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Home My WebLink About2018-265-E Planning - Wellsmont Landscaping SedStruct3DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC [Departmental Use Only] TITLE SedStruct3Maint2018 -2 FY 17 -18 ORANGE COUNTY CONTRACT UNDER $5,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 10th day of July, 2018, ( "Effective Date ") by and between Orange County, North Carolina, a body politic and corporate organized under the laws of the State of North Carolina, (the "County "), party of the first part; and Wellsmont Landscaping (the "Provider "), party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following services to the County in accordance with the terms of this Agreement, time being of the essence: The services and/or materials and/or construction (hereinafter referred to collectively as "Services ") to be furnished under this Agreement are as follows: Mow and trim brush on dam and surrounding area (approximately 1.6 acres in total) at Sediment Control Structure No. 3 to within six inches of the ground in a manner that does not cause rutting. This includes cutting any saplings or scrubby vegetation that may be growing at the water line of the dam. This also includes tree and shrub removal around the perimeter of the dam outfall structure. Trees and shrubs designated for removal around the dam outfall structrue will be marked in the field by Orange County prior to starting work. Resulting debris shall be removed from site and legally disposed of by Provider. See Attachment A for detailed quote. See Attachment B for map of limits of work. The term of this agreement rendered shall be from July 10, 2018 to September 10, 2018. Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not sub - contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement, without the prior written approval of the County. SPECIFIC TERMS I. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed TWO THOUSAND TWO HUNDRED AND THIRTY FIVE DOLLARS, ($2,235.00). Payment shall be made within thirty (30) days of an invoice properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. 2. Non — waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non - Waiver Clause. 3. Independent Contractor: The Provider shall operate as an independent contractor, and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or Revised 10/17 (Mgr appry 5k 6/18) DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 4. Insurance: Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by County's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at http: / /www.orangecountync.gov /departments /purchasing division / contracts.php). If County's Risk Manager determines additional insurance coverage is required such additional insurance shall be designated here N/A (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the County's Risk Manager. 5. Indemnity: The Provider agrees, without limitation, to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider in carrying out Provider's duties and obligations related to the Services to be provided in this Agreement. 6. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. County may suspend this Agreement upon reasonable notice to Provider. 7. Entire Agreement and Signatures: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and the intent of the parties to comply with Article I IA and Article 40 of North Carolina General Statute Chapter 66. 8. Governing Law and Priority: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina and Orange County. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti - discrimination laws, policies, rules, and regulations and the Orange County Non - Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http: / /www.oran etync og v/ departments /purchasing_ division /contracts.php.). Any violation of this requirement is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147 - 86.58. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147- 86.81. By executing this Agreement Provider affirms Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. Revised 10/17 (Mgr appry 5k 6/18) 2 DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC 9. Dispute Resolution: Neither party may initiate binding arbitration. Any disputes shall be resolved by nonbinding mediation. If such mediation fails either party may initiate litigation to resolve the dispute. Should either party initiate litigation to settle any dispute involving the terms of this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. 10. Non Appropriation: Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non - appropriation of public funds. IN WITNESS WHEREOF, Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORANGE COUNTY PROVIDER By: Department Director 200 S. Cameron St. P.O. Box 8181 Hillsborough, NC 27278 Revised 10/17 (Mgr appry 5k 6/18) By: f� Title: Doug Malinowski, Jr., Owner Wellsmont Landscaping 1005 Dimmocks Mill Rd., Hillsborough, NC 27278 DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC Attachment A Quote Wellsmont Landscaping 1005 Dimmocks Mill Rd 1.- Hillsborough, NC 27278 L s C A P 1 N c 919.810.6282 919. 810 -62a2 Customer Customer Number OR1 Quote Date May 16, 2018 Orange County Sales Person DPM 131 W. Margret Lane, PO Box 8181 Expiration Date June 15, 2018 Hillsborough, NC 27278 Terms Proposal Name Spill way tree clearing Project Name Efland Sediment control structure r Proposal Number 2018 -168 Version Number 1 SKU Size/ Description Quantity Unit Extended Unit Price Price Clear trees and shrubs as discussed ( to be marked out in the field by Orange County ) along toe of pond bermand adjacent to pond outfall structure. Grind /cut all stumps to less than 6" from grade. Collect and haul all debris from site. Haul tree/ mulch debris offsite Mow /bush hog dam at the Efland Sediment Structure #3. Mow grass to the height of 6" across the dam and from waters edge to woodline. 1.00 $1,680.00 $1,680.00 1.00 $180.00 $180.00 1.00 $375.00 $375.00 Taxable $0.00 Tax Exempt $2,235.00 Tax $0.00 Total $2,235.00 E DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC CORRECTED NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. CERTIFICATE OF LIABILITY INSURANCE 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(les) must be endorsed. It SUBROGATION IS WAIVED, subject to the terns 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). INSURED DOUG MALINOWSKI JR NAMEAND DBA WELLSMONT LANDSCAPING ADDRESS 1740 JOHNSON ROAD BURLINGTON NC 27217 CERTIFICATE ORANGE COUNTY PLANNING AND HOLDER INSPECTIONS DEPT CSANDT6a ORANGECOUNTYNC.GOV 131 W MARGARET LANE PO BOX 8181 HILLSBOROUGH NC 27278 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 REOUIREPAENT, TEPM C11. 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. X TYPE OFI SURANCE ADDL'SUBR MJCYNUIMBER POLICYE'FF I PC!R EXP LIMITS X COMMERCIAL GENERAL LIABILITY X GL 0483161 2/23/2018 2/2312019 - OCCURRENCE GEN'L AGGREGATE APPLIES PER POLICY BUSINESSOW NERS IUTDf+ OBILE LIABILITY SCHEDULEDAUTOS BAP 2177023 2/24/2018 8/24/2018 HIRED AUTOS NON -OWNED AUTOS GARAGE I.IASII..ITY (Oftr) GENERAL AGGREGATE $2'U1 PRODUCTS - COMPIOPS AGGREGATE $0 PERSONAL & ADV INJURY $110 EACH OCCURRENCE $1,0( DAMAGE TO RENTED $1 MED EXP (Any one parson) $5.0( EACH OCCURRENCE Is AGGREGATE I $ COMBINED SINGLE LIMIT 50�10(�0 (Each awdem) BODILY INJURY (Per person) $ BODILY INJURY (Per s=ided)) $ PROPERTY DAMAGE $ I EACH OCCURRENCE $ EXCESS LIABILITY- - OCCURRENCE AGGREGATE $ WC STATUTORY LIMITS X WORKERS COMPENSATION NIA, WC 0253741 8/24/2017 8124/2018 ' E.L EACH ACCIDENT $100,000 AND EMPLOYERS "LIABILITY _ POLICY APPLIES TO THE WORKERS L DISEASE - EA EMPLOYEE 1 $140,000 i COMPENSATION LAW IN THE STATE or NC = L DISEASE - POLICY umrT $Ej00,000 OTHER: DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES: --I ■laLLr --t{ I I%JIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE L.M. Squires C ,fy) DATE JUNE 12, 2018 '' J COI 0910 068 55381smf DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC COMMERCIAL LINES CHANGE ENDORSEMENT NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. p P.C. Box 27427 / Raleigh, North Carolina 27611 -7427 Mutual Company Named Insured and Mailing Address: DOUG MALINOWSKI JR DBA WELLSMONT LANDSCAPING 1005 DIMMOCKS MILL RD HILLSBOROUGH, NC 27278 -7357 Non Assessable Policy Policy No: GL 0483161 Member ID Number: 1644652 Policy Period: From 02/23/2018 To 02/23/2019 at 12:01 A.M. Standard Time at your mailing address shown above. Effective Date of Change: 05/16/2018 Transaction # 003 DESCRIPTION NAMED INSURED IS AMENDED AS SHOWN ABOVE. ADDITIONAL INSURED, ORANGE COUNTY PLANNING & INSPECTIONS DEPT IS ADDED AS REFLECTED ON THE ATTACHED NAMED INSURED AND INSURABLE INTEREST SCHEDULE. FORM CG 2026 (ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION)IS REVISED AND ATTACHED. WILL LAWS II, LUTCF TELE: (919) 732 -7430 110 MILLSTONE DR HILLSBOROUGH, NC 27278 -8775 Agent CLCE 0913 068 5538 Agency No. 06/05/2018 Countersignature Date ADDITIONAL INSURED COPY Authorized Representative Page 1 of 1 Doc Sign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC FARM NORTH CAROLINA FAW BUREAU MUTUAL INSURANCE COMPANY, INC. IBUREAU COMMERCIAL GENERAL LIABILITY COVERAGE PART INSURANCE SUPPLEMENTAL DECLARATIONS Policy Number: GL 0483151 Policy Period: From: 02/23/2018 To: 02/23/2019 Effective Date of Change: 05/16/2018 Named Insured: DOUG MALINOWSKI JR LIMITS OF INSURANCE S 2,000,000 s 0 S 1,000,000 S 1,000,000 S 100,000 S 5,000 FORM OF BUSINESS: General Aggregate Limit (Other Than Products - Completed Operations) Products /Completed Operations Aggregate Limit Personal Advertising Injury Limit Each Occurrence Limit Damage to Premises Rented To You Limit Medical Expense Limit (Any One Person) INDIVIDUAL Business Description: LANDSCAPE GARDENING Location of All Premises You Own, Rent or Occupy: Refer to Location Schedule - CLOS if applicable AUDIT PERIOD, ANNUAL UNLESS OTHERWISE STATED. TOTAL PREMIUM FOR THIS COVERAGE PART: FORM(S) AND ENDORSEMENT(S) APPLICABLE TO THIS COVERAGE PART: Refer to Forms Schedule - CLFS CGLD 0712 ADDITIONAL INSURED COPY , 1,174.00 Page 1 of 1 Rates Advance Premiums Estimated Premises/ Products/ Premises/ Products/ Premium Operations Completed Operations Completed Classifications Codes Bases Operations Operations WAIVER OF SUBROGATION 97047 34.337 34 ADDITIONAL INSUREDS 49950 ._ 77.259 155 LANDSCAPE GARDENING 97047 106,663 C, Ill` "L. 9$5 `i::'- PRODUCTS /COMPLETED PAYROLL OPERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT TOTAL PREMIUM FOR THIS COVERAGE PART: FORM(S) AND ENDORSEMENT(S) APPLICABLE TO THIS COVERAGE PART: Refer to Forms Schedule - CLFS CGLD 0712 ADDITIONAL INSURED COPY , 1,174.00 Page 1 of 1 DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. NAMED INSURED AND INSURABLE INTEREST SCHEDULE Policy Number: GL 0483161 Effective Date: 02/23/2018 DOUG MALINOWSKI JR DBA WELLSMONT LANDSCAPING ADDITIONAL INSURED MOFFAT PIPE INC 4901 UNICORN DR WAKE FOREST, NC 27587 -5082 CG2026 Endorsement Effective Date: 05/16/2018 Expiration Date: 02/23/2019 NAMED INSURED SCHEDULE INSURABLE INTEREST SCHEDULE ADDITIONAL INSURED ORANGE COUNTY PLANNING & INSPECTIONS DEPT PO SOX 8181 HILLSBOROUGH, NC 27278 CG2026 CNIS 0510 ADDITIONAL INSURED COPY Page 1 of 1 DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. FORMS SCHEDULE Policy Number: Effective Date: GL 0483161 02/23/2018 Named Insured: DOUG MALINOWSKI JR Expiration Date: 02/23/2019 Effective Date of Change: 05/16/2018 POLICY FORMS Forms and Endorsements Applying to all Coverage Parts and made part of the policy at time of issue: CLPJNC 05 09 COMMERCIAL LINES POLICY JACKET IL0003 09 08 CALCULATION OF PREMIUM IL0017 11 98 COMMON POLICY CONDITIONS IL0269 09 08 NORTH CAROLINA CHANGES - CANCELLATION AND NONRENEWAL GENERAL LIABILITY FORMS Forms and Endorsements Applying to this Coverage Part and made part of the policy at time of issue: CG0001 12 07 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG0068 05 09 RECORDING & DISTRIB OF MATERIAL OR INFO IN VIOLATION OF LAW EXCL CG0300 01 96 DEDUCTIBLE LIABILITY INSURANCE CG2026 07 04 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION CG2104 11 85 EXCLUSION - PRODUCTS - COMPLETED OPERATIONS HAZARD CG2107 05 14 EXCL- DISCL - PERS /CONE DATA RELATED LIAB CG2132 05 09 COMMUNICABLE DISEASE EXCLUSION CG2142 12 04 EXCL - EXPLOSION, COLLAPSE AND UNDERGROUND PROPERTY DAMAGE HAZARD CG2144 07 98 LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT CG2146 07 98 ABUSE OR MOLESTATION EXCLUSION CG2147 12 07 EMPLOYMENT - RELATED PRACTICES EXCLUSION CG2150 09 89 AMENDMENT OF LIQUOR LIABILITY EXCLUSION CG2155 09 99 TOTAL POLLUTION EXCLUSION WITH A HOSTILE FIRE EXCEPTION CG2160 09 98 EXCLUSION -YEAR 2000 COMPUTER- RELATED & OTHER ELECTRONIC PROBLEMS CG2167 12 04 FUNGI OR BACTERIA EXCLUSION CG2170 01 15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CG2176 01 15 EXCL OF PUNITIVE DAMAGES RELATED TO A CERTIFIED ACT OF TERRORISM CG2186 12 04 EXCLUSION - EXTERIOR INSULATION AND FINISH SYSTEMS CG2196 03 05 SILICA OR SILICA- RELATED DUST EXCLUSION CG2294 10 01 EXCL - DAMAGE TO WORK PERFORMED BY SUBCONTRACTORS ON YOUR BEHALF CG2404 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG2426 07 04 AMENDMENT OF INSURED CONTRACT DEFINITION FBGL03 06 04 EXCLUSION - LEAD FBGL04 06 12 EARTH MOVEMENT AND SUBSIDENCE EXCLUSION FBGL07 02 06 DESCRIPTION OF TERMS USED AS PREMIUM BASES FBGL08 1.1 08 QUICK REFERENCE COMMERCIAL GENERAL LIABILITY COVERAGE PART FBIL01 01 15 CERTIFIED TERROR LOSS DISCLOSURE OF PREM /FED SHARE OF INS LOSSES IL0021 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT {BROAD FORM} CLFS 0409 ADDITIONAL INSURED COPY Page 1 of 1 DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC POLICY NUMBER: GL 0483161 COMMERCIAL GENERAL LIABILITY CG 03 00 01 96 I I ]OR I R2 41111101► &,Mu lAs! A& C.' .I EWM:J :l :r_l of k droy-- w —a01"" DEDUCTIBLE LIABILITY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Coverage Bodily Injury Liability OR Property Damage Liability OR Bodily Injury Liability and /or Property Damage Liability Combined Amount and Basis of Deductible PER CLAIM or PER OCCURRENCE $ $ 250 (if no entry appears above, information required to complete this endorsement will be shown in the De.%larations as applicable to this endorsement.) APPLICATION OF ENDORSEMENT (Enter below any limitations on the application of this endorsement. If no limitation is entered, the deductibles apply to damages for all "bodily injury" and "property damage", 'however caused): A $250 PD DEDUCTIBLE PER OCCURRENCE APPLIES TO 97047 LANDSCAPE GARDENING A. Our obligation under the Bodily Injury Liability and Property Damage Liability Coverages to pay damages on your behalf applies only to the amount of damages in excess of any deductible amounts stated in the Schedule above as appli- cable to such coverages. B. You may select a deductible amount on either a per claim or a per "occurrence" basis. Your se- lected deductible applies to the coverage option and to the basis of the deductible indicated by the placement of the deductible amount in the Schedule above. The deductible amount stated in the Schedule above applies as follows. 1. PER CLAIM BASIS. If the deductible amount indicated in the Schedule above is on a per claim basis, that deductible applies as follows: a. Under Bodily Injury Liability Coverage, to all damages sustained by any one person because of "bodily injury", b. Under Property Damage Liability Cover- age, to all damages sustained by any one person because of "property damage "; or c. Under Bodily Injury Liability and/or Property Damage Liability Coverage Combined, to all damages sustained by any one person because of: (1) "Bodily injury"; (2) "Property damage "; or (3) "Bodily injury" and "property damage" combined as the result of any one "occurrence ". If damages are claimed for care, loss of serv- ices or death resulting at any time from "bodily injury", a separate deductible amount will be applied to each person making a claim for such damages. With respect to "property damage" person in- cludes an organization. CG 03 00 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 7 of 2 DocuSign Envelope ID: 23B19021- F3AC -4D83- 8621- FD21A11682EC 2. PER OCCURRENCE BASIS. If the deductible amount indicated in the Schedule above is on a "per occurrence" basis, that deductible amount applies as follows: a. Under Bodily Injury Liability Coverage, to all damages because of "bodily injury"; b. Under Property Damage Liability Cover- age, to all damages because of "property damage "; or c. Under Bodily Injury Liability and/or Property Damage Liability Coverage Combined, to all damages because of: (1) "Bodily injury"; (2) "Property damage ", or (3) "Bodily injury" and "property damage" combined as the result of any one "occurrence ", regard- less of the number of persons or organizations who sustain damages because of that " "occurrence C. The terms of this insurance, including those with respect to: 1. Our right and duty to defend the insured against any "suits" seeking those damages; and 2. Your duties in the event of an "occurrence ", claim, or "suit" apply irrespective of the application of the de- ductible amount. D. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit " and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. Page 2 of 2 Copyright, insurance Services Office, Inc., 1994 CG 03 00 01 96 DocuSign Envelope ID: 23B19021- F3AC -4D83- 8621- FD21A11682EC POLICY NUMBER- GL 0483161 COMMERCIAL GENERAL LIABILI'T'Y CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orcianization(s) I C�Ti�+e�— �+I�Ii�jl� �'�:�+Is1 �1�� /►�[e'�+i �� I�'l�a[�1r [�lr(.'irl��f li I Information required to complete this Schedule, if not shown above. will be shown in the Declarations. J Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury ", "property damage" or '.personal and advertising injury" caused, in whole or in part. by your acts or omissions or the acts or omis- sions of those acting on your behalf A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you, CG 20 26 07 04 O ISO Properties, Inc.. 2004 Page 1 of 1