HomeMy WebLinkAboutRes-2021-059 Award BidBOARD OF COUNTY COMMISSIONERS
COUNTY OF'KITTITAS
STATE OF'WASHINGTON
RESOLUTION NO. 2021. Osq
RESOLUTION TO AWARD BID
WHEREAS: Kittitas County went out to bid for a contractor to provide services forthe
Kittitas County Transfer station Phase l- Road and Utility improvements; and
WHEREAS: Kittitas County received three bids for the Kittitas County Transfer station
Phase 1- Road and Utility improvements; and
WHEREAS: Jacobs Engineering group has reviewed the bid's required documents; and
WHEREAS: Jacobs Engineering group has confirmed that the low bidder in as licensed
contractor with the Department of Labor and Industries and;
WHEREAS: It has been confirmed with the Federal Govemment website oogAM"
(System for Award Management) that the contractor has not been debarred or suspended
from with the Federal Government; and
NOW, THEREFORE' BE IT RESOLVED: the Board of County Commissioners, in
the best interest of the public, and having considered the review documents copies of
which are attached hereto and incorporated by reference, hereby awards the bid for the
Kittitas County Transfer station Phase 1- Road and Utility improvements to Belsaas and
Smith Construction Inc.
ADOPTED this ft)of 202t.
BOARD OF' COUNTY COMMISSIONERS
GTON
th, Chair
Wright, Commissioner
APPROVED AS TO FORM:
Douglas R. Mitchell, Deputy Prosecuting Attorney
tsCtot.of the Board- Julie Kjorsvik
tl Deputy Clerk of the Board- Mandy Buchholz
tllll lll,,
ooM
!
.Iacobs 3921 Rutl.edge Rd. NE, Ste. 81
Atbuquerque, NM 87109
United States
T +1.505.884.5600
wwwjacobs,com
April12,2021
Attention: Patti Stacey
Director
Sotid Waste Department
Kittitas County
925 lndustrial Way
Eltensburg, Washington 98926
Re: Recommendation of Award
Kittitas Coungr Transfer Station Phase 1 - Roadway and Utitity Construction
Dear Ms. Stacey,
Bids were accepted electronicatly and opened for the above-referenced project on Tuesday, Apri[ 6,
2021, at 9:30 a.m. The following bids were received:
Belsaas & Smith Construction, lnc. $2,467,381.7O
Pacific Civil and lnfrastructure, lnc.$2,878,740.43
Granite Construction, lnc.$2,929,364.96
The bid forms for a[[ three bidders were reviewed and checked for correct quantities, unit prices, and
extended (totat) prices for each bid item. A tabulation of the reviewed bids and the Engineer's cost
estimate are attached. No mathematical errors were identified in the bid proposats.
Any and a[[ items that had a unit cost that exceeded the engineer's estimate by 15o/o or more have
been verified that the quantity presented in the engineer's estimate is correct. We are confident
that these quantities are appropriate. Therefore, we betieve that the bid is balanced and acceptable.
The apparent low bidder for the project is Belsaas & Smith Construction, lnc. We have carefutty
reviewed the documents, as fottows:
. The Bid Proposal was signed by Russ Belsaas, President, and Brandon Drexter, Vice President,
individuats duty authorized to bind the company.
' Betsaas & Smith Constructors, lnc. is a ticensed contractor in the State of Washington, License
No. BELSASCO33OH, with an expiration date of JuIy 24,2022. We have verified this
information with Washington State Department of Labor & lndustries (https://l.ni.wa.gov) and a
printed copy of the search resutts is inctuded herewith.
Jacobs Engineering Group lnc.
-Iacobs
fuSH[--
April12,2021
We have reviewed the FederaI Government website 'SAM' (System for Award Management,
https://sam.gov/SAM/pages/pubtic/searchRecords/search jsO and determined that thb
apparent [ow bidder (see SFPA form) is not debarred or suspended from working with the
Federat Government. The result of this investigation sha[[ be reported in this recommendation
of award [etter and printed copies of the search results are inctuded herewith.
Along with the signed Bid Proposal form, Belsaas & Smith Construction, lnc. submitted the
fottowing:
. Bid Bond in the amount of 5% of the Bid with Power of Attorney. The surety for the Bid Bond is
Travelers Casuatty and Surety Company of America, who is [isted on FederaI Circular 570 (NAIC
#19038) and licensed to do business in the State of Washington to an underwriter's limit of
$670,641,OO0. We have verified this information with the U. S. Department of the Treasury's
Listing of Sureties Approved to Conduct Business in the State of Washington
(https://www.fiscat.treasury.gov/surety-bonds/[ist-certified-companies.html).
' Compteted Local Agency Subcontractor List.
. Compteted and signed Locat Agency Proposal Bond.
. Completed and signed Wage Law Comptiance.
. Non-CottusionDectaration.
. Completed and signed Local Agency Proposal Signature Page.
. Acknowledgement of receipt for Addendum No. 1, Addendum No. 2, Addendum No. 3, and
Addendum No.4.
Based on the information before us, Belsaas & Smith Construction, lnc. has submitted the lowest
responsive, responsible bid. We therefore recommend that, if a Contract for this work is awarded, it
be awarded to Betsaas & Smith Construction, lnc. for the Base Bid total of $2,467,381.7O.
Should you have any questions or require additional information, please feet free to contact Tom
Parker at the number provided betow. Thank you for this opportunity to provide services to the
Kittitas County Solid Waste Department.
Sincerely,
Thomas D. Parker, PE, BCEE
Senior Project Manager
(s0s)ee1-4e87
Tom.Pa rker@jacobs.com
.Iacobs
Aprlt't2,2021
Recommended:
Solid Waste Department
Patti Stacey, Director
Concur:
Board of County Commissioners
Enclosures:
Date
Bid Tabutation and Bid Opening Checklist
Washington State Department of Labor & lndustries search resutts
SAM Search Results
3
4t6t2021 BELSMS & SMITH CONSI INC
A,wmsramro\.1 Lab6r a tndustriesJhtlps://lnt.wa.gov).
BELSAAS & SMITH CONST INC
License
Verifo the contractor's active registration / license / cerlification (depending on trade) and any past violations.
-q-o-I-s-!.r-g_cl-l9]t.q9l!f3"cl9.f Active
Meets currenl requlrements.
Ucense speciaftles
GENERAL
Licenss no.
BELSASCO33OH
Efiective - expiration
o9to8t1s97-o7t2A,t2022
F--o..nC
TRAVELERS CAS & STY CO OF AMER
Bond account no.
400sM9863
$12,000.00
ggmLetlAC.gSJgJggL s MITH, R JoH N
Prindpab
SMITH, R JOHN
SMITH, MARSHA C
NELSON, BRYAN A, MEMBER
DREXLER, BRANDON R MEMBER
BELSMS, RUSS E, MEMBER
WA UBI No.
600 3{5 643
Received by L&l
01t24t2006
!n":$.tfl[99-
Continental lnsurance Co
Pollcy no.
4032762755
Rocelved by L&l
0812712020
lnfrectlon no.
ESTLU00288
lseue dats
08/18/2016
Vlolatlon olty
ELLENSBURG
Type ol vlolatlon
ELECTRICAL CITATION
PO BOX 926
ELLENSBURG, WA 98926
509.925-9747
KITTITAS Gounty
Business gpe
Corporation
Efiectivo date
03/31/2006
Exphation date
Until Canceled
$1,000,000.00
Effectlve date
0st01t2011
Expiration date
09t01t2021
$nfi"sfled
RCWWAC
19.28.041 RCW
Vlolation amount
$s00.00
^s*+-vin"ssNo savings accounts during the previous 6 year period.
!.er.v-:Hit-s-.e.s-?-in*[.th-e-.hsn"d.p-r.-ssvinss".
No lawsuits against the bond or savings accounts during the previous 6 year perlod.
k*!.-T"ex..d"c.bj"s"
No L&l tax debts are recorded for this contractor license during the previous 6 year period, but some debts
may be recorded by other agencies.
kis"e"nsn,Vjslnllp"ns
https://secure.lni.wa.gov/verify/Detail.aspx?UBl=600315643&LlC=BELSASC033OH&SAW=1t2
4t6t2021
Desdip8on
Offering to perform, submitting a bld for,, advertising, installing or maintaining cables,
conduclors or equlpment that convey or utilize
'elecl.lcal-current'without having a valid
electrical contractor license.
BELSMS & SMITH CONST INC
lnhac,tlon no.
ESTLUO02S9
lssue date
08/1 8/201 6
Molation city
ELLENSBURG
Type ofvlolation
ELECTRICAL CITATION
Desffipdon
Falllng to get an inspection or obtain a valid
eleclrical/telecommunications work permit or
post a provislonal electrical work permlt prior
to beginning the electrical/telecommunlcation
installation or alteration as referenced ln WAC
296.468.901.
$.s!i-sl-is.C.
RCWWAC
19.28.101 RCW
Vlolation amount
$250.00
Gertifi cations & Endorsements
OMWBE Certifications
No a6iii;i;AiiffiAii6rid ixist for this business.
Anprsnliss*..T-r-er,-ins.A-g--e-n!
Registered training agent. Check their eligible programs and occupations.
WorkersoComp
Do you know if lhe business has employees? lf so, veriry the business is uFto-date on workers' comp premiums.
L&l Account lD
?.1-"3,-5'9""8,"-{-9
Doing business as
BELSAAS & SMITH CONST INC
Estimatod workers rEport€d
Quarter 4 ol Yeat 2020 "31 to 50 Workers"
L&l account contact
T0 / JULIE SUR (360)9024715 - Email: SURJ235@|ni.wa.gov
Account is currenl,
Public Works Requirements
Verify the contractor is eligible to perform work on public works projects.
B.p.slt-inC--T"Lejning_--e*tr"e-g$-v..e.-J".U!y-.1...?919
Exempt from this requirement.
Contractor Strikes'iid;iliid; iiliA"6ien issued against this contractor.
Contractors not allowed to bid
Nd a;6iiiiiili; iiiil tCiii iSiued asainst this coniractor.
Workplace Safety & Health
Check for any pasi safely and health violations found on jobsites this business was responsible for.
No inspections during the previous 6 year period.
https://Secure.lni.wa.gov/verify/Detail.aspx?UBl=600315643&LlC=BELSASC033OH&SAW=212
SAM Search Results
List of records matching your search for :
Scarch Term : BELSAAS AND SMITII CONSTRUCTION n\e*
Record Status: Active
Expiration Date: 0610412021 Has Active Exclusion?: No Debt Subject to Offset?: No
Address: 103 E 4TH AVE STE 209
City: ELLENSBURG
ZIP Code: 98926-3189
BELSMS AND SMITH CONSTRUCTION INC Status: Active
DUNS:027302249 +4 CAGECode: 3XJA0 DoDAAC:
State/Province : WAS H I NGTON
Country: UNITED STATES
April 07, 2021 1'l:.49 AM https://www.sam.gov Page 'l of 1
KITTITAS COUNTYTRANSFER STATION, PHASE 1- ROAD AND UTILITY IMPROVEMENTSElDs oPENED PUBIICLY AT 09:30 AM oN APR\L6,\mt AT KnrffAS COUNTY PUBLICWORKSBASE BIDRoadway }loblllzallonRGdiEy Sch€d.doTotdUliIty Sdedule Sobtotalt tlily filobfiiza$onUlfty Sdre(hlleToid8id ltdn$sroldSales TdSUBCONTRACTOR LIST TOPTIOML)WAGE I.AWCERTIF|CANONLOCAL AGENCY SIGMTURE PAGEPROPOSAL BONONON€OLLUSION DECTAFATIONPROPOSAL COMPLETERESPOTISIVE BIDDER CR'IERIA,x7ItGnnlt€ ConstrucdotIIutIIPadtlc Cl{ll and Intrcttruc,trrstxxIIIB€lsas&smlthr[tl35ft3015002utt l700570387008NStNStNSNSNS69716S4969456635ITEIINO_6l176l3{3:'n25x27201Eb181716ct6b1{t3127E2TBIDt.IEMCONSTRTICTION GEOYEKTILE FC'R SCIL STABILIZATIONtrFF FFNCE TYPF '\IN UNK FENCE TYPE 3ROADVI'AY SI.,RVEYII'IGSIRUCTURE EXCAVATION CI.ASS BOIHER ITETSI LlM0,rAYlON SYSTFMCF-MENI CONC. ORfuEWAY ENTRANCE TYPECEiIENT CONC, CIJRB RAT'P {FERPETII)ICULAR'ICFI'ENY CONC- CURB RAMP 'PARALI-ELICFTFN?(IbNC. 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Local Agency Gontract
THIS AGREEMENT, made and entered into this day of
between the KITTITAS COUNTY WITH REGARD TO THE SOLID WASTE
, 2021
ELLENSBURG TRANSFER STATION, hereinafter called the Local Agency, under and
by virtue of Title 47 RCW, as amended and Belsaas & Smith Construction Inc.
hereinafter called the Contractor.
WITNESSETH:
That in consideration of the terms and conditions contained herein and attached and made a
part of this agreement, the parties hereto covenant and agree as follows:
L The Contractor shall do all work and fumish all tools, materials, and equipment for:
The improvement of Collector Road, a new collector road in Ellensburg, Woshington, by
constructing a new roadway and associatedfeatures and extending utility services along
US-97 and along Collector Road in accordance with Contract Plans, Contract
Provisions, and the Standard Specifications.
in accordance with and as described in the attached plans and specifications, and the
standard specifications of the Washington State Department of Transportation and the City of
Ellensburg which are by this reference incorporated herein and made part hereof and, shall
perform any changes in the work in accord with the Contract Documents.
The Contractor shall provide and bear the expense of all equipment, work and labor, of any
sort whatsoever that may be required for the transfer of materials and for constructing and
completing the work provided for in these Contract Documents except those items mentioned
therein to be furnished by KITTITAS COUNTY WITH REGARD TO THE SOLID WASTE
ELLENSBURG TRANSFER STATION.
il. KITTITAS COUNTY WITH REGARD TO THE SOLID WASTE ELLENSBURG
TRANSFER STATION hereby promises and agrees with the Contractor to employ, and does
employ the Contractor to provide the materials and to do and cause to be done the above desoribed
work and to complete and finish the same in accord with the attached plans and specifications and
the terms and conditions herein contained and hereby contracts to pay for the same according to the
attached specifioations and the schedule of unit or itemized prices at the time and in the manner and
upon the conditions provided for in this contract.
DOT Form272-0064
0712011
m. The Contractor for himself/herself, and for his/her heirs, executors, administrators,
suooessors, and assigns, does hereby agree to full performanoe ofall convenants required ofthe
Contractor in the contraot.
IV. It is further provided that no liability shall attach to the State by reason of entering
into this contract, except as provided herein.
IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year
first below written and REGARD TO THE SOLID W
ELLENSBURG TRANSFER STATION has caused this instrument to be executed by and in the
name of KITTITAS COUNTY the day and year first above written
Executed by the Contractor r{ - \\t aoal
Be-\gorg^.* g, El*,+l^ Cn l^st"ucho"\n-
(Contractoo
Local Agency:Kittitas Cou
Title Chair
t't4 u.
Date n,fr)I tq z6LI
1/
DOT Form272-006A
07t201',|
19ffi lAqlff€vrAqng-,(n'. r i,r)r-ci",
Local Agency Address
4 a* \rrdustrp"l t't"li"i'1
?{ I *rs\nrrrq, r.DtA 4?-ii J r,"
Project t,tame H
Local Agency Subcontractor List
Prepared in compliance with RCW 39.W.060 as amended
To Be Submitted with the Bid Proposal
S\
Fallure to list subcontractors with whom the bidder, lf awarded the contract, will dlrectly subcontract for performance of the
work of structural steel installation, rebar installation, heating, ventilation and air conditioning, plumbing, as described in
Chapter 18.106 RCW and electrical, as described in Chapter 19.28 RCW or naming more than one subcontractor to perform
the same work will result in your bid being non-responsive and therefore void.
Subcontracto(s) with whom the bidder will directly subcontract that are proposed to perform the work of structural steel installation,
rebar installation, heating, ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and eledrical as
described in Chapter 19,28 RCW must be listed below. The work to be performed is to be listed below the subcontractor(s) name.
To the extent the Project includes one or more categories of work referenced in RGW 39.30,060, and no subcontractor is
listed below to perform such work, the bidder certifies that the work will either (i) be performed by the bldder itself, or (ii) be
performed by a lower tier subcontractor who will not contract directly with the bidder.
Subcontractor Name
Work to be performed
Subcontractor Name
Work to be performed
Subcontractor Name
Work to be performed
Subcontractor Name
Work to be performed
Subcontractor Name
Work to be performed
* Bidder's are notified that it is the opinion of the enforcement agency that PVC or metal conduit, junction boxes, etc, are considered
electrical equipment and therefore considered part of electrical work, even if the installation is for future use and no wiring or electrical
current is connected during the project.
DOT Form 271-0154
Revised 0612020
ADDENDUM NO. 02
ATTACHMENT NO" 01
Local Agency Proposal Bond
KNOW ALL MEN BY THESE PRESENTS, That we, Belsaas & Smith Construction lnc.
Travelers Casualty and Surety
6f Ellensburg, WA as principal,and the Company of America
a corporation duly organized under the laws of the state of CT , and
authorized to do business in the State of Washington, as surety, are held and firmly bound unto Kittitas
Gounty in the full and penal sum of five (5) percent of the total amount of the bid proposal of said
principal for the work hereinafter described, for the payment of which, well and truly to be made, we bind
our heirs, executors, administrators and assigns, and successors and assigns, firmly by these presents.
The condition of this bond is such, that whereas the principal herein is herewith submitting his or
its sealed proposal for the following:
KITTITAS COUNTY TRANSFER STATION
PHASE 1 - ROAD AND UTILITY IMPROVEMENTS
said bid and proposal, by reference thereto, being made a part hereof.
NOW, THEREFORE, If the said proposal bid by said principal be accepted, and the contract be
awarded to said principal, and if said pfi1g.ipal^shall duly make and enter into and execute said contract
and shall tumish boniur rrquirra uyl$tt'$itfri##tr.riod of t*"nty (20) days from and after said
award, exclusive of the day of such award, then this obligation shall be null and void, otherwise it shall
remain and be in full force and effect.
IN TESTIMONY WHEREOF, The principal and surety have caused these presents to be signed
and sealed this 30th day of March 2021
Belsaas & Smith Construction, lnc.
Travelers Casualty and Suretv Companv of America
(Surety)
t Vtt
DOT Fonn 272-001AEF
07t2011
SR
riMcKimmy (Attorney-Attorney-in-Fact
TRAYELER
Travelers Casualty and Surety Company of America
TratClGis G-sualty and Surety CdmFahy
St. Paul Fire and Marine fnsurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of Amerlca, Travelers Casualty and Sulety Company, and St.
Paul Fire and Marine lnsurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint Lori McKlmmy of YAKIMA
Washington , lheir true and lawful Attorney-in-Fact to slgn, execute, seal and acknowledge any and all bonds, recognizances,
conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing lhe
fldelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
lN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 17th day of January,
20.19.
State of Connecticut
By:
City of Hartford ss.L Vice President
On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President
of Travelers Casualg and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine lnsurance Company, and
that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said
Companies by himself as a duly aulhorized officer.
lN WTNESS WHEREOF, I hereunto set my hand and official seal
My Commission expires the 30th day of June, 2021
Anna P. Nowik, Notary Public
This Power of Attorney is granted under and by the authority ol the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine lnsurance Company, which resolutions are now in full
force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice Presidenl, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoinl Attorneys-in-Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said ofiicers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of ihis Company, provided that each such
delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice Presidenl, any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secrelary or any
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if
required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or lheir certificates of authority or by one
or more Company ofiicers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that lhe signature of each of the following ofiicers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of
Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of
execuling and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power ofAttorney or certilicate bearing
such facsimile signature or facsimile seal shall be valid and binding upon ihe Company and any such power so executed and cerlified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to whlch it is attached.
l, Kevin E, Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine lnsurance Company, do hereby certiry that the above and foregoing is a true and correct copy of the Power of
Attorney execuled by said Companies, which remains in full force and effect.
Dated this 30th day of March 2021
/* { /4-/*! Kevin E. Hughes, Assi5tant Secretary
lo rca? tlf e aot/berrtro? of tfitb &n er of Aafprrleh ptease cE r os at f .80G42f -3880,
dease rerbr to t be a6orc-aarDed4t6orael^ri'r-Aicf orrd ttre otetad/s of tdre 6ot d b tr'0tctb tlftb &uor of Atfm,ttqy rb oftacied.
sinr.*D
ilol$fit
.|t
fuEllli
0ffiir
^-,W ffim*mi"'-*"*.'
Gontractor Gertificatio n
Wage Law Compliance - Responsibility Griteria
Washington State Public Works Contracts
FAILURE TO RETURN THIS CERTIFICATION AS PART OF THE BID PROPOSAL PACKAGE WILL
MAKE THIS BID NONRESPONSIVE AND INELIGIBLE FOR AWARD
I hereby certify, under penalty of perjury under the laws of the State of Washington, on behalf of the firm
identified below that, to the best of my knowledge and belief, this firm has NOT been determined by a final
and binding citation and notice of assessment issued by the Washington State Department of Labor and
lndustries or through a civiljudgment entered by a court of limited or generaljurisdiction to have willfully
violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46,49.48, or 49.52 within three
(3) years prior to the date of the Call for Bids.
Bidder Name:Rc\s.anq & Svrr,,,*h L^,uts*rt ichon r\L.\
Name of
By:
Signature of authorized person
Title . Secrerf
Title of person certificate
- Print full legal entity name of firm
$rqo.;r ftaisc-'r
Print Name of person making certifications for firm
Place:ttle^sc*l'r-l ,WA
Print city and state where signed
Date:I -(c - A\
Form272-009
o812017
Failure to return this Declaration as part of the bid proposal package
will make the bid nonresponsive and ineligible for award.
NON.COLLUSION DECLARATION
I, by signing the proposal, hereby declare, under penalty of
perjury under the laws of the United States that the following
statements are true and correct;
1 That the undersigned person(s), firm, association or corporation has
(have) not, either directly or indirectly, entered into any agreement,
participated in any collusion, or otherwise taken any action in restraint of
free competitive bidding in connection with the project for which this
proposal is submitted.
That by signing the signature page of this proposal, I am
deemed to have signed and to have agreed to the provisions
of this declaration.
2.
NOTICE TO ALL BIDDERS
To report rigging activities call:
1-800-424-9071
The U.S. Department of Transportation (USDOT) operates the above toll-free
"hotline" Monday through Friday, 8:00 a.m. to 5:00 p.m., eastern time. Anyone
with knowledge of possible bid rigging, bidder collusion, or other fraudulent
activities should use the "hotline" to report such activities.
The "hotline" is part of USDOT's continuing effort to identify and investigate
highway construction contract fraud and abuse and is operated under the
direction of the USDOT Inspector General. All information will be treated
confidentially and caller anonymity will be respected.
DOT Form 272-036lEF
0712011
SR
Local Agency Proposal -
Signature Page
The bidder is hereby advised that by signature of this proposal he/she is deomed to have acknowledged
all requirements and signed all certificates contained herein.
A proposal guaranty in an amount of five percent (5%) of the total bid, based upon the approximate
estimate of quantities at the above prices and in the form as indicated below is attached hereto:
Cash
Cashier's Check
Certified Check
Proposal Bond
ln the Amount oftr
n
n
B
Dollars
) Payable to the State Treasurer
ln the Amount of 5o/o of the Bid
Receipt is hereby acknowledged of addendum(s) No.(s) I e & 3,1{
Signatu of Authorized (s)
Firm Name irr.-\so.as; * Svra;\+r Lbr"rsbnuc#o", \rri
Address tD$ r, +u ft* *auq
P o tlox Qar,,
\i S Bt?
State of Washington Contractor's License No.
Federal lD No.
BZLSRSCo3ap *
Note:
(l)
($
q i - lD5?;1q+
This proposal form is not transferable and any alteration of the firm's name entered hereon
without prior permission from the - will be cause for considering the
proposal irregular and subsequent rejection of the bid.
Pleaso refer to section l-02.6 of the standard specifications, rs: "Preparation of Proposal," ot
"Article 4" of the Instruction to Bidders for building construction jobs.
DOT Form 272-036KEF
0712011
SR
(2)
ADDENDUM NO. 04
ATTACFIMENT NO. 04
util Schedule
is certifies that the undersigned has thoroughly examined the location of:
COUNTY TRANSFER STATION, PHASE 1 . ROAD AND UTILITY IMPROVEMENTS
Specifications, and Contract, and the following Bid Proposal Schedule of Rates and Prices:
(unit prices for all items, all extensions, and total amount of bid, shall be shown)
dn thethat Pla ns,and Contract workthe emSpecifications,braced thistn nda thethat methodgoverning whichmprovementby
will madebe saidfor rswork understood.The undertaketo na dundersigned worktheherebyproposescomplete
thtn tmls mor muchasprovement,asthereof becan leted thewith accordatn withnce saidcompavailable,money
Kittitas County Courthouse
205 West Sth Street
Ellensburg, WA 98926
Item No.Plan
Quantitv Unit Item Description Unit Price Total
Amount
PREPARATION
1 &00 L.S.
825.00 L.F PVC SANITARY
TION
&WATER LINES
IN. DIAM
3 2595.00 L.F.PVC SANITARYSEWER PIPE 1O IN. DIAM
4 1845.00 L.F.DUCTILE IRON PIPE FOR WATER MAIN 8IN. DIAM.$ 6i.oo
5 5.00 EACH BUTTERFLYVALVE lO IN g 2.obo.@ lc ,9@,@
6 2.O0 EACH COMB. AIR RELEASE/AIR VACUUM VALVE ASSEMBLY 2 IN.; t.'l$oteE.$'2.5m^ec
7 1.00 EACH BLOWOFF ASSEMBLY ', 2.lLO,oo $ 2.lzo,oo
8 8.00 EACH HYDRANT ASSEMBLY ; 't toa.oo t.W,&I 2580.00 L.F DUCTILE IRON PIPE FOR WATER MAIN 10 IN. DIAM.$ 74'Q $ fio.qao.ot
10 8.00 EACH GATE VALVE 8 IN.$ l,65O,O0
NG
oo
15.00
1600
MANHOLE 48IN
CONTROL AND
HIGH VISIBILI
TRAFFIC
13 6180.00 L.F.CONDUIT PIPE2IN. DIAM.g to.oo
14 6180.00 L.F CONDUIT PIPE 4IN. DIAM tq.w $ *,9b,a
15 6180.00 L.F CONDUIT PIPE 6IN, DIAM.$ zt.oD 2
16 1.00 L.S-PROJECT TEMPORARY TRAFFIC CONTROL
16b 1.00 EACH VAULT CONC. 6'x12', SPEC VP612 r1-11.{@,Al
16c 4.00 EACH VAULICONC. 7'x7', SPEC VP77 S Q.?a,e i!.
16d 7-00 EACH VAULT CONC. 5'x7', SPEC VP57 i lLoaOo $l o,q@,e
16e .00 EACH
OTHER ITEMS
LASS VAULT
17 34360.00 S.F.SHORING ATION CLASS B $ o.50
18 1.00 L.S ROA NG s Ll,w,e 8 -r.|,@.b
18b 12000.00 c.Y EXCAVATION S .Leo Stl
Roa Schedule
Item No.Unit Price
19 MOBIL
Unit
1
Item Description
PREP
Total
Amount
Plan
Quantity
20 8.00 ACRE CLEARING AND GRUBBING $ b.o@,o $ il8ooo.oo
22
1.00 L.S
GRADING STOC
NCL.HAUL
MOVAL OF D OBSTRUCTIONS
23 8100.00 c.Y 8roL,J@]COMMON BORROW INCL. HAUL 21.oo
24 3070.00 c.Y DITCH EXCAVATION INCL. HAUL I tb.@ $ .adl .t20,l
DRAINAGE & STORM SEWER
25 80.00 L"F ST. RIB REINF POLYETHYLENE CULV. PIPE 36 IN. DIAM ?,4D.h Ia{@.4
Item No.Flan
Quantitv Unit Item Description Unit Price Total
Amaunl
26 2.OO EACH GRATE INLET TYPE 1 i tl,,a/o€o
27 40-00 L.F.SOLID WALL PVC STORM SEWER PIPE 12IN. DIAM.c.q-oo i z.tuO.oo
2A 120.00 L.F SOLID WALL PVC STORM SEWER PIPE 18 IN" DIAM.S ?b.ao i A{6.@
29 110.00 L.F DUCTILE IRON SEWER PIPE 6IN- DIAM t b.bdfr
30 3900.00 S.Y MEDIUM COMPOST $ ?.@ $ 21,3€,€0
31 2.OO EACH FLARED END SECTION 36 IN. DIAM $ ?qD,D $ ,.{go.00
32 8.00 c.Y.ROCK FOR EROSION AND SCOUR PROTECTION CLASS A $ *t.@ $ aca.oo
33 1-60 c.Y.COMMERCIAL CONCRETE i t-q@.tu
34 36.90 L.B ST. REINF. BAR | 14.fr s 6q?.@
35 3.00 L.F SAFETY BARS FOR CULVERT PIPE TYPE 2 $ I ^aaa.oo , a.oqo.oo
ASPHALT BST ccP HMA& SEAL COAT
36 1900.00 TON CRUSHED SURFACING BASE COURSE 7h,@ g {?,.loo,a(
37 100.00 TON CRUSHED SURFACING TOP COURSE $ ro"m g 1 o@.a
HMA
38 1720.O0 TON HMA CL. 1/2IN. PG lo tz<^ot ,
39 1.00 CALC ASPHALT COST PRICE ADJUSTMENT s t.@ 6 t.oo
EROSION CONTROL AND ROADSIDE PLANTING
40 27588.00 S.Y SEEDING, FERTILIZING, AND MULCHING $ l.oo s 27.58,g,.6
41 993.00 EACH PSIPE - SHRUBS.,l GAL CONT s ?lts-oo $
"?.?4rlot4275-00 EACH PSIPE - SHRUBS.2 GAL CONT <o.oo 7'I9.or
43 510_00 EACH PSIPE - LIVE POLE CUTTINGS I -oo q-Ifud'.
44 45_00 EACH PSIPE - DECIDUOUS TREES - 2" CAL.$ 2l.qe.d
45 300.00 S.Y TOPSOIL TYPE B $ 2o.oo
46 2316.00 S.Y BARK OR WOOD CHIP MULCH $1A
47 1.00 EST PLANT ESTABLISHMENT - SECOND YEAR $'t0.000.00 $10.000.00
TRAFFIC
48 1775.OO L.F.CEMENT CONC. TRAFFIC CURB AND GUTTER lt '.OO 2,L.bZS,a
49 '1875.00 L.F.PLASTIC LINE $ i-@ g q bTcDr
50 2.OO EACH PLASTIC TRAFFIC ARROW $€q-ep
5'l 240.OO S.F PLASTIC CROSSWALK LINE $ Boo 7?p,@
52 55.00 L.F PLASTIC STOP LINE $ le,@ s qso,oo
53 1.00 L.S.PERMANENT SIGNING S T oapo S r.m,oo
54 5.00 EACH MONUMENT CASE AND COVER i q.qa'eo
55 1025.00 S.Y-CEMENT CONC. SIDEWALK L fr i qq o-rq.oo
56 1.00 EACH CEMENT CONC. CURB RAMP {PARALLEL)$ t,usoa
57 1.00 EACH CEMENT CONC. CURB RAMP {PERPENDICULAR'I $ lia!
58 700.00 S.Y CEMENT CONC. DRIVEWAY ENTRANCE TYPE ,@
5C 1.00 L.S ILLUMINATION SYSTEM $ 6e,ooo@ ; ffi ccD.ef
OTHER ITEMS
60 340.00 c.Y.STRUCTURE EXCAVATION CLASS B 4 ao i t.AA>,W
61 1.00 L.S.ROADWAY SURVEYING i l'ltfr-@ $17we
62 1230.00 L.F CHAIN LINK FENCE TYPE 3 s -2 |^@ $ ?u.'l{a@
63 1670.00 L.F WIRE FENCE TYPE2 $ ro.@ i tb.'7@.w
64 5000.00 S.Y NONWOVEN GEOTEXTILE $ 2.50 ; t2.5@,W
ILITY SCHEDULE
UTILITY SCHEDULE TOTAL
sc
CONTRACT TOTAL (Utilitv + Roadway)$rll37,wr,
ADDENDUM NO. 01
KITTITAS COUNTY TRANSFER STATION
PHASE 1 - ROAD AND UTILITY IMPROVEMENTS
KITTITAS COUNW
ELLENSBURG, WASHINGTON
Date(s) lssued:
March 12,2O2'l
The foltowing sha[[ be incorporated into the Contract Documents for the subject project and shat[ govern
the work taking precedence over previousty issued documents covering the items noted. A[[ conditions not
modified sha[[ remain unchanged.
REVISE INVITATION TO BID
Prebid Virtuat Conference to be March 25,2021at 1 pm PST. Conference attendance is not
required but is encouraged for interested bidders.
Bidders may call join the WebEx Prebid conference using the following information:
Join from the meeting link:
https:/lkittitascounty.webex.com/kittitascounty/j.php?MTID=m4a35d32575b773cB0bbbd9da0
a75ccf8
Join by rneeting number:
Meeting number (access code): 187 040 5150
Meeting password: T3SQmmTedxT
Join by phone:
+1 -408-41 8-9388 United States Toll
Join using Microsoft Lync or Microsoft Skype for Business:
Dial 1 8704051 S0.kittitascounty@lync.webex.com
Please acknowtedge the receipt of the above ADDENDUM issued by Kittitas County, by signature and
recording the date of receipt below. Addendum shall be inctuded in submitted documents at time of
bidding.
* Sr'n'\t\tBidder:
Authorized Signatory:5-1*-ai
ADDENDUM NO. 02
KITTITAS COU NTY TRANSFER STATION
PHASE i - ROAD AND UTILITY IMPROVEMENTS
KITTITAS COUNW
ELLENSBURG, WASHINGTON
Date(s) lssued:
March 24,2021
The foltowing shat[ be incorporated into the Contract Documents for the subject project and shatl govern
the work taking precedence over previously issued documents covering the items noted. A[[ conditions not
modified sha[[ remain unchanged.
REVISE LOCAL AGENCY PROPOSAL BOND FORM
Replace LocaI Agency ProposaI Bond Form with Attachment No. 01
Please acknowledge the receipt of .the above ADDENDUM issued by Kittitas County, by signature and
recording the date of receipt below. Addendum sha[[ be included in submitted documents at time of
bidding.
*,e-\n y\(;\Bidder:
Authorized Signatory:
F Si",i C)v1
Date:b 4q -el
ADDENDUM NO. 03
KITTITAS COU NTY TRANSFER STATION
PHASE 1 - ROAD AND UTILITY IMPROVEMENTS
KITTITAS COUNW
ELLENSBURG, WASHINGTON
Date(s) lssued:
March 25,2021
The fol[owing shal[ be incorporated into the Contract Documents for the subject project and shal[ govern
the work taking precedence over previously issued documents covering the items noted. Al[ conditions not
modified sha[[ remain unchanged.
REVISE INVITATION TO BID
Questions sha[[ be submitted through the QuestCDN.com bidding portal or directly to Patti Stacey
at Patti.Johnson@co.kittitas.wa.us. A[[ questions must be submitted by Tuesday March 30,2021
at 4:00 pm PST. Ouestions raised on this project wilt be answered and provided to a[[ potential
bidders for consideration.
REVISE BID PROPOSAL SCHEDULE OF RATES AND PRICES
Replace Bid Proposal Schedu[e of Rates and Prices with Attachment No. 02.
Adding ltem No.64: NONWOVEN GEOTEXTILE - 5OOO S.V.
PRE-BID MEETING SUMMARY
Attendees, Pre-Bid Meeting Summary, and Questions can be found in Attachment No.03,
Ptease acknowledge the receipt of the above ADDENDUM issued by Kittitas County, by signature and
recording the date of receipt betow. Addendum shal.l be included in submitted documents at time of
bidding.
Bidder:
Authorized Signatory:
LnvrStr C-
5 '-c'i? - rll
ADDENDUM NO. 04
KITTITAS COU NTY TRANSFER STATION
PHASE 1 - ROAD AND UTILITY IMPROVEMENTS
KITTITAS COUNW
ELLENSBURG, WASH INGTON
Date(s) lssued:
March 31,2A21
The fottowing shall. be incorporated into the Contract Documents for the subject project and shatl govern
the work taking precedence over previously issued documents covering the items noted. At[ conditions not
modified shat[ remain unchanged.
REVISE INVITATION TO BID
Response to Questions from Bidders:
Ouestion: For pay item 2O Clear and Grub. there is no reference to what you want done with the
excess spoils that can't be re-used as topsoit. ls the intent to leave the excess on site in a
stockpite, spread-out, or export off site?
The contractor shall haul excess C&G material to a stockpile onsite located within 25O' of
the collector road.
Ouestion: For Pay items 13, 14. 15. Conduit oioe in. Diam.. With City of El.lensburg oversight
will a ticensed etectrician stitl be needed to assemble. bed. and backfitt the conduits if the city is
going to be oroviding and instatting the conductors themsetves.
A Journeyman Lineman tS NOT required to installthe conduit or perform any of the
excavation. A City Light Quolified Worher lS required to be onsite to approve conduit
installation.
A Journeyman Lineman IS required to provide grounding for the concrete vaults if they
aren't manufactured with internal grounding.
A Journeyman Lineman lS required to provide grounding for the fiberglass vault.
StreetlightvauLts and bases do not require grounding, so a Journeyman Lineman and/or
Journeyman Electrician lS NOT required.
Question: Regarding Addendum No. 3. ltem No. 5 (gl (hl (i\ - As these documents woutd not be
executed until Notice of Award has been received, therefore qlpicatly not be required as part of
a Bid Prooosal package, please confirm that you are requesting the "Sample"/blank documents
to be included within the Bid Proposat package.
Item No. 5 (g) (h) (i) are required as samples
Ouestion: ls there a cross section for the road on this project?
On sheet TYPI (5 of 31) of the drawing set there is a Typical Road Section.
Ouestion: Reviewing the contract start date. duration. bore logs and the Groundwater Monitor
data the contractor is having to instatt the utilities when the ground water table is at its highest.
Can the county delay the start of this oroject or add a susuension time to where the utitities can
be insta[ed in the fall/winter when the groundwater is at its lowest point?
While Kittitos County will not dictate the contractor's schedule of activities, the County will
not delay the start of this project or add a suspension time.
Ouestion: The concern was raised about any project with targe amounts of pipe due to material
constraints and price uncertainty.
Kittitas County is committed to award within two weeks of opening bids.
Question: Section 8-2O.4 States: Excavation of Joint Utitity Trench witl be measured as
Structural Excavation CL B or Structural excavation Class B lnctuding hau] by the Cubicyard.
There is no Structural Excavation Ctass B in the Utitity Schedute. How wi[[ the Excavation be
compensated?
See Revise Bid Proposal Schedule of Rates and prices Below.
Question: There is no Pay item for utility vautts. How wilt thev be compensated?
See Revise Bid Proposal Schedule of Rates and prices Below.
REVISE BID PROPOSAL SCHEDULE OF RATES AND PRICES
Reptace Bid ProposaI Schedute of Rate and Prices with Attachment No. O4.
Adding ltems:
NO.16b: VAULT CONC. 6'x12', SPEC Vp612 - 1.OO EACH
NO.16c VAULT CONC. 7'x7', SPEC VP77 - 4.OO EACH
NO.16d: VAULT CONC. 5'x7', SPEC VPSZ- 7.OO EACH
NO.16e: FIBERGLASS VAULT FOR TRANSFORMER - 1.OO EACH
NO.18b: STRUCTURE EXCAVATTON CLASS B- 12,OOO.OO C.y.
Ptease acknowledge the receipt of the above ADDENDUM issued by Kittitas County, by signature and
recording the date of receipt betow. Addendum shatt be inctuded in submitted docupents at time of
bidding.
ilQt e- 4Bidder:
Authori
\r..i
zed Signatory:
3vur,lt
3 -3 "et
P.O, BOX 926
ELLENSBURG, WA 98926
509,925"9747 o FAX 509.962"3031
BELSASCOS3OH
EVIDENCE OF AUTHORITYTO SIGN
Belsaas & Smith Construction, lnc. is a corporation duly organized under the laws of the State of
Washington and the corporation does hereby acknowledge, constitute and appoint Russ Belsaas known
to be President, Brandon Drexler known to be Vice President, Bryan Nelson known to be Secretary and
Treasurer of said corporation in the City of Ellensburg, State of Washington, its true and iawful officers
each in their separate capacity, to sign, execute, seal and acknowledge any and all bid bonds, perforrnance
bonds, bid documents, contract documents obligatory in the nature thereof on behalf of the Corporation
in their business of guaranteeing the performance of bidding contracts, contracts, bid bonds, performance
bonds and related undertakings required in the nature of procuring contracts.
lN WITNESS WHEREOF, the Corporation has caused this instrument to be signed and its corporate seal
to be hereto affixed this 6th day of Januarv 2021.
BELSAAS & SMITH CONSTRUCTION, INC./-c ,4"/--
Russ Belsaas, President
Brandon D r, Vice nt
Nelson, Secretary & Treasurer
State of Washington
County of Kittitas
On this 6th day of Januarv 2021, before me personally appeared Russ Belsaas known to me as President,
Brandon Drexler known to me as Vice President, Bryan Nelson known to me as Secretary and Treasurer,
all of Belsaas & Smith Construction, lnc. and that they as such, being authorized to do so, execute the
foregoing instrument for the purpose therein contained by signing on behalf of the corporation as duly
authorized officers.
lN WITNESS WHEREOF, I hereunto set my hand and official seal as a Notary Public in and for the State of
Washi \rtt
ss.
!
Pamela Bosman, Notary Public
My Commission expires the 5th day of Januarv 2021 rl$€fut
Pusuto
Opttt1t
-05-
--,-lACORD"l---
BELS&SM-OI
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
4116t2021
THIS CERTIFICA TE ts ISSUE D AS A MA TTER OF N FORMA Tro N ON LY AND coN FERS NO RIG HTS UPO N THE CE RTI FICATE HOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTEN D OR ALTER THE COVERAGE AF FORDE D BY THE POLIC!ESBELOW.THIS CERTIFICATE OF INSURANC E DOES NOT CONSTITUTE A CONTRACT BETWEEN THE tssutNG rNs URER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,AND THE CERTIFICATE HOLDER.
IM PORTANT:the certificate holder ts an ADDITIONAL NSU RED,the policy(ies)must have ADDlTIONAL INSURED provisions or be endorsed.If SUBROGA TION rs WAIVED,subiect to the terms and con d itions ol the policy,certaln may requ tre an endorsement.A statement onthiscertificatedoesnotconfertothecertificaleholderlnlieuofsuch
PRODUCER
Terril, Lewis & Wilke lnsurance, lnc.
P.O. Box 1789 248-3515 248-3673
kima, WA 98907 s.Gom
INSURED
Belsaas & Smith Construction, lnc.
P O Box 926
Ellensburg, WA 98926
rNsuRER B : Continental lnsurance Comoanv 35289
INSURER C :
INSURER D :
INSURER E :
INSURER F :
CERTIFICATE MAY MAY
ISTHIS CERTITO THAFY T THE OFPOLICIES EINSURANC BELISTED HAVELOW ISSUEDBEEN THETO NSU DRE ABOVENAMED THEFOR PERPOLICY toDINNOTWTHSTANDANYNGDICATED.REQUIREMENT ORTERM coN DITION ANYOF ORCONTRACT OTHER DOCUME WNT RESPECTTH WHTO Htc THI sBEISSUEDORETHPERTAIN,NSURANCE DEDAFFOR THEBY POLIC DESCRIBEDES ISHEREIN BJECTSU TO ALL TERTHE MS,ANDEXCLUSIONS ONSCONDITI SUCHOF LIMITSPOLtCtES.SHOWN MAY BEENHAVE BYREDUCED DPAI CLAIMS.
TYPE OF INSURANCE POLICY NUMBER UMITS
X
100,000
X
A COMMERCIAL GENERAL LIABILITY
LIMIT
POLICY PRO.
JECT E
OCCURCLAIMS.MADE
Work-Site
PER:
LOC
9t1t2020 91112021
GAP
LIMIT
X
Y
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON-OWNEDAUTOS ONLY
911t2020 9t1t2021
x xUMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS.MADE
DED x RETENToN $ 1
9t1t2020 911t2021
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?(Mandatory ln NH)l
tf
N'A
ls primary
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
I
Kittitas Gounty
205 West Sth Street
Ellensburg, WA 98926
*.""*4/,?"r--e
AUTHORIZED REPRESENTATME
@ 1988-2015 ACORD CORPOMTION. Alt rights reserved.
The AGORD name and logo are registered marks of ACORD
ACORD 25 (2016/03)
r!!!
n
trNA
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
l. WHO lS AN INSURED is amended to include as an lnsured any person or organization whom you are required by
written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily
injury, propefi damage or personal and advertising injury caused in whole or in part by your acts or omissions, or
the acts or omissions of those acting on your behalf:
A. in the performance of your ongoing operations subject to such wriften contract; or
B. in the performance of your work subject to such wriften contract, but only with respect to bodily injury or
property damage included in the products-completed operations hazard, and only if:
1. the written contract requires you to provide the additional insured such coverage; and
2. this coverage part provides such coverage.
ll. But if the written contract requires:
A. additional insured coverage under the 1 1-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10-
01 edition of CG2037; or
B. additional insured coverage with "arising out of" language; or
C. additional insured coverage to the greatest extent permissible by law;
then paragraph l. above is deleted in its entirety and replaced by the following:
WHO lS AN INSUREO is amended to include as an lnsured any person or organization whom you are required by
wriften contract to add as an additional insured on this coverage part, but only with respect to liability for bodily
injury, property damage or personal and advertising injury arising out of your work that is subject to such wriften
contract.
lll. Subject always to the terms and conditions of this policy, including the limits of insurance, the lnsurer will not provide
such additional insured with:
A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
lV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage, or personal and adveftising injury arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or suryeying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other lnsurance is amended to
add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage
part:
CNA75079XX (10-16) Policy No: 4a32'762755
Page I ol2 Endorsement No: s
COIfTINEIilTAL CASUALTf COMPAIIY Effective Date: 09/01/2020
lnsured Name:BELSAAS & SMITH CONSTTIUCTION, INC.
Copyright CNAAII Rights Reserved. lncludes copyrighted material of lnsurance Services Offce, lnc., with its permission.
Blanket Additional lnsured - Owners, Lessees or
Gontractors - with Prod ucts-Com pleted
Operations Coverage Endorsement
GNA PARAMOUNT
CNA CNA PARAMOUNT
Blanket Additional lnsured - Owners, Lessees or
Gontractors - with Prod ucts-Gom pleted
Operations Goverage Endorsement
Primary and Noncontributory lnsurance
With respect to other insurance available to the additional insured under which the additional insured is a named
insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written
contract requires the insurance provided by this policy to be:
1. primary and non-contributing with other insurance available to the additional insured; or
2. primary and to not seek contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional insured.
Vl. Solely wtth respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENEML
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties ln The Event of Occurrence, Offense, Glaim or Suit is amended with the addition of
the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the lnsurer wriften notice of any claim, or any occurrence or offense which may result in a claim;
2. send the lnsurer copies of all legal papers received, and otherwise cooperate with the lnsurer in the investigation,
defense, or settlement of the claim; and
3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or
self-insurer, whose policy or program applies to a loss that the lnsurer covers under this coverage part However,
if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not
apply to insurance on which the additional insured is a named insured.
The lnsurer has no duty to defend or indemnify an additional insured under this endorsement until the lnsurer receives
written notice of a claim from the additional insured.
Vll. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to
add the following definition:
Wriften contract means a written contract or written agreement that requires you to make a person or organization an
additional insured on this coverage part, provided the contract or agreement.
A. is currently in effect or becomes effective during the term of this policy; and
B. was executed prior to:
1. the bodily injury or property damage; or
2. the offense that caused the personaland adveilising injury;
for which the additional insured seeks coverage.
Any coverage granted by this endosement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
CNA75079XX (10-o: 4032762755Page2of2 EndorsementNo: s
Co$ETNEIITAT CASUALTY CoMPAIIY Effective Date: 09/01/2020
lnsured Name:BELSAAS & sMrTH coNsTRUcTroN, rNc.
Copydght CNA All Rights Reserued. lncludes copydghted material of lnsurance Services Offce, lnc., with its permission.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated lnsurers, takes effect
effective date is shown below, andon the eflective date of said Pol at the hour stated in said Policy, unless another
res concurre with said
-
r
CT(A CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART
as follows. lf any other endorsement attached to this policy amends any provision also amended by this endorsement,
then that other endorsement controls with respect to such provision, and the changes made by this endonement with
respect to such provision do not apply.
TABLE OF CONTENTS
1. Additionallnsureds
2. Additional lnsured - Primary And Non-Gontributory To Additional lnsured's lnsurance
3. Bodily lnjury - Expanded Definition
4. Broad Knowledge of Occurrence/ Notice of Occurrence
5. Broad Named lnsured
6. Broadened Liability Goverage For Damage To Your Product And Your Work
7. Contractual Liability - Railroads
8. Electronic Data Liability
9. Estates, Legal Representatives and Spouses
10. Expected Or lntended lnjury - Exception for Reasonable Force
11. GeneralAggregate Limits of lnsurance - Per Project
12. ln Rem Actions
,l3. lncidental Health Gare Malpractice Coverage
I 4. J oint Ventu reslPartne rsh i p/Limited Liabil ity Gompanies
15. Legal Liability - Damage To Premises / Alienated Premises / Property ln The Named lnsured's Care,
Custody or Gontrol
16. Liquor Liability
17. MedicalPayments
18. Non-owned Aircraft Coverage
19. Non-owned Watercraft
20. Personal And Advertising lnjury - Discrimination or Humiliation
21. Personal And Advertising lnjury - Gontractuat Liability
22. Property Damage - Elevators
23. Supplementary Payments
24. Unintentional Failure To Disclose Hazards
25. Waiver of Subrogation - Blanket
26. Wrap-Up Extension: OCIP CCIP, or Consolidated (Wrap-Up| lnsurance Programs
qNA74705XX (1-i5) poticy No: 4032762788
Page 1 of 17 Endorsement No: 3
COMTINENTAI, cAsUAiJTy COMPANY Etfective Date: OgtOlt2O2O
lnsured Name. BELSAAS 6. sMrTIi coNsrR.ucTroN, rNc.
CopyrightCNAAll RightsReserved. lncludescopyightedmaterial oflnsuranceServicesOffce, lnc.,withitspermission.
CT(A CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
1. ADDITIONAL INSUREDS
a. WHO lS AN INSURED is amended to include as an lnsured any person or organization described in paragraphs
A. through H. below whom a Named lnsured is required to add as an additional insured on this Coverage Part
under a written contract or written agreement, provided such contract or agreement:
({} is currently in effect or becomes effective during the term of this Coverage Part; and
(2f was executed prior to:
(a) the bodily injury or property damage; or
(bf the offense that caused the personaland advertising injury,
for which such additional insured seeks coverage.
b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the lnsurer
will not provide such additional insured with:
{1} a higher limit of insurance than required by such contract or agreement; or
(2) coverage broader than required by such contract or agreement, and in no event broader than that described
by the applicable paragraph A. through H. below.
Any coverage granted by this endorsement shall apply only to the extent permissible by law.
A. Controlling lnterest
Any person or organization with a controlling interest in a Named lnsured, but only with respect to such person or
organization's liability for bodily injury, property damage or personal and advertising injury arising out of:
L such person or organization's financial control of a Named lnsured; or
2. premises such person or organization owns, maintains or controls while a Named lnsured leases or
occupies such premises;
provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or
demolition operations performed by, on behalf of, orfor such additional insured,
B. Go-owner of lnsured Premises
A co-owner of a premises co-owned by a Named lnsured and covered under this insurance but only with respect
to such co{wner's liability for bodily injury, property damage or personal and advertising injury as co-owner
of such premises.
C. Lessor of Equipment
Any person or organization from whom a Named lnsured leases equipment, but only with respectto liability for
bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named
lnsured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such
bodily injury, propefi damage or the offense giving rise to such personal and advertising injury takes place
prior to the termination of such lease.
D. Lessor of Land
Any person or organaation from whom a Named lnsured leases land but only with respect to liability for bodily
injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use
of such land, provided that the occurrence giving rise to such bodily injury, propedy damage or the offense
giving rise to such personal and advertising injury takes place prior to the termination of such lease. The
CNA74705XX (1-15) Poticy No: 4032i 627ss
Page 2 of 17 Endorsement No: 3
COMTINE}ITAL CASUAI,TY COMPANY - EffECtiVE DAIC: O9IO1I2O2O
Insured Name:BEI,SAAS & SMITH coNsTR.UcTIoN, INc.
CopyrightCNAAll RightsReserved. lncludescopyightedmaterial oflnsuranceSeruicesOfice, lnc.,withitspermissim.
r
n
CNA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by, on behalf of, or for such additional insured.
E. Lessor of Premises
An owner or lessor of premises leased to the Named lnsured, or such owner or lessols real estate manager, but
only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of
the ownership, maintenance or use of such part of the premises leased to the Named lnsured, and provided that
the occurrence giving rise to such bodily injury or ptoperty damage, or the offense giving rise to such personal
and advertising injury, takes place prior to the termination of such lease. The coverage granted by this
paragraph does not apply to structural alterations, new construction or demolition operations performed by, on
behalf of, or for such additional insured.
F. Moftgagee, Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's
liability for bodily injury, property damage or personal and advertising injury arising out of the Named
Insured's ownership, maintenance, or use of a premises by a Named Insured.
The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by, on behalf of, or for such additional insured.
G. State or GovernmentalAgency or Subdivision or Political Subdivisions - Permits
A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but
only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily
injury, property damage or personal and advertising injury arising out of:
1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which
this insurance applies:
a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings,
canopies, cellar entrances, mal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults, street banners, or decorations and similar exposures; or
b. the construction, erection, or removal of elevators; or
c. the ownership, maintenance or use of any elevators covered by this insurance; or
2. the permitted or authorized operations performed by a Named lnsured or on a Named lnsured's behalf.
The coverage granted by this paragraph does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of operations performed
for the state or governmental agency or subdivision or political subdivision; or
b. Bodily injury or properly damage included within the products-completed operations hazard.
With respect to this provision's requirement that additional insured status must be requested under a written
contract or agreement, the lnsurer will treat as a written contract any governmental permit that requires the
Named lnsured to add the governmental entity as an additional insured.
H. Trade Show Event Lessor
1. With respect to a Named lnsured's participation in a trade show event as an exhibitor, presenter or displayer,
any person or organization whom the Named lnsured is required to include as an additional insured, but only
with respect to such person or organization's liability for bodily injury, property damage or personal and
advertising injury caused by:
CNA74705XX (1-15) Policy No: 4032'162755
Page 3 of 17 Endorsement No: 3
CONTINENTAL CASUAIJTT COMPAITY Effective Date: O9IO1I2Q2O
INSUTCd NAME:BEIJSAAS & SMITH CONSTIIUCTION, INC.
Copytight CNA All Rights Reserved. lncludes copyighted material of lnsurance Services Ofrce, lnc., with its permission.
CT(A CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
a. the Named lnsured's acts or omissions; or
b. the acts or omissions of those acting on the Named lnsured's behalf,
in the performance of the Named lnsured's ongoing operations at the trade show event premises during the
trade show event.
2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within
the products-completed operations hazard.
2. ADDITIONAL INSURED - PRIMARY AND NON-GONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE
The Other lnsurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to
add the following paragraph:
lf the Named lnsured has agreed in writing in a contract or agreement that this insurance is primary and non-
contributory relative to an additional insured's own insurance, then this insurance is primary, and the lnsurer will not
seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own
insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding
. anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess
of any other insurance available to such person or organization.
3. BODILY INJURY- EXPAT.IDED DEFINITION
Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following:
Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock,
mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical
injury, sickness or disease.
4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE
Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended
to add the following provisions:
A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the lnsurer or the lnsureds authorized representative notice of an occurrence,
offense or claim only when the occurrence, offense or claim is known to a natural person Named lnsured, to a
partner, executive officer, manager or member of a Named Insured, or an employee designated by any of the
above to give such notice.
B. NOTICE OF OCCURRENCE
The Named lnsured's rights under this Goverage Part will not be prejudiced if the Named lnsured fails to give
the lnsurer notice of an occurrence, offense or claim and that failure is solely due to the Named lnsured's
reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However,
the Named lnsured shall give written notice of such occurrence, offense or claim to the lnsurer as soon as the
Named lnsured is aware that this insurance may apply to such occurrence, offense or claim.
5. BROAD NAMED INSURED
WHO lS AN INSURED is amended to delete its Paragraph 3. in its entirety and replace it with the following:
3. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named lnsured has
management control:
a. on the effective date of this Coverage Part;or
CNA74705XX (1-15) Policy No:
Page 4 of 17 Endorsement No:
COITTINENTAI CASUAI,TY CoMPA}TY Effective Date:
lnsured Name:BELSAAS s, SMITH CONSTRUCTION, INC.
CopyightCNAAll RightsReserved. lncludescopyightedmaterialoflnsuranceServicesOffice, lnc.,withitspermission.
4032',762755
3
09t01t2020
n
:
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
b. by reason of a Named lnsured creating or acquiring the organization during the policy period,
qualifies as a Named lnsured, provided that there is no other similar liability insurance, whether primary,
contributory, excess, contingent or othenivise, which provides coverage to such organization, or which would have
provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or
narrower than that provided by this insurance.
But this BROAD NAMED INSURED provision does not apply to:
(a) any partnership, limited liability company or joint venture; or
(b| any organization for which coverage is excluded by another endorsement attached to this Goverage Part.
For the pupose of this provision, management control means:
A. cnrvning interests representing more than 5070 of the voting, appointment or designation power for the
selection of a majority of the Board of Directors of a corporation; or
B. having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer or
sell property held by a trust.
4. With respect to organizations which qualiff as Named lnsureds by virtue of Paragraph 3. above, this insurance
does not apply to:
a. bodi$ injury or property damage that first occurred prior to the date of management control, or that flrst
occurs after management control ceases; nor
b. personal or advertising injury caused by an offense that flrst occurred prior to the date of management
control or that first occurs after management control ceases.
5. The insurance provided by this Goverage Part applies to Named lnsureds when trading under their own names
or under such other trading names or doing-business-as names (dba) as any Named lnsured should choose to
employ.
6. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCTANDYOURWORK
A. Under COVERAGES, Coverage A - Bodily Injury and Property Damage Liabitity, the paragraph entitled
Exclusions is amended to delete exclusions k. and l. and replace them with the following:
This insurance does not apply to:
k. Damage to Your Product
Property damage to your product arising out of it, or any part of it except when caused by or resulting from:
{1} fire;
(2! smoke;
(3) collapse;or
(4f explosion.
l. 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.
This exclusion does not apply:
(1) lf the damaged wor( or the work out of which the damage arises, was performed on the Named
lnsured's behalf by a subcontractor; or
CNA74705XX (1-15) Policy No: 4a32i 6278s
Page 5 of 17 Endorsement No: 3
CONTTNENTAL CASUALTY COMPANY Effective Date: OgtOltZO2O
lnsured Name: BEtsAAs & sMrrl{ coNsrI?ucrroN, rNc.
Copyight CNA All Rights Reserved. lncludes copyighted material of lnsurance Seryices Ofice, lnc., with its permission.
CNA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
(2) lf the cause of loss to the damaged work arises as a result of:
(al fire;
(b) smoke,
(c) collapse; or
(d) explosion.
B. The following paragraph is added to LIMITS OF INSURANCE:
Subject to 5. above, $100,000 is the most the lnsurer will pay under Goverage A for the sum of damages arising
out of any one occurtence because of property damage to your product and your work that is caused by fire,
smoke, collapse or explosion and is included within the product+ompleted operations hazard This sublimit
does not apply to property damage to your work if the damaged work, or the work out of which the damage
arises, was performed on the Named lnsured's behalf by a subcontractor.
C. This Broadened Liability Goverage For Damage To Your Product And Your Work Provision does not apply if
an endorsement of the same name is attached to this policy.
7. CONTRACTUAL LIABILITY. RAILROADS
With respect to operations performed within 50 feet of railroad property, the definition of insured contract is replaced
by the following:
lnsured Contract means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies
any person or organization for damage by fire to premises while rented to a Named lnsured or temporarily
occupied by a Named lnsured with permission of the owner is not an insured contract;
b. A sidetrack agreement;
c, Any easement or license agreement;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a
municipality;
e. An elevator maintenance agreement;
t. That part of any other contract or agreement pertaining to the Named lnsured's business (including an
indemnification of a municipality in connection with work performed for a municipality) under which the Named
Insured assumes 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 an architect, engineer or surveyor for injury or damage arising out of:
(a| Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
(b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or
damage;
(2) Under which the lnsured, if an architect, engineer or surveyor, assumes liability for an injury or damage
arising out of the insured's rendering or failure to render professional services, including those listed in {1}
above and supervisory, inspection, architectural or engineering activities.
8, ELECTRONIC DATA LIABILITY
CNA74705XX (1-15) Policy No: 4e32'r627ss
Page 6 of 17 Endorsement No: 3
colfirINENTAI CASUAIJTV CoMPANY Effective Date: 09/01/2020
lnsured Name: BELSAAS & sMrTH coNsTRUcTroN, rNc.
Copyight CNAAII Rights Reserued. lncludes copyighted material of lnsurance Services Office, lnc., with its permission.
n
n
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
A. Under COVERAGES, Coverage A - Bodily Injury and Property Damage Liabili$, the paragraph entitled
Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following:
This insurance does not apply to:
p. Access Or Disclosure Of Confidential Or Personal lnformation And Data-related Liability
Damages arising out of:
(1) any access to or disclosure of any person's or organization's confidential or personal information,
including patents, trade secrets, processing methods, customer lists, flnancial information, credit card
information, health information or any othertype of nonpublic information; or
(2f the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate
electronic data that does not result from physical injury to tangible property.
However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of bodily
injury.
This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses,
forensic expenses, public relation expenses or any other loss, cost or expense incurred by the Named
lnsured or others arising out of that which is described in Paragraph (1| or (2) above.
B. The following paragraph is added to LIMITS OF INSUMNCE:
Subject to 5. above, $100,000 is the most the lnsurer will pay under Coverage A for all damages arising out of
any one occurlence because of property damage that results from physical injury to tangible property and
arises out of electronic data.
C. The following definition is added to DEFINITIONS:
Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or
from computer sofiware (including systems and applications software), hard or floppy disK, CD-ROMS, tapes,
drives, cells, data processing devices or any other media which are used with electronically controlled equipment.
D. For the purpose of the coverage provided by this ELECTRONIC DATA LIABILITY Provision, the definition of
propefty damage in DEFINITIONS is replaced by the following:
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;
b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at
the time of the occurrence that caused it; or
c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate
electronic data, resulting from physical injury to tangible property. All such loss of electronic data shall be
deemed to occur at the time of the occurrence that caused it.
For the purposes of this insurance, eleckonic data is not tangible property.
E. lf Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the
$100,000 limit provided bythis ELECTRONIC DATA LIABILITY Provision is part of, and not in addition to, that
higher limit.
9. ESTATES, LEGAL REPRESENTATTVES,ANDSPOUSES
The estates, heirs, legal representatives and spouses of any natural person lnsured shall also be insured under this
policy; provided, however, coverage is afforded to such estates, heirs, legal representatives, and spouses only for
CNA74705XX (1-1 5) Policy No: 40327 62"1ss
PageT of 17 Endorsement No: 3
COMTINENTA! CASUAIJTT COMPANY Effective Date: 09t01t2020
lnsured Name:BEtsAAs & sMrrH coNsrR.ucrroN, rNc.
Copyight CNA All Rights Reserved. lncludes copyighted material of lnsurance Services Offce, lnc., with its permissior.
CNA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks
damages from marital community property, jointly held property or property transferred from such natural person
lnsured to such spouse. No coverage is provided for any act, enor or omission of an estate, heir, legal
representative, or spouse outside the scope of such person's capacity or status as such, provided however that the
spouse of a natural person Named lnsured and the spouses of members or partners of jointventure or partnership
Named lnsureds are lnsureds with respect to such spouses' acts, errors or omissions inthe conduct of the Nameil
lnsured's business,
10. EXPECTED OR INTENDED INJURY- EXCEPTION FOR REASONABLE FORGE
Under GOVERAGES, Coverage A - Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entitled Expected or lntended lnjury and replace it with the following:
This insurance does not apply to:
Expected or lntended lnjury
Bodily injury or propefty damage expected or intended from the standpoint of the Insured. This exclusion does not
apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property.
11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT
A. For each construction project away from premises the Named lnsured owns or rents, a separate Construction
Project GeneralAggregate Limit, equalto the amount of the GeneralAggregate Limit shown in the Declarations,
is the most the lnsurer will pay for the sum of:
1. Alldamages under Coverage A, except damages because of bodily injury or property damage included in
the prod ucts-completed ope rations hazard ; an d
2. All medical expenses under Coverage G,
that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction
project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the
Construction Project General Aggregate Limit of any other construction prolect.
B, AII:
1. Damages under Coverage B, regardless of the number of locations or construction prolects involved;
2. Damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing
operations at a single construction project, except damages because of bodily injury or property damage
included in the products-completed operations hazard; and
3. Medical expenses under Coverage G caused by accidents which cannot be attributed solely to ongoing
operations at a single construction project,
will reduce the General Aggregate Limit shcxrun in the Declarations.
C. The limits shown in the Declarations for Each Occunence, for Damage To Premises Rented To You and for
Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit
or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be
attributed solely to ongoing operations at a particular construction project.
D' When coverage for liability arising out of the products-completed operations hazard is provided, any payments
for damages because of bodily injury or propefi damage included in the products-completed operations
hazard will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations, regardless of
the number of projects involved.
CNA74705XX (1-15) Policy No: 40327627ss
Page B of 17 Endorsement No: 3
colflrINEI\rTAl CASUALTY coMPAl{Y Effective Date: 09/01/2020
INSUTEd NAME:BEI,SAAS 6. SMITH CONSTR,UCTION, INC,
Copyight CNA All Rights Reserued. lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
T
:
CNA GNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
E. lf a single construction project away from premises owned by or rented to the lnsured has been abandoned and
then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or
timetables, the project will still be deemed to be the same construction project.
F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as
stipulated.
12. IN REM ACTIONS
A quasi in rem action against any vessel owned or operated by or forthe Named lnsured, or chartered by or for the
Named lnsured, will be treated in the same manner as though the action were in peronam against the Named
lnsured.
13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE
Solely with respect to bodily injury that arises out of a health care incident:
A. Under GOVERAGES, Coverage A - Bodily lnjury and Property Damage Liability, the paragraph entitled
lnsuring Agreement is amended to replace Paragraphs 1.b.{{l and 1.b.(2f with the following:
b. This insurance applies to bodily injury provided that the professional health care services are incidental to
the Named lnsured's primary business purpose, and only if:
(1) such bodily injury is caused by an occurrence that takes place in the coverage territory.
(2f the bodily injury first occurs during the policy period. All bodily injury arising from an occurrence will
be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence;
and
B. Under GOVERAGES, Goverage A - Bodily lnjury and Property Damage Liability, the paragraph entitled
Exclusions is amended to:
i. add the following to the Employers Liability exclusion:
This exclusion applies only if the bodily injury arising from a health care incident is covered by other
liability insurance available to the lnsured (or which would have been available but for exhaustion of its
limits).
ii. delete the exclusion entitled Contractual Liability and replace it with the following:
This insurance does not apply to;
Conbactual Liability
the lnsured's actual or alleged liability under any oral or written contract or agreement, including but not
limited to express warranties or guarantees.
iii. add the following additionalexclusions:
This insurance does not apply to:
Discrimination
any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on
an individual's race, creed, color, age, gendeq national origin, religion, disability, marital status or sexual
orientation.
Dishonesty or Crime
Any actual or alleged dishonest, criminal or malicious act, error or omission.
MedicarelMedicaid Fraud
CNA74705XX (1-15) Policy No: 4a3276zi\E
Page 9 of 17 Endorsement No: 3
COIi:TINENTAL CASUALTY COMPANY Effective Date'. 0910112020
INSured NAme:BEI,SAAS & SMITIT CONSTR,UCTION, INC.
Copyight CNA All Rights Reserved. lncludes copyighted matedal of lnsurance Services ffice, lnc., wilh its permission.
CT(A CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
any actual or alleged violation of law with respect to Medicare, Medicaid, Tricare or any similar federal, state
or local governmental program.
Services Excluded by Endorsement
Any health care incident for which coverage is excluded by endorsement.
C. DEFINITIONS is amended to:
i. add the following definitions:
Health care incident means an act, error or omission by the Named lnsured's employees or volunteer
workers in the rendering of:
a. professional health care services on behalf of the Named lnsured or
b. Good Samaritan services rendered in an emergency and for which no payment is demanded or received.
Professional health care services means any health care services or the related furnishing of food,
beverages, medical supplies or appliances by the following providers in their capacity as such but solely to
the extent they are duly licensed as required:
a. Physician;
b. Nurse;
c. Nurse practitioner,
d. Emergency medical technician;
e. Paramedic;
f. Dentist;
g. Physical therapist;
h. Psychologist;
i. Speech therapist;
j. Other allied health professional; or
Professional health care services does not include any services rendered in connection with human clinical
trials or product testing.
ii. delete the definition of occurrence and replace it with the following:
Occurrence means a health care incident. All acts, enors or omissions that are logically connected by any
common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a
single occurrence;
iii. amend the definition of lnsured to:
a. add the following:
the Named lnstred's employees are lnsureds with respect to:
{1} bodily injury to a co-employee while in the course of the co-employee's employment by the
Named lnsured or while performing duties related to the conduct of the Named lnsured's
business; and
CNA74705XX (1-15) Poticy No:
Page 10 of 17 Endorsement No:
COMTINENTAT CASUAI,W COMPANY Effective Date:
lnsured Name:BELSAAS & sMrrlt coNsrRucrroN, rNc.
Copyight CNA All Rights Reserved. lncludes copyrighted material of lnsurance Services Office, lnc., with its permissiur
4432762755
3
09t01t2020
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CNA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
(2) bodily injury to a volunteer worker while performing duties related to the conduct of the
Named lnsured's business;
when such bodily injury arises out of a health care incident.
the Named lnsured's volunteer workers are lnsureds with respect to:
({} bodily injury to a co-volunteer worker while performing duties related to the conduct of the
Named lnsured's business; and
(2) bodily iniury to an employee while in the course of the employee's employment by the Named
lnsured orwhile performing duties related to the conduct of the Named lnsured's birsiness;
when such bodily injury arises out of a health care incident.
b' delete Subparagraphs (al, (b), (c| and (df of Paragraph 2.a.(1| of WHO lS AN INSURED.
D' The Other lnsurance condition is amended to delete Paragraph b.(lf in its entirety and replace it with the
following:
Other lnsurance
b. Excess lnsurance
(1) To the extent this insurance applies, it is excess over any other insurance, self insurance or risk transfer
instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased
specifically by the Named Insured to be excess of this coverage.
14. JOINT VENTURES / PARTNERSHIP/ LIMITED LIABILITY COMPANIES
WHO lS AN INSURED is amended to delete its last paragraph and replace it with the following:
llo.P"ligf or organization is an lnsured with respect to the conduct of any current or past partnership, joint venture or
limited liability company that is not shown as a Named lnsured in the Dei;larations, excepi that if thd Named lnsured
was a joint venturer, partner, or member of a limited liability company and such joint venture, partnership or limited
liability company terminated prior to or during the policy period, such Named Iniured is an lniured w1h respect to
its interest in such joint venture, partnership or limited liability company but only to the extent that
a. any offense giving rise to personal and advertising injury occurred prior to such termination date, and the
personal and advertising injury arising out of such offense first occuned after such termination date;
b. the bodily injury or propefi damage first occurred after such termination date; and
c. there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or
limited liability company; and
lf the joint venture, partnership or limited liability company is or was insured under a consolidated (wrap-up)
insurance program, then such insurance will always be considered valid and collectible for the purpose of paragraph
c. above. But this provision will not serve to exclude bodily injury, property damage or personal and advertising
injurythat would othenruise be covered underthe Contractors General Liability Extension Endorsement provision
entitled WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSUMNCE nROGRAMS.
Please see that provision for the definition of consolidated {wrap-up} insurance program.
15. LEGAL LIABILITY _ DAMAGE TO PREMISES / ALIENATED PREMTSES / PROPERTY IN THE NAMED
INSURED'S CARE, CUSTODY OR CONTROL
A. Under COVERAGES, Coverage A - Bodily lnjury and Property Damage Liability, the paragraph entifled
Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following:
This insurance does not apply to:
cNA7470sXX (1-15)
Page1lof17
Policy No: 4032762788
Endorsement No: 3
COMTINENTAIJ CASUALT]T COMPANY Effective Date: OgtOlt2OZO
INsured Name: BEIJSAAS & SMITH CONSTR,UCTIoN, INc.
Copyight CNAAII Rights Reserved. lncludes copyighted material of lnsurance Services ffice, lnc., with its permission.
CT(A CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
j. Damage to Property
Propefty damage to:
(1) Property the Named lnsured owns, rents, or occupies, including any costs or expenses incurred by you,
or any other person, organization or entity, for repair, replacement, enhancement, restoration or
maintenance of such property for any reason, including prevention of injury to a person or damage to
anothe/s property;
(2| Premises the Named lnsured sells, gives away or abandons, if the propefi damage arises out of any
part of those premises;
(3) Property loaned to the Named Insured;
(4f Personal property in the care, custody or control of the lnsured;
{5} That particular part of real property on which the Named lnsured or any contractors or subcontractors
working directly or indirectly on the Named lnsured's behalf are performing operations, if the property
damage arises out of those operations; or
(6) That particular part of any property that must be restored, repaired or replaced because your work was
incorrectly performed on it.
Paragraphs (11, {3) and (4} of this exclusion do not apply to property damage (other than damage by fire) to
premises rented to the Named lnsured or temporarily occupied by the Named lnsured with the permission of
the owner, nor to the contents of premises rented to the Named lnsured for a period of 7 or fewer
consecutive days. A separate limit of insurance applies to Damage To Premises. Rented To You as described
in LIMITS OF INSURANCE.
Paragraph (2) of this exclusion does not apply if the premises are your work.
Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack
agreement.
Paragraph (6| of this exclusion does not apply to property damage included in the products-completed
operations hazard.
Paragraphs (3) and (4) of this exclusion do not apply to property damage to:
i. tools, or equipment the Named lnsured borrovus from othen, nor
ii. other personal property of others in the Named lnsured's care, custody or control while being used in the
Named lnsured's operations away from any Named lnsured's premises.
However, the coverage gnanted by this exception to Paragraphs (3) and {4} does not apply to:
a. property at a job site awaiting or during such property's installation, fabrication, or ereotion;
b. property that is mobile equipment leased by an lnsured;
c. property that is an auto, aircraft or watercraft;
d. property in transit; or
e. any portion of property damage for which the lnsured has available other valid and collectible
insurance, or would have such insurance but for exhaustion of its limits, or but for application of one of its
exclusions.
A separate limit of insurance and deductible apply to such property of others. See LIMITS OF INSURANCE
as amended below.
CNA74705XX (1-15) Poticy No: 4a32l62jss
Page 12ot 17 Endorsement No: 3
colflrINElITAI CASUAITTy COMPAIIY Effective Date: O9tO1t2e2O
lnsured Name;BELSAAS & SMITI{ CoNSTRUCTION, INC.
Cop),right CNAAII Rights Reserved. lncludes copydghted material of lnsurance Services Offce, lnc., Mth its permission.
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CXA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
B. Under COVEMGES, Goverage A - Bodily lnjury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete its last paragraph and replace it with the foliowing:
Exclusions c. through n. do not apply to damage by fire to premises while rented to a Named lnsured or
temporarily occupied by a Named lnsured with permission of the owner, nor to damage to the contents of
premises rented to a Named Insured for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE.
G. The following paragraph is added to LIMITS OF INSUMNCE:
Subject to 5. above, $25,000 is the most the lnsurer will pay under Goverage A for damages arising out of any
one occurrence because of the sum of all property damage to borrowed tools or equipment, and to other
personal property of others in the Named lnsured's care, custody or control, while being used in the Named
lnsured's operations away from any Named lnsured's premises. The lnsure/s obligation to pay such property
damage does not apply until the amount of such property damage exceeds $1,000. The lnsurer has the right but
not the duty to pay any portion of this $1 ,000 in order to effect settlement. lf the lnsurer exercises that right, the
Named lnsured will promptly reimburse the lnsurer for any such amount.
D. Paragraph 6., Damage To Premises Rented To You Limit, of LIMITS OF INSURANCE is deleted and replaced by
the following:
6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit
is the most the lnsurer will pay under Coverage A for damages because of property damage to any one
premises while rented to the Named lnsured or temporarily occupied by the Named Insured with the
permission of the owner, including contents of such premises rented tothe Named lnsured fora period of 7
or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of:
a. $500,000; or
b. The Damage To Premises Rented To You Limit shown in the Declarations.
E. Paragraph 4.b.({}{af(ii} of the Other lnsurance Condition is deleted and replaced by the following:
(ii) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by
the Named lnsured with the permission of the owner; or for personal property of others in the Named
lnsuredis care, custody or control;
16. LIQUOR LIABILITY
Under COVERAGES, Coverage A - Bodily lnjury and Property Damage Liability, the paragraph entifled
Exclusions is amended to delete the exclusion entitled Liquor Liabitity.
This LIQUOR LIABILITY provision does not apply to any person or organization who othenruise qualifies as an
additional insured on this Goverage Part.
17. MEDICAL PAYMENTS
A. LIMITS OF INSUMNCE is amended to delete Paragraph 7. (the Medical Expense Limit) and replace it with the
following:
7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most the
lnsurer will pay under Coverage C - Medical Payments for all medical expenses because of bodily injury
sustained by any one person. The Medical Expense Limit is the greater of:
(1) $15,000 unless a different amount is shown here: $N,NNN,NNN,NNN; or
(2| the amount shown in the Declarations for Medical Expense Limit.
CNA74705XX (1-15) poticy No: 4012762785
Page 1 3 ol 17 Endorsement No: 3
CO}TTINENTAIJ CASUAIJTY COMPANY Effective Date: 09/01/2020
Insured Name:BEI,SAAS & SMITH coNSTT?,UcTIoN, INc.
copyightC-ltlAAll RightsReserved. lncludescopyightedmaterial oflnsunnceServicesOffce, lnc.,withitspermission.
CNA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
B. Under COVERAGES, the lnsuring Agreement of Coverage C - Medical Payments is amended to replace
Paragraph 1.a.{3}(b) with the following:
(b) The expenses are incurred and reported to the lnsurerwithin three years of the date of the accident; and
,l8. NONOWNEDAIRCRAFT
Under COVERAGES, Coverage A - Bodily Injury and Prope*y Damage Liability, the paragraph entitled
Exclusions is amended as follows:
The exclusion entitled Aircraft Auto or Watercraft is amended to add the following:
This exclusion does not apply to an aircraft not owned by any Named lnsured, provided that:
1. the pilot in command holds a cunently effective certificate issued by the duly constituted authority of the United
States of America or Canada, designating that person as a commercial or airline transport pilot;
2. the aircraft is rented with a trained, paid crew to the Named Insured; and
3. the aircraft is not being used to carry persons or property for a charge.
19. NONOWNED WATERCRAFT
Under COVERAGES, Coverage A - Bodily lnjury and Propefty Damage Liability, the paragraph entitled
Exclusions is amended to delete subparagraph (2) of the exclusion entitled Aircraft, Auto or Watercraft, and
replace it with the following.
This exclusion does not apply to:
(2f a watercraft that is not owned by any Named lnsured, provided the watercraft is:
(a) lessthan 75 feet long; and
(b) not being used to carry persons or property for a charge.
20. PERSONAL AND ADVERTISING INJURY -DISCRIMINATION OR HUMILIATION
A. Under DEFINITIONS, the definition of personal and advertising injury is amended to add the following tort:
Discrimination or humiliation that results in injury to the feelings or reputation of a natural person.
B. Under GOVERAGES, Coverage B - Personal and Advertising lnjury Liability, the paragraph entitled
Exclusions is amended to:
1, delete the Exclusion entitled Knowing Violation Of Rights Of Another and replace it with the following:
This insurance does not apply to:
Knowing Violation of Rights of Another
Personal and advertising injury caused by or at the direction of the lnsured with the knowledge that the act
would violate the rights of another and would inflict personal and advertising injury. This exclusion shall not
apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but
only if such discrimination or humiliation is not done intentionally by or at the direction of:
(a) the Named lnsured;or
(b! any executive officer, director, stockholder, partner, member or manager (if the Named lnsured is a
limited liability company) of the Named lnsured.
2. add the following exclusions:
CNA74705XX (1-15) Policy No: 4032762755
Page 14of17 EndorsementNo: 3
CONTINEDTTAIJ CASUAIJTY COMPA}IY Effective Date: 09/01/2020
lnsured Name: BEIJSAAS & sMrrH coNsrRucrroN, rNc.
Cop!,tight CNA All Rigftts Reserved. lncludes copyighted material of lnsurance Services Ofice, lnc., with its permission.
r
E
n
CT(A CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
This insurance does not apply to:
Employment Related Disc rimination
Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past
employment or termination of employment of any person by any lnsrirei.
Premises Related Disc rimination
discrimination or humiliation arising out of the sale, rental, lease or sub-lease or prospective sale, rental,
lease or sub-lease of any room, dwelling or premises by or at the direction of any lnsured.
Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity
beca use of discrimination.
'The coverage provided by this PERSoNAL AND ADVERT|S|NG tNJURy -DtscRtMtNATtoN oR HUMtLtATtoN
Provision does not apply to any person or organization whose status as an lnsured derives solely from
Provision 1. ADD|flONAL INSURED of this endorsement; or
attachment of an additional insured endorsement to this Coverage Part.
This PERSONAL AND ADVERTISING INJURY -DISGRIMINATION OR HUMILIATION Provision does not appty to
any person or organization who othenruise qualifies as an additional insured on this Coverage pail.
21. PERSONAL ANDADVERTISING INJURY - GONTRACTUAL LIABTLITY
A. Under COVERAGES, .Covegage B -Personal and Advertising lnjury Liability, the paragraph entiiled' Exclusions is amended to delete the exclusion entitled Contractuall-iaUilitir.
B. Qo-t9!1fgr lhe purpose of the coverage provided by this PERSONAL AND ADVERT|S|NG tNJURy -CONTRACTU4L LIABILITY provision, the following changes are made to the section entiled
SUPPLEMENTARY PAYMENTS - COVERAGES AAND B:
1. Paragraph 2.d. is replaced by the following:
d. The allegations in the suit and the information the lnsurer knows about the offense alleged in such suit
are such that no conflict appears to exist between the interests of the Insured and thJinterests of the
indemnitee;
2- The first unnumbered paragraph beneath Paragraph 2.f.(2[b) is deleted and replaced by the following:
So long as the above conditions are met, attorneys fees incurred by the lnsurer in the defense of that
indemnitee, necessary litigation expenses incurred by the lnsurer, and necessary litigation expenses incurred
by the indemnitee at the lnsurer's requestwill be paid as defense costs. Such fuyments will'not be deemed
to be damages for personal and advertising injury and will not reduce the limiis irf insurance.
C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not appty ifCoverage B -Personal and Advertising lnjury Liability is excluded by another endorsement attached io inis
Coverage Part.
This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not appty to any
person or organization who othenruise qualifies as an additional insured on this Coverage Paft.
22, PROPERTY DAMAGE _ ELEVATORS
A. Under COVERAGES., Coverage A -_Bodily lnjury and Property Damage Liabitity, the paragraph entifledExclusions is amended such that the Damage to Your Produci Exblusion anO sunparilrapnd 1r;,-11jand (6f of
the Damage to Property Exclusion do not apply to property damage that results from the ube oi ejevators '
oNA74705XX (1-15)
Page 15 of 17
Policy No: 4032762788
Endorsement No: 3
COI\ITINENTAIJ CASUAIJTY COMPANY Effective Date: 09/01/2020
lnsured Name:BEIJSAAS & sMrrH coNsrR.ucrroN, rNc.
Copyight CNA All Rights Reserved. lncludes copyighted material of lnsurance Selices Ofice, lnc., r^iilh its permission.
CNA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE - ELEVATORS Provision, the
Other lnsurance conditions is amended to add the following paragrapn:
This insurance is excess over any of the other insurance, whether primary, ex6€ss, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevatois.
23. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is amended as foilows:
A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
limit;and
B' lgl.pluPn I'd' is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a
$1,000. limit.
24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
lf the Named lnsured unintentionally fails to disclose all existing hazards at the inception date of the Named
lnsured's Goverage Part, the lnsurer will not deny coverage under this Coverage Part because of such failure.
25. WAIVER OF SUBROGATION - BLANKET
Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to
add the following:
The lnsurer waives any right of recovery the lnsurer may have against any person or organization because of
payments the lnsurer makes for injury or damage arising out of:
1. the Named lnsured's ongoing operations; or
2. your work included in the products-completed operations hazard.
However, this waiver applies only when the Named lnsured has agreed in writing to waive such rights of recovery in
a written contract or written agreement, and only if such contract or agreement:
f . is in effect or becomes effective during the term of this Coverage Part; and
2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the
claim.
26. WRAP-UP EXTENSION: OCIP, CCIP, ORCONSOLIDATED (WRAP-UPI TNSURANCE PROGRAMS
Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any
construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up)
insurance program by applicable state statute or regulation.
lf the endorsement EXCLUSION - CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary
endorsement pertaining to Owner Controlled lnsurance Programs (O.C.l.P.) or Contractor Controlled lnsurance
Programs (C.C.l.P.) is attached, then the following changes apply:
A. The following wording is added to the above-referenced endorsement:
With respect to a consolidated (wrap-up) insurance proglam project in which the Named Insured is or was
involved, this exclusion does not apply to those sums the Named lnsured become legally obligated to pay as
damages because of:
1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named lnsured's
ongoing operations at the project, or during such operations of anyone acting on the Named lnsured's
behalf; nor
ONA74705XX (1-15)
Page 16 of 17
Policy No: 4o3zi627Es
Endorsement No: 3
CONTINEIITAI CASUALTY COMPANY Effective Date: 09/01/2020
lnsured Name:BELSAAS & SMITI{ CONSTR.UCTfON, INC.
Copyright CNA All Rights Reserved. lncludes copyrighted material of lnsurance Services Ofice, lnc., with its permission.
CXA CNA PARAMOUNT
Gontractors' General Liability Extension Endorsement
2. Bodily injury or property damage included within the products-completed operations hazard that arises
out of those portions of the project that are not residential structures.
B. Condition 4. Other lnsurance is amended to add the following subparagraph a.b.{1}(c}:
This insurance is excess over:
(c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available
to the Named lnsured as a result of the Named lnsured being a participant in a consolidated (wrap-up)
insurance program, but only as respects the Named lnsured's involvement in that consolidated (wrap-up|
insurance program,
C. DEFINITIONS is amended to add the following definitions:
Consolidated (wrap-up) insurance program means a construction, erection or demolition project for which the
prime contractor/project manager or owner of the construction project has secured general liability insurance
covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled
lnsurance Program (O.C.l.P.) or Contractor Controlled lnsurance program (C.C.l.p.).
Residential structure means any structure where 30% or more of the square foot area is used or is intended to
be used for human residency, including but not limited to.
1. single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned un1
developments, and
2' the common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs,
detached garages, guest houses or any similar structures).
However, when there is no individual ownership of units, residential structure does not include military housing,
college/university housing or dormitories, long term care facilities, hotels or motels. Residential struiture also
does not include hospitals or prisons.
This WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UPI INSURANCE PROGRAMS Provision
does not apply to any person or organization who otheruise qualifies as an additional insured on this Coverage Part.
Allotherterms and conditions of the Policy remain unchanged
This endo rsement, which forms a part of and is for attachment to the Policy issued by the designated lnsurers, takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
res concurrently with said P
lr
n
n
CNA74705XX (1-15) poticy No: 40327 G27Es
Page 17 of 17 Endorsement No: 3
coNTINElilTAr, CASUALTY COMPAUY Effective Date.. ogtoltzo2o
lnsured Name:BEIJSAAS & sMrTH coNsTRucTroN, rNc.
CopyightCNAAll RightsReserued. lncludescopyrightedmaterial oflnsuranceSelicesOffce, lnc.,withitspermission.