumed in a private passenger auto lease or rental agreement, provided you are an individual and a party to the contract. 3. Employee Indemnification and Employer's Liability Bodily injury to: a. An employee of the insured arising out of and in the course of: (1) Employment by the insured; or (2) Performing the duties related to the con- duct of the insured's business; or b. The spouse, child, parent, brother or sister of that employee as a consequence of Par- agraph 3.a. above. This exclusion applies: a. Whether the insured may be liable as an employer or in any other capacity; and b. To any obligation to share damages with or repay someone else who must pay dam- ages because of the injury. This exclusion does not apply to bodily injury to domestic employees not entitled to workers compensation benefits or to liability assumed by the insured under an insured contract. 4. Fellow Employee Bodily injury to: a. Any fellow employee of any insured arising out of and in the course of the fellow em- ployee's employment or while performing duties related to the conduct of your busi- ness; or b. The spouse, child, parent, brother or sister of the fellow employee as a consequence of Paragraph 4.a. above. 5. Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the insured. 6. Handling of Property Bodily injury or property damage resulting from the handling of property: a. Before it is moved from the place where it is accepted by the insured for movement into or onto the covered auto; b. After it is moved from the covered auto to the place where it is finally delivered by the insured; or c. To or from any non -motorized farm machin- ery or farm wagon. 7. Operations Bodily injury or property damage arising out of the operation of: a. Any equipment listed in Paragraphs 6.b. and 6.c. of the definition of mobile equipment. b. Machinery or equipment that is in, upon or attached to a land vehicle that would qualify under the definition of mobile equipment if it were not subject to a compulsory or finan- cial responsibility law or other motor vehicle insurance law where it is licensed or princi- pally garaged. c. Machinery or equipment that is in, upon or attached to a trailer, non -motorized farm machinery or farm wagon. 8. Completed Operations Bodily injury or property damage arising out of your work after that work has been completed or abandoned. In this exclusion, your work means: a. Work or operations performed by you or on your behalf; and b. Materials, parts or equipment furnished in connection with such work or operations. Your work includes warranties or representa- tions made at any time with respect to the fit- ness, quality, durability or performance of any of the items included in Paragraph 8.a. or 8.b. above. Your work will be deemed completed at the earliest of the following times: a. When all of the work called for in your con- tract has been completed; b. When all the work to be done at the site has been completed if your contract calls for work at more than one site; or c. When that part of the work done at a job site has been put to its intended use by any per- son or organization other than another con- tractor or subcontractor working on the same project. Work that may need service maintenance, cor- rection, repair or replacement, but which is oth- erwise complete, will be treated as completed. 9. Pollution a. Bodily injury or property damage arising out of the actual, alleged or threatened dis- charge, dispersal, seepage, migration, re- lease or escape of pollutants: (1) That are, or that are contained in any property that is: 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 (a) Being transported or towed by, 11. Racing handled or handled for movement Bodily injury or property damage arising out of into, onto or from the covered auto; the use of any covered auto while participating (b) Otherwise in the course of transit by in any prearranged racing, prearranged high or on behalf of the insured; or speed driving, prearranged competitive driving (c) Being stored, disposed of, treated or or prearranged demolition event. This exclusion processed in or upon the covered also applies while any covered auto is preparing auto; for or practicing for any of the previously men- (2) Before the pollutants or any property in tioned events. which the pollutants are contained are 12. War or Military Action moved from the place where they are Bodily injury or property damage arising di - accepted by the insured for movement rectly or indirectly out of: into or onto the covered auto; or a. War, including undeclared or civil war; (3) After the pollutants or any property in b. Warlike action by a military force, including which the pollutants are contained are action in hindering or defending against an moved from the covered auto to the actual or expected attack, by any govern - place where they are finally delivered, ment, sovereign or other authority using disposed of or abandoned by the military personnel or other agents; or insured. c. Insurrection, rebellion, revolution, usurped b. Paragraph 9.a.(1) above does not apply to power, or action taken by governmental fuels, lubricants, fluids, exhaust gases or authority in hindering or defending against other similar pollutants that are needed for any of these. or result from the normal electrical, hydraulic 13. Workers Compensation or mechanical functioning of the covered Any obligation for which the insured or the auto or its parts, if: insured's insurer may be held liable under any (1) The pollutants escape, seep, migrate, workers compensation, disability benefits or un- or are discharged, dispersed or released employment compensation law or any similar directly from an auto part designed by law. its manufacturer to hold, store, receive 14. Autos Leased Under Hold Harmless or dispose of such pollutants; and Agreements (2) The bodily injury, property damage or Bodily injury or property damage arising out of covered pollution cost or expense the use of any covered auto (that is not a does not arise out of the operation of trailer) while: any equipment listed in Paragraphs 6.b. a. Leased to you in writing in accordance with and 6.c. of the definition of mobile a written agreement in which the lessor equipment. holds you harmless; and c. Paragraphs 9.a.(2) and 9.a.(3) above do not b. Used pursuant to operating rights (permits) apply to accidents that occur away from granted to you by a public authority. premises owned by or rented to an insured with respect to pollutants not in or upon a C. LIMIT OF INSURANCE covered auto if: We will pay damages for bodily injury, property (1) The pollutants or any property in which damage and covered pollution cost or expense the pollutants are contained are upset, up to the Limit of Insurance shown in the Declara- overturned or damaged as a result of tions for this coverage. Such damages shall be paid the maintenance or use of a covered as follows: auto; and 1. When combined liability limits are shown in the (2) The discharge, dispersal, seepage, mi- Declarations, the limit shown for each accident gration, release or escape of the pol,lut- is the total amount of coverage and the most we ants is caused directly by such upset, will pay for damages because of or arising out of overturn or damage. bodily injury, property damage and covered 10. Public or Livery Conveyance pollution cost or expense in any one accident. Bodily injury or property damage arising out of 2. When separate bodily injury and property the use of any covered auto as a public mode of damage limits are shown in the Declarations: transportation of people. This exclusion does a. For bodily injury: not apply to car pooling on a share the expense (1) The limit shown for "each person" is the basis. amount of coverage and the most we 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 will pay for all damages because of or arising out of bodily injury to one per- son in any one accident. (2) The limit shown for "each accident" is the total amount of coverage and the most we will pay, subject to 2.a.(1) above, for all damages because of or arising out of bodily injury to two or more persons in any one accident. b. For property damage, the limit shown is the amount of coverage and the most we will pay for all property damage in any one accident. 3. The Limit of Insurance applicable to a trailer, non -motorized farm machinery or farm wagon which is connected to an auto covered by this policy shall be the limit of insurance applicable to such auto. The auto and connected trailer, non -motorized farm machinery or farm wagon are considered one auto and do not increase the Limit of Insurance. 4. The Limit of Insurance applicable to a trailer covered by this policy but not scheduled in the Declarations: a. Which is not connected to an auto; or b. Which is connected to an auto not covered for Covered Autos Liability Coverage by this policy shall be the Limit of Insurance applicable to any covered auto. 5. The Limit of Insurance for this coverage may not be added to the limits for the same or similar coverage applying to other autos insured by this policy to determine the amount of coverage available for any one accident or covered pol- lution cost or expense, regardless of the num- ber of: a. Covered autos; b. Insureds; c. Premiums paid; d. Claims made or suits brought; e. Persons injured; or f. Vehicles involved in the accident. All bodily injury, property damage and cov- ered pollution cost or expense resulting from continuous or repeated exposure to substantially the same conditions will be considered as re- sulting from one accident. SECTION III - PHYSICAL DAMAGE COVERAGE A. COVERAGE 1. We will pay for loss to a covered auto or its equipment or custom furnishings under: a. Comprehensive Coverage From any cause except: (1) The covered auto's collision with another object; or (2) The covered auto's overturn. However, we will pay for: (1) Glass breakage from any cause includ- ing upset or collision, (2) Damage caused by missiles or falling objects; and (3) Damage caused by collision with an animal or bird. When a deductible is shown in the Declara- tions for this coverage, we will reduce our payment by that amount. The deductible shall not apply to the repair of safety or lam- inated glass contained within the windshield, rear window, a door window or any other side window of a covered auto that is a pri- vate passenger auto, provided both you and we agree to the repair. However, the deductible will still apply to: (1) Any light or any component of any light to such covered auto; (2) Any glass contained in the roof; (3) Removable roof panels of any type; (4) Mirrors of any type; or (5) Replacement of any safety or laminated glass. Collision Coverage Caused by: (1) The covered auto's collision with another object; or (2) The covered auto's overturn. When a deductible is shown in the Declara- tions for this coverage, we will reduce our payment by that amount. The deductible shall not apply when a covered auto that is a private passenger auto is: (1) In a collision with another auto: (a) We insure and which you do not own, rent or have in your care, cus- tody or control; or (b) Whose owner or operator has been identified; and 1) Is legally responsible for the entire amount of the damage; and 2) Is covered by a property dam- age liability policy or bond but only if the damage exceeds the deductible amount. (2) Legally parked and is accidentally struck by another of your private passenger autos, provided Collision Coverage ap- plies to both autos. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 2. Road Trouble Service We will pay up to the amount shown in the Dec- larations for this coverage each time a covered auto that is a private passenger auto is disabled: a. For towing to the nearest available garage; and b. For the cost of labor performed at the place of disablement. 3. Coverage Extensions a. Trailers The Comprehensive Coverage and Collision Coverage provided to a covered auto will extend to certain trailers you do not own. The trailer must: (1) Have a load capacity of 2,000 pounds or less; (2) Be used with your private passenger auto; and (3) Be other than a trailer of the home, of- fice, store, display or passenger type. Our limit of insurance under this coverage extension is $500 in any one loss. No de- ductible applies. b. Transportation Expenses Following Theft If Comprehensive Coverage is shown in the Declarations for a private passenger auto scheduled in the Declarations, we will pay up to $30 per day but not more than $900 in any one loss for transportation expenses in- curred if such auto is stolen. We will pay such expenses incurred during the period beginning 48 hours after an insured reports the theft to us and to the police and ending when such auto is returned to use or we pay for its loss. c. Personal Property The Comprehensive Coverage and Collision Coverage provided to a covered auto that is a private passenger auto will extend to loss to personal property contained in or on such auto as follows: (1) Comprehensive Coverage because of: (a) Fire; (b) Lightning; or (c) Theft or attempted theft if there are visible signs of someone breaking into such auto or the entire auto is stolen; or (2) Collision Coverage. The personal property must be owned by you, a family member or your employee. This coverage extension does not apply to: (1) Property used in a business, trade or profession. (2) Money. or jewelry. (3) Property specifically insured. (4) Anything that is otherwise excluded by this policy. Our limit of insurance under this coverage extension is $300 in any one loss. No de- ductible applies. d. Air Bag Replacement The Comprehensive Coverage provided to a private passenger auto scheduled in the Declarations will extend to replacement of an air bag that inflates without such auto having been involved in a Comprehensive or Collision loss. No deductible applies. e. Loss of Use - Rental Fee Reimbursement (1) We shall provide the following extension of coverage when you become legally responsible to pay for loss of use of: (a) A private passenger auto rented or hired without a driver under a written rental contract or agreement and a covered auto under this policy is a private passenger auto with Com- prehensive and Collision Coverages which extend to such rented or hired private passenger auto; or (b) An auto (that is not a private pas- senger auto) rented or hired without a driver under a written rental con- tract or agreement and such auto is provided Hired Auto Physical Dam- age coverage under this policy. (2) We shall reimburse you or pay on your behalf: (a) The rental fee that would have been paid if such auto (that is a private passenger auto); or (b) Up to $30 per day but not more than $900 in any one loss, of the rental fee that would have been paid, if such auto (that is not a private pas- senger auto) had not sustained loss. (3) This coverage begins the day following the loss and ends, regardless of the policy expiration date, at the earliest of the following: (a) The day repairs to the rental auto are completed, not to exceed a pe- riod longer than required to repair such auto, exercising due diligence and dispatch; (b) The day we make payment for re- placement of the rental auto; or (c) Thirty (30) days after the date cov- erage begins. (4) You or the rental agency must submit proper receipts to us for all expenses claimed under this coverage extension. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 f. Diminished Value 4. Conversion, Embezzlement or Secretion When Diminished Value Coverage is shown Loss to a covered auto because of or arising in the Declarations for an auto, we shall out of conversion, embezzlement or secretion by pay: any person lawfully having a covered auto under (1) An additional 15% of the settlement a sale, lease or similar agreement. amount if the model year of such auto is 5. Illegal Activities no older than the model year of the date Loss to a covered auto because of confiscation of the loss and the two prior model or destruction by any civil or governmental au - years; or thorities because of illegal activities engaged in (2) An additional 10% of the settlement by you or a family member. amount for prior model years 6. Loss of Use for damage to such auto because of dimin- Loss of use of a covered auto, except as pro- ished value, only if such auto is repaired. vided in Coverage Extensions. This provision does not apply to damage to 7. Nuclear Hazard glass. Loss caused by or resulting from: a. The explosion of any weapon employing B. EXCLUSIONS atomic fission or fusion; or Comprehensive and Collision Coverages do not b. Nuclear reaction or radiation, or radioactive apply to: contamination, however caused. 1. Audio, Visual or Data Electronic Equipment 8. Racing Loss to any of the following: Loss to any covered auto while participating in a. Any electronic equipment that reproduces, any prearranged racing, prearranged high speed receives or transmits audio, visual, global driving, prearranged competitive driving or pre - positioning or data signals. However, such arranged demolition event. This exclusion also equipment is covered if: applies while any covered auto is preparing for (1) Standard or optional equipment for the or practicing for any of the previously mentioned manufacturer of a covered auto for that events. make, model and model year; 9. Radar Detectors (2) Permanently installed in a covered auto Loss to any device designed or used to: and was not standard or optional equip- a. Detect speed -measuring equipment such as ment for the manufacturer of such cov- radar or laser detectors; or ered auto for that make, model and b. Elude or disrupt speed -measuring equip - model year; or ment such as a jamming apparatus. (3) Scheduled in the Declarations and a 10. Tires premium charged. Loss to tires, unless the loss is caused by: Our limit under a.(2) above shall not exceed a. Fire; $1,000 in any one loss. No deductible ap- b. Theft; or plies to the coverage extension in a.(2) c. Malicious mischief; or above. is part of other loss covered by this policy. b. Tapes, discs or other similar media de- 11. Truck Campers signed for use with equipment described in Loss to: a. above. a. A truck camper; or c. Any accessories used with the media or b. A pickup cover with built-in cooking and equipment described in a. or b. above. sleeping equipment 2. Diminished Value unless scheduled in the Declarations and a Loss to a covered auto because of or arising premium charged. out of diminished value. This exclusion does 12. War or Military Action not apply to the extent that coverage is provided Loss caused by or resulting from: when Diminished Value Coverage is shown in a. War, including undeclared or civil war; the Declarations. b. Warlike action by a military force, including 3. Expected or Intentional Act action in hindering or defending against an Loss to a covered auto because of or arising actual or expected attack, by any govern - out of your intentional act or an intentional act ment, sovereign or other authority using mil - committed at your direction or with your itary personnel or other agents; or knowledge. c. Insurrection, rebellion, revolution, usurped power or action taken by governmental 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 authority in hindering or defending against 3. If a loss to an auto scheduled in the Declara- any of these. tions can be paid under either Comprehensive 13. Wear and Tear Coverage or Collision Coverage, payment will Loss to a covered auto because of and con- be made under the coverage that pays the fined to: most. a. Wear and tear; 4. Coinsurance b. Freezing; or If a scheduled auto has been altered, remod- c. Mechanical or electrical breakdown, other eled, converted or modified so that its value is than burning of wiring. substantially increased over that of a standard This exclusion does not apply to such loss fol- auto of the same make and model, and such lowing and resulting from other loss covered by modifications affect the amount of the loss, we this policy. will pay only the proportion that the value of a standard auto bears to the value of the sched- C. LIMIT OF INSURANCE uled auto. This does not apply when an addi- 1. The most we will pay for loss to any one cov- tional premium is charged based on the in- ered auto is the lesser of: creased value. a. The actual cash value of damaged or stolen 5. Deductible - Hired Auto Physical Damage property at the time of the loss; Coverage b. The cost, at local prices, to repair or replace If other insurance is available to you or the damaged or stolen property with other owner of a covered auto (that is a hired auto) property of like kind and quality; or and such insurance is subject to a deductible c. The Limit of Insurance shown in the Decla- greater than the deductible which applies to this rations. coverage, we shall pay the difference between 2. We will, at our option, replace an auto sched- the two deductibles. uled in the Declarations with a new one of equal value or pay you your original purchase price if: a. Such auto is a private passenger auto; b. You purchased it new; c. We determine the loss cannot be repaired; and d. The loss occurs within 90 days of the pur- chase date. SECTION IV - INDIVIDUAL NAMED INSURED If a Named Insured shown in the Declarations is an indi- vidual and any auto scheduled in the Declarations is a private passenger auto, the following extensions of coverage apply: A. The Covered Autos Liability Coverage provided for any scheduled auto (that is not a trailer) also applies to an auto (that is not a trailer): 1. Not owned by you or anyone living with you. 2. Not furnished or available for regular use to you or anyone living with you. However, we will af- ford you Covered Autos Liability Coverage for your use of an auto (that is not a trailer) owned by or furnished for the regular use of a family member. 3. Not used in a business you own or operate sell- ing, servicing, repairing, parking or storing autos. 4. Not used by you, a family member or the chauffeur or domestic employee of either while working in your business or occupation or that of a family member, unless the auto is a pri- vate passenger auto. 5. Not used by you or a family member without a reasonable belief of permission to do so. We only extend this coverage to and while used by: 1. You, if an individual; and 2. Family members: a. Who do not own an auto (that is not a trailer); or b. Who own an auto (that is not a trailer) if scheduled in the Declarations. We also extend this coverage to anyone legally re- sponsible for the use of the auto (that is not a trailer) by the persons described in 1. and 2. imme- diately above. B. The Physical Damage Coverage provided for any scheduled auto (that is not a trailer) also applies to an auto (that is not a trailer): 1. Not owned by you or anyone living with you. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 10 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 2. Not furnished or available for regular use to you or anyone living with you. 3. Not used in a business you own or operate sell- ing, servicing, repairing, parking or storing autos. 4. Not used by you, a family member or the chauffeur or domestic employee of either while working in your business or occupation or that of a family member, unless the auto is a pri- vate passenger auto. 5. Not used by you or a family member without a reasonable belief of permission to do so. We only extend this coverage to and while used by: 1. You, if an individual; and 2. Family members: a. Who do not own an auto (that is not a trailer); or b. Who own an auto (that is not a trailer) scheduled in the Declarations. These extensions do not apply when there is other insurance covering your interest or the interest of the owner. However, they do apply if you are legally liable. SECTION V - CONDITIONS A. LOSS CONDITIONS 1. Duties in the Event of Accident, Claim, Suit or Loss We have no duty to provide coverage under this policy unless there has been full compliance with the following duties: a. In the event of accident, claim, suit or loss, an insured must give us or our authorized representative prompt notice of the acci- dent or loss, including: (1) How, when and where the accident or loss occurred; (2) The insured's name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. b. Additionally, the insured and any other in- volved insured must: (1) Immediately send us copies of any re- quest, demand, order, notice, summons or legal paper received concerning the claim or suit. (2) Cooperate with us in the investigation or settlement of the claim or defense against the suit. (3) Authorize us to obtain medical records or other pertinent information. (4) Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require. (5) Assume no obligation, make no pay- ment or incur no expense without our consent, except at the insured's own cost. (6) Agree to examinations under oath at our request and give us a signed state- ment of such answers. c. If there is loss to a covered auto or its equipment or custom furnishings, an insured must also do the following: (1) Promptly notify the police if the covered auto or any of its equipment or custom furnishings is stolen. (2) Take all reasonable steps to protect the covered auto from further damage. Also keep a record of expenses for con- sideration in the settlement of the claim. (3) Permit us to inspect the covered auto and records proving the loss before its repair or disposition. Legal Action Against Us No legal action may be brought against us until there has been full compliance with all the terms of this policy. Further, under the Covered Autos Liability Coverage, no legal action may be brought until we agree a person entitled to cov- erage has an obligation to pay or until the amount of that obligation has been determined by judgment after trial. No one has any right under this policy to bring us into any action to determine the liability of any person we have agreed to protect. Appraisal for Physical Damage Loss If you and we disagree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select a competent and impartial umpire. The appraisers will state separately the actual cash value and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If we submit to an appraisal, we will still retain our right to deny the claim. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 11 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 4. Loss Payment - Physical Damage Coverage without a driver for a period of 30 days At our option, we may: or less, provided that the insured's re - a. Pay for, repair or replace damaged or stolen sponsibility to pay damages is deter - property; mined in a suit on the merits in any of b. Return stolen property at our expense. We the coverage territories described in will pay for any damage that results to the b.(1), b.(2) or b.(3) above or in a settle - auto from the theft; or ment to which we agree. c. Take all or any part of damaged or stolen We also cover loss to, or accidents involy- property at an agreed or appraised value. ing, a covered auto while being transported If we pay for the loss, our payment will include, between any of these places. where required by law, the applicable sales tax 2. Other Insurance for damaged or stolen property. We may adjust a. For any covered auto that is scheduled in the loss for an auto you lease, hire, rent or bor- the Declarations, this policy provides pri- row with either you or the owner of such auto, mary insurance. For any covered auto whomever we choose. which is not scheduled in the Declarations, 5. Our Right to Recover Payments the insurance provided by this policy is ex - If we make a payment under this policy and the cess over any other collectible insurance. person or organization to or for whom payment However, this coverage shall be primary is made has a right to recover damages from when any covered auto (that is a trailer) is another, we will be entitled to that right. That connected to an auto that is scheduled in person or organization shall do everything nec- the Declarations and this coverage shall be essary to transfer that right to us and do nothing excess when any covered auto (that is a to prejudice it. trailer) is connected to an auto that is not 6. Motor Carriers scheduled in the Declarations. a. When this policy is amended by an endorse- b. Regardless of the provisions of Paragraph ment prescribed in compliance with any law a. above, the Covered Autos Liability Cov- for the regulation of: erage of this policy is primary for any liability (1) Common carriers; assumed under an insured contract. (2) Contract carriers; or c. When this policy and any other coverage (3) Private carriers form or policy covers on the same basis, of passengers or property, all amended either excess or primary, we will pay only policy terms and conditions remain in full our share. Our share is the proportion that force and are binding between you and us. the Limit of Insurance of our policy bears to b. If as a result of that endorsement, we are the total of the limits of all the coverage obligated to make a payment that we would forms and policies covering on the same not make except for that endorsement, you basis. agree to reimburse us for any payment, in- 3. Assignment cluding payment for defense costs, we must No interest in this policy may be assigned with - make as a result of that endorsement. out our written consent. However, if you are an individual and you die within the policy term, the B. GENERAL CONDITIONS policy will cover as though named in the 1. Policy Term and Territory Declarations: Under this policy, we cover accidents and a. Your spouse; losses occurring: b. Your legal representative, but only with re - a. During the policy term shown in the Declara- spect to his or her legal responsibility for the tions; and maintenance or use of a covered auto; and b. Within the coverage territory. c. Any person having proper temporary cus- The coverage territory is: tody of a covered auto until a legal repre- (1) The United States of America; sentative is appointed (2) The territories and possessions of the provided we are given written notice of your United States of America; death within 60 days of the date of your death (3) Canada; and or by the expiration of the policy term in which (4) Anywhere in the world if a covered auto you die, whichever is greater. This requirement that is a private passenger auto is does not apply with regard to your spouse. leased, hired, rented or borrowed 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 12 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 4. Bankruptcy company affiliated with us to specifically Bankruptcy or insolvency of an insured or an provide excess insurance over this policy. insured's estate will not relieve us of any obli- 8. Examination of Your Books and Records gation under the terms of this policy. We may examine and audit your books and S. Changes records as they relate to this policy at any time a. This policy contains all the agreements be- during the policy term and up to one year tween you and us or any of our agents, afterward. concerning the insurance afforded. The 9. Inspections terms of this policy can be amended or a. We have the right to: waived only by endorsement issued by us (1) Make inspections at any time; and made part of this policy. (2) Give you reports on the conditions we b. The first Named Insured shown in the Dec- find; and larations is authorized to make changes in (3) Recommend changes. the terms of this policy with our consent. b. We are not obligated to make any inspec- We may adjust your policy premium be- tions, reports or recommendations and any cause of changes made to the policy. such actions we do undertake relate only to c. We may adjust your premium during the insurability and the premiums to be charged. policy term because of changes in the fac- We do not make safety inspections. We do tors that were used to determine such pre- not undertake to perform the duty of any mium. These factors include but are not person or organization to provide for the limited to: health or safety of workers or the public. (1) The principal place of garaging a cov- We do not warrant that conditions: ered auto; (1) Are safe or healthful; or (2) Coverages, limits of insurance and (2) Comply with laws, regulations, codes or deductibles; standards. (3) The type, make and model of a covered c. Paragraphs 9.a. and 9.b. of this condition auto and its use; and apply not only to us, but also to any rating, (4) The operators of a covered auto. advisory, rate service or similar organization Premium adjustments will be made at the which makes insurance inspections, reports time of such changes or when we become or recommendations. aware of the changes, if later. We will use 10. Liberalization the governing rules and rates in effect on If we revise this policy to provide more coverage the inception date of the policy term. without additional premium charge, your policy 6. Concealment, Misrepresentation or Fraud will automatically provide the additional cover - This policy is void in any case of fraud by you at age as of the day the revision is effective in any time as it relates to this policy. It is also your state. void if you or any other insured, at any time, 11. No Benefit to Bailee - Physical Damage intentionally conceals or misrepresents a mate- Coverage rial fact concerning: We will not recognize any assignment or grant a. This policy; any coverage for the benefit of any person or b. The covered auto; organization holding, storing or transporting c. Your interest in the covered auto; or property for a fee regardless of any other pro- d. A claim under this policy. vision of this policy. 7. Duplication of Coverage 12. Premiums a. If this policy and any other policy or cover- The first Named Insured shown in the age form provided by us or a company af- Declarations: filiated with us, provides coverage for the a. Is responsible for the payment of all pre - same accident or loss, our maximum limit miums; and of insurance under all the policies or cover- b. Will be the payee for any return premiums age forms shall not exceed the highest limit we pay. of insurance under any single policy or cov- 13. Premium Audit erage form applicable to the accident or The estimated premium for this policy is based loss. on the exposures you told us you would have b. This condition does not apply to any policy when this policy began. We will compute the or coverage form issued by us or a final premium due when we determine your 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 13 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 actual exposures. The estimated total premium will be credited against the final premium due, and the first Named Insured will be billed for the balance, if any. The due date for the final pre- mium is the date shown as the due date on the bill. If the estimated total premium exceeds the final premium due, a return premium will be paid. Failure to pay any premium, including the final premium, by the due date shown on the bill will be considered to be non payment of premium. 14. Severability Except as to the Limit of Insurance, the cover- age provided by this policy applies separately to each person against whom claim is made or suit is brought. SECTION VI - DEFINITIONS A. Accident includes continuous or repeated exposure to the same conditions resulting in bodily injury or property damage. B. Auto means: 1. A land motor vehicle, designed for travel on pub- lic roads; 2. A trailer; or 3. Any other land vehicle that is subject to a com- pulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, auto does not include mobile equipment. C. Bodily injury means physical injury, sickness or disease sustained by a person, including resulting death of that person. D. 1. Covered pollution cost or expense means any cost or expense arising out of: a. Any request, demand, order or statutory or regulatory requirement that an insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, pollutants; or b. Any claim or suit by or on behalf of a gov- ernmental authority for damages because of testing for, monitoring, cleaning up, remov- ing, containing, treating, detoxifying or neu- tralizing, or in any way responding to, or assessing the effects of, pollutants. 2. Covered pollution cost or expense does not include any cost or expense arising out of the actual, alleged or threatened discharge, disper- sal, seepage, migration, release or escape of pollutants: a. That are, or that are contained in any prop- erty that is: (1) Being transported or towed by, handled or handled for movement into, onto or from the covered auto; (2) Otherwise in the course of transit by or on behalf of an insured; or (3) Being stored, disposed of, treated or processed in or upon the covered auto; b. Before the pollutants or any property in which the pollutants are contained are moved from the place where they are ac- cepted by an insured for movement into or onto the covered auto; or c. After the pollutants or any property in which the pollutants are contained are moved from the covered auto to the place where they are finally delivered, disposed of or abandoned by an insured. Paragraph 2.a. above does not apply to fuels, lubricants, fluids, exhaust gases or other similar pollutants that are needed for or result from the normal electrical, hydraulic or mechanical functioning of the covered auto or its parts, if: (1) The pollutants escape, seep, migrate or are discharged, dispersed or released directly from an auto part designed by its manufacturer to hold, store, receive or dispose of such pollutants; and (2) The bodily injury, property damage or covered pollution cost or expense does not arise out of the operation of any equipment listed in Paragraph 6.b. or 6.c. of the definition of mobile equipment. Paragraphs 2.b. and 2.c. above do not apply to accidents that occur away from premises owned by or rented to an insured with respect to pollutants not in or upon a covered auto if: (1) The pollutants or any property in which the pollutants are contained are upset, overturned or damaged as a result of the maintenance or use of a covered auto; and (2) The discharge, dispersal, seepage, mi- gration, release or escape of the pol- lutants is caused directly by such upset, overturn or damage. E. Diminished value means the actual or perceived reduction in market value or resale value of a cov- ered auto as the result of a covered loss. F. Domestic employee means a person engaged in household or domestic work performed principally in connection with a residence premises. G. Employee includes a leased worker. Employee does not include a temporary worker. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 14 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 H. Equipment or custom furnishings means: 1. An apparatus or device (that is not a trailer): a. Permanently attached to or installed in or upon a covered auto; or b. Designed for use with, but detached from, a covered auto. 2. Keys and key fobs designed for a covered auto. 3. Custom paint, decals, wraps or other interior or exterior modifications to a covered auto. Equipment or custom furnishings does not include: 1. Anything attached to real estate; or 2. Removable child seats. I. Executive officer means a person holding any of the officer positions created by your charter, consti- tution, by-laws or any other similar governing document. J. Family member means a person who resides with you and who is related to you by blood, marriage or adoption. Family member includes a ward or foster child who resides with you. K. Insured means any person or organization qualify- ing as an insured in the Who Is An Insured provi- sion of the applicable coverage. L. Insured contract means: 1. A lease of premises; 2. A sidetrack agreement; 3. Any easement or license agreement, except in connection with: a. Construction; or b. Demolition operations on or within 50 feet of a railroad; 4. An indemnification of a municipality as required by ordinance, except in connection with work for a municipality; 5. That part of any other contract or agreement pertaining to your business (including an indem- nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay damages because of bodily injury or property damage to a third person or organization. Tort liability means liability that would be imposed by law in the absence of any contract or agree- ment; or 6. That part of any contract or agreement entered into, as part of your business, pertaining to the rental or lease, by you or any of your employ- ees, of any auto. However, such contract or agreement shall not be considered an insured contract to the extent that it obligates you or any of your employees to pay for property damage to any auto rented or leased by you or any of your employees. An insured contract does not include that part of any contract or agreement that: 1. Indemnifies a railroad for bodily injury or prop- erty damage arising out of: a. Construction; or b. Demolition operations on or within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass or crossing; 2. Pertains to the loan, lease or rental of an auto to you or any of your employees, if the auto is loaned, leased or rented with a driver; or 3. Holds a person or organization engaged in the business of transporting property by auto for hire harmless for your use of a covered auto over a route or territory that person or organiza- tion is authorized to serve by public authority. M. Leased worker means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm to perform duties related to the conduct of your business. Leased worker does not include a temporary worker. N. Loss means direct and accidental loss or damage. O. Mobile equipment means any of the following types of land vehicles, including any attached machinery or equipment: 1. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; 2. Vehicles maintained for use solely on or next to premises you own or rent; 3. Vehicles that travel on crawler treads; 4. Vehicles, whether self-propelled or not, main- tained primarily to provide mobility to perma- nently mounted: a. Power cranes, shovels, loaders, diggers or drills; or b. Road construction or resurfacing equipment such as graders, scrapers or rollers; 5. Vehicles not described in Paragraph 1., 2., 3. or 4. above that are not self-propelled and are maintained primarily to provide mobility to per- manently attached equipment of the following types: a. Air compressors, pumps and generators, including spraying, welding, building clean- ing, geophysical exploration, lighting and well -servicing equipment; or b. Cherry pickers and similar devices used to raise or lower workers; or 6. Vehicles not described in Paragraph 1., 2., 3. or 4, above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the follow- ing types of permanently attached equipment are not mobile equipment but will be consid- ered autos: a. Equipment designed primarily for: 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 15 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 P. M 713 (1) Snow removal; (2) Road maintenance, but not construction or resurfacing; or (3) Street cleaning; b. Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and c. Air compressors, pumps and generators, including spraying, welding, building clean- ing, geophysical exploration, lighting or well - servicing equipment. However, mobile equipment does not include land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial respon- sibility law or other motor vehicle insurance law are considered autos. Pollutants means any solid, liquid, gaseous or ther- mal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, recondi- tioned or reclaimed. Private passenger auto means: 1. A passenger or station wagon type auto with four or more wheels; 2. A pickup or van type auto with a gross weight of 15,000 pounds or less which is not used in the business of carrying passengers for hire; or 3. A motorhome. Property damage means damage to or destruction of tangible property including resulting loss of use of that property. Suit means a civil proceeding in which: 1. Damages because of bodily injury or property damage; or 2. A covered pollution cost or expense to which this insurance applies, are alleged. Suit includes: 1. An arbitration proceeding in which such dam- ages or covered pollution costs or expenses are claimed and to which the insured must sub- mit or does submit with our consent; or 2. Any other alternative dispute resolution proceed- ing in which such damages or covered pollu- tion costs or expenses are claimed and to which the insured submits with our consent. T. Temporary worker means a person who is fur- nished to you to substitute for a permanent em- ployee on leave or to meet seasonal or short-term workload conditions. U. Trailer means a vehicle which is designed: 1. For travel on public roads; and 2. To be connected to and towed by a power unit. Trailer does not include non -motorized farm ma- chinery or farm wagons. A trailer is not equipment or custom furnishings. V. Volunteer worker means a person who is not your employee, and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. W. We, us or our means the Company providing this insurance. X. You or your means the Named Insured shown in the Declarations and if an individual, your spouse who resides in the same household. 58001 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 16 of 16 Agency Code 12-0422-00 Policy Number 42-753-052-00 59495 (8-11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION OR NONRENEWAL DESIGNATED PERSON(S) OR ORGANIZATION(S) OTHER THAN THE NAMED INSURED It is agreed: This policy is subject to the following condition: If this policy is canceled or nonrenewed, the designated person(s) or organization(s) shown in the SCHEDULE below shall be notified at least: 1. 10 days prior to the effective date of cancellation if we cancel for nonpayment of premium; or 2. The number of days shown in the SCHEDULE prior to the effective date if we cancel for any other reason. If the law of the state in which notice is mailed to requires a longer notice period, we will comply with those requirements. SCHEDULE Number of Days Notice 030 Name Of Designated Person(s) Or Organization(s) Mailing Address DICKERSON FLORIDA INC PO BOX 910 FORT PIERCE, FL 34954-0910 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) All other policy terms and conditions apply. 59495 (8-11) Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58122 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER PAYMENTS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is shown below. Named Insured: VEST CONCRETE CONTRACTORS INC Endorsement Effective Date: 08-31-2020 SCHEDULE Name(s) Of Person(s) Or Organization(s) C.W. ROBERTS CONTRACTING, INC. (Information required to complete this endorsement, if not shown above, will be shown in the Declarations.) SECTION V - CONDITIONS, A. LOSS CONDITIONS is amended. 5. Our Right to Recover Payments is deleted and replaced by the following condition. S. Our Right to Recover Payments If we make a payment under this policy and the per- son to or for whom payment is made has a right to recover damages from another, we will be entitled to that right. That person shall do everything neces- sary to transfer that right to us and do nothing to prejudice it. However, we waive our right to recover payments made for bodily injury or property damage: a. Covered by the policy; and b. Arising out of the operation of autos covered by the policy, in accordance with the terms and conditions of a written contract between you and the person(s) or organizations(s) shown in the schedule only if such rights have been waived by the written contract prior to the accident or loss which caused the bodily injury or property damage. All other policy terms and conditions apply. 58122 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58122 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER PAYMENTS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is shown below. Named Insured: VEST CONCRETE CONTRACTORS INC Endorsement Effective Date: 08-31-2020 SCHEDULE Name(s) Of Person(s) Or Organization(s) NATIVE AMERICAN CONSTRUCTION, LLC (Information required to complete this endorsement, if not shown above, will be shown in the Declarations.) SECTION V - CONDITIONS, A. LOSS CONDITIONS is amended. 5. Our Right to Recover Payments is deleted and replaced by the following condition. S. Our Right to Recover Payments If we make a payment under this policy and the per- son to or for whom payment is made has a right to recover damages from another, we will be entitled to that right. That person shall do everything neces- sary to transfer that right to us and do nothing to prejudice it. However, we waive our right to recover payments made for bodily injury or property damage: a. Covered by the policy; and b. Arising out of the operation of autos covered by the policy, in accordance with the terms and conditions of a written contract between you and the person(s) or organizations(s) shown in the schedule only if such rights have been waived by the written contract prior to the accident or loss which caused the bodily injury or property damage. All other policy terms and conditions apply. 58122 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58122 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER PAYMENTS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is shown below. Named Insured: VEST CONCRETE CONTRACTORS INC Endorsement Effective Date: 08-31-2020 SCHEDULE Name(s) Of Person(s) Or Organization(s) DICKERSON FLORIDA, INC. (Information required to complete this endorsement, if not shown above, will be shown in the Declarations.) SECTION V - CONDITIONS, A. LOSS CONDITIONS is amended. 5. Our Right to Recover Payments is deleted and replaced by the following condition. 5. Our Right to Recover Payments If we make a payment under this policy and the per- son to or for whom payment is made has a right to recover damages from another, we will be entitled to that right. That person shall do everything neces- sary to transfer that right to us and do nothing to prejudice it. However, we waive our right to recover payments made for bodily injury or property damage: a. Covered by the policy; and b. Arising out of the operation of autos covered by the policy, in accordance with the terms and conditions of a written contract between you and the person(s) or organizations(s) shown in the schedule only if such rights have been waived by the written contract prior to the accident or loss which caused the bodily injury or property damage. All other policy terms and conditions apply. 58122 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58548 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE FOR NAMED INDIVIDUALS - DRIVE OTHER CARS This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SCHEDULE Name(s) Of Person(s) MARGARET ELLEN VEST Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. COVERAGE The individual named insured coverage provisions or the Who Is An Insured provision of each coverage shown in the Declarations as applying to the auto to which this endorsement applies extend to you or a family member. This coverage does not apply to: 1. You while operating an auto: a. Owned; or b. Rented or leased for more than 90 consecu- tive days by you. 2. A family member while operating an auto: a. Owned; or b. Rented or leased for more than 90 consecu- tive days by such family member. We will also afford the minimum coverages and amounts for the types of mandatory no-fault coverages required by the state where you reside. We will afford these same no-fault coverages to a family member who does not own an auto or who owns an auto scheduled in the Declarations, pro- vided the family member has no other source of coverage. B. The coverage afforded by this endorsement shall be excess of any other collectible coverage. C. DEFINITION SECTION VI - DEFINITIONS is amended. Definition x. is deleted and replaced by the following definition as it applies to this endorsement only. x. You or your means the person named in the Schedule above and that person's spouse who resides in the same household. All other policy terms and conditions apply. 58548 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58548 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE FOR NAMED INDIVIDUALS - DRIVE OTHER CARS This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SCHEDULE Name(s) Of Person(s) JEFFREY VEST Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. COVERAGE The individual named insured coverage provisions or the Who Is An Insured provision of each coverage shown in the Declarations as applying to the auto to which this endorsement applies extend to you or a family member. This coverage does not apply to: h. You while operating an auto: a. Owned; or b. Rented or leased for more than 90 consecu- tive days by you. 2. A family member while operating an auto: a. Owned; or b. Rented or leased for more than 90 consecu- tive days by such family member. We will also afford the minimum coverages and amounts for the types of mandatory no-fault coverages required by the state where you reside. We will afford these same no-fault coverages to a family member who does not own an auto or who owns an auto scheduled in the Declarations, pro- vided the family member has no other source of coverage. B. The coverage afforded by this endorsement shall be excess of any other collectible coverage. C. DEFINITION SECTION VI - DEFINITIONS is amended. Definition x. is deleted and replaced by the following definition as it applies to this endorsement only. x. You or your means the person named in the Schedule above and that person's spouse who resides in the same household. All other policy terms and conditions apply. 58548 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58504 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE - BLANKET COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION II - COVERED AUTOS LIABILITY COVER- person or organization qualifies as an insured under AGE is amended. The following provision is added. SECTION II - COVERED AUTOS LIABILITY COVER - Any person or organization is an insured for Covered AGE, A. COVERAGE, 1. Who Is An Insured. Autos Liability Coverage, but only to the extent that All other policy terms and conditions apply. 58504 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 58583 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER PAYMENTS (WAIVER OF SUBROGATION) - BLANKET This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION V CONDITIONS, A. LOSS CONDITIONS is amended. S. Our Right to Recover Payments is de- leted and replaced by the following condition. 5. Our Right to Recover Payments If we make a payment under this policy and the per- son to or for whom payment is made has a right to recover damages from another, we will be entitled to that right. That person shall do everything neces- sary to transfer that right to us and do nothing to prejudice it. However, we waive our right to recover payments made for bodily injury or property damage: a. Covered by the policy; and b. Arising out of the operation of autos covered by the policy, in accordance with the terms and conditions of a written contract between you and such person or entity only if such rights have been waived by the written con- tract prior to the accident or loss which caused the bodily injury or property damage. All other policy terms and conditions apply. 58583 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58200 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY The insurance does not apply: a. Under Covered Autos Liability Coverage, to bodily injury or property damage: (1) With respect to which an insured under the policy is also an insured under a nuclear en- ergy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nucle- ar 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 liability; 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 indem- nity from the United States of America, or any agency thereof, under any agree- ment entered into by the United States of America, or any agency thereof, with any person or organization. b. Under any Medical Payments coverage, to ex- penses incurred with respect to bodily injury resulting from the hazardous properties of nu- clear material and arising out of the operation of a nuclear facility by any person or organi- zation. c. Under Covered Autos Liability Coverage, to bodily injury or property damage resulting from hazardous properties of nuclear mate- rial, if: (1) The nuclear material: (a) Is at any nuclear facility owned by, or operated by or on behalf of, an insured; or (b) Has been discharged or dispersed therefrom; (2) The nuclear material is contained in spent fuel or waste at any time possessed, handled, used, processed, stored, trans- ported or disposed of, by or on behalf of an insured; or (3) The 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 nu- clear facility, but if such facility is located within the United States of America, its terri- tories or possessions or Canada, this exclu- sion (3) applies only to property damage to such nuclear facility and any property thereat. 2. As used in this endorsement: Hazardous properties includes radioactive, toxic or explosive properties. Nuclear material means source material, special nuclear material or by-product material. Source material, special nuclear material, and by-product material have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. Spent fuel means any fuel element or fuel compo- nent, solid or liquid, which has been used or ex- posed to radiation in a nuclear reactor. Waste means any waste material: 58200 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Agency Code 1 2-0422-00 Policy Number 42-753-052-00 (a) Containing by-product material other than the tailings or wastes 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 or organization of any nuclear facility included under paragraphs (a) and (b) of the definition of nuclear facility. Nuclear facility means: (a) Any nuclear reactor; (b) Any equipment or device designed or used for: (1) Separating the isotopes of uranium or pluto- nium; (2) Processing or utilizing spent fuel; or (3) Handling, processing or packaging waste; (c) Any equipment or device used for the process- ing, fabricating or alloying of special nuclear material if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is lo- cated consists of or contains more than 25 grams of plutonium or uranium 233 or any com- bination thereof, or more than 250 grams of ura- nium 235; (d) Any structure, basin, excavation, premises or place prepared or used for the storage or dis- posal of waste and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. 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 fission- able material. Property damage includes all forms of radioactive contamination of property. All other policy terms and conditions apply. 58200 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Agency Code 12-0422-00 Policy Number 42-753-052-00 58308 (1-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA UNINSURED MOTORIST COVERAGE - NON -STACKED For a covered auto licensed or principally garaged in Florida, this endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. COVERAGE 1. An individual, then the following are insureds: 1. We will pay all sums the insured is legally en- a. The Named Insured and any family titled to recover as compensatory damages from members. the owner or driver of an uninsured motor ve- b. Anyone else occupying: hicle. The damages must result from bodily (1) A covered auto; or injury sustained by the insured caused by an (2) A temporary substitute for a covered accident. The owner's or driver's liability for auto. The covered auto must be out of these damages must result from the ownership, service because of its breakdown, re - maintenance or use of the uninsured motor ve- pair, servicing, loss or destruction. hicle. This includes loss of consortium any per- c. Anyone for damages he or she is entitled to son is legally entitled to recover because of: recover because of bodily injury sustained a. Bodily injury sustained by the insured; and by another insured. b. Caused by an accident. 2. A partnership, limited liability company, corpora- l. With respect to damages resulting from an acci- tion or any other form of organization, then the dent with a vehicle described in Paragraph a.(2) following are insureds: of the definition of uninsured motor vehicle, we a. Anyone occupying: will pay under this coverage only if Paragraph a. (1) A covered auto is an insured; or or b. below applies: (2) A temporary substitute for a covered a. The limit of any applicable liability bonds or auto is an insured. The covered auto policies has been exhausted by payment of must be out of service because of its judgments or settlements; or breakdown, repair, servicing, loss or b. A tentative settlement has been made be- destruction. tween an insured and the insurer of the un- b. Anyone for damages he or she is entitled to derinsured motor vehicle and we: recover because of bodily injury sustained (1) Have been given prompt written notice by another insured. of such tentative settlement; and (2) Advance payment to the insured in an C. EXCLUSIONS amount equal to the tentative settlement This insurance does not apply to: within 30 days after receipt of 1. Any claim settled orjudgment reached without notification. our consent, unless our right to recover pay- 3. Any judgment for damages arising out of a suit ment has not been prejudiced by such settle - brought without our written consent is not bind- ment or judgment. However, this exclusion ing on us. does not apply to a settlement made with the in- surer of a vehicle described in Paragraph b. of B. WHO IS AN INSURED the definition of an uninsured motor vehicle. If the Named Insured is designated in the Declara- tions as: 58308 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 2. The direct or indirect benefit of any insurer or 8. Bodily injury sustained by any insured while self -insurer under any workers compensation, occupying or when struck by any vehicle that is disability benefits or similar law. a covered auto for Uninsured Motorist Coverage 3. Anyone using a vehicle without a reasonable - Non -stacked while such auto is being used as belief that the person is entitled to do so. a public mode of transportation of people. This 4. Bodily injury sustained by: exclusion does not apply to car pooling on a a. An individual Named Insured while occupy- share the expense basis. ing or when struck by a vehicle owned by D. LIMIT OF INSURANCE that individual Named Insured that is not a 1. Regardless of the number of covered autos, in - covered auto for Uninsured Motorist Cover- sureds, premiums paid, claims made or suits age under this policy; brought, persons injured or vehicles involved in b. Any family member while occupying or the accident, the limit of insurance is as follows: when struck by any vehicle owned by that a. The most we will pay for all damages result - family member that is not a covered auto ing from bodily injury to any one person for Uninsured Motorist Coverage under this caused by any one accident, including all policy; damages claimed by any person or organi- c. Any family member while occupying or zation for care, loss of services or death re - when struck by any vehicle owned by the sulting from the bodily injury, is the limit of Named Insured that is insured for Uninsured Uninsured Motorist - Non -stacked shown in Motorist Coverage on a primary basis under the Declarations for each person. any other coverage form or policy; or b. Subject to the limit for each person, the d. Any insured with respect to damages for most we will pay for all damages resulting pain, suffering, mental anguish or inconve- from bodily injury caused by any one acci- nience unless the bodily injury consists in dent is the limit of Uninsured Motorist - whole or in part of: Non -stacked shown in the Declarations for (1) Significant and permanent loss of an each accident. important bodily function; 2. No one will be entitled to receive duplicate pay- (2) Permanent injury within a reasonable ments for the same elements of loss under this degree of medical probability, other than coverage and any Liability Coverage form, No - scarring or disfigurement; fault Coverage endorsement, Medical Payments (3) Significant and permanent scarring or Coverage endorsement, or Uninsured Motorist disfigurement; or Coverage endorsement attached to this policy. (4) Death. 3. We will not make a duplicate payment under this 5. Punitive or exemplary damages. coverage for any element of loss for which pay- 6. Bodily injury arising directly or indirectly out of: ment has been made by or for anyone who is a. War, including undeclared or civil war; legally responsible. b. Warlike action by a military force, including 4. We will not pay for any element of loss if a per - action in hindering or defending against an son is entitled to receive payment for the same actual or expected attack, by any govern- element of loss under any workers compensa- ment, sovereign or other authority using tion, disability benefits or similar law. military personnel or other agents; or c. Insurrection, rebellion, revolution, usurped E. CHANGES IN CONDITIONS power, or action taken by governmental au- SECTION V - CONDITIONS is amended for the thority in hindering or defending against any purposes of this endorsement only. of these. 1. The Other Insurance Provision in the policy is 7. Bodily injury sustained by any insured while deleted and replaced by the following: occupying or when struck by any vehicle that is Other Insurance a covered auto for Uninsured Motorist Coverage a. If there is other applicable insurance avail- - Non -stacked while such auto is: able under one or more coverage forms, a. Enrolled in an electronic or written auto policies or provisions of coverage, any re - sharing program agreement; and covery for damages sustained by an individ- b. Being used in connection with such auto ual Named Insured or any family member: sharing program. (1) While occupying a vehicle owned by If you are an individual, this exclusion does not that Named Insured or any family apply to you or any family member while using member may equal, but not exceed, the such auto. 58308 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 limit of insurance for Uninsured Motorist Coverage applicable to that vehicle. (2) While occupying a vehicle not owned by that Named Insured or any family member may equal, but not exceed, the sum of: (a) The limit of insurance for Uninsured Motorist Coverage applicable to the vehicle such Named Insured or any family member was occupying at the time of the accident; and (b) The highest limit of insurance for Uninsured Motorist Coverage appli- cable to any one vehicle under any one policy affording coverage to such Named Insured or any family member. (3) While not occupying any vehicle may equal, but not exceed, the highest limit of insurance for Uninsured Motorist Cov- erage applicable to any one vehicle un- der any one policy affording coverage to an individual Named Insured or any family member. b. Any insurance we provide with respect to a vehicle the Named Insured does not own will be excess over any collectible uninsured motorist insurance providing coverage on a primary basis. c. If the coverage under this policy is provided: (1) On a primary basis, we will pay only our share of the loss that must be paid un- der insurance providing coverage on a primary basis. Our share is the propor- tion that our limit of liability bears to the total of all applicable limits of liability for coverage on a primary basis. (2) On an excess basis, we will pay only our share of the loss that must be paid under insurance providing coverage on an excess basis. Our share is the pro- portion that our limit of liability bears to the total of all applicable limits of liability for coverage on an excess basis. The Duties in the Event of Accident, Claim, Suit or Loss provision is changed by adding the following: a. Promptly notify the police if a hit-and-run driver is involved; and b. Promptly send us copies of the legal papers if a suit is brought. c. A person seeking Uninsured Motorist Cover- age must also promptly notify us in writing by certified or registered mail of a tentative settlement between the insured and the in- surer of the vehicle described in Paragraph b. of the definition of an uninsured motor vehicle and allow us 30 days to advance payment to that insured in an amount equal to the tentative settlement to preserve our rights against the insurer, owner or operator of such vehicle described in Paragraph b. of the definition of an uninsured motor vehicle. 3. The Our Right to Recover Payments provision is changed by adding the following: If we make any payment and the insured re- covers from another party, the insured will hold the proceeds in trust for us and pay us back the amount we have paid. Our rights do not apply under this provision with respect to Uninsured Motorist Coverage if we: a. Have been given prompt written notice of a tentative settlement between an insured and the insurer of a vehicle described in Paragraph b. of the definition of an unin- sured motor vehicle; and b. Fail to advance payment to the insured in an amount equal to the tentative settlement within 30 days after receipt of notification. If we advance payment to the insured in an amount equal to the tentative settlement within 30 days after receipt of notification: a. That payment will be separate from any amount the insured is entitled to recover under the provisions of Uninsured Motorist Coverage; and b. We also have a right to recover the ad- vanced payment. 4. The following condition is added: a. Arbitration (1) If we and an insured do not agree: (a) Whether that person is legally enti- tled to recover damages under this endorsement; or (b) As to the amount of damages that are recoverable by that person then the matter may be mediated, in ac- cordance with the Mediation pro- vision, if the damages resulting from bodily injury are for $10,000 or less, or arbitrated. However, dis- putes concerning coverage under this endorsement may not be arbi- trated. Both parties must agree to arbitration. In this event, each party will select an arbitrator. The two arbitrators will select a third. If they cannot agree within 30 days, either may request that selection be made by a judge of a court having jurisdiction. 58308 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 C. (2) Each party will pay the expenses it in- (5) Only one mediation may be requested curs and bear the expenses of the third for each claim unless all parties agree to arbitrator equally. further mediation. A party demanding (3) Unless both parties agree otherwise, ar- mediation will not be entitled to demand bitration will take place in the county in or request mediation after a suit is filed which the insured lives. Local rules of relating to the same facts already law as to arbitration procedure and evi- mediated. dence will apply. A decision agreed to (6) The mediation will be conducted as an by two of the arbitrators will be binding. informal process and formal rules of Florida Arbitration Act evidence and procedures need not be If we and an insured agree to arbitration, observed. the Florida Arbitration Act will not apply. Mediation F. ADDITIONAL DEFINITIONS (1) In any claim filed by an insured with us SECTION VI - DEFINITIONS is amended. As used for: in this endorsement only: (a) Bodily injury in an amount of 1. Occupying means in, upon, getting in, on, out $10,000 or less, arising out of the or off. ownership, operation, use or main- 2. a. Uninsured motor vehicle means a land tenance of a covered auto; motor vehicle or trailer: (b) Property damage in any amount, (1) For which no liability bond or policy ap- arising out of the ownership, opera- plies at the time of an accident; tion, maintenance or use of a cov- (2) That is an underinsured motor vehicle. ered auto; or An underinsured motor vehicle is a land (c) Loss to a covered auto or its equip- motor vehicle or trailer for which a ment, in any amount bodily injury liability bond or policy ap- either party may make a written demand plies at the time of an accident but the for mediation of the claim prior to the in- amount paid under that bond or policy to stitution of litigation. an insured is not enough to pay the full (2) A written request for mediation must be amount the insured is legally entitled to filed with the Florida Department of Fi- recover as damages caused by the nancial Services on an approved form, accident; which may be obtained from the Florida (3) For which an insuring or bonding com- Department of Financial Services. pany denies coverage or is or becomes (3) The request must state: insolvent; or (a) Why mediation is being requested. (4) For which neither the driver nor owner (b) The issues in dispute, which are to can be identified. The land motor vehi- be mediated. cle or trailer must: (4) The Florida Department of Financial (a) Hit an individual Named Insured or Services will randomly select mediators. any family member, a covered Each party may reject one mediator, ei- auto or a vehicle such Named In- ther before or after the opposing side sured or any family member is has rejected a mediator. The mediator occupying; or will notify the parties of the date, time (b) Cause an accident resulting in and place of the mediation conference. bodily injury to an individual The mediation conference will be held Named Insured or any family mem- within 45 days of the request for media- ber without hitting that Named In- tion. The conference will be held by sured, any family member, a cov- telephone, if feasible. Participants in the ered auto or a vehicle such Named mediation conference must have the au- Insured or any family member is thority to make a binding decision, and occupying. must mediate in good faith. Each party If there is no physical contact with the will bear the expenses of the mediation land motor vehicle or trailer, the facts of equally, unless the mediator determines the accident must be proved. We will that one party has not mediated in good only accept competent evidence other faith. than the testimony of a person making 58308 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 claims under this or any similar coverage. b. However, uninsured motor vehicle does not include any vehicle: (1) Owned by a governmental unit or agency; (2) Designed for use mainly off public roads while not on public roads; or (3) Owned by or furnished or available for the regular use of the Named Insured, or if the Named Insured is an individual, any family member unless it is a cov- ered auto to which the coverage form's Liability Coverage applies and liability coverage is excluded for any person or organization other than the Named In- sured, or if the Named Insured is a in- dividual, any family member; or (4) Located for use as a residence or premises. All other policy terms and conditions apply. 58308 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 58428 (1-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA - AUTO MEDICAL PAYMENTS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY A. COVERAGE (e) For hospital outpatient services, 1. We will pay Auto Medical Payments Coverage to other than emergency services and or for any insured who accidentally sustains care, 200 percent of the Medicare bodily injury caused by an accident. Part A Ambulatory Payment Classi- 2. Auto Medical Payments Coverage shall consist fication for the specific hospital pro- of: viding the outpatient services. a. (1) Medical Benefits, meaning the following (fl For all other medical services, sup - schedule of maximum charges specified plies, and care, 200 percent of the in the Florida Motor Vehicle No -Fault allowable amount under: Law, section 627.736, Florida Statutes, 1) The participating physicians fee for medically necessary medical, sur- schedule of Medicare Part B, gical, X-ray, dental and rehabilitative except as provided in 2) and 3) services, including prosthetic devices below. and medically necessary ambulance, 2) Medicare Part B, in the case of hospital and nursing services, if the in- services, supplies, and care jured person receives initial services and provided by ambulatory surgical care within 14 days after the accident centers and clinical laboratories. involving a covered auto. 3) The Durable Medical Equipment (a) For emergency transport and treat- Prosthetics/Orthotics and Sup- ment by providers licensed under plies fee schedule of Medicare chapter 401, Florida Statutes, 200 Part B, in the case of durable percent of Medicare. medical equipment. (b) For emergency services and care However, if such services, supplies, provided by a hospital licensed un- or care is not reimbursable under der chapter 395, Florida Statutes, Medicare Part B, as provided in (fl 75 percent of the hospital's usual above, we will limit reimbursement and customary charges. to the maximum reimbursable allow- (c) For emergency services and care as ance under workers' compensation, defined by s. 395.002, Florida Stat- as determined under s. 440.13, utes, provided in a facility licensed Florida Statutes, and rules adopted under chapter 395, Florida Statutes, thereunder which are in effect at the rendered by a physician or dentist, time such services, supplies, or care and related hospital inpatient ser- is provided. Services, supplies, or vices rendered by a physician or care that is not reimbursable under dentist, the usual and customary Medicare or workers' compensation charges in the community. will not be reimbursed by us. (d) For hospital inpatient services, other (2) For purposes of the above, the appli- than emergency services and care, cable fee schedule or payment limitation 200 percent of the Medicare Part A under Medicare is the fee schedule or prospective payment applicable to payment limitation in effect on March 1 the specific hospital providing the of the service year in which the ser- inpatient services. vices, supplies, or care is rendered and 58428 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 for the area in which such services, chapter 459, Florida Statutes, or an supplies, or care is rendered, and the advanced registered nurse practi- applicable fee schedule or payment limi- tioner licensed under chapter 464, tation applies to services, supplies or Florida Statutes. Followup services care rendered during that service year, and care may also be provided by notwithstanding any subsequent change the following persons or entities: made to the fee schedule or payment 1) A hospital or ambulatory surgi- limitation, except that it will not be less cal center licensed under chap - than the allowable amount under the ter 395, Florida Statutes. applicable schedule of Medicare Part B 2) An entity wholly owned by one for 2007 for medical services, supplies, or more physicians licensed un- and care subject to Medicare Part B. der chapter 458 or chapter 459, We shall use the Medicare coding poli- Florida Statutes, chiropractic cies and payment methodologies of the physicians licensed under chap - federal Centers for Medicare and Medi- ter 460, Florida Statutes, or caid Services, including applicable modi- dentists licensed under chapter fiers, to determine the appropriate 466, Florida Statutes, or by amount of reimbursement for medical such practitioners and the services, supplies or care. spouse, parent, child, or sibling However, the Medical Benefits shall of such practitioners. provide reimbursement only for such: 3) An entity that owns or is wholly (a) Initial services and care that are owned, directly or indirectly, by lawfully provided, supervised, or- a hospital or hospitals. dered, or prescribed by a physician 4) A physical therapist licensed un- licensed under chapter 458 or chap- der chapter 486, Florida Stat- ter 459, Florida Statutes, a dentist utes, based upon a referral by a licensed under chapter 466, Florida provider described in (b) imme- Statutes, or a chiropractic physician diately above. licensed under chapter 460, Florida 5) A health care clinic licensed un- Statutes, or that are provided in a der part X of chapter 400, hospital or in a facility that owns, or Florida Statutes, which is ac- is wholly owned by, a hospital. Initial credited by an accrediting or - services and care may also be pro- ganization whose standards in- vided by a person or entity licensed corporate comparable regula- under part III of chapter 401, Florida tions required by this state, or: Statutes, which provides emergency a) Has a medical director li- transportation and treatment; and censed under chapter 458, (b) Followup services and care referred Florida Statutes, chapter by the health care provider of the 459, Florida Statutes, or initial services and care, consistent chapter 460, Florida with the underlying medical diag- Statutes; nosis rendered in the initial services b) Has been continuously li- and care that are lawfully provided, censed for more than 3 supervised, ordered or prescribed years or is a publicly traded by a physician licensed under chap- corporation that issues se - ter 458 or chapter 459, Florida Stat- curities traded on an ex- utes, a chiropractic physician li- change registered with the censed under chapter 460, Florida United States Securities Statutes, a dentist licensed under and Exchange Commission chapter 466, Florida Statutes, or, to as a national securities ex - the extent permitted by applicable change; and law and under the supervision of c) Provides at least four of the such physician, osteopathic physi- following medical cian, chiropractic physician, or den- specialties: tist, by a physician assistant li- i General medicine. censed under chapter 458 or ii Radiography. 58428 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 iii Orthopedic medicine. iv Physical medicine. v Physical therapy. vi Physical rehabilitation. vii Prescribing or dispensing outpatient prescription medication. viii Laboratory services. Medical Benefits do not include massage as defined in s. 480.033, Florida Statutes, or acupuncture as defined in s. 457.102, Florida Statutes, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for Medical Benefits under this provision. b. Reasonable funeral service expenses equal to the lesser of $5,000 or the remainder of the unused Auto Medical Payments Cover- age per person. Reasonable funeral service expenses must be incurred within three years of the accident resulting in death and reported to us within one year of the funeral. We may pay reasonable funeral service ex- penses to the executor or administrator of the deceased, to any of the deceased's rela- tives by blood, legal adoption, or marriage, or to any person appearing to us to be equitably entitled to such benefits. B. WHO IS AN INSURED 1. Anyone occupying a covered auto; and 2. If you are an individual and a covered auto is a private passenger auto to which Auto Medical Payments applies: a. You; and b. Any family member, who does not own an auto (that is not a trailer) unless shown in the Declarations when struck by or while occupying an auto not owned by, furnished or available for regular use by you or anyone living with you. C. EXCLUSIONS Auto Medical Payments Coverage does not apply to: 1. Bodily injury expected or intended from the standpoint of the insured. 2. Bodily injury to an insured while working in a business of selling, leasing, servicing, repairing, parking, storing, delivering or testing autos, unless that business is yours. 3. Bodily injury arising out of the use of any cov- ered auto as a public mode of transportation of people. This exclusion does not apply to car pooling on a share the expense basis. 4. Bodily injury arising out of the use of any cov- ered auto while participating in any prearranged racing, prearranged high speed driving, prear- ranged competitive driving or prearranged de- molition event. This exclusion also applies while any covered auto is preparing for or practicing for any of the previously mentioned events. 5. Bodily injury to any person occupying a cov- ered auto without a reasonable belief of your permission to do so. 6. Bodily injury 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 govern- ment, sovereign or other authority using mili- tary personnel or other agents; or c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental au- thority in hindering or defending against any of these. 7. Any obligation for which the insured or the in- sured's insurer may be held liable under any workers compensation, disability benefits or un- employment compensation law or any similar law. 8. Bodily injury to an insured occupying or struck by a covered auto located for use as a residence or premises. 9. Bodily injury to any person injured while committing a felony. 10. Bodily injury sustained by any insured while occupying or when struck by any vehicle that is a covered auto while such auto is: a. Enrolled in an electronic or written auto sharing program agreement; and b. Being used in connection with such auto sharing program. If you are an individual, this exclusion does not apply to you or any family member while using such auto. D. LIMIT OF INSURANCE 1. The Limit of Insurance shown in the Declara- tions for each person is the most we will pay to or for any person in one accident for medical benefits and reasonable funeral service expenses. 2. Subject to D.1. above, the most we will pay for reasonable funeral service expenses is $5,000 per person. 3. The Limit of Insurance is not increased because of the number of: a. Covered autos; b. Insureds; c. Premiums paid; 58428 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 d. Claims made or suits brought; deny the claim or pay the claim with simple interest. e. Persons injured; or Interest shall be assessed from the date the claim f. Vehicles involved in the accident. was submitted until the day the claim is paid. All 4. We will not pay any amount for medical or claims denied for suspected fraudulent insurance funeral services that duplicate amounts paid or acts shall be reported to the Division of Investigative payable by other insurance of any type. and Forensic Services. S. If you, or a family member who does not own an auto unless shown in the Declarations, sus- G. The following provisions apply in addition to those tain bodily injury while not occupying an auto, contained in SECTION V — CONDITIONS, A. LOSS the maximum amount of coverage available for CONDITIONS, 1. Duties in the Event of Accident, such bodily injury is the highest single limit of Claim, Suit or Loss of the policy. insurance for this coverage applying to any auto MEDICAL REPORTS; PROOF OF CLAIM; with respect to which the injured person is an REHABILITATION NOTICE insured. As soon as practicable, the injured person or some- one on his or her behalf shall send us written proof E. OTHER INSURANCE of claim, under oath if required. This must include The coverage afforded by this endorsement shall be full details of the bodily injury, treatment, and re - excess over benefits paid or payable under the habilitation received and considered. It must also Florida Motor Vehicle No -Fault Law. However, when include such other information as may help us de - the injured person is eligible for Personal Injury Pro- termine the amount we must pay. At our request tection Benefits, coverage shall only apply to the ex- the injured person or someone acting on the behalf tent coverage is afforded under the Personal Injury of the injured person must authorize us to obtain Protection Benefits of this policy and is not payable medical and other records which pertain to the under the Personal Injury Protection Benefits of this bodily injury. The injured person must, at our ex - policy due to: pense, submit to mental or physical examinations by 1. The 80% limitation; or doctors we select as often as we may reasonably 2. The maximum aggregate limitation. require. An injured person's refusal to submit to or failure to appear at two examinations raises a re- F. FRAUD buttable presumption that the refusal or failure was Benefits are not due or payable to or on the behalf unreasonable. If an injured person unreasonably of an insured person if that person has committed, refuses to submit to or fails to appear at an exami- by a material act or omission, insurance fraud re- nation, we are no longer liable for subsequent lating to Auto Medical Payments Coverage under Medical Benefits. this policy, if the fraud is admitted to in a sworn EXAMINATION UNDER OATH statement by the insured or established in a court of An injured person seeking benefits under Auto competent jurisdiction. Any insurance fraud voids all Medical Payments Coverage must comply with the coverage arising from the claim related to such fraud terms of this policy, which include, but are not under the Auto Medical Payments Coverage of the limited to, submitting to an examination under oath. insured person who committed the fraud, irrespec- The scope of questioning during the examination is tive of whether a portion of the insured person's limited to relevant information or information that claim may be legitimate, and any benefits paid be- could reasonably be expected to lead to relevant fore the discovery of the fraud is recoverable by us information. Compliance with the examination under in its entirety from the person who committed insur- oath requirement is a condition precedent to ance fraud. The prevailing party is entitled to its receiving benefits. costs and attorney fees in any action in which it pre- vails in our action to enforce our right of recovery H. SECTION VI — DEFINITIONS is amended. under this paragraph. The following definitions are added for the purposes If we have a reasonable belief that a fraudulent in- of this endorsement only. surance act, for the purposes of coverage under this 1. Entity wholly owned means a proprietorship, coverage form, has been committed, we shall notify group practice, partnership, or corporation that the claimant, in writing, within 30 days after submis- provides health care services rendered by li- sion of the claim that the claim is being investigated censed health care practitioners and in which for suspected fraud. Beginning at the end of the licensed health care practitioners are the busi- initial 30-day period, we have an additional 60 days ness owners of all aspects of the business to conduct fraud investigation. No later than 90 entity, including, but not limited to, being days after the submission of the claim, we must reflected as the business owners on the title or 58428 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 lease of the physical facility, filing taxes as the business owners, being account holders on the entity's bank account, being listed as the princi- pals on all incorporation documents required by this state, and having ultimate authority over all personnel and compensation decisions relating to the entity. However, this definition does not apply to an entity that is wholly owned, directly or indirectly, by a hospital licensed under chap- ter 395, Florida Statutes. 2. Medically necessary means a medical service or supply that a prudent physician would provide for the purpose of preventing, diagnosing or treating an illness, injury, disease or symptom in a manner that is: a. In accordance with generally accepted standards of medical practice; b. Clinically appropriate in terms of type, fre- quency, extent, site and duration; and c. Not primarily for the convenience of the pa- tient, physician or other health care provider. 3. Occupying means being in or on an auto as a passenger or operator, or being engaged in the immediate acts of entering, boarding or alighting from an auto. 4. Service year means the period from March 1 through the end of February of the following year. All other policy terms and conditions apply. 58428 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 Agency Code 12-0422-00 Policy Number 42-753-052-00 58455 (1-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA - PERSONAL INJURY PROTECTION For a covered auto licensed or principally garaged in Florida, this endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. We agree with the named insured, subject to all the provisions of this endorsement and to all of the provisions of the policy except as modified herein, as follows that: A. COVERAGE We will pay Personal Injury Protection benefits in accordance with the Florida Motor Vehicle No-fault Law to or for an insured who sustains bodily injury in an accident arising out of the ownership, mainte- nance or use of a motor vehicle. Personal Injury Protection benefits consist of the following: 1. Medical Benefits a. Medical Benefits, meaning 80% of the following schedule of maximum charges specified in the Florida Motor Vehicle No - Fault Law, section 627.736, Florida Stat- utes, for medically necessary medical, surgical, X-ray, dental and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital and nursing services, if the injured person receives initial services and care within 14 days after the motor vehicle accident: (1) For emergency transport and treatment by providers licensed under chapter 401, Florida Statutes, 200 percent of Medicare. (2) For emergency services and care pro- vided by a hospital licensed under chapter 395, Florida Statutes, 75 percent of the hospital's usual and customary charges. (3) For emergency services and care as defined by s. 395.002, Florida Stat- utes, provided in a facility licensed un- der chapter 395, Florida Statutes, ren- dered by a physician or dentist, and related hospital inpatient services ren- dered by a physician or dentist, the usual and customary charges in the community. (4) For hospital inpatient services, other than emergency services and care, 200 percent of the Medicare Part A prospec- tive payment applicable to the specific hospital providing the inpatient services. (5) For hospital outpatient services, other than emergency services and care, 200 percent of the Medicare Part A Ambula- tory Payment Classification for the spe- cific hospital providing the outpatient services. (6) For all other medical services, supplies, and care, 200 percent of the allowable amount under: (a) The participating physicians fee schedule of Medicare Part B except as provided in (b) and (c) below. (b) Medicare Part B, in the case of services, supplies and care pro- vided by ambulatory surgical centers and clinical laboratories. (c) The Durable Medical Equipment Prosthetics/Orthotics and Supplies fee schedule of Medicare Part B, in the case of durable medical equipment. However, if such services, supplies, or care is not reimbursable under Medicare Part B, as provided in (6) above, we will limit reimbursement to 80% of the maxi- mum reimbursable allowance under workers compensation, as determined under s. 440.13, Florida Statutes, and 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 rules adopted thereunder which are in licensed under chapter 460, Florida effect at the time such services, sup- Statutes, a dentist licensed under plies, or care is provided. Services, chapter 466, Florida Statutes, or, to the supplies, or care that is not reimburs- extent permitted by applicable law and able under Medicare or workers com- under the supervision of such physician, pensation will not be reimbursed by us. osteopathic physician, chiropractic b. For purposes of the above, the applicable physician, or dentist, by a physician fee schedule or payment limitation under assistant licensed under chapter 458 or Medicare is the fee schedule or payment chapter 459, Florida Statutes, or an ad - limitation in effect on March 1 of the service vanced registered nurse practitioner li- year in which the services, supplies, or care censed under chapter 464, Florida is rendered and for the area in which such Statutes. Followup services and care services, supplies, or care is rendered, and may also be provided by the following the applicable fee schedule or payment persons or entities: limitation applies to services, supplies or (a) A hospital or ambulatory surgical center care rendered during that service year, licensed under chapter 395, Florida notwithstanding any subsequent change Statutes. made to the fee schedule or payment limita- (b) An entity wholly owned by one or more tion, except that it will not be less than the physicians licensed under chapter 458 allowable amount under the applicable or chapter 459, Florida Statutes, chiro- schedule of Medicare Part B for 2007 for practic physicians licensed under chap - medical services, supplies, and care subject ter 460, Florida Statutes, or dentists li- to Medicare Part B. censed under chapter 466, Florida We shall use the Medicare coding policies Statutes, or by such practitioners and and payment methodologies of the federal the spouse, parent, child, or sibling of Centers for Medicare and Medicaid Ser- such practitioners. vices, including applicable modifiers, to de- (c) An entity that owns or is wholly owned, termine the appropriate amount of reim- directly or indirectly, by a hospital or bursement for medical services, supplies or hospitals. care. (d) A physical therapist licensed under However, the Medical Benefits shall provide chapter 486, Florida Statutes, based reimbursement only for such: upon a referral by a provider described (1) Initial services and care that are lawfully in (2) immediately above. provided, supervised, ordered, or (e) A health care clinic licensed under part prescribed by a physician licensed X of chapter 400, Florida Statutes, under chapter 458 or chapter 459, which is accredited by an accrediting or - Florida Statutes, a dentist licensed un- ganization whose standards incorporate der chapter 466, Florida Statutes, or a comparable regulations required by this chiropractic physician licensed under state, or: chapter 460, Florida Statutes, or that 1) Has a medical director licensed un- are provided in a hospital or in a facility der chapter 458, Florida Statutes, that owns, or is wholly owned by, a hos- chapter 459, Florida Statutes, or pital. Initial services and care may also chapter 460, Florida Statutes; be provided by a person or entity li- 2) Has been continuously licensed for censed underpart III of chapter 401, more than 3 years or is a publicly Florida Statutes, which provides emer- traded corporation that issues se- gency transportation and treatment; and curities traded on an exchange (2) Followup services and care referred by registered with the United States the health care provider of the initial Securities and Exchange Commis - services and care, consistent with the sion as a national securities ex - underlying medical diagnosis rendered change; and in the initial services and care that are 3) Provides at least four of the lawfully provided, supervised, ordered or following medical specialties: prescribed by a physician licensed un- a) General medicine. der chapter 458 or chapter 459, Florida b) Radiography. Statutes, a chiropractic physician c) Orthopedic medicine. 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 d) Physical medicine. e) Physical therapy. f) Physical rehabilitation. g) Prescribing or dispensing outpa- tient prescription medication. h) Laboratory services. Medical Benefits, do not include massage as defined in s. 480.033, Florida Statutes, or acupuncture as defined in s. 457.102, Florida Statutes, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage thera- pist or licensed acupuncturist may not be reimbursed for Medical Benefits under this provision. 2. Disability Benefits a. Replacement Services Expenses With respect to the period of disability of the injured person, all expenses reasonably in- curred in obtaining from others ordinary and necessary services in lieu of those that, but for such injury, the injured person would have performed without income for the ben- efit of his or her household, subject to the total aggregate limit; b. Wage Loss With respect to the period of disability of the injured person, 60% of any loss of income and earning capacity from inability to work proximately caused by the injury sustained by the injured person, subject to the total aggregate limit; and 3. Death Benefits Death Benefits are in addition to the Medical Benefits, Replacement Services Expenses and Wage Loss provided under this policy. We may pay Death Benefits to the executor or adminis- trator of the deceased, to any of the deceased's relatives by blood, legal adoption, or marriage, or to any person appearing to us to be equitably entitlted to such benefits. B. WHO IS AN INSURED 1. The named insured. 2. If the named insured is an individual, any fam- ily member. 3. Any other person while occupying a covered motor vehicle with the named insured's consent. 4. A pedestrian if the pedestrian is struck by a covered motor vehicle. C. EXCLUSIONS We will not pay Personal Injury Protection benefits for bodily injury: 1. Sustained by the named insured or any family member while occupying any motor vehicle owned by the named insured that is not a covered motor vehicle; 2. Sustained by any person while operating the covered motor vehicle without the named insured's expressed or implied consent; 3. Sustained by any person, if such person's con- duct contributed to his or her bodily injury under any of the following circumstances: a. Causing bodily injury to himself or herself intentionally; or b. While committing a felony; 4. To any pedestrian, other than the named in- sured or any family member, not a legal resident of the state of Florida; 5. To any person, other than the named insured, if that person is the owner of a motor vehicle for which security is required under the Florida Motor Vehicle No-fault Law; 6. To any person, other than the named insured, or any family member, who is entitled to Per- sonal Injury Protection benefits from the owner of a motor vehicle that is not a covered motor vehicle under this insurance or from the owner's insurer; or 7. To any person who sustains bodily injury while occupying a motor vehicle located for use as a residence or premises. D. LIMIT OF INSURANCE 1. Regardless of the number of persons insured, policies or bonds applicable, premiums paid, vehicles involved or claims made, the total ag- gregate limit of Personal Injury Protection ben- efits, available under the Florida Motor Vehicle No-fault Law from all sources combined, includ- ing this policy, for or on behalf of any one per- son who sustains bodily injury as the result of any one accident, shall be $10,000 when it has been determined, by a physician licensed under chapter 458 or chapter 459, Florida Statutes, a dentist licensed under chapter 466, Florida Statutes, a physician assistant licensed under chapter 458 or chapter 459, Florida Statutes, or an advanced registered nurse practitioner li- censed under chapter 464, Florida Statutes, that the injured person had an emergency medical condition. However, Medical Benefits shall be limited to $2,500 when: a. A health care provider, as described in A. COVERAGE, 1.b.(1) which provided the initial services and care; or b. A health care provider, as described in A. COVERAGE, 1.b.(2) which provided the followup services and care did not determine that the injured person had an emergency medical condition. 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 2. We will pay no more than $5,000 per individual for Death Benefits. Death Benefits are in addi- tion to the Medical and Disability Benefits provided under this policy. 3. Any amount paid under this coverage will be re- duced by the amount of benefits an injured per- son has been paid or is entitled to be paid for the same elements of loss under any workers compensation law. 4. If Personal Injury Protection benefits, under the Florida Motor Vehicle No-fault Law, have been received from any insurer for the same elements of loss and expense benefits available under this policy, we will not make duplicate payments to or for the benefit of the injured person. The in- surer paying the benefits shall be entitled to re- cover from us its pro rata share of the benefits paid and expenses incurred in handling the claim. 5. The deductible amount shown in the Decla- rations will be deducted from the total amount of expenses and losses listed in Paragraphs A.1., A.2. and A.3. of this endorsement before the application of any percentage limitation for each insured to whom the deductible applies. Such deductible will apply: a. Only to the named insured, if designated PIP Deductible (X); or b. Only to the named insured and each de- pendent family member, if designated PIP Deductible (Y) as shown in the Declarations under Personal Injury Protection. The deductible does not apply to the Death Benefit. 6. Any amount paid under this coverage for Medi- cal Benefits shall be limited by the medical fee schedule as provided by this policy. E. CHANGES IN CONDITIONS SECTION V - CONDITIONS is amended for the purposes of this endorsement only. 1. Duties In The Event Of Accident, Claim, Suit Or Loss is deleted and replaced by the following: Compliance with the following duties is a condi- tion precedent to receiving benefits: In the event of an accident, the named insured must give us or our authorized representative prompt written notice of the accident. If any injured person or his or her legal repre- sentative institutes a legal action to recover damages for bodily injury against a third party, a copy of the summons, complaint or other pro- cess served in connection with that legal action must be forwarded to us as soon as possible by the injured person or his or her legal representative. A person seeking personal injury protection ben- efits must, as soon as possible, give us written proof of claim, under oath if required, containing full particulars concerning the injuries and treat- ment received and/or contemplated, and send us any other information that will assist us in de- termining the amount due and payable. A person seeking personal injury protection ben- efits must submit to an examination under oath. The scope of questioning during the examination under oath is limited to relevant information or information that could reasonably be expected to lead to relevant information. 2. Legal Action Against Us is deleted and re- placed by the following: Legal Action Against Us a. No legal action may be brought against us until there has been full compliance with all terms of this policy. In addition, no legal action may be brought against us: (1) Until the claim for benefits is overdue in accordance with Paragraph F.2. of this endorsement; and (2) Until we are provided with a demand letter in accordance with the Florida Motor Vehicle No-fault Law sent to us via U.S. certified or registered mail; and (3) With respect to the overdue claim speci- fied in the demand letter, if, within 30 days of receipt of the demand letter, we: (a) Pay the overdue claim; or (b) Agree to pay for future treatment not yet rendered in accordance with the requirements of the Florida Motor Vehicle No-fault Law. b. If legal action is brought against us, all claims related to the same health care pro- vider or facility shall be brought in a single action, unless good cause can be shown why such claims should be brought separately. 3. Our Right to Recover Payments is deleted and replaced by the following: Our Right to Recover Payments Unless prohibited by the Florida Motor Vehicle No-fault Law, in the event of payment to or for the benefit of any injured person under this coverage: a. We will be reimbursed for those payments, not including reasonable attorneys' fees and other reasonable expenses, from the pro- ceeds of any settlement or judgment result- ing from any right of recovery of the injured 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 4. a person against any person or organization Florida but within the United States of legally responsible for the bodily injury America, its territories or possessions or from which the payment arises. We will also Canada. have a lien on those proceeds. F. ADDITIONAL CONDITIONS b. If any person to or for whom we pay bene- SECTION V - CONDITIONS is amended for the pur- fits has rights to recover benefits from an- poses of this endorsement only. The following con - other, those rights are transferred to us. ditions are added: That person must do everything necessary 1. Mediation to secure our rights and must do nothing a. In any claim filed by an insured with us for: after loss to impair them. (1) Bodily injury in an amount of $10,000 c. The insurer providing Personal Injury Pro- or less, arising out of the ownership, op- tection benefits on a private passenger mo- eration, use or maintenance of a cov- tor vehicle, as defined in the Florida Motor ered auto; Vehicle No-fault Law, shall be entitled to re- (2) Property damage in any amount, aris- imbursement to the extent of the payment of ing out of the ownership, operation, Personal Injury Protection benefits from the maintenance or use of a covered auto; owner or the insurer of the owner of a com- or mercial motor vehicle, as defined in the (3) Loss to a covered auto or its equip - Florida Motor Vehicle No-fault Law, if such ment, in any amount injured person sustained the injury while either party may make a written demand for occupying, or while a pedestrian through mediation of the claim prior to the institution being struck by, such commercial motor of litigation. vehicle. However, such insurer's right of b. A written request for mediation must be filed reimbursement under this Paragraph c. with the Florida Department of Financial does not apply to an owner or registrant of Services on an approved form, which may a motor vehicle used as a taxicab. be obtained from the Florida Department of Concealment, Misrepresentation or Fraud is Financial Services. deleted and replaced by the following: c. The request must state: Concealment, Misrepresentation or Fraud (1) Why mediation is being requested. We do not provide coverage under this endorse- (2) The issues in dispute, which are to be ment for an insured if that insured has com- mediated. mitted, by a material act or omission, insurance d. The Florida Department of Financial Ser- fraud relating to personal injury protection cov- vices will randomly select mediators. Each erage under this form, if fraud is admitted to in a party may reject one mediator, either before sworn statement by the insured or if the fraud is or after the opposing side has rejected a established in a court of competent jurisdiction. mediator. The mediator will notify the par - Any insurance fraud voids all personal injury ties of the date, time and place of the medi- protection coverage arising from the claim with ation conference. The mediation conference respect to the insured who committed the fraud. will be held within 45 days of the request for Any benefits paid prior to the discovery of the mediation. The conference will be held by fraud are recoverable from that insured. telephone, if feasible. Participants in the Policy Term and Territory is deleted and mediation conference must have the author - replaced by the following: ity to make a binding decision, and must Policy Term and Territory mediate in good faith. Each party will bear The insurance under this section applies only to the expenses of the mediation equally, un- accidents which occur during the policy term: less the mediator determines that one party a. In the state of Florida; has not mediated in good faith. b. As respects the named insured or any fam- e. Only one mediation may be requested for ily member, while occupying the covered each claim unless all parties agree to further motor vehicle outside the state of Florida mediation. A party demanding mediation but within the United States of America, its shall not be entitled to demand or request territories or possessions or Canada; and mediation after a suit is filed relating to the c. As respects the named insured, while oc- same facts already mediated. cupying a motor vehicle of which a family f. The mediation shall be conducted as an in - member is the owner and for which security formal process and formal rules of evidence is maintained under the Florida Motor Ve- and procedures need not be observed. hicle No -Fault Law outside the state of 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 3. 4. Payment of Benefits Personal Injury Protection benefits payable un- der this policy, whether the full or partial amount, may be overdue if not paid within 30 days after we are furnished with written notice of the cov- ered loss and the amount of the covered loss in accordance with the Florida Motor Vehicle No- fault Law. However, if we have a reasonable belief that a fraudulent insurance act has been committed relating to Personal Injury Protection coverage under this policy, we will notify the insured in writing, within 30 days after the submission of the claim, that the claim is being investigated for suspected fraud. No later than 90 days after the submission of the claim, we will either deny or pay the claim, in accordance with the Florida Motor Vehicle No-fault Law. If we pay only a portion of a claim or reject a claim because of an alleged error in the claim, we, at the time of the partial payment or rejec- tion, will provide an itemized specification or ex- planation of benefits because of the specified error. Upon receiving the specification or expla- nation, the person making the claim, at the per- son's option and without waiving any other legal remedy for payment, has 15 days to submit a revised claim, which will be considered a timely submission of written notice of a claim. Modification of Policy Coverages Any Auto Medical Payments Coverage and any Uninsured Motorist Coverage afforded by the policy shall be excess over any Personal Injury Protection benefits paid or payable. Regardless of whether the full amount of Per- sonal Injury Protection benefits has been ex- hausted, any Medical Payments Coverage af- forded by the policy shall pay the portion of any claim for personal injury protection medical ex- penses which are otherwise covered but not payable because of the limitation of 80% of medical expense benefits but shall not be pay- able for the amount of the deductible selected. Medical Reports and Examinations; Payment of Claim Withheld As soon as practicable, the person making the claim shall submit to mental and physical exam- inations at our expense when and as often as we may reasonably require and a copy of the medical report shall be forwarded to such per- son if requested. At our request, the person making the claim or someone acting on behalf of such person must authorize us to obtain medical and other records which pertain to the bodily injury. If the person unreasonably refuses to submit to, or fails to appear at, an examination, we will not be liable for subsequent Personal Injury Protec- tion benefits. Such person's refusal to submit to, or failure to appear at, two examinations, raises a rebuttable presumption that such per- son's refusal or failure was unreasonable. Whenever a person making a claim as a result of an injury sustained while committing a felony is charged with committing that felony, we shall withhold benefits until, at the trial level, the pros- ecution makes a formal entry on the record that it will not prosecute the case against the person, the charge is dismissed or the person is acquitted. 5. Provisional Premium In the event of any change in the rules, rates, rating plan, premiums or minimum premiums applicable to the insurance afforded, because of an adverse judicial finding as to the constitution- ality of any provisions of the Florida Motor Vehi- cle No-fault Law providing for the exemption of persons from tort liability, the premium shown in the Declarations for any Liability, Medical Pay- ments and Uninsured Motorist insurance shall be deemed provisional and subject to recom- putation. If this policy is a renewal policy, such recomputation shall also include a determination of the amount of any return premium previously credited or refunded to the named insured pur- suant to the Florida Motor Vehicle No-fault Law with respect to insurance afforded under a previous policy. If the final premium thus recomputed exceeds the premium shown in the Declarations, the named insured shall pay to us the excess as well as the amount of any return premium pre- viously credited or refunded. 6. Special Provisions For Rented Or Leased Vehicles Notwithstanding any provision of this coverage to the contrary, if a person is injured while occu- pying, or through being struck by, a motor ve- hicle rented or leased under a rental or lease agreement which does not specify otherwise in language required by FLA. STAT. SECTION 627.7263(2) in at least 10-point type on the face of the agreement, the Personal Injury Protection benefits available under the Florida Motor Vehi- cle No-fault Law and afforded under the lessor's policy shall be primary. 7. Insured's Right To Personal Injury Protection Information a. In a dispute between us and an insured, or between us and an assignee of the in- sured's Personal Injury Protection benefits, 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 we will, upon request, notify such insured or assignee that the limits for Personal Injury Protection have been reached. We will pro- vide such information within 15 days after the limits for Personal Injury Protection have been reached. b. If legal action is commenced, we will, upon request, provide an insured with a copy of a log of Personal Injury Protection benefits paid by us on behalf of the insured. We will provide such information within 30 days of receipt of the request for the log from the insured. G. ADDITIONAL DEFINITIONS SECTION VI - DEFINITIONS is amended. As used in this endorsement only: 1. Emergency medical condition means a medi- cal condition manifesting itself by acute symp- toms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: a. Serious jeopardy to insured's health; b. Serious impairment to bodily functions; or c. Serious dysfunction of any bodily organ part. 2. Entity wholly owned means a proprietorship, group practice, partnership, or corporation that provides health care services rendered by li- censed health care practitioners and in which licensed health care practitioners are the busi- ness owners of all aspects of the business en- tity, including, but not limited to, being reflected as the business owners on the title or lease of the physical facility, filing taxes as the business owners, being account holders on the entity's bank account, being listed as the principals on all incorporation documents required by this state, and having ultimate authority over all per- sonnel and compensation decisions relating to the entity. However, this definition does not apply to an entity that is wholly owned, directly or indirectly, by a hospital licensed under chapter 395, Florida Statutes. 3. Medically necessary refers to a medical ser- vice or supply that a prudent physician would provide for the purpose of preventing, diagnos- ing or treating an illness, injury, disease or symptom in a manner that is: a. In accordance with generally accepted standards of medical practice; b. Clinically appropriate in terms of type, fre- quency, extent, site and duration; and c. Not primarily for the convenience of the patient, physician or other health care provider. 4. Motor vehicle means any self-propelled vehicle with four or more wheels which is of a type both designed and required to be licensed for use on the highways of Florida and any trailer or semi- trailer designed for use with such vehicle. However, motor vehicle does not include: a. A mobile home; b. Any motor vehicle which is used in mass transit, other than public school transporta- tion, and designed to transport more than five passengers exclusive of the operator of the motor vehicle and which is owned by a municipality, a transit authority or a political subdivision of the state. S. Named insured means the person or organiza- tion named in the Declarations of the policy and, if an individual, shall include the spouse if a resi- dent of the same household. 6. Occupying means in or upon or entering into or alighting from. 7. Owner means a person or organization who holds the legal title to a motor vehicle and also includes: a. A debtor having the right to possession, in the event a motor vehicle is the subject of a security agreement; b. A lessee having the right to possession, in the event a motor vehicle is the subject of a lease with option to purchase and such lease agreement is for a period of six months or more; and c. A lessee having the right to possession, in the event a motor vehicle is the subject of a lease without option to purchase, and such lease is for a period of six months or more, and the lease agreement provides that the lessee shall be responsible for securing insurance. 8. Pedestrian means a person while not an occu- pant of any self-propelled vehicle. 9. Service year means the period from March 1 through the end of February of the following year. All other policy terms and conditions apply. 58455 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 Agency Code 12-0422-00 Policy Number 42-753-052-00 58514 (9-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO PLUS COVERAGE PACKAGE This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY 1. Supplementary Payments SECTION II - COVERED AUTOS LIABILITY COV- ERAGE, 2. Coverage Extensions is amended. Paragraphs (3) and (7) of a. Supplementary Pay- ments are deleted and replaced by the following: (3) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an accident we cover. We will not apply for or furnish such bonds. (7) All reasonable expenses incurred by an insured at our request, including actual loss of earnings up to $500 per day. 2. Waiver of Collision Deductible For Collision With Another Auto -Owners Insured SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. Under paragraph 1., b. Collision Coverage is de- leted and replaced by the following. We will pay for loss to a covered auto or its equip- ment or custom furnishings under: b. Collision Coverage Caused by: (1) The covered auto's collision with another object; or (2) The covered auto's overturn. When a deductible is shown in the Declarations for this coverage, we will reduce our payment by that amount. The deductible shall not apply when a covered auto is in a collision with another auto: (1) We insure and which you do not own, rent or have in your care, custody or control; or (2) Whose owner or operator has been identified; and (a) Is legally responsible for the entire amount of the damage; and (b) Is covered by a property damage liability policy or bond but only if the damage exceeds the de- ductible amount. 3. Deductible SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. a. Paragraph 1.a. Comprehensive Coverage is amended. The following provision is added. When more than one covered auto is involved in the same loss, only one deductible shall apply. If the deductibles differ, we shall only apply the highest deductible. b. Paragraph 1.b. Collision Coverage is amended. The following provisions are added. When more than one covered auto is involved in the same loss, only one deductible shall apply. If the deductibles differ, we shall only apply the highest deductible. When provision 2. Waiver of Collision Deductible For Collision With Another Auto -Owners Insured of this endorsement also applies to the same loss, the deductible shall be further reduced to no deductible. For the purposes of this provision only, an auto and attached trailer shall be considered two covered autos. 4. Non -Owned Trailer Physical Damage SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. Under 3. Coverage Extensions, paragraph a. Trail- ers is deleted and replaced by the following. a. Trailers The Comprehensive Coverage and Collision Coverage provided to a covered auto extend to certain trailers you do not own. The trailer must: (1) Be designed for use with the covered auto; (2) Be used with the covered auto; and (3) Be other than a trailer of the home, office, store, display, or passenger type. Our limit of insurance shall not exceed $1,000 in any one loss. No deductible applies to this coverage extension. 58514 (9-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 4 Agency Code 12-0422-00 Policy Number 42-753-052-00 S. Personal Property SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. Under 3. Coverage Extensions, paragraph c. Per- sonal Property is deleted and replaced by the following. c. Personal Property The Comprehensive Coverage and the Collision Coverage provided to a covered auto will extend to loss to personal property contained in or on such auto as follows: (1) Comprehensive Coverage because of: (a) Fire; (b) Lightning; or (c) Theft or attempted theft if there are visi- ble signs of someone breaking into such auto or the entire auto is stolen; or (2) Collision Coverage. The personal property must be owned by you, a family member or your employee. This coverage extension does not apply to: (1) Any electronic equipment that reproduces, receives or transmits audio, visual, global positioning or data signals. (2) Tapes, discs, or other similar media de- signed for use with equipment described in (1) immediately above. (3) Any accessories used with the media or equipment described in (1) or (2) immedi- ately above. (4) Money or jewelry. (5) Any device designed or used to: (a) Detect speed -measuring equipment such as radar or laser detectors; or (b) Elude or disrupt speed -measuring equipment such as a jamming apparatus. (6) Property specifically insured. (7) Any property covered under any other cov- erage extension within this endorsement. Our limit of insurance under this coverage ex- tension is $600 in any one loss. No deductible applies to this coverage extension. 6. Audio, Visual or Data Electronic Equipment SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. The following coverage extension is added. a. We will extend the Comprehensive Coverage and the Collision Coverage that apply to a cov- ered auto to loss to: (1) Any electronic equipment that reproduces, receives or transmits audio, visual, global positioning or data signals that is designed for use with a covered auto and was not standard or optional equipment for the manufacturer of such covered auto for that make, model and model year. (2) Tapes, discs or other similar media de- signed for use with electronic equipment de- scribed in a.(1) above. (3) Any accessories used with the media or equipment described in a.(1) or a.(2) above. b. Our limit under a.(1) above will not exceed $2,500 in any one loss and supercedes any other limit for such coverage provided elsewhere within this policy. Our limit under a.(2) and a.(3) above combined will not exceed $200 in any one loss. No deductible applies to this coverage extension. c. This coverage extension does not apply to any property covered under any other coverage ex- tension within this endorsement. d. B. EXCLUSIONS is amended. Exclusion 1. is deleted only as it applies to the coverage pro- vided by this extension. 7. Business Personal Property SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. The following coverage extension is added. We will extend the Comprehensive Coverage and the Collision Coverage that apply to a covered auto to loss to business personal property contained in or on such auto. This coverage extension is subject to the following: a. The business personal property must be owned by you, a family member or your employee. b. Comprehensive Coverage is extended only for loss because of: (1) Fire; (2) Lightning; or (3) Theft or attempted theft. Unless the entire auto is stolen, there must be visible signs of someone breaking into the auto for b.(3) above to apply. c. This coverage extension does not apply to: (1) Any electronic equipment that reproduces, receives or transmits audio, visual, global positioning or data signals. (2) Tapes, discs, or other similar media de- signed for use with equipment described in (1) immediately above. (3) Any accessories used with the media or equipment described in (1) or (2) immedi- ately above. (4) Money or jewelry. (5) Any device designed or used to: (a) Detect speed -measuring equipment such as radar or laser detectors; or (b) Elude or disrupt speed -measuring equipment such as a jamming apparatus. 58514 (9-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 4 Agency Code 12-0422-00 Policy Number 42-753-052-00 8. 9. 10 (6) Property specifically insured. (7) Any property covered under any other cov- erage extension within this endorsement. d. Our limit of insurance for any one loss under this coverage extension shall not exceed $500. A $50 deductible applies to this coverage exten- sion. We will reduce our payment by such de- ductible amount. Hired Autos Physical Damage SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. The following coverage extension is added. a. If Hired Autos Liability Coverage is provided to you by this policy, or any other policy or cover- age form provided by us or a company affiliated with us, then SECTION III - PHYSICAL DAM- AGE COVERAGE, A. COVERAGE, 1. a. Com- prehensive Coverage and b. Collision Cover- age extend to an auto you lease, hire, rent or borrow. b. The most we will pay for loss to any one cov- ered auto is the lesser of: (1) The actual cash value of stolen or damaged property at the time of loss; (2) The cost, at local prices, to repair or replace damaged or stolen property with other prop- erty of like kind and quality; or (3) $50,000. A $100 Comprehensive Coverage deductible and a $250 Collision Coverage deductible apply separately to each auto covered by this cover- age extension. Transportation Costs SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. The following coverage extension is added. We will reimburse you for expenses you incur for transportation from where a covered auto was dis- abled, to your home, place of business or intended destination. Our maximum payment shall not ex- ceed $100. No deductible applies to this coverage extension. Transportation Expenses Following Theft SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE 3. Coverage Extensions is amended. b. Transportation Expenses Following Theft is deleted and replaced by: b. Transportation Expenses Following Theft If Comprehensive Coverage is shown for an auto scheduled in the Declarations, we will pay up to $50 per day but not more than $1,500 in any one loss for transportation expenses incur- red if such auto is stolen. We will pay such ex- penses incurred beginning 48 hours after you report the theft to us and to the police and end- ing when such auto is returned to use or we pay for its loss. No deductible applies to this cover- age extension. This coverage extension is ex- cess of any other insurance. 11. Motor Cargo SECTION III - PHYSICAL DAMAGE COVERAGE A. COVERAGE is amended. The following coverage extension is added. We will extend the Comprehensive Coverage and the Collision Coverage that apply to a covered auto to loss to: a. Your property owned, sold or serviced by you and in the course of delivery; b. Property of others for which you are legally lia- ble as a truckman under a: (1) Tariff; (2) Bill of lading; or (3) Shipping receipt. This coverage extension is subject to the following: a. This coverage extension does not apply to: (1) Accounts, bills, currency, deeds, evidences of debt, notes, money, securities, jewelry, or other similar valuables. (2) Damage to live animals, except for death or death made immediately necessary be- cause of injury caused by: (a) Fire; (b) Lightning; (c) Flood; (d) Explosion; (e) Collision; (f) Derailment; (g) Overturn; or (h) Stranding, burning or sinking of a ferry or lighter. (3) Painting, statuary or other works of art, or articles that are antique or curious in nature unless such loss is an absolute total loss caused by a peril we insure against. (4) Loss by pilferage. (5) Insects, rodents, vermin, birds, animals or inherent vice. (6) Loss from profit, loss of use or loss of market. (7) Leakage, evaporation, shrinkage, breakage, heat or cold, or by being scented, molded, rusted, rotted, soured or changed in flavor or by bending, denting, chipping, marring or scratching unless caused by any of the following: (a) Fire; (b) Lightning; (c) Wind; (d) Flood; (e) Explosion; (f) Collision; (g) Derailment; 58514 (9-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 4 Agency Code 12-0422-00 Policy Number 42-753-052-00 12. 13. (h) Overturn; or (i) Stranding, burning or sinking of a ferry or lighter. (8) Riots and civil commotion. (9) Strikers, lock -out workers, or persons tak- ing part in labor disturbances. (10)Any property covered under any other cov- erage extension within this endorsement. b. All shipments shall be valued at the actual in- voice cost, including: (1) Prepaid freight; and (2) Cost and charges which have accrued and become legally due on such shipments. c. If there is no invoice, the valuation of the prop- erty coverage shall be the cash market value of the article(s) covered on the date and at the place of shipment. d. With respect to loss to any part of covered property made up of several parts, when com- plete for sale or use, we shall only pay for the part lost or damaged. With respect to damage to labels, capsules or wrappers, we shall only pay the cost of: (1) New labels, capsules or wrappers; and (2) Reconditioning the goods. e. With respect to loss by breakage of eggs, we will pay only when such loss exceeds 50% of the value of each shipping package, but we will pay no more than $250 for any one loss. f. Our limit of insurance for all loss under this cov- erage extension shall not exceed $1,000. A $50 deductible applies to this coverage extension. We will reduce our payment by such deduct- ible amount. g. This coverage extension shall apply as excess insurance over any other specific insurance. Air Bag Replacement (Other Than a Private Pas- senger Auto) SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE is amended. The following coverage extension is added. a. We will extend the Comprehensive Coverage that applies to a covered auto, other than a pri- vate passenger auto, for the replacement of the air bag when it inflates without such auto having been involved in a Comprehensive or Collision loss. b. A $50 deductible applies to this coverage exten- sion. We will reduce our payment by such de- ductible amount. Replacement Cost On New Vehicles SECTION III - PHYSICAL DAMAGE COVERAGE, C. LIMIT OF INSURANCE is amended. Paragraph 2. is deleted and replaced by the following. 2. We will, at our option, replace an auto sched- uled in the Declarations with a new one of equal value or pay you your original purchase price if: a. Such auto is not a motorcycle; b. You purchased it new, c. We determine the loss cannot be repaired; and d. The loss occurs within 90 days of the pur- chase date. As it applies to this coverage only, a motorcycle means a vehicle having a saddle or seat for the use of the rider, designed to travel on not more than three wheels in contact with the ground, which is equipped with a motor that exceeds fifty cubic centimeters piston displacement. The wheels on any attachment to the vehicle shall not be considered as wheels in contact with the ground. 14. Rental Auto Gap SECTION III - PHYSICAL DAMAGE COVERAGE, C. LIMIT OF INSURANCE is amended. The following provision is added. a. If the first Named Insured is: (1) An individual; or (2) Other than an individual with the Broadened Coverage for Named Individuals - Drive Other Cars endorsement attached to a pri- vate passenger auto with Comprehensive and Collision Coverages; and b. If the auto is: (1) A rented private passenger auto; (2) Not a total loss; and (3) Sold in its damaged condition rather than re- paired, as decided by the rental company from which you rented the auto, we will pay the amount for which: (a) You, if an individual; or (b) The individual listed on the Broadened Coverage for Named Individuals - Drive Other Cars endorsement, if you is other than an individual are liable under the terms of the rental agreement; or c. If the auto is: (1) A rented private passenger auto; (2) Not a total loss; and (3) Repaired we will pay for damages to the rented private passenger auto because of or resulting from the diminished value. All other policy terms and conditions apply. 58514 (9-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 4 Agency Code 12-0422-00 Policy Number 42-753-052-00 58706 (1-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA - POLICY CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION V - CONDITIONS, B. GENERAL CONDI- TIONS is amended. The following conditions are added. 1. Cancellation a. The first Named Insured shown in the Declara- tions may cancel this policy at any time by re- turning it to us or by notifying us of the date on which cancellation is to take effect. However, during the first 60 days this policy is in effect the first Named Insured may cancel only for one or more of the following reasons: (1) The covered auto has been totally destroyed, (2) Ownership of the covered auto has been transferred to another person or corporation; or (3) The first Named Insured has purchased an- other policy to replace this policy. b. (1) If a Named Insured is: (a) A natural person; or (b) One or more related persons residing in the same household we may cancel this policy by mailing or de- livering written notice stating the reason for cancellation to the first Named Insured at the address shown in the Declarations. (2) This notice shall be mailed or delivered at least: (a) 10 days prior to the effective date when the reason for cancellation is nonpay- ment of premium; or (b) 45 days prior to the effective date when cancellation is for any other reason. We will not cancel for nonpayment of pre- mium during the first 60 days this policy is in effect, unless a check for payment of pre- mium issued to us is dishonored for any reason or any other type of premium pay- ment is determined to be rejected or invalid. (3) If this policy has been in effect 60 days or more, we may cancel this policy only for one or more of the following reasons: (a) Nonpayment of premium; (b) Material misrepresentation or fraud; or (c) The suspension or revocation of your driver's license or motor vehicle registra- tion or the driver's license of any other operator who either resides in your household or customarily operates an auto insured by this policy. Such sus- pension or revocation must have oc- curred during the policy period or within 180 days immediately preceding the effective date of the policy period. (4) If we determine that you have been charged a premium that is incorrect for the coverage you applied for on the insurance application, we shall immediately provide you with no- tice of the amount of additional premium due. If within 10 days of the date of notice, or a longer period if specified in such notice, you do not either: (a) Pay the additional premium due and maintain the policy in full force under its original terms; or (b) Cancel this policy and demand a pro rata refund of any unearned premium then this policy shall be canceled 14 days from the date of notice or a longer period if specified in such notice. c. If b. above does not apply, we may cancel this policy by mailing or delivering written notice stating the reason for cancellation to the first Named Insured at the address shown in the Declarations. This notice shall be mailed or delivered at least: (1) 10 days prior to the effective date when the reason for cancellation is nonpayment of premium; or (2) 45 days prior to the effective date when can- cellation is for other than nonpayment of premium. 58706 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Agency Code 12-0422-00 Policy Number 42-753-052-00 e. f. We will not cancel for nonpayment of premium during the first 60 days this policy is in effect, unless a check for payment of premium issued to us is dishonored for any reason or any other type of premium payment is determined to be rejected or invalid. If the first Named Insured cancels this policy, we shall mail any unearned premium to the first Named Insured within 30 days after the effective date of the cancellation. If we cancel this policy, we shall mail any un- earned premium to the first Named Insured within 15 days after the effective date of the cancellation. If this is an audit policy, then, subject to you pro- viding us or our agent the necessary data for audit, we will refund any unearned premium within 90 days from the date of cancellation. If our audit is not completed within this time limita- tion, then we will accept your audit, and any un- earned premium refund due will be mailed within 10 working days of receipt of your audit. 2. Nonrenewal If we decide not to renew this policy, we will mail or deliver written notice stating the reason for non - renewal to the first Named Insured at the address shown in the Declarations. This notice shall be mailed or delivered at least 45 days prior to the ex- piration of this policy. All other policy terms and conditions apply. 58706 (1-17) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Agency Code 12-0422-00 Policy Number 42-753-052-00 58800 (4-18) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA CHANGES For a covered auto licensed or principally garaged in Florida, this endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. SECTION II - COVERED AUTOS LIABILITY COV- ERAGE, A. COVERAGE, 2. Coverage Extensions, a. Supplementary Payments is amended. Paragraph (6) is deleted and replaced by the following. (6) All costs we incur in the settlement of any claim or defense of any suit we defend. However, such costs shall not include attorneys' fees or attorneys' expenses taxed against the insured unless the attorneys' fees or attorneys' ex- penses were taxed against the insured as a result of our rejection of an offer of judgment at or below the applicable limit of insurance while providing a defense for that insured. B. SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, Paragraph 1. is amended. Paragraph a.(5) is deleted and replaced by the following. (5) Replacement of any safety or laminated glass. However, in no event, shall a deductible apply to loss to glass used in the windshield. C. SECTION V - CONDITIONS is amended. 1. A. LOSS CONDITIONS is amended. 3. Ap- praisal for Physical Damage Loss is deleted and replaced by the following. 3. Appraisal for Physical Damage Loss If you and we disagree on the amount of loss, either may demand an appraisal of the loss. Upon notice of a demand for ap- praisal, the opposing party may, prior to appraisal, demand mediation of the dispute in accordance with the Mediation provision contained in this endorsement. The media- tion must be completed before a demand for appraisal can be made. In this event, each party will select a competent appraiser. The two appraisers will select a competent and impartial umpire. The appraisers will state separately the actual cash value and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be bind- ing. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the ap- praisal and umpire equally. If we submit to an appraisal, we will still retain our right to deny the claim. 2. B. GENERAL CONDITIONS is amended. a. The following is added to 2. Other Insurance. a. When this policy and any other Cover- age Form or policy providing liability coverage applies to an auto and: (1) One provides coverage to a lessor of autos for rent or lease; and (2) The other provides coverage to a person not described in Paragraph B.1.a.(1) then the Coverage Form or policy is- sued to the lessor described in Para- graph B.1.a.(1) is excess over any in- surance available to a person described in B.1.a.(2) if the face of the lease or rental agreement contains, in at least 10 point type, the following language: The valid and collectible liability insurance and personal injury protection insurance of any autho- rized rental or leasing driver is pri- mary for the limits of liability and personal injury protection coverage required by FLA. STAT. SECTION 324.021(7) and FLA. STAT. SECTION 627.736. 58800 (4-18) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Agency Code 12-0422-00 Policy Number 42-753-052-00 b. The following conditions are added. (1) Mediation a. In any claim filed by an insured with us for: (1) Bodily injury in an amount of $10,000 or less, arising out of the ownership, operation, use or maintenance of a covered auto; (2) Property damage in any amount, arising out of the own- ership, operation, maintenance or use of a covered auto; or (3) Loss to a covered auto or its equipment or custom fur- nishings, in any amount either party may make a written demand for mediation of the claim prior to the institution of litigation. b. A written request for mediation must be filed with the Florida Department of Financial Services on an ap- proved form, which may be obtained from the Florida Department of Financial Services. c. The request must state: (1) Why mediation is being requested. (2) The issues in dispute, which are to be mediated. d. The Florida Department of Financial Services will randomly select media- tors. Each party may reject one mediator, either before or after the opposing side has rejected a me- diator. The mediator will notify the parties of the date, time and place of the mediation conference. The mediation conference will be held within 45 days of the request for mediation. The conference will be held by telephone if feasible. Partic- ipants in the mediation conference must have the authority to make a binding decision, and must mediate in good faith. Each party will bear the expenses of the mediation equally, unless the mediator deter- mines that one party has not medi- ated in good faith. e. Only one mediation may be re- quested for each claim unless all parties agree to further mediation. A party demanding mediation shall not be entitled to demand or request mediation after a suit is filed relating to the same facts already mediated. f. The mediation shall be conducted as an informal process and formal rules of evidence and procedures need not be observed. g. Disclosures and information di- vulged in the mediation process shall not be admissible in any sub- sequent action or proceeding re- lating to the claim or cause of action giving rise to the claim. (2) INSUFFICIENT FUNDS FEE We may impose an insufficient funds fee of up to $15 per occurrence, if, because of insufficient funds, your payment of premium by debit card, credit card, elec- tronic funds transfer or electronic check is returned, declined or cannot be pro- cessed. However, we may not charge you an insufficient funds fee if the fail- ure in payment resulted from fraud or misuse on your account from which the payment was made and such fraud or misuse was not attributed to you. All other policy terms and conditions apply. 58800 (4-18) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Agency Code 12-0422-00 Policy Number 42-753-052-00 58555 (1-16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES - OUR RIGHT TO RECOVER PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION V — CONDITIONS, A. LOSS CONDITIONS, prorated between you and us based on the interest of 5. Our Right to Recover Payments is amended. With each in the loss. This condition only applies if we pay respect to SECTION III - PHYSICAL DAMAGE COVER- for a loss and then payment is made by those AGE only, the following condition is added. responsible for the loss. If the claim paid is less than the agreed loss because of any deductible or other limiting terms, the recovery is All other policy terms and conditions apply. 58555 (1-16) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 58550 (1-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF INJURY TO FAMILY MEMBERS This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION II — COVERED AUTOS LIABILITY Exclusion of Injury to Family Members COVERAGE, B. EXCLUSIONS is amended. The Bodily injury to you, if an individual, and to your family following exclusion is added. members. All other policy terms and conditions apply. 58550 (1-17) Includes copyrighted material of Insurance Services Office Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58524 (1-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF DEFINITIONS This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION VI - DEFINITIONS is amended. 1. B. is deleted and replaced by the following definition. B. Auto means: 1. A land motor vehicle; 2. A trailer; or 3. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, auto does not include mobile equip- ment. As it applies to this endorsement only, mobile equipment does not include a snowmobile. 2. U. is deleted and replaced by the following definition. U. Trailer means a vehicle which is designed to be connected to and towed by a power unit. Trailer does not include non -motorized farm machinery or farm wagons. A trailer is not equipment or custom furnishings. All other policy terms and conditions apply. 58524 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58558 (3-16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO SHARING PROGRAM EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY A. SECTION II — COVERED AUTOS LIABILITY COVERAGE, B. EXCLUSIONS is amended. The following exclusion is added: Auto Sharing Program Bodily injury, property damage or covered pollution cost or expense for the ownership, maintenance or use of a covered auto while: 1. Enrolled in an electronic or written auto sharing program agreement; and 2. Being used in connection with such auto sharing program. If you are an individual, this exclusion does not apply to you or any family member while using such auto. However, this exclusion applies only to the extent that the limits of liability for this coverage exceed the minimum limits of liability required by the financial responsibility law of the state in which you reside. B. SECTION III — PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended. The following exclusion is added: Auto Sharing Program Loss to a covered auto which occurs while: 1. Enrolled in an electronic or written auto sharing program agreement; and 2. Being used in connection with such auto sharing program. If you are an individual, this exclusion does not ap- ply to you or any family member while using such auto. C. SECTION IV - INDIVIDUAL NAMED INSURED is amended. The following provision is added to Paragraph B. This extension does not apply to loss to, or loss of use, of an auto in connection with an auto sharing program if the provisions of such auto sharing program preclude the recovery of such loss or loss of use, from you or such family member, or if otherwise precluded by any state law. All other policy terms and conditions apply. 58558 (3-16) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 12-0422-00 Policy Number 42-753-052-00 58903 (10-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE CLAUSE This endorsement modifies insurance provided under the following: COMMERCIAL AUTO POLICY SECTION III — PHYSICAL DAMAGE COVERAGE is amended. The following condition is added. Loss Payable Clause 1. Loss under the policy shall be paid to the: a. Named Insured; and b. The loss payee (lienholder) shown in the Decla- rations as their interest may appear at the time of the loss. 2. We shall notify the loss payee ten (10) days prior to the effective date of cancellation of this policy. 3. If the insured fails to render proof of loss within the time required in the policy, the loss payee shall ren- der proof of loss: a. Within 60 days after our request; and b. In a form and manner required in the policy. 4. At our option, we may pay the loss payee: a. The amount of loss; or b. The whole principal due with interest accrued at the time of settlement. If we make such pay- ment, the loss payee shall assign and transfer the lien to us. 5. After we make payment to the loss payee under this agreement, we will have the right to recover, to the extent of our payment, from anyone held respon- sible. The transfer of such right to recover shall not impair the loss payee's right to recover the full amount of its claim. All other policy terms and conditions apply. 58903 (10-17) Includes copyrighted material of Insurance Services Office Inc., with its permission. Page 1 of 1 Okeechobee 2020 Sidewalk and Roadway Concrete Improvements PW 03-11-08-20 Bid Tabulation Vest COBB Heavy Civil American Design ITEM NO. DESCRIPTION UNIT EST. UNIT PRICE AMOUNT UNIT PRICE AMOUNT UNIT PRICE AMOUNT UNIT PRICE AMOUNT MEASURE CITY. Pour 8" concrete roadway slab 24' X 150', 3,000 psi minimum W/6" X 6" -1.4 X 1.4 WWF Reinforcement on NW 10`h Street. City to remove existing asphalt and excavate existing road 1 Each 1 $ 17,100.00 $ 17,300.00 $ 54,911.62 $ 54,911.62 $ 31,000.00 $ 31,000.00 $ 32,000.00 $ 32,000.00 base and provide new sub base. Work to be performed in two segments to maintain access to apartment complex on North side of 10`h Street. Pour 8" concrete roadway slab, 450 sgyd, 3,000 minimum psi W/6" X 6" -1.4 X 1.4 WWF 2 Reinforcement on NE 5`h Avenue. City to remove existing asphalt and excavate existing road Each 1 $ 19,237.50 $ 19,237.50 $ 54,911.62 $ 54,911.62 $ 31,000.00 $ 31,000.00 $ 32,000.00 $ 32,000.00 base and provide new sub base. Work to be performed in two segments to maintain access to Diamond R Fertilizer. Remove existing sidewalk and install new curb ramp CR-A per FDOT indexes 300- Curb & Curb and Gutter, and 304- Detectable Warnings and Sidewalk Curb Ramps. 3 EACH 1 $ 1,900.00 $ 1,900.00 $ 8,034.29 $ 8,034.29 $ 4,050.00 $ 4,050.00 $ s,soo.00 $ s,soo.00 Concrete shall be 3,000 psi with fiber of other appropriate reinforcement material. Detectable warning mat color shall be brick red. Remove existing sidewalk and install new curb ramp CR-B per FOOT indexes 300- Curb & Curb and Gutter, and 304- Detectable Warnings and Sidewalk Curb Ramps. a Each 7 $ 1,9o0.0o $ 13,300.00 $ 6,237.50 $ 43,662.50 $ 3,500.00 $ 24,500.00 $ 5,500.00 $ 38,500.00 Concrete shall be 3,000 psi with fiber of other appropriate reinforcement material. Detectable warning mat color shall be brick red. Remove existing sidewalk and install new curb ramp CR-L per FDOT indexes 300- Curb & Curb and Gutter, and 304 - Detectable Warnings and Sidewalk Curb Ramps. 5 Each z $ 1,900.00 $ 3,800.00 $ 6,069.05 $ 12,138.10 $ 5,000.00 $ 10,000.00 $ 3,780.00 $ 7,560.00 Concrete shall be 3,000 psi with fiber of other appropriate reinforcement material. Detectable warning mat color shall be brick red. 6 REMOVE AND REPLACE EXISTING FIVE (5) FOOT WIDE CONCRETE SIDEWALK. TEN (10) YARD LINEAR 100 $ 30.00 $ 3,000.00 $ 49.70 $ 4,970.00 $ 38.00 S 3,800.00 $ 65.00 $ 6,500.00 TOTAL. FOOT REMOVE AND REPLACE EXISTING FIVE -FOOT -WIDE CONCRETE SIDEWALK. LESS THAN TEN (10) LINEAR 7 50 $ 35.00 $ 1,750.00 $ 82.05 $ 4,102.50 $ 60.00 $ 3,000.00 $ 65.00 $ 3,250.00 YARD TOTAL FOOT 8 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LINEAR 100 $ 28.00 $ 2,800.00 $ 47.06 $ 4,706.00 $ 33.00 $ 3,300.00 $ 28.00 $ 2,800.00 FOOT 9 TEN (10) YARD TOTAL LINEAR 100 $ 28.00 $ 2,800.00 $ 34.19 $ 3,419.00 $ 50.00 $ 5,000.00 $ 34.00 $ 3,400.00 FOOT 10 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LINEAR 500 $ 16.25 $ 8,125.00 $ 25.40 $ 12,700.00 $ 19.50 $ 9,750.00 $ 40.00 $ 20,000.00 FOOT 11 LESS THAN TEN (10) YARD TOTAL LINEAR 100 $ 21.25 $ 2,125.00 $ 67.26 $ 6,726.00 $ 32.00 $ 3,200.00 $ 40.00 $ 4,000.00 FOOT 12 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE SIDEWALK. TEN (10) YARD TOTAL LINEAR 100 $ 18.00 $ 1,800.00 $ 61.98 $ 6,198.00 $ 22.00 $ 2,200.00 $ 30.00 $ 3,000.00 FOOT 13 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE SIDEWALK. LESS THAN TEN (10) YARD TOTAL LINEAR 50 $ 30.00 $ 1,500.00 $ 123.37 $ 6,168.50 $ 50.00 $ 2,500.00 $ 35.00 $ 1,750.00 FOOT 14 INSTALL NEW CONCRETE "D" CURB. TEN (10) YARD OR GREATER TOTAL LINEAR 100 $ 28.00 $ 2,800.00 $ 66.47 $ 6,647.00 $ 25.00 $ 2,500.00 $ 30.00 $ 3,000.00 FOOT 15 INSTALL NEW CONCRETE "D" CURB. LESS THAN TEN (10) YARD TOTAL LINEAR 50 $ 35.00 $ 1,750.00 $ 123.37 $ 6,168.50 $ 50.00 $ 2,500.00 $ 35.00 $ 1,750.00 FOOT 16 INSTALL NEW CONCRETE "F" CURB. TEN (10) YARD OR GREATER TOTAL SQUARE 500 $ 4.00 $ 2,000.00 $ 13.32 $ 6,660.00 $ 7.00 $ 3,500.00 $ 6.00 $ 3,000.00 FOOT NEW CONCRETE "F" CURB. LESS THAN TEN (10) YARD TOTAL I SO"' I 500 I $ 4.70 I $ 2,350.00 I $ 15.23 I $ 7,615.00 I $ 8.00 I $ 4,OOo.00 I $ 8.00 I $ 4,000.00 CITY OF OKEECHOBEE PW 03-11-08-20 September 1, 2020 3:00 PM Bid Opening Okeechobee Sidewalk and Roadway Concrete Improvements Vest Concrete Heavy Civil I Cobb Actual Amount American Design UNIT ITEM NO. DESCRIPTION EST. QTY. UNIT PRICE AMOUNT UNIT PRICE AMOUNT UNIT PRICE AMOUNT UNIT PRICE AMOUNT MEASURE POUR EIGHT (8) INCH CONCRETE ROADWAY SLAB TWENTY- FOUR (24) FEET X ONE HUNDRED -FIFTY (150) FEET, 3,000 PSI MINIMUM W/6INCHES X 6INCHES -1.4 X 1.4 WWF 1 REINFORCEMENT ON NW LOTH STREET. CITY TO REMOVE EACH 1 $ 17,100.00 $ 17,100.00 $ 31,000.00 $ 31,000.00 $ 54,911.62 $ 54,911.62 $ 54,911.62 EXISTING ASPHALT AND EXCAVATE EXISTING ROAD BASE AND PROVIDE NEW SUBBASE. WORK TO BE PERFORMED IN TWO SEGMENTS TO MAINTAIN ACCESS TO APARTMENT $ 32,000.00 $ 32,000.00 POUR EIGHT (8) INCH CONCRETE ROADWAY SLAB TWENTY- FOUR (24) FEET X ONE HUNDRED -FIFTY (150) FEET, 3,000 PSI MINIMUM W/6 INCHES X 61NCHE5 -1.4 X 1.4 WWF 2 REINFORCEMENT ON NW 10TH STREET. CITY TO REMOVE EACH 1 $ 19,237.50 $ 19,237.50 $ 31,000.00 $ 31,000.00 $ 54,911.62 $ 56,911.62 $ 54,911.62 EXISTING ASPHALT AND EXCAVATE EXISTING ROAD BASE AND PROVIDE NEW SUBBASE. WORK TO BE PERFORMED IN TWO SEGMENTS TO MAINTAIN ACCESS TO DIAMOND R FERTILIZER. $ 32,000.00 $ 32,000.00 REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-B PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND SIDEWALK EACH 1 $ 1,900.00 $ 1,900.00 $ 4,050.00 $ 4,050.00 $ $ 3 CURB RAMPS. CONCRETE SHALL BE 3,DD0 PSI WITH FIBER OF 8,034.29 $ 8,034.29 8,034.29 OTHER APPROPRIATE REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. $ 5,500.00 $ 5,500.00 REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-C PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 PSI WITH FIBER OF 4 OTHER APPROPRIATE REINFORCEMENT MATERIAL. EACH 7 $ 1,900.00 $ 13,300.00 $ 3,500.00 $ 24,500.00 $ 6,237.50 $ 43,662.50 $ 43,662.50 DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. WIDTH TO VARY FROM 6 FEET TO 8 FEET DEPENDING ON LOCATION. RAMP WIDTH TO MATCH WIDTH OF EXISTING PAVER SIDEWALK. 5,500.00 $ 38,500.00 REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-L PER FDOT INDEXES 300 CURB & CURB AND 5 GUTTER, AND 304 DETECTABLE WARNINGS AND SIDEWALK EACH z $ 1,9D0.00 $ 3,800.00 $ 5,000.00 $ 10,000.00 $ 6,069,05 $ 12,138.10 $ 12,138.10 CURB RAMPS. CONCRETE SHALL BE 3,000 PSI WITH FIBER OF OTHER APPROPRIATE REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. $ 3,780.00 $ 7,560.00 REMOVE AND REPLACE EXISTING FIVE (5) FOOT WIDE LINEAR 6 CONCRETE SIDEWALK. TEN (10) YARD TOTAL. FOOT 100 $ 30.00 $ 3,000.00 $ 38.00 $ 3,800.00 $ 49.70 $ 4,970.00 $ 4,970.00 $ 65.00 $ 6,500.00 REMOVE AND REPLACE EXISTING FIVE -FOOT -WIDE LINEAR 7 CONCRETE SIDEWALK. LESS THAN TEN (10) YARD TOTAL FOOT so $ 35.00 $ 1,750.00 $ 60.00 $ 3,000.00 $ 82.05 $ 4,102.50 $ 4,102.50 $ 65.00 $ 3,250.00 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. TEN LINEAR 8 (10) YARD TOTAL FOOT 100 $ 28.00 $ 2,800.00 $ 33.00 $ 3,300.00 $ 47.06 $ 4,706.00 $ 4,706.00 $ 28.00 $ 2,800.00 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LESS LINEAR 9 THAN TEN (10) YARD TOTAL FOOT 100 $ 28.00 $ 2,800.00 $ 50.00 $ 5,000.00 $ 34.19 $ 3,419.00 $ 3,419.00 $ 34.00 $ 3,400.00 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE SIDEWALK. LINEAR soo $ 16.25 $ 8,125.00 $ $ 9,750.00 25.40 10 TEN (10) YARD TOTAL FOOT 19.50 $ $ 12,700.00 $ 12,700.00 $ 40.00 $ 20,000.00 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE SIDEWALK. LINEAR 11 LESS THAN TEN (10) YARD TOTAL FOOT 100 $ 21.25 $ 2,125.00 $ 32.00 $ 3,200.00 $ 67.26 $ 6,726.00 $ 6,726.00 $ 40.00 $ 4,000.00 INSTALL NEW CONCRETE "D" CURB. TEN (10) YARD OR LINEAR 12 GREATER TOTAL ]00 $ 18.00 $ 1,800.00 $ 22.00 $ 2,200.00 $ 61.98 $ 6,198.00 $ 6,198.00 FOOT $ 30.00 $ 3,000.00 INSTALL NEW CONCRETE "D" CURB. LESS THAN TEN (10) LINEAR 50 30.00 $ $ 2,500.00 13 YARD TOTAL FOOT E 1,500.00 50.00 $ $ 123.37 $ 6,168.50 $ 6,168.50 $ 35.00 $ 1,750.00 INSTALL NEW CONCRETE "F" CURB. TEN (10) YARD OR LINEAR 14 GREATER TOTAL FOOT 100 $ 28.00 $ 2,800.00 $ 25.00 $ 2,500.00 $ 66.47 $ 6,647.00 $ 6,647.00 $ 30.00 $ 3,000.00 INSTALL NEW CONCRETE "F" CURB. LESS THAN TEN (10) LINEAR 15 50 S 35.00 $ 1,750.00 $ 50.00 $ 2,500.00 $ 123.37 $ 6,168.50 $ 6,168.50 YARD TOTAL FOOT $ 35.00 $ 1,750.00 16 INSTALL NEW 4-INCH-THICK CONCRETE SLAB SQUARE 500 S 4.00 $ 2,000.00 $ 7.00 $ 3,500.00 $ 13.32 $ 6,660.00 $ 6,660.00 FOOT $ 6.00 $ 3,000.00 17 INSTALL NEW 6-INCH-THICK CONCRETE SLAB SQUARE 500 $ 4.70 $ 2,350.00 $ 8.00 $ 4,000.00 $ 15.23 $ 7,615.00 $ 7,615.00 FOOT .- $ 8.00 $ 4,000.00 TOTAL BID AMOUNT (Based on Bid unit Prices & Estimated Quantities) $ 88,137.50 $ 145,800.00 $ 251,738.63 $ 249,738.63 $ 172,010.00 Posted on September 3, 2020 at 10:10 A.M. To be removed on September 10, 2020 at 10:10 A.M. Bid Opening Sign In Sheet dih q Okeechobee 2020 Sidewalk and Roadway Concrete Improvements PW 03-11-08-20, September 1, 2020, 3:00 P.M. Company Contact Person Phone Number Fax Number E-mail 1 � O O is C��.+t.l� P �V`�2�� t 1AG. � 1 /A� 2 a� l� 4+ J33 (JFI� / / d LJCj w crJ S1 .G AVhQ. , i i^ti 2 3 c eve I"n i o 159- 7 9 C l 4 5 6 7 8 9 10 11 ti��p � 12 Allen 13 14 �SI0&1 11 d 15 " 16 17 18 19 20 Lake Okeechobee News 147SIM 107 SW 17th Street, Suite D 911DEPENDENT Okeechobee, Florida 34974 863-763-3134 NEWSMEDIA INC. USA STATE OF FLORIDA COUNTY OF OKEECHOBEE Before the undersigned authority personally appeared Katrina Elsken Muros, who on oath says she is the Publisher of the Lake Okeechobee News, a weekly Newspaper published in Okeechobee County -,�lori``da, that, the attached copy of an advertisement being a -, �QF a in the matter of Ak in the 19th Judicial District of the Circuit Court of Okeechobee County, Florida, was published in said newspaper in the issues of Affiant further says that the said Lake Okeechobee News is a newspaper published at Okeechobee, in said Okeechobee County, Florida, and that said newspaper has heretofore been published continuously in said Okeechobee County, Florida each week and has been entered, as 'qecond class mail matterat the post office in Okeechobee, in said Okeechobee County, Florida, for a period of one year next preceding the first publication of the attached copy of advertisement, and affiant further says that she has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the purpose of securing this advertisement for publication in the said newspaper. Katrina Elsken Muros Sworn ,to.and subscribed bef�re me this C day of t " '�ac.3�r AD Notary Public, State of Florida at Large :=�is1p ANGIE BRIDGES MY COMMISSION # GG 971582 EXPIRES: April 20. 2024 'rFogF °� Bonded Thru Notary Public Underwriters INVITATION TO BID NO. PW 03-11-08-20 g V1lEE 2020 SIDEWALK AND ROADWAY CONQtEfE II'tPROVEMEMS gxneg Date and Tines Sepwn1ber 1, 2D20, 3:00 PM The Ciyof Ol dx�, Findda s a+rerdH 9: =bh 1. needed m r�,�,s mnoe� aa1 kAxIing: . s:a u��,�n � t�invald�sde�slCand ristandon of rrev AQA rdrrps P." and replaaxrnernt of Z5.1- gdevelc arn,1or aub and gWhs IrE aiatia, of rxw antt/oraub and g0 S,aied d r,,,.c oe nod w1W u e c,,„.d se,*Dq,b. tabxtlna,n 3:00 PM ESTm or6eSoreiu��. AI nesporse=,,erlbytned�dnewi beop��d andnmrrdeAnthepe�r�i oforeormaewtrne�swthntheCnrudClmnhe$ Rm200,attheaddre� �hd abae Arty Olds reo*ed after the alome noted date and tine w➢ not be opexd a oxedeerr. facmae oremaiad Bids A not be ao3VW. mr+v 4k—,t m are malable In the Bid Padrnts to may be obtained on cNbrta DieWr Da&l NOTE Bondag Re - Bid sWkals mat be warn a-�e ard_mrPa�b+o Ql dearN �07r�orkinats and nrw,rn mw of_ Ihe�d, wih the aRside d the er vkpe day tabdaj'BID ND PW 03-11.OB-2l 01 7t w..—� �A 3,•QQpM"wih the a�rtrTliS Cortnparry 9-1-21 Naar„ and tL�,n /dhes Bids nW he nailed, hand deFged .4W qre$ mailed to the addres listed above I,- V-Z=red in the staba of Florida are efmrraged togfxnt txk Bid (or it k the 9* W— YXr4>Qy of the adder toer defPasrnaly or by mal, tl- f Bid to the &ane a SwAmo De atnent on or bdae the dig twr and date for the reoeipt of B& as noted &ove This soiciation does rct oxrurt tee ay of Okeednbee bo award arty oxf bads, to Ip�ey ary msts trarred h the prepamtbn d a nsporv=m tts Bd, a m axtbactfarary gnus The Cry Card reseves the djRm njed arty r al Bidsr m vshe itfarnakies and m amept or reject al or part of ay Bd, as they may deem to be inttebatYterestsoftheCity ofOkeedvbeet lal es to this Bid, Won oeilot by, the General Sevls Departrrat, wfl be= pu6fo reoa�stbjectto pr' m.or P0rW SYallr� CiNpA�r ll9 Fw,rffi PWnic law. %.MkWD01&gR.Wat 43conAgList19,2020 4251230NO/19/ BIDDER NOTIFICATION FOR OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS PW 03-11-08-20 Company Name E-Mail Address Date Sent Sunshine Land Design Inc. info sunshinelandanddesi n.com � 8/18/20 Better Roads Inc. donnad@betterroads.net 8/18/20 Optimum Services Inc. info o tsvc.com 8/18/20 WGI bcurrie landdesi nsouth.com 8/18/20 B&B Site Development skullsteel@yahoo.com 8/18/20 Florida Blacktop info floridablackto .com 8/18/20 A&E Land Clearing Inc aelandclearin aol.com 8/18/20 ABC Transfer, Inc 'uanabctransferinc.com 8/18/20 Circle H Citrus levi antusoinc.com 8/18/20 CW Roberts Contracting Inc. almer cwrcontractin .com 8/18/20 CW Roberts Contracting Inc. ramsdell cwrcontractin .com 8/18/20 APAC Florida, Inc m'ohnson a ac.com 8/18/20 Dickerson Florida, Inc ldale dfifl.com 8/18/20 Dickerson Florida, Inc rickf dfifl.com 8/18/20 Ranger Construction estimatin ran erconstruction.com 8/18/20 R. E. L.L Corporation rellco tam aba .rr.com 8/18/20 Community Asphalt Corp _greg@asphaltspecialist.com 8/18/20 Sweat Trucking & Paving Inc sweat embar mail.com 8/18/20 Vest Concrete Contractors, Inc vestconcrete hotmail.com 8/18/20 Mike Bevis mike@bevisconstructioninc.com 8/18/20 Dubels Pressure Cleaning & Asphalt Sealcoatin Dubels23@yahoo.com 8/18/20 Bob's Barricades elbertbobsbarricades.com 8/18/20 Traffic Sign Contractors, LLC sales trafficsi ncontractors.com 8/18/20 Carr Construction LLC scar carrconstruction.or 8/18/20 Williams Masonry Williamsmaso l2.cw mail.com 8/18/20 Ennis Flint sales ennisflint.com 8/18/20 Weekle as aol.com weekle as aol.com 8/18/20 Louis Poulson USA, Inc c r louis oulson.com 8/18/20 Optimum Services Inc mash o tsvc.com 8/18/20 Florida Blacktop floridablacktop@gmail.com 8/18/20 Asphalt Maintenance LLC Proas halts ecialist mail.com 8/18/20 B&B Site Development Bbsitedevelo mentinc mail.com 8/18/20 E = Emailed Yesica Montoya From: Yesica Montoya Sent: Tuesday, August 18, 2020 4:33 PM Cc: Patty Burnette Subject: Bid for Sidewalk and Roadway Concrete Improvements Attachments: PW 03-11-08-20 Sidewalk and Roadway Invitation to Bid Final.pdf Tracking: Recipient Patty Burnette info@sunshinelandanddesign.com donnad@betterroads.net info@optsvc.com bcurrie@landdesignsouth.com skullsteel@yahoo.com info@floridablacktop.com aelandclearing@aol.com juan@abctransferinc.com levi@pantusoinc.com jpalmer@cwrcontracting.com pramsdell@cwrcontracting.com gmjohnson@apac.com Idale@dfifl.com rickf@dfifl.com donnad@betterroads.net estimating@rangerconstruction.con rellcorp@tampabay.rr.com greg@asphaltspecialist.com sweat@embarqmail.com vestconcrete@hotmail.com mike@bevisconstructioninc.com dubels23@yahoo.com jelbert@bobsbarricades.com sales@trafficsigncontractors.com scar@carrconstruction.org williamsmasonry12.cw@gmail.com sales@ennisflint.com weekleyasp@aol.com cgr@louispoulson.com Good afternoon, Delivery Read Delivered: 8/18/2020 4:33 PM Read: 8/19/2020 8:13 AM i Please see the attached Invitation to Bid for Sidewalk and Roadway Concrete Improvements for the City of Okeechobee. Please submit any questions or requests for additional information in writing or e-mail as stated in the attached notification. Thank you. Regards, Yesica Montoya Administrative Secretary 55 SE 3" Avenue Okeechobee, FL 34974 Phone: (863) 763-3372 Direct: (863) 763-9824 FAX: (863) 763-1686 Email: m�yaC&cityofokeecho bee. com Website: www.cityofokeecliobee.com Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Yesica Montoya From: Yesica Montoya Sent: Wednesday, August 19, 2020 10:12 AM Cc: Patty Burnette Subject: FW: Bid for Sidewalk and Roadway Concrete Improvements Attachments: PW 03-11-08-20 Sidewalk and Roadway Invitation to Bid Final.pdf Tracking: Recipient Patty Burnette info@sunshinelanddesign.com mash@optsvc.com floridablacktop@gmail.com proasphaltspecialist@gmail.com Good morning, Read Read: 8/19/2020 11:15 AM Please see the attached Invitation to Bid for Sidewalk and Roadway Concrete Improvements for the City of Okeechobee. Please submit any questions or requests for additional information in writing or e-mail as stated in the attached notification. Thank you. Regards, Yesica Montoya Administrative Secretary 55 SE 3'd Avenue Okeechobee, FL 34974 Phone: (863) 763.33 72 Direct: (863) 763.9824 FAX: (863) 763.1686 Email: m� a�yofokeechobee.com Website: www.citwofokeechobee.com Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Yesica Montoya From: Yesica Montoya Sent: Thursday, August 20, 2020 1:22 PM To: BBsitedevelopmentinc@gmail.com Cc: Patty Burnette Subject: Bid for Sidewalk and Roadway Concrete Improvements Attachments: PW 03-11-08-20 Sidewalk and Roadway Invitation to Bid Final.pdf Tracking: Recipient Read BBsitedevelopmentinc@gmail.com Patty Burnette Good afternoon, Read: 8/20/2020 1:26 PM As requested Mr. Baughman, please see attached Bid for Sidewalk and Roadway Concrete Improvements. If you have any questions or concerns please feel free to contact us. Regards, Yesica Montoya Administrative Secretary 55 SE 3'd Avenue Okeechobee, FL 34974 Phone: (863) 763-33 72 Direct: (863) 763-9824 FAX: (863) 763-1686 Email: Ymonto a� @cityofokeechobee.com Website: www.cityofokeechobee.com Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Yesica Montoya From: Yesica Montoya Sent: Thursday, August 20, 2020 3:57 PM To: cgr@louispoulsen.com Cc: Patty Burnette Subject: Bid for Sidewalk and Roadway Concrete Improvements Attachments: PW 03-11-08-20 Sidewalk and Roadway Invitation to Bid Final.pdf Tracking: Recipient Read cgr@louispoulsen.com Patty Burnette Good afternoon, Read: 8/20/2020 4:40 PM Please see the attached Invitation to Bid for Sidewalk and Roadway Concrete Improvements for the City of Okeechobee. Please submit any questions or requests for additional information in writing or e-mail as stated in the attached notification. Thank you. Regards, Yesica Montoya Administrative Secretary 55 SE 3'd Avenue Okeechobee, FL 34974 Phone: (863) 763-33 72 Direct: (863) 763-9824 FAX: (863) 763-1686 Email: ymontoya@cityofokeechobee.com Website: auww.cityofokeechobee.com Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. A W-9 if this is a new vendor setup. Patty Burnette From: Ellen Vest <jdvestconcrete@gmail.com> Sent: Wednesday, August 26, 2020 1:51 PM To: Patty Burnette Subject: Re: Bid Notice Attachments: Scan0008.pdf It's always great seeing you. Have a great rest of your week! Ellen On Wed, Aug 26, 2020 at 12:33 PM Patty Burnette<pburnetteCcDcityofokeechobee.com> wrote: Hi Ellen. Please see the attached invitation to bid. You can access the entire bid document on the city's website using the following link: https://citVofol<eechobee.com/contracting-opportunities.html Scroll down to the bottom to see the notice and bid document. It was great seeing you again. Path M. Burnette Cj, eneraCServices Coordinator City of Okeechobee 55 SE 3rd Avenue Okeechobee, AFL 34974 Phone: (863) 763-3372 ext. 9820 1 t Direct: (863) 763-9820 Fax: (863) 763-1686 e-maiC--�burriette@citilofokeec6obee.com website: www.citUofokeec6.o6ee.coni Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Yesica Montoya From: Magen Fenton<Mfenton@sunshinelanddesign.com> Sent: Wednesday, August 19, 2020 10:25 AM To: Yesica Montoya Cc: Ana Gonzalez Subject: RE: Bid for Sidewalk and Roadway Concrete Improvements Good morning, I am confirming receipt of the subject bid documents. We appreciate the opportunity to provide the City with our proposal. Thank you. Best Regards, Magen Margaret (Magen) Fenton Vice President Sunshine Land Design, Inc. mfentonasunshinelanddesian.com 3291 SE Lionel Terrace Stuart, FL 34997 Phone: 772 283 2648 Fax: 772 283 8944 tr.► COMPLETE PROPERTY MAINTENANCE RESTORATION & CONSTRUCTION" SERVICES From: Yesica Montoya <ymontoya@cityofokeechobee.com> Sent: Wednesday, August 19, 2020 10:12 AM Cc: Patty Burnette<pburnette@cityofokeechobee.com> Subject: FW: Bid for Sidewalk and Roadway Concrete Improvements Good morning, 1 Please see the attached Invitation to Bid for Sidewalk and Roadway Concrete Improvements for the City of Okeechobee. Please submit any questions or requests for additional information in writing or e-mail, as stated in the attached notification. Thank you. Regards, Yesica Montoya Administrative Secretary 55 SE 3,d Avenue Okeechobee, FL 34974 Phone: (863) 763-3372 Direct: (863) 763-9824 FAX: (863) 763-1686 Email:-vrnonto a�yofokeechobee.com Website: www.cityofokeechobee.com rac Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Patty Burnette From: Ana Gonzalez <Agonzalez@sunshinelanddesign.com> Sent: Thursday, August 27, 2020 9:27 AM To: David Allen; Patty Burnette Subject: RE: PW 03-11-08-20 - Sidewalk and Roadway Thank you David. From: David Allen <dallen@cityofokeechobee.com> Sent: Thursday, August 27, 2020 9:26 AM To: Ana Gonzalez <Agonzalez@sunshinelanddesign.com>; Patty Burnette <pburnette@cityofokeechobee.com> Subject: RE: PW 03-11-08-20 - Sidewalk and Roadway Ana, We have not developed an engineers estimate for the bid. David Allen Public Works Director City of Okeechobee �. e"chobee VLORK�A NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. From: Ana Gonzalez<AgonzalezCcDsunshinelanddesien.com> Sent: Thursday, August 27, 2020 8:43 AM To: David Allen<dallen(@citvofol<eechobee.com>; Patty Burnette <pburnette(@cityofokeechobee.com> Subject: PW 03-11-08-20 - Sidewalk and Roadway Good Morning, We were invited to bid the above mentioned project. May you tell me if any further information has been provided? I don't see the Engineers Cost Estimate, is that available by any chance? Kind Regards Asia igosizaeez, Sunshine Land Design, Inc. 3291 SE Lionel Terrace, Stuart, FL 34997 Phone: 772 283 2648, Fax: 772 283 8944 , . , I: � , i :'T , I , ; ,,, c I t . % Nlalfll "'i Ull, ". : � , 1 , � , " t .. m '! ! t:cl 11 , ., ; . 1, *, Patty Burnette From: David Allen Sent: Monday, August 31, 2020 9:08 AM To: Michelle Tenedero; Patty Burnette Cc: Dodge -Quality Subject: RE: 202000704729 2020 Sidewalk and Roadway Concrete Improvements Michelle, The bid date is the same, there was not a pre -bid so no sign in sheet and We do not have an engineers estimate. Thanks, David Allen Public Works Director City of Okeechobee Okeichobee FLORIDA - F„ u�Jrt 191 S NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. From: Michelle Tenedero <Michelle.Tenedero@construction.com> Sent: Friday, August 28, 2020 2:58 PM To: David Allen <dallen@cityofokeechobee.com>; Patty Burnette <pburnette@cityofokeechobee.com> Cc: Dodge_Quality <dodge_quality@construction.com> Subject: 202000704729 2020 Sidewalk and Roadway Concrete Improvements Hi, I'm currently working with the that's out for bidding on I just would like to ask the following: * Does the Bid date remains the same? * Can I request for a copy of the planholders list/sign in sheet of the prebid meeting? * Do you have an Estimated Cost/Engineer's Estimate? Thank you so much in advance for help :) Cheers, DODGE DATA b ANALYTIGS Michelle Joy E. Tenedero T (413) 461-0666 1 E michelle.tenedero@construction.com Dodge Data & Analytics Hamilton, NJ Dodge I Sweets construction.com Company Name Sunshine Land Design, Inc Better Roads, Inc. Optimum Services Inc. tM"esign--S wC) r: B&B Site Development Florida Blacktop (Rob Shouy) A & E Land Clearing, Inc. ABC Transfer, Inc. Juan Bentancor, President Circle H Citrus dba 294 Constr levi@pantusoinc.com CW Roberts Contracting Inc Bidder's List� Site Construction Preparation w �� EIUJCJ �'� �ow iGC Address Phone Nurn S�ew 3291 Lionel Terrace 772-283-2& Stuart, FL 34997 772-283-891 S tJ(J K I Vl info@sunsh PO Box 1908 Old State Road 8 Lake Placid, FL 33862 208 N. Parrott Ave Okeechobee, FL 34972 501 SE Port St Lucie Blvd [\ Port St./�Lucie, FL 34984 863- 465-57 863-465-24E donnad(@be no oQt 863-467-25; ? �le) 863-467-80E 772- 871-7778 772- 871-9992 Fax bcurrie@landdesiensouth.com. 1505-C S. Parrott Avenue 863-763-6053 Home Okeechobee, FL 34974 863-634-7194 863-763-4948 Fax skullsteel@yahoo.com �( i , ` J " � C`'• 1287 W Atlantic Blvd 954- 943-9700 Pompano Beach, FL 33069 954- 943-9222 Fax i Cc�-� 7040 Seminole Pratt Whitney Rd 561-784-8525 Loxahatchee, FL 33470 866- 788-8525 561- 784-1617 Fax aelandclearine@aol.com 307 E. Aztec Avenue (863) 983-1611 Clewiston, FL 33440 (863) 983-6774 Fax 4uan@abctransferinc.com 3500 Shinn Rd/P O Box 14049 772-461-8868 l V,� of (X) 1 Ft Pierce, FL 34979 772-461-9477 Fax 806-NW 9th St 863-763-7373 Okeechobee, FL 34972 863-763-7379 ipalmer@cwrcontractine.com Pramsdell@cwrcontractine.com Bidder's List Street Improvements Company Name APAC-Florida, Inc. Central Florida Division Dickerson Florida, Inc Better Roads, Inc. Traffic Services Inc. CW Roberts Contracting Inc Address 1445 42nd Street N.W. Winter Haven, FL 33881 3122 North 25th Street Ft. Pierce, FL 34946 PO Box 910 Ft. Pierce, FL 34954-0910 PO Box 1908 2830 Old State Road 8 Lake Placid, FL 33862-1908 405 E. Terrace Drive Plant City, FL 33563 806 NW 9th St PO Box 2128 Okeechobee, FL 34973 Ranger Construction 2501 NW 48th Street Winter Haven: 407-749-6266 Pompano Beach, FL 33073 407-656-3188 R.E.L.L. Corporation Community Asphalt Corp Asphalt Maintenance LLC ow -) Sunshine Land Design, Inc. (See also Site Construction) 1620 N Hercules Av Ste E Clearwater, FL 33758 14005 NW 186th Street Hialeah, FL 33018 6839 Narcoossee Rd Ste 43 Orlando, FL 32822 3291 Lionel Terrace Stuart, FL 34997 Phone Number (863) 967-0646 (863) 967-3907 Fax gmiohnson@apac.com (772) 429-4444 (772) 429-4445 Fax Idale@dfifl.com rickf@dfifl.com 863-465-5797 863-465-2764 Fax DonnaD@betterroads.net �C• (800) 814-3169 (813)659-1777 (813) 659-9395 Fax (863) 763-7373 (863) 763-7379 Fax 6palmer@cwrcontracting.com pramsdell@cwrcontracting.com (954) 428-8712 (954) 429-9637 Fax estimating@rangerconstruction.com 727-443-4200 727-443-4220 Fax rellcorpCa@tampabay.rr.com (305) 829-0700 (305) 829-8772 Fax (407) 380-0265 (407) 249-0267 Fax g_reg-@tasphaltspeciali"OM-4 11 772-283-2648 772-283-8944 Fax info@sunshinelanddesign.com Bidder's List Street Improvements Company Name Sweat Trucking & Paving Inc James Sweat Vest Concrete Contractors, Inc Mike Bevis Dubel's Pressure Cleaning & Asphalt Sealcoating Bob's Barricades Traffic Sign Contractors, LLC Carr Construction LLC Williams Masonry Ennis Flint (Flint Trading) sales@ennisflint.com Weekley Asphalt Paving Inc weeklevasp@aol.com Address 3157 Hwy 441 N PO Box 1908 Okeechobee, FL 34972 Phone Number (863) 357-3000 (863) 357-5783 Fax sweat@embargmail.com 1366 SW 18th Terrace (863) 763-3720 Okeechobee, FL 34974 vestconcrete@hotmail.com jJ\1 S+e CDnU'�E Lake Placid, FL 33852 (863) 465-0073 Fax J mike@bevisconstructioninc.com PO Box 841 Okeechobee, FL 34974 921 Shotgun Road Sunrise, FL 33326 (863) 261-6258 (Darryl or Diane) dubels23@vahoo.com (954) 423-2627 (954) 473 8737 Fax ielbert@bobsbarricades.com 815 Kraft Rd (800) 470-5880 Ext 2 Lakeland, FL 33815 (888) 890-3285 Fax salesC&trafficsiRncontractors.com 2968 Hwy 710 Okeechobee, FL 34974 1044 NE 96th Ave Okeechobee, FL 34974 115 Todd Court/P O Box 160 Thomasville, NC 27360 20701 Stirliing Rd Pembroke Pines, FL 33332 863-824-0409 863-582-9299 scar@ca rrconstruction.or� 863-634-0932 863-467-7241 Fax williamsmasonrV12.cw@Rmail.com 800-331-8118 336-475-7900 Fax 954-680-8005 954-680-8671 Fax Louis Poulson USA, Inc 3260 Meridian Parkway 954-253-1554 (Interior/exterior lighting) Weston, FL 33331 It O,r'\ Bidder's List Asphalt/Concrete Vest Concrete 1366 SW 18th Terr 863-763-3720 Okeechobee, FL 34974 863-634-4462 C vestconcrete.@hot ai .cr�`—Jd ve4 concre k e. Dickerson Florida, Inc. 3122 N. 25th St. 772-429-4444 P.O. Box 910 772-429-4445 Fax Ft. Pierce, FL 34954 (dale@dfifl.com Weekley Asphalt Paving, Inc. 20701 Stirling Rd 954-680-8005 weekleyaspCa@aol.com Pembroke Pines, FL 33332 954-680-8671 Fax CW Roberts Contracting Inc. 806 NW 9th St 863-763-7373 Okeechobee, FL 34972 863-763-7379 ipalmer@cwrcontractine.com pramsdell@cwrcontractine.com Patty Burnette From: Patty Burnette Sent: Wednesday, October 7, 2020 10:38 AM To: Kay Matchett (kmatchett@cityofokeechobee.com) Cc: David Allen; Yesica Montoya Subject: Sidewalk and Concrete Improvements Bid Kay I have placed copies of everything I believe you need for preparing the Purchase Rec in an envelope to you in your mail bin here at City Hall. Ellen Vest has a copy of everything and the Notice to Proceed was issued to her today. There is an original W-9 to give to Melissa in Finance when you submit the Purchase Rec. Please let me know if you need something not included in the envelope. Thank you Path N. Burnette Cj. eneraCServices Coordinator City of Okeechobee 55 SE 3rd Avenue Okeechobee, B'.- 34974 Phone: (863) 763-3372 ext. 9820 Direct: (863) 763-9820 Tax: (863) 763-1686 e-maiC*,a6urnette@citlaofokeecbobee.coini website: www.ciLijofokeecbobee.cont Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Exhibit 3 CcCITY OF OKEECHOBEE, PUBLIC WORKS 9/21 /2020 't�v� Okeechobee Memo FLORIDA • Founded 1915 To: Marcos Montes De Oca, City Administrator From: David Allen, Public Works Director Date: 9/10/2020 Re: Sidewalk and Concrete Roadway Bid award to Vest Concrete, PW 03-11-08-20 The Public Works Department is requesting the award of the contract for Sidewalk and Concrete Roadway Improvements, PW 03-11-08-20 to Vest Concrete Contractors Inc. The period of the contract is for one year. The Total Budgeted amount for Sidewalk and Concrete Roadway work is $86,337.50. The breakdown between budget line items is as follows: FY 21 Concrete Improvements Budget Items Sidewalk Repair and ADA Ramp Installation 301-549-4609 $40,000.00 Asphalt and Roadway Reconstruction/Sidewalk Program* 301-549-6300 $46,337.50 Total: $ 86,337.50 *The remainder of the $90,000 in budget line item 301-549-6300 Will be used for asphalt improvements. The contract can be extended on an annual basis at the same or superior terms by mutual agreement/acceptance between the vendor and the City. Amounts in the bid were based on estimated quantities for sidewalk, curbing and other non-specific work. The detailed bid tabulation is attached. In Summary the quotes were as follows: Contractor Total Bid Vest Concrete Contractors Inc. $ 88,137.50 Heavy Civil Inc $145,800.00 COBB Site Development Inc. $249,738.63 American Design Engineering Construction Inc $172,010.00 �--W* CenturyLink Customer Name: CITY OF OKEECHOBEE Order#: Q-01010090 Order Generation Date: 9/10/2020 8:02:34 AM Cutoff/Expiration Date: 10/25/2020 Currency: USD 9. Charges/Orders. CenturyLink will charge Customer the rates for the Services shown above. If Customer changes any of the Bundle/Package or Service Details or moves a Service Address, these rates will not apply. Rates and charges for Service elements not identified appear in the applicable terms and conditions. Existing services, bundles, offers, or packages will continue to be governed by the terms and conditions incorporated by attachment or reference when previously added to the Agreement. If the Agreement does not allow for rates to be set forth in a quote, this Order amends the Agreement to include CenturyLink-approved signed quotes as a method to order the Services listed above. Despite anything to the contrary in the Service -specific terms and conditions and for purposes of this Order only, NRCs are NOT waived unless this Order expressly states NRCs are waived or the NRCs appear in the waived column in the above table(s). If a Cancellation Charge requires Customer to pay the amount of any waived or discounted NRC, the NRC will be the amount stated in this Order or shown in the "Waived NRC' column in the above table(s) despite anything to the contrary in the Existing Agreement or Agreement. If in this Order Customer is upgrading, moving, disconnecting or otherwise changing an existing Service, cancellation charges may apply as set forth in the Agreement. Customer: CITY OF OKEECHOBEE Authorized Signature Name Typed or Printed Title Date Opportunity ID#: 56881630 Page 4 of 4 © CenturyLink. All Rights Reserved. CONFIDENTIAL OFC Patty Burnette From: Ellen Vest <jdvestconcrete@gmail.com> Sent: Tuesday, September 8, 2020 3:33 PM To: Patty Burnette Subject: Re: Bid for Okeechobee Sidewalk and Roadway Concrete Improvements Attachments: image001.png I forwarded this to my insurance agent. Ellen On Tue, Sep 8, 2020, 1:00 PM Patty Burnette<pburnette(d)cityofokeechobee.com> wrote: Hi Ms. Ellen. am missing some information that should be included with your Bid Bond. It is the surety information from the insurance company. I am needing this ASAP. I left you a couple of phone messages as well. Please contact me with any questions. Thank you Path M. Burnette generabServices Coordinator City of Okeechobee 55 SE 3rd Avenue Okeecho6ee, ` f- 34974 Phone: (863) 763-3372 ext. 9820 Direct: (863) 763-9820 Fax: (863) 763-1686 e-maiC- 12burnette9citi okeec6o6eexom 1 J,, I Patty Burnette From: Patty Burnette Sent: Monday, October 5, 2020 3:25 PM To: 'rudy@heavycivilinc.com' Cc: Yesica Montoya Subject: PW 03-11-08-20 Tracking: Recipient Read 'rudy @ h eavyc ivi l i n c. co m' Yesica Montoya Read: 10/5/2020 3:27 PM Good Afternoon. On behalf of the City of Okeechobee, I would like to thank you for submitting a proposal for the Okeechobee 2020 Sidewalk and Roadway Concrete Improvements Bid. The contract has been awarded to Vest Concrete Contractors, Inc. This award was approved by the City Council on September 21, 2020. Your company's name has been placed on the vendors list and you will be automatically notified of any upcoming bidding opportunities on projects within this scope of work. Although your company was not awarded this contract, the City of Okeechobee appreciates your participation in this process. Thank you, Path M. Burnette Cj. eneraCServices Coordinator City of Okeechobee 55 SE 3' `' Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 9820 Direct: (863) 763-9820 Fax: (863) 763-1686 e-maid 126urriette@ciryofokeechobee.coil I website: wwW.ckeechobee.com 1 Patty Burnette From: Patty Burnette Sent: Monday, October 5, 2020 3:26 PM To: operations@ Icobbconstruction.com' Cc: Yesica Montoya Subject: PW 03-11-08-20 Good Afternoon. On behalf of the City of Okeechobee, I would like to thank you for submitting a proposal for the Okeechobee 2020 Sidewalk and Roadway Concrete Improvements Bid. The contract has been awarded to Vest Concrete Contractors, Inc. This award was approved by the City Council on September 21, 2020. Your company's name has been placed on the vendors list and you will be automatically notified of any upcoming bidding opportunities on projects within this scope of work. Although your company was not awarded this contract, the City of Okeechobee appreciates your participation in this process. Thank you, Path M. Burnette Cj, eneraCServices Coordinator City o_ f Okeechobee 55 SE 3' `- Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 9820 Direct: (8(53) 763-9820 Fax: (863) 763-1686 e-maid oburitette@cirvofokeechobee.cont website: www.citti�ofo�eechobee.cvr�i J 1 Patty Burnette From: Patty Burnette Sent: Monday, October 5, 2020 3:28 PM To: steven.espinal@adeconstructioninc.com' Cc: Yesica Montoya Subject: PW 03-11-08-20 Good Afternoon. On behalf of the City of Okeechobee, I would like to thank you for submitting a proposal for the Okeechobee 2020 Sidewalk and Roadway Concrete Improvements Bid. The contract has been awarded to Vest Concrete Contractors, Inc. This award was approved by the City Council on September 21, 2020. Your company's name has been placed on the vendors list and you will be automatically notified of any upcoming bidding opportunities on projects within this scope of work. Although your company was not awarded this contract, the City of Okeechobee appreciates your participation in this process. Thank you, Path IA4. Burnette Cj, eneraCServices Coordinator City of Okeechobee 55 SE 3' ' Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 982o Direct. (863) 763-982o Fax: (863) 763-1686 e-mad P6urnetteC@cititofokeechobee.coni we6site: www.cittiivfv(zeec(wbee.cvr►i 1 Patty Burnette From: Kay Matchett Sent: Thursday, June 11, 2020 10:56 AM To: Patty Burnette Subject: RE: INVITATION TO BID 2020 Sidewalk And Roadway Patty, I apologize for not getting back to you on this. As we discussed, this work was budgeted for FY 2019-2020, page 4 No. 5 is correct, it should say on page 13 No. 3.1 work should be completed within ninety (90) days. Kay Matchett, Administrative Secretary City of Okeechobee, Public Works e-mail: kmatchett@cityoFokeechobee•com website: iviviv.citycifokeechobee.com Mailing Address: 55 5E 3.d Avenue, Okeechobee FL, 3497q Physical Address: 500 NW 71th Avenue, Okeechobee Fl- 3g972 Phone: (863) 763-3926 ext• 9797 Direct: (863) 763-9797 NOFI(i Duc In Fl,,,I , bnrul puhbr hi"'. ihia u,a l may hc,uhµri iu puhlic J nn,um. PUBLIC RECORD'Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request. do not send electronic mall to this entity. Instead. contact this office by phone or in writing Florida Statute 668 6076 CITY OF OKEECHOBEE E-MAIL DISCLAIMER: Florida has a very broad public records law Most written communications to or from local officials regarding city business are public records available to the public and media upon request, Your e- mail communications may therefore be subject to public disclosure. From: Patty Burnette <pburnette@cityofokeechobee.com> Sent: Wednesday, June 3, 2020 4:22 PM To: Kay Matchett <kmatchett@cityofokeechobee.com>; David Allen <dallen@cityofokeechobee.com> Subject: RE: INVITATION TO BID 2020 Sidewalk And Roadway Kay/David, Sending this off to the Attorney to review. Have a question though. On page 4 No. 5 says to start work within thirty calendar days ............ and to thereafter complete the work within ninety calendar days. THEN on page 13 No. 3.1 says the work say be completed within one hundred and eighty days????????? Please review and thank you. 1 Patty M. Burnene Cj, eneral Services Coordinator City of Okeechobee SS SE 3, d Avenue Okeechobee, FL 34974 Phone: (8 63) 763 -3372 ext. 9820 Direct: (863) 763-9820 Eax: (863) 763-1686 e-maiC pburnette@ciuofokeecb.obee.com website: www.cittilofokeechobee.coni Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. From: Kay Matchett <kmatchett@cityofol<eechobee.com> Sent: Tuesday, June 2, 2020 4:51 PM To: David Allen <dallen@citvofokeechobee.com>; Patty Burnette<pburnette@citvofokeechobee.com> Subject: INVITATION TO BID 2020 Sidewalk And Roadway David & Patty, Could you please check over this and see if I need to change anything. Thank you Oke+ chobee Kay Matchett, Hdministrative Secretary City of Okeechobee, Public Works e-mail. • kmatchett@cityofokeechobee•com Patty Burnette From: City Attorney Sent: Friday, June 5, 2020 11:21 AM To: Patty Burnette Cc: Marcos Montes De Oca; Robin Brock; David Allen; Kay Matchett; Yesica Montoya; City Attorney Subject: RE: 2020 Sidewalk and Roadway Bid Hey Patty — I will review these as well as the Landscape Maintenance Bid and get back with you on Monday. Carlyn From: Patty Burnette Sent: Wednesday, June 3, 2020 4:26 PM To: City Attorney<cityattorney@cityofokeechobee.com> Cc: Marcos Montes De Oca<mmontesdeoca@cityofokeechobee.com>; Robin Brock <rbrock@cityofokeechobee.com>; David Allen <dallen@cityofokeechobee.com>; Kay Matchett<kmatchett@cityofokeechobee.com>; Yesica Montoya <ymontoya@cityofokeechobee.com> Subject: 2020 Sidewalk and Roadway Bid Importance: High Good Afternoon John and Carlyn. Attached is another Bid for your review that Council is wishing to get advertised. Please let me know if you have any questions. Thank you Path 2V1. Burnette generaCServices Coordinator City of Okeechobee 55 SE P' Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Eax: (863) 763-1686 e-mail: a6uriiette@citilofokeechobee.com website: vwvw.ciryofo(eec6.obee.coin 1 Patty Burnette From: Patty Burnette Sent: Wednesday, June 3, 2020 4:26 PM To: City Attorney Cc: Marcos Montes De Oca; Robin Brock; David Allen; Kay Matchett (kmatchett@cityofokeechobee.com); Yesica Montoya (ymontoya@cityofokeechobee.com) Subject: 2020 Sidewalk and Roadway Bid Attachments: Invitation to Bid Okeechobee 2020 Sidewalk and Roadway Concrete Improvements.doc Importance: High Good Afternoon John and Carlyn. Attached is another Bid for your review that Council is wishing to get advertised. Please let me know if you have any questions. Thank you Path M. Burnette Cj, eneraCServices Coordinator City o, f Okeechobee 55 SE 3Yd Avenue Okeechobee, Tf- 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 'Fax: (863) 763-1686 e-mail: vbit rnetteCxcitilofokeecho6ee.cord website: vnm,ciryofokeec606ee.c0r"1 Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. Patty Burnette From: Patty Burnette Sent: Wednesday, June 3, 2020 4:22 PM To: Kay Matchett; David Allen Subject: RE: INVITATION TO BID 2020 Sidewalk And Roadway Kay/David, Sending this off to the Attorney to review. Have a question though. On page 4 No. 5 says to start work within thirty calendar days ............ and to thereafter complete the work within ninety calendar days. THEN on page 13 No. 3.1 says the work say be completed within one hundred and eighty days????????? Please review and thank you. Path IA . Burnette generaCServices Coordinator City of Okeechobee 55 SE 3r" _ Avenue Okeechobee, E134974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Tax: (863) 763-1686 e-maid: a6urriette@cittiiofokeecliobee.coni website: www.citti,lofoFeechobee.com N Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. From: Kay Matchett <kmatchett@cityofokeechobee.com> Sent: Tuesday, June 2, 2020 4:51 PM To: David Allen <dallen@cityofokeechobee.com>; Patty Burnette<pburnette@cityofokeechobee.com> Subject: INVITATION TO BID 2020 Sidewalk And Roadway David & Patty, Could you please check over this and see if I need to change anything. Thankyou 1Y� Kay Matchett, Administrative Secretary City of Okeechobee, Public Works e-mail. kmatchett@cityoFokeechobee•com website: iviv>v.cityofokeechobee.com Mailing Address: 55 SE 3rd Avenue, Okeechobee FG 3497q Physical Address: 500 N6+/ 77" Avenue, Okeechobee FG 3g972 Phone: (863) 763-3926 ext• 9797 Direct: (863) 763-9797 W ll lr'I'- Dl -, Nund.l. bn�,id puhh< Ln' , i - "hail ul," I,r .nlqui is pld,hc d- l.,, PUBLIC RECORDS NOTICE Under Florida law. entail addresses are public records If you do riot want youm r email address released in response to a public. reconls request. do nnt) (lot seelectronic mail to this entity Instead, contact this office by phone or 11 wnf ng. Flood, Statute 668 6076 CITY OF OKEECHOBEE E-MAIL DISCLAIMER Florida has a very broad public records law Most written conlmuninahons to w from local officials regarding city business am public records available to the public and modla upon request Your I>- itiall cominllnicatiorls play therefore be subject to public disclosure. 2 Pattv Burnette From: Kay Matchett Sent: Tuesday, May 19, 2020 4:42 PM To: David Allen; Patty Burnette Subject: Invitation to Bid Okeechobee 2020 Sidewalk and Roadway Concrete Improvements Attachments: Invitation to Bid Okeechobee 2020 Sidewalk and Roadway Concrete Improvements.doc David/Patty, I did make several changes to include punctuation, page numbering, and page title headings to conform with the Index page. Thank you AI f'e"g r' keec 1obee Kay Matchett, Administrative Secretary City of Okeechobee, Public Works e-mail. kmatchett@cityoFokeechobee•com website: www.cityofokeechobee.com Moiling Address: 55 5F 3rd Avenue, Okeechobee Fi, 3g97cf Physical Address: 500 NW 776h Avenue, Okeechobee R. 34972 Phone: (863) 763-3926 ext• 9791 Direct: (863) 763-9791 IA tl� 6^ oopq _6 a_." q u'�&'L ]liTl(1 Un. ,, Ftond.i� I pnhh. la„+ Ili, :.ni.id n " I" ruhµU ,, puhhi I[,,,I xu'c PUBLIC RECORDS NOTICE Under Flonda law, eni f addr,.-S are publiC records II y 1, do not want yxnr ._mail add—, released in response to a publ.c reronls request. cb not send electronic mail to this P.nMy Instead. contact thls office by phone or In wnhng Florida Statute 668 6076 CITY OF OKEECHOBEE E-MAIL DISCLAIMER. Florida has a very broad public records law Most written rnlnnnunications to or fron, local officials regarding city YillCinesS are phbhc records available to the pul,hr and media upon request Yonir e- mail com,ni-cations may th-irefore be SubleO 10 public rhsclosure. 1 Patty Burnette From: David Allen Sent: Monday, May 4, 2020 2:39 PM To: Patty Burnette; Marcos Montes De Oca Cc: Kay Matchett; Robin Brock; Yesica Montoya Subject: RE: Bids for Landscaping and sidewalk have revised the Landscape bid to incorporate the comments below and our discussion this morning. actually removed the equipment questions in the bidder qualification section. If this was a very specific project that absolutely required a specific piece of equipment for the project to be completed correctly then we should state that. For a general landscaping bid I don't I'm qualified or is it necessary to tell the landscape contractor that he needs X zero turn mowers, y trimmers and so on. The contractor can figure out what they need as long as the work is performed to specification. also removed the fertilizer section of the specification. In the years I have been here we have never had the landscape company apply fertilizer. I did add specific criteria for the mulch and palm tree trimming sections of the specification. In the bid quantities I added the minimum quantities and referenced the specific section of the specification for the bid item. Patty, has the clerks office given us feed back on the language for the notary section? My understanding is that the wording changed this year so I want it correct. Let me know your comments so I can work on the concrete and 3rd ave/6th Street SCOP bids David From: Patty Burnette<pburnette@cityofokeechobee.com> Sent: Thursday, April 30, 2020 9:33 AM To: David Allen <dalien @cityofokeechobee.com>; Marcos Montes De Oca <mmontesdeoca@cityofokeechobee.com> Cc: Kay Matchett <kmatchett@cityofokeechobee.com>; Robin Brock <rbrock@cityofokeechobee.com>; Yesica Montoya <ymontoya@cityofokeechobee.com> Subject: Bids for Landscaping and sidewalk Importance: High Good Morning. Marcos, I had forwarded these two bid documents to John and Carlyn to review on February 24th. Carlyn called and spoke to me the next day about several changes that should be made to the documents. I had reviewed some of those changes with you and you were going to speak to Carlyn to go over some of them. I am not sure if you have had an opportunity to get with her yet or how you are wishing us to proceed? Below is a recap of some of the items we discussed: • Both documents use the term "bid" and "proposal' throughout them. If these are to truly be bids, awarded on cost alone after meeting the minimum qualifications, we need to change the term "proposal' to "bid" everywhere in the document. • Tighten up the "minimum requirements" to ensure that they give precise requirements that we can measure. This section is not a "questionnaire" as it would be in a Request for Proposals. • On the Bid Unit Price Schedule page, no abbreviations for unit of measure. • Questionnaire page, should remove the word questionnaire. We need to "have" them meet the minimum requirements. We need to list what equipment is needed. • On the agreement for Landscaping, needs to list what the frequency is for each of the locations to be maintained. • Under the Governing Specifications information needs to be clear and measurable. • Scope of Work is also listed in the Agreement. I am thinking that she was saying to list it just once, but would need to clarify since it has been a few months. Please let me know if we need to have a conference call to speak with Carlyn or how you are wishing to proceed. Thank you Patty M. Burnetre (j. eneraCServices Coordinator City of Okeechobee SS SE 3rd Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 9820 Direct: (863) 763-9820 Tax: (863) 763-1686 e-mad_p6iul tcrreOc[rt1ofo(eec606CC.cooI, website: vvww.cirtl fo�,eecl-iobee.coiii NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. 5 a be t0601t Nj Patty Burnette From: Sent: To: Cc: Subject: Tracking: Patty Burnette Thursday, April 30, 2020 11:14 AM Marcos Montes De Oca; David Allen Kay Matchett; Robin Brock; Yesica Montoya; Robin Brock RE: Bids for Landscaping and sidewalk Recipient Marcos Montes De Oca David Allen Kay Matched Robin Brock Yesica Montoya Robin Brock I am available anytime except today from 2-3 Patty 'A4. Burnette (j, eneraCServices Coordinator City of okeecho6ee 55 SE 3' ' Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Fax: (863) 763-1686 e-mai[ pburriette@c%ttiofokeechobee.coiit T we6site: wwwxitirofokeecho6eexom Read Read: 4/30/2020 11:53 AM Read: 4/30/2020 1:20 PM Read: 4/30/2020 11:15 AM NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. 1 From: Marcos Montes De Oca <mmontesdeoca@cityofokeechobee.com> Sent: Thursday, April 30, 2020 10:38 AM To: Patty Burnette <pburnette@cityofokeechobee.com>; David Allen <dallen@cityofokeechobee.com> Cc: Kay Matchett<katchett@cityofokeechobee.com>; Robin Brock <rbrock@cityofokeechobee.com>; Yesica Montoya <ymontoya@cityofokeechobee.com>; Robin Brock <rbrock@cityofokeechobee.com> Subject: RE: Bids for Landscaping and sidewalk think we should have a quick meeting to discuss the items before calling or suppling the items to the attorney for modification Let me/robin know a good time we can do a zoom practice meeting if that works Marcos Montes De Oca, P.E. City Administrator �1 55 SE 3rd Avenue Okeechobee, FL 34974 Phone: (863) 763-3372 x 9812 Cell: (863) 801-0177 FAX: (863) 763-1686 Email: marcos(@,cityofokeechobee._c_om Website: www.citvofol<eechobee.com NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. From: Patty Burnette <pburnette@cityofol<eechobee.com-> Sent: Thursday, April 30, 2020 9:33 AM To: David Allen <dallen@cityofol<eechobee.com>; Marcos Montes De Oca <mmontesdeocaPcityofol<eechobee.com> Cc: Kay Matchett<1<matchettPcityofol<eechobee.com>; Robin Brock<rbrocl<pcityofol<eechobee.com>; Yesica Montoya <ymontoya Pcityofol<eechobee.com> Subject: Bids for Landscaping and sidewalk Importance: High Good Morning. Marcos, I had forwarded these two bid documents to John and Carlyn to review on February 24th. Carlyn called and spoke to me the next day about several changes that should be made to the documents. I had reviewed some of those changes with you and you were going to speak to Carlyn to go over some of them. I am not sure if you have had an opportunity to get with her yet or how you are wishing us to proceed? Below is a recap of some of the items we discussed: • Both documents use the term "bid" and "proposal" throughout them. If these are to truly be bids, awarded on cost alone after meeting the minimum qualifications, we need to change the term "proposal" to "bid" everywhere in the document. • Tighten up the "minimum requirements" to ensure that they give precise requirements that we can measure. This section is not a "questionnaire" as it would be in a Request for Proposals. • On the Bid Unit Price Schedule page, no abbreviations for unit of measure. • Questionnaire page, should remove the word questionnaire. We need to "have" them meet the minimum requirements. We need to list what equipment is needed. • On the agreement for Landscaping, needs to list what the frequency is for each of the locations to be maintained. • Under the Governing Specifications information needs to be clear and measurable. • Scope of Work is also listed in the Agreement. I am thinking that she was saying to list it just once, but would need to clarify since it has been a few months. Please let me know if we need to have a conference call to speak with Carlyn or how you are wishing to proceed. Thank you Patty M. Burnette Cj. eneraCServices Coordinator City of Okeechobee SS SE 3rd- Avenue Okeechobee, Tf- 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Fax: (863) 763-1686 e-maid p6ur-iiette@citiIoCo(zeecrto6ee.coiii website: www.ciL1J0 ohecc(iobee.co,tn Y- i Patty Burnette From: Carlyn H. Kowalsky <CKowalsky@nasonyeager.com> Sent: Tuesday, February 25, 2020 3:19 PM To: Patty Burnette; Karen Chang; John Fumero Cc: Carlyn Kowalsky; Missy Hernandez Subject: RE: Copies of Bid dots Hey Patty I just left you a message to discuss these documents. Sorry I missed you. There are several items we need to discuss, but here's a few to address as a start. Both documents use the term "bid" and "proposal" throughout them. If these are to truly be bids, awarded on cost alone after meeting the minimum qualifications, we need to change the term "proposal" to "bid" everywhere in the document. We also need to tighten up the "minimum requirements" to ensure that they give precise requirements that we can measure. This section is not a "questionnaire" as it would be in a Request for Proposals. Give me a call when you are available to discuss. Thanks— Carlyn 561-248-3922 From: Patty Burnette[mailto:pburnette@cityofokeechobee.com] Sent: Monday, February 24, 2020 4:20 PM To: Carlyn H. Kowalsky <CKowalsky@nasonyeager.com>; Karen Chang <KChang@nasonyeager.com>; John Fumero <JFumero@nasonyeager.com> Cc: Carlyn Kowalsky <carlynkowalsky@gmail.com>; Missy Hernandez <mhernandez@nasonyeager.com> Subject: RE: Copies of Bid dots Thank you. Will speak to you then. Have a good evening. Patty 4. Burnette (j. eneraCServices Coordinator City of Okeechobee 55 SE 3`1' Avenue Okeecho6ee, Ef- 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Eax: (863) 763-1686 e-mai6 pC)-it-},-rtette@citl.jofoF,eec6o6ee.col�}i J Patty Burnette From: Patty Burnette Sent: Monday, February 24, 2020 4:34 PM To: John Fumero; Carlyn H. Kowalsky Cc: Karen Chang Subject: RE: Copies of Bid docs Great and thank you John. Patty M. Burnette GeneraCServices Coordinator City of Okeechobee 55 SE 3rd Avenue Okeechobee, Ef 34974 Phone: (8 63) 763 -3372 ext. 9820 Direct. (863) 763-9820 Tax: (863) 763-1686 e-mai[ -abut-riette@cittiiofokeecho6ee.coin website: wwwxiLt�ofokeec6o6ee.coni NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. From: John Fumero <JFumero@nasonyeager.com> Sent: Monday, February 24, 2020 4:29 PM To: Patty Burnette <pburnette@cityofokeechobee.com>; Carlyn H. Kowalsky <CKowalsky@nasonyeager.com> Cc: Karen Chang <KChang@nasonyeager.com> Subject: RE: Copies of Bid docs Patty- Carlyn is our procurement Pro. She will review and follow up with you. Thanks. John J. Fumero6f°' Attorney at Law Board Certified State & Federal ; Government & Administrative Practice Lawyer Email: jfumero@nasonyeager.com ocra Tel: 561-314-3999 1 Fax:561-982-7116 STArP&FEN RAt GOVERNMEN7 & Profile vCard MMINISTRI'iW PR CTLCE Nano I Yea per V���VII F�4iER174�f�1�VG�l.e 1. Ar rGRNLYS Al IMY L11.. MCI 750 Park of Commerce Blvd., Suite 210 1 Boca Raton IF 133487 www.nasonveager.com The information contained in this transmission is attorney privileged and confidential. It is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you receive this communication in error, please notify us immediately by telephone (collect) and return the original message to us at the above address via the U.S. Postal Service. We will reimburse you for postage and/or telephone expenses. WIRE FRAUD ADVISORY: Due to the increased risk associated with wire fraud and e-mail hacking and phishing attacks, in the event you receive an e-mail from Nason Yeager containing wire transfer instructions, please call Nason Yeager using previously known contact information and NOT information provided in the email, to verify the information contained within said wire transfer instructions prior to sending funds pursuant to such wire transfer instructions. Think Green! Please do not print this e-mail unless absolutely necessary. From: Patty Burnette rmailto:pburnette(@citvofol<eechobee.com] Sent: Monday, February 24, 2020 1:16 PM To: John Fumero <JFumero(@nasonyeager.com>; Carlyn H. Kowalsky <CKowalskyPnasonyeager.com> Cc: Karen Chang <KChang0Dnasonveager.com> Subject: RE: Copies of Bid docs Good Afternoon. Know you all are swamped but just checking on the review for these two Bid Documents? Thank you Path M. Burnette generaCServices Coordinator City of Okeechobee 55 SE 3'`' Avenue Okeechobee, EL 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Tax: (863) 763-1686 e-mail:,P6u►-riette@eittiofoizeec6o6ee.colii we6site: www.cittiiofokeecho6ee.cajn NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. From: Patty Burnette Sent: Monday, February 17, 2020 3:19 PM To: John J. Fumero <ifumero@nasonveager.com>; Carlyn H. Kowalsky <CI<owalsl<v@nasonyeager.com> Cc: Marcos Montes De Oca<mmontesdeoca@cityofokeechobee.com>; Robin Brock<rbrocl<@cityofol<eechobee.com>; Karen Chang <KChang@nasonyeager.com> Subject: FW: Copies of Bid dots Importance: High Hi John and Carlyn. Attached are two proposed bid documents for review. I will assign the correct Bid numbers and dates once reviewed. Should you have any questions, please just let me know. Thankyou Patty IVl. Burnette Cj, eneraCServices Coordinator City of Okeechobee SS SE 3rd'Avenue Okeechobee, FL 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Fax: (863) 763-1686 e-mail: pburnette@c%tti�ofo�Zeec(o6ee.co►n we6site: www.citti�ofo(zeec(io6ee.com NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. if you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. This email has been scanned for email related threats and delivered safely by Mimecast. For more information please visit http://www.mimecast.corn Patty Burnette From: Patty Burnette Sent: Monday, February 24, 2020 4:20 PM To: Carlyn H. Kowalsky; Karen Chang; John Fumero Cc: Carlyn Kowalsky; Missy Hernandez Subject: RE: Copies of Bid dots Thank you. Will speak to you then. Have a good evening. Patty M. Burnette generaCServices Coordinator City of Okeechobee 55 SE 3' d'Avenue Okeechobee, Ef- 34974 Phone: (863) 763-3372 ext. 9820 Direct: (863) 763-9820 Fax: (863) 763-1686 e-maid o6ui-nette@cittlofokeeci tobee.coni we6site: www.ci yofofieechobee.cain NOTICE: Florida has a very broad public records law. Asa result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. From: Carlyn H. Kowalsky <CKowalsky@nasonyeager.com> Sent: Monday, February 24, 2020 4:15 PM To: Karen Chang <KChang@nasonyeager.com>; John Fumero <J Fume ro @ naso nyeager.co m>; Patty Burnette <pburnette@cityofokeechobee.com> Cc: Carlyn Kowalsky <carlynkowalsky@gmail.com>; Missy Hernandez <mhernandez@nasonyeager.com> Subject: Re: Copies of Bid dots Hi Patty I will give you a call tomorrow about these, unless John has already responded. Ca rlyn Hi John and Carlyn. Attached are two proposed bid documents for review. I will assign the correct Bid numbers and dates once reviewed. Should you have any questions, please just let me know. Thankyou Path M. Burnette (j, eneraCServices Coordinator City of Okeechobee 55 SE 3rd'Avenue Okeechobee) Ef- 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Tax: (863) 763-1686 e-mad p6urnette@citijofokeecho6ee.cojii J J we6site: wwwxitti�ofoheecFio6ee.co►n J 2 r7 NOTICE: Florida has a very broad public records law. As a result, any written communication created or received by the City of Okeechobee officials and employees will be available to the public and media, upon request, unless otherwise exempt. Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this office. Instead, contact our office by phone or in writing. Carlyn H. Kowalsky Attorney at Law Email: CKowalskyCanasonyeager.com Tel: 561-982-7114 1 Direct Dial: 561-227-4552 1 Cell 561-248-3922 1 Fax: 561-982-7116 Profile vCard NasonYeager 'GERSON HARRIS & FILIMERO, R& ATTORNEYS AT LAW j Ut. 1960 750 Park of Commerce Blvd., Suite 210 Boca Raton I FL 133487 www.nasonveager.com The information contained in this transmission is attorney privileged and confidential. It is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you receive this communication in error, please notify us immediately by telephone (collect) and return the original message to us at the above address via the U.S. Postal Service. We will reimburse you for postage and/or telephone expenses. WIRE FRAUD ADVISORY: Due to the increased risk associated with wire fraud and e-mail hacking and phishing attacks, in the event you receive an e-mail from Nason Yeager containing wire transfer instructions, please call Nason Yeager using previously known contact information and NOT information provided in the email, to verify the information contained within said wire transfer instructions prior to sending funds pursuant to such wire transfer instructions. Think Green! Please do not print this e-mail unless absolutely necessary. This email has been scanned for email related threats and delivered safely by Mimecast. For more information please visit http://www.mimecast.com Patty Burnette From: Patty Burnette Sent: Monday, February 17, 2020 3:19 PM To: John J. Fumero ; Carlyn H. Kowalsky Cc: Marcos Montes De Oca; Robin Brock; Karen Chang Subject: FW: Copies of Bid dots Attachments: 2020 Invitation to Bid Landscape & Maint..doc; 00-00-00-20 Okeechobee 2020 Sidewalk and Roadway Concrete Improvements.doc Importance: High Tracking: Recipient Read John J. Fumero Carlyn H. Kowalsky Marcos Montes De Oca Robin Brock Karen Chang Read: 2/17/2020 3:28 PM Hi John and Carlyn. Attached are two proposed bid documents for review. I will assign the correct Bid numbers and dates once reviewed. Should you have any questions, please just let me know. Thankyou Path M. Burnette generaCServices Coordinator City of Okeechobee 55 SE 3rd Avenue Okeechobee, Pf- 34974 Phone: (863) 763-3372 ext. 9820 Direct. (863) 763-9820 Eax: (863) 763-1686 e-maid:,v6i,ci-riette@citl,tofo�,eechobee.coni we6site: www.cit1,tofo(zeec6o6ee.com 1