Agreement - Ritoch-Powell & Associates
Extracted text (via pymupdf)
310415 characters
City of Chandler Professional Services Agreement
Page 1
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
PROFESSIONAL SERVICES AGREEMENT
Construction Management Services
CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No. ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Council Date: March 24, 2022 Item No.
THIS AGREEMENT (“Agreement”) is made and entered into on the ______ day of_________________,
2022 (“Effective Date”), by and between City of Chandler, an Arizona municipal corporation,
("City''), and Ritoch-Powell & Associates Consulting Engineers, Inc., an Arizona corporation,
("Consultant") (City and Consultant may individually be referred to as “Party” and collectively
referred to as “Parties”).
RECITALS
A. City proposes to engage Consultant to provide Construction Management Services for
CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD) project as
more fully described in Exhibit "A", which is attached to and made a part of this Agreement
by this reference.
B. Consultant is ready, willing, and able to provide the services described in Exhibit “A” for
the compensation and fees set forth and as described in Exhibit ”B”, which is attached to
and made a part of this Agreement by this reference.
C. City desires to contract with Consultant to provide these services under the terms and
conditions set forth in this Agreement.
AGREEMENT
NOW, THEREFORE, in consideration of the premises and the mutual promises contained in this
Agreement, City and Consultant agree as follows:
SECTION I--CONSULTANT’S SERVICES
Consultant must perform the services described in Exhibit “A” to City’s satisfaction within the
terms and conditions of this Agreement and within the care and skill that a person who
provides similar services in Chandler, Arizona exercises under similar conditions. All work or
services furnished by Consultant under this Agreement must be performed in a skilled and
workmanlike manner. All fixtures, furnishings, and equipment furnished by Consultant as
part of the work or services under this Agreement must be new, or the latest model, and of
City of Chandler Professional Services Agreement
Page 2
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
the most suitable grade and quality for the intended purpose of the work or service.
SECTION II--PERIOD OF SERVICE
Consultant must perform the services described in Exhibit “A” for the term of this
Agreement. Unless amended in writing by the Parties, the Agreement term expires 600
calendar days after the Notice to Proceed (NTP) Date.
SECTION III--PAYMENT OF COMPENSATION AND FEES
Unless amended in writing by the Parties, Consultant’s compensation and fees as more fully
described in Exhibit “B” for performance of the services approved and accepted by City
under this Agreement must not exceed $2,351,150.56 for the full term of the Agreement.
Consultant may not increase any compensation or fees under this Agreement without the
City’s prior written consent. Consultant must submit monthly requests for payment of
services approved and accepted during the previous billing period and must include, as
applicable, detailed invoices and receipts, a narrative description of the tasks accomplished
during the billing period, a list of any deliverables submitted, and any subconsultant’s or
supplier’s actual requests for payment plus similar narrative and listing of their work.
Consultant must submit an Application and Certification for Payment Sheet with the monthly
request for payment to: CapitalProjects.Payables@chandleraz.gov. Payment for those
services negotiated as a lump sum will be made in accordance with the percentage of the
work completed during the preceding billing period. Services negotiated as a not-to-exceed
fee will be paid in accordance with the work effort expended on the service during the
preceding month. All requests for payment must be submitted to City for review and
approval. City will make payment for approved and accepted services within 30 calendar days
of City’s receipt of the request for payment. Consultant bears all responsibility and liability for
any and all tax obligations that result from Consultant’s performance under this Agreement.
SECTION IV--CITY'S OBLIGATIONS
As part of Consultant’s services under this Agreement, City will provide furnished items,
services, or obligations as detailed in Exhibit “D”.
SECTION V--GENERAL CONDITIONS
5.1 Notices. Unless otherwise provided herein, demands under this Agreement must be in
writing and will be deemed to have been duly given and received either (a) on the date of
service if personally served on the party to whom notice is to be given, or (b) on the third day
after the date of the postmark of deposit by first class United States mail, registered or
certified, postage prepaid and properly addressed as follows:
City of Chandler Professional Services Agreement
Page 3
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
To City:
City of Chandler
Public Works & Utilities Department
Attn: CIP City Engineer
P.O. Box 4008, Mail Stop 407
Chandler, AZ 85244-4008
Phone: 480-782-3343
Email: andrew.goh@chandleraz.gov
With a Copy to:
City of Chandler
Public Works & Utilities Department
Attn: Project Manager
P.O. Box 4008, Mail Stop 407,
Chandler, AZ 85244-4008
To Consultant:
Ritoch-Powell & Associates Consulting Engineers, Inc.
Mailing Address: 1001 N Central Ave Ste 900 Phoenix AZ 85004
Statutory Agent Name: Karl Obergh
Statutory Agent Mailing Address: 1001 N Central Ave Ste 900 Phoenix AZ
85004
CONSULTANT’S AUTHORIZED PROJECT REPRESENTATIVE
Name: Frank Henderson
Title: Transportation and CM Practice Leader
Phone: 602-263-1177
Email: fhenderson@rpaeng.com
5.2 Records/Audit. Records of Consultant’s direct personnel payroll, reimbursable expenses
pertaining to this Agreement and records of accounts between City and Consultant must be
kept on the basis of generally accepted accounting principles and must be made available to
City and its auditors for up to three years following City’s final acceptance of the services
under this Agreement (this requirement is increased to five years if construction of this
project is federally funded). City, its authorized representative, or any federal agency,
reserves the right to audit Consultant’s records to verify the accuracy and appropriateness of
all cost and pricing data, including data used to negotiate this Agreement and any
amendments. City reserves the right to decrease the total amount of Agreement price or
payments made under this Agreement or request reimbursement from Consultant following
final contract payment on this Agreement if, upon audit of Consultant’s records, the audit
discloses Consultant has provided false, misleading, or inaccurate cost and pricing data.
Consultant will include a similar provision in all of its contracts with subconsultants who
provide services under the Agreement to ensure that City, its authorized representative, or
the appropriate federal agency, has access to the subconsultants’ records to verify the
accuracy of all cost and pricing data. City reserves the right to decrease Contract price or
payments made on this Agreement or request reimbursement from Consultant following
final payment on this Agreement if the above provision is not included in subconsultant
agreements, and one or more subconsultants refuse to allow City to audit their records to
verify the accuracy and appropriateness of all cost and pricing data. If, following an audit of
City of Chandler Professional Services Agreement
Page 4
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
this Agreement, the audit discloses Consultant has provided false, misleading, or inaccurate
cost and pricing data, and the cost discrepancies exceed 1% of the total Agreement billings,
Consultant will be liable for reimbursement of the reasonable, actual cost of the audit.
5.3 Alteration in Character of Work. Whenever an alteration in the character of work results
in a substantial change in this Agreement, thereby materially increasing or decreasing the
scope of services, cost of performance, or Project schedule, the work will be performed as
directed by City. However, before any modified work is started, a written amendment must
be approved and executed by City and Consultant. Such amendment must not be effective
until approved by City. Additions to, modifications, or deletions from this Agreement as
provided herein may be made, and the compensation to be paid to Consultant may
accordingly be adjusted by mutual agreement of the Parties. It is distinctly understood and
agreed that no claim for extra services or materials furnished by Consultant will be allowed
by City except as provided herein, nor must Consultant do any work or furnish any materials
not covered by this Agreement unless such work is first authorized in writing. Any such work
or materials furnished by Consultant without prior written authorization will be at
Consultant’s own risk, cost, and expense, and Consultant hereby agrees that without written
authorization Consultant will make no claim for compensation for such work or materials
furnished.
5.4 Termination. City and Consultant hereby agree to the full performance of the covenants
contained herein, except that City reserves the right, at its discretion and without cause, to
terminate or abandon any service provided for in this Agreement, or abandon any portion of
the Project for which services have been performed by Consultant. In the event City abandons
or suspends the services, or any part of the services as provided in this Agreement, City will
notify Consultant in writing and immediately after receiving such notice, Consultant must
discontinue advancing the work specified under this Agreement. Upon such termination,
abandonment, or suspension, Consultant must deliver to City all drawings, plans,
specifications, special provisions, estimates and other work entirely or partially completed,
together with all unused materials supplied by City. Consultant must appraise the work
Consultant has completed and submit Consultant’s appraisal to City for evaluation. City may
inspect Consultant’s work to appraise the work completed. Consultant will receive
compensation in full for services performed to the date of such termination. The fee will be
paid in accordance with Section Ill of this Agreement, and as mutually agreed upon by
Consultant and City. If there is no mutual agreement on payment, the final determination will
be made in accordance with the "Disputes" provision in this Agreement. However, in no event
may the fee exceed the fee set forth in Section Ill of this Agreement nor as amended in
accordance with Section "Alteration in Character of Work." City will make the final payment
within 60 days after Consultant has delivered the last of the partially completed items and
the Parties agree on the final fee. If City is found to have improperly terminated the
Agreement for cause or default, the termination will be converted to a termination for
convenience in accordance with the provisions of this Agreement.
5.5 Indemnification. To the extent permitted by law, the Consultant ("lndemnitor") must
indemnify, save and hold harmless City and its officers, officials, agents and employees
("lndemnitee") from any and all claims, actions, liabilities, damages, losses or expenses
(including court costs, attorneys' fees and costs of claim processing, investigation and
City of Chandler Professional Services Agreement
Page 5
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
litigation) ("Claims") caused or alleged to be caused, in whole or in part, by the wrongful,
negligent or willful acts, or errors or omissions of Consultant or any of its owners, officers,
directors, agents, employees, or subconsultants in connection with this Agreement. This
indemnity includes any claim or amount arising out of or recovered under workers'
compensation law or on account of the failure of Consultant to conform to any federal, state
or local law, statute, ordinance, rule, regulation or court decree. Consultant must indemnify
lndemnitee from and against any and all Claims, except those arising solely from
lndemnitee's own negligent or willful acts or omissions. Consultant is responsible for primary
loss investigation, defense and judgment costs where this indemnification applies. In
consideration of the award of this Agreement, Consultant agrees to waive all rights of
subrogation against lndemnitee for losses arising from or related to this Agreement. The
obligations of Consultant under this provision survive the termination or expiration of this
Agreement.
5.6 Insurance Requirements. Consultant must procure insurance under the terms and
conditions and for the amounts of coverage set forth in Exhibit “C” against claims that may
arise from or relate to performance of the work under this Agreement by Consultant and its
agents, representatives, employees, and subconsultants. Consultant and any subconsultant
must maintain this insurance until all of their obligations have been discharged, including any
warranty periods under this Agreement. These insurance requirements are minimum
requirements for this Agreement and in no way limit the indemnity covenants contained in
this Agreement. City in no way warrants that the minimum limits stated in Exhibit “C” are
sufficient to protect Consultant from liabilities that might arise out of the performance of the
work under this Agreement by Consultant, Consultant’s agents, representatives, employees,
or subconsultants. Consultant is free to purchase such additional insurance as may be
determined necessary.
5.7 Cooperation and Further Documentation. Consultant agrees to provide City such other
duly executed documents as may be reasonably requested by City to implement the intent
of this Agreement.
5.8 Successors and Assigns. City and Consultant each bind itself, its partners, successors,
assigns, and legal representatives to the other party to this Agreement and to the partners,
successors, assigns, and legal representatives of such other party in respect to all covenants
of this Agreement. Neither City nor Consultant may assign, sublet, or transfer its interest in
this Agreement without the written consent of the other party. In no event may any
contractual relation be created between any third party and City.
5.9 Disputes. In any dispute arising out of an interpretation of this Agreement or the duties
required not disposed of by agreement between Consultant and City, the final determination
at the administrative level will be made by City Engineer.
5.10 Completeness and Accuracy of Consultant’s Work. Consultant must be responsible for
the completeness and accuracy of Consultant’s services, data, and other work prepared or
compiled under Consultant’s obligation under this Agreement and must correct, at
Consultant’s expense, all willful or negligent errors, omissions, or acts that may be discovered.
Correction of errors disclosed and determined to exist during any construction of the project on
City of Chandler Professional Services Agreement
Page 6
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
architectural or engineering drawings and specifications must be accomplished by Consultant.
The cost of the design necessary to correct those errors attributable to Consultant and any
damage incurred by City as a result of additional construction costs caused by such engineering
or architectural errors will be chargeable to Consultant and will not be considered a cost of the
Work. The fact that City has accepted or approved Consultant’s work will in no way relieve
Consultant of any of Consultant’s responsibilities.
5.11 Reporting. Written monthly reports, along with updated work schedules, will be made by
Consultant in the format prescribed by City. These reports will be delivered to City per schedule.
When requested by City, Consultant will attend Council meetings and provide finished documents
including correspondence for Council action, supporting charts, graphs, drawings and colored
slides of same.
5.12 Withholding Payment. City reserves the right to withhold funds from Consultant’s
payments up to the amount equal to the claims City may have against Consultant until such
time that a settlement on those claims has been reached.
5.13 City's Right of Cancellation. The Parties acknowledge that this Agreement is subject to
cancellation by City under the provisions of Section 38-511, Arizona Revised Statutes (A.R.S.).
5.14 Independent Consultant. For this Agreement Consultant constitutes an independent
contractor. Any provisions in this Agreement that may appear to give City the right to direct
Consultant as to the details of accomplishing the work or to exercise a measure of control
over the work means that Consultant must follow the wishes of City as to the results of the
work only. These results must comply with all applicable laws and ordinances.
5.15 Project Staffing. Prior to the start of any work under this Agreement, Consultant must
submit to City detailed resumes of key personnel that will be involved in performing services
prescribed in the Agreement. City hereby acknowledges its acceptance of such personnel to
perform services under this Agreement. At any time hereafter that Consultant desires to
change key personnel while performing under the Agreement, Consultant must submit the
qualifications of the new personnel to City for prior approval. Key personnel include, but are
not limited to, principals-in-charge, project manager, and project Consultant. Consultant will
maintain an adequate and competent staff of qualified persons, as may be determined by
City, throughout the performance of this Agreement to ensure acceptable and timely
completion of the Scope of Services. If City objects, with reasonable cause, to any of
Consultant’s staff, Consultant must take prompt corrective action acceptable to City and, if
required, remove such personnel from the Project and replace with new personnel agreed to
by City.
5.16 Consultants or Subconsultants. Prior to beginning the work, Consultant must furnish City
for approval the names of consultants or subconsultants to be used under this Agreement.
Any subsequent changes are subject to City’s written prior approval.
5.17 Force Majeure. If either party is delayed or prevented from the performance of any act
required under this Agreement by reason of acts of God or other cause beyond the control
and without fault of the Party (financial inability excepted), performance of that act may be
City of Chandler Professional Services Agreement
Page 7
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
excused, but only for the period of the delay, if the Party provides written notice to the other
Party within ten days of such act. The time for performance of the act may be extended for a
period equivalent to the period of delay from the date written notice is received by the other
Party.
5.18 Compliance with Federal Laws. Consultant understands and acknowledges the
applicability of the Americans with Disabilities Act, the Immigration Reform and Control Act
of 1986 and the Drug Free Workplace Act of 1989 to it. Consultant agrees to comply with these
laws in performing this Agreement and to permit City to verify such compliance.
5.19 No Israel Boycott. By entering into this Agreement, Consultant certifies that Consultant
is not currently engaged in, and agrees for the duration of the Agreement, not to engage in a
boycott of Israel as defined by state statute.
5.20 Legal Worker Requirements. A.R.S. § 41-4401 prohibits City from awarding a contract to
any consultant who fails, or whose subconsultants fail, to comply with A.R.S. § 23-214(A).
Therefore, Consultant agrees Consultant and each subconsultant it uses warrants their
compliance with all federal immigration laws and regulations that relate to their employees
and their compliance with § 23-214, subsection A. A breach of this warranty will be deemed a
material breach of the Agreement and may be subject to penalties up to and including
termination of the Agreement. City retains the legal right to inspect the papers of any
Consultant’s or subconsultant’s employee who provides services under this Agreement to
ensure that Consultant and subconsultants comply with the warranty under this provision.
5.21 Lawful Presence Requirement. A.R.S. §§ 1-501 and 1-502 prohibit City from awarding a
contract to any natural person who cannot establish that such person is lawfully present in
the United States. To establish lawful presence, a person must produce qualifying
identification and sign a City-provided affidavit affirming that the identification provided is
genuine. This requirement will be imposed at the time of contract award. This requirement
does not apply to business organizations such as corporations, partnerships, or limited
liability companies.
5.22 Covenant Against Contingent Fees. Consultant warrants that no person has been
employed or retained to solicit or secure this Agreement upon an agreement or
understanding for a commission, percentage, brokerage, or contingent fee, and that no
member of the Chandler City Council, or any City employee has any interest, financially, or
otherwise, in Consultant’s firm. For breach or violation of this warrant, City may annul this
Agreement without liability or, at its discretion, to deduct from the Agreement price or
consideration, the full amount of such commission, percentage, brokerage, or contingent fee.
5.23 Non-Waiver Provision. The failure of either Party to enforce any of the provisions of this
Agreement or to require performance of the other Party of any of the provisions hereof must
not be construed to be a waiver of such provisions, nor must it affect the validity of this
Agreement or any part thereof, or the right of either Party to thereafter enforce each and
every provision.
5.24 Disclosure of Information Adverse to City’s Interests. To evaluate and avoid potential
City of Chandler Professional Services Agreement
Page 8
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
conflicts of interest, Consultant must provide written notice to City, as set forth in this Section,
of any work or services performed by Consultant for third parties that may involve or be
associated with any real property or personal property owned or leased by City. Such notice
must be given 7 business days prior to commencement of the services by Consultant for a
third party, or 7 business days prior to an adverse action as defined below. Written notice
and disclosure must be sent in accordance with Section 6.7 above. An adverse action under
this Agreement includes, but is not limited to: (a) using data as defined in the Agreement
acquired in connection with this Agreement to assist a third party in pursuing administrative
or judicial action against City; or (b) testifying or providing evidence on behalf of any person
in connection with an administrative or judicial action against City; or (c) using data to produce
income for Consultant or its employees independently of performing the services under this
Agreement, without the prior written consent of City. Consultant represents that except for
those persons, entities, and projects identified to City, the services performed by Consultant
under this Agreement are not expected to create an interest with any person, entity, or third
party project that is or may be adverse to City’s interests. Consultant’s failure to provide a
written notice and disclosure of the information as set forth in this Section constitute a
material breach of this Agreement.
5.25 Data Confidentiality and Data Security. As used in the Agreement, "data" means all
information, whether written or verbal, including plans, photographs, studies, investigations,
audits, analyses, samples, reports, calculations, internal memos, meeting minutes, data field
notes, work product, proposals, correspondence and any other similar documents or
information prepared by, obtained by, or transmitted to Consultant or its subconsultants in
the performance of this Agreement. The Parties agree that all data, regardless of form,
including originals, images, and reproductions, prepared by, obtained by, or transmitted to
Consultant or its subconsultants in connection with Consultant’s or its subconsultant’s
performance of this Agreement is confidential and proprietary information belonging to City.
Except as specifically provided in this Agreement, Consultant or its subconsultants must not
divulge data to any third party without City’s prior written consent. Consultant or its
subconsultants must not use the data for any purposes except to perform the services
required under this Agreement. These prohibitions do not apply to the following data
provided to Consultant or its subconsultants have first given the required notice to City: (a)
data which was known to Consultant or its subconsultants prior to its performance under this
Consultant or its subconsultants by a third party, who to the best of Consultant’s or its
subconsultants’ knowledge and belief, had the legal right to make such disclosure and
Consultant or its subconsultants are not otherwise required to hold such data in confidence;
or (c) data which is required to be disclosed by virtue of law, regulation, or court order, to
which Consultant or its subconsultants are subject. In the event Consultant or its
subconsultants are required or requested to disclose data to a third party, or any other
information to which Consultant or its subconsultants became privy as a result of any other
contract with City, Consultant must first notify City as set forth in this Section of the request
or demand for the data. Consultant or its subconsultants must give City sufficient facts so
that City can be given an opportunity to first give its consent or take such action that City may
deem appropriate to protect such data or other information from disclosure. All data must
continue to be subject to the confidentiality agreements of this Agreement. Consultant or its
subconsultants assume all liability to maintain the confidentiality of the data in its possession
and agrees to compensate City if any of the provisions of this Section are violated by
City of Chandler Professional Services Agreement
Page 9
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
Consultant, its employees, agents or subconsultants. Solely for the purposes of seeking
injunctive relief, it is agreed that a breach of this Section must be deemed to cause irreparable
harm that justifies injunctive relief in court. Consultant agrees that the requirements of this
Section must be incorporated into all subagreements entered into by Consultant. A violation
of this Section may result in immediate termination of this Agreement without notice.
5.26 Personal Identifying Information-Data Security. Personal identifying information,
financial account information, or restricted City information, whether electronic format or
hard copy, must be secured and protected at all times by Consultant or its subconsultants. At
a minimum, Consultant or its subconsultants must encrypt or password-protect electronic
files. This includes data saved to laptop computers, computerized devices, or removable
storage devices. When personal identifying information, financial account information, or
restricted City information, regardless of its format, is no longer necessary, the information
must be redacted or destroyed through appropriate and secure methods that ensure the
information cannot be viewed, accessed, or reconstructed. In the event that data collected or
obtained by Consultant or its subconsultants in connection with this Agreement is believed
to have been compromised, Consultant or its subconsultants must immediately notify City
contact. Consultant agrees to reimburse City for any costs incurred by City to investigate
potential breaches of this data and, where applicable, the cost of notifying individuals who
may be impacted by the breach. Consultant agrees that the requirements of this Section must
be incorporated into all subcontracts entered into by Consultant. It is further agreed that a
violation of this Section must be deemed to cause irreparable harm that justifies injunctive
relief in court. A violation of this Section may result in immediate termination of this
Agreement without notice. The obligations of Consultant or its subconsultants under this
Section must survive the termination of this Agreement.
5.27 Jurisdiction and Venue. This Agreement is made under, and must be construed in
accordance with and governed by the laws of the State of Arizona without regard to the
conflicts or choice of law provisions thereof. Any action to enforce any provision of this
Agreement or to obtain any remedy with respect hereto must be brought in the courts
located in Maricopa County, Arizona, and for this purpose, each Party hereby expressly and
irrevocably consents to the jurisdiction and venue of such court.
5.28 Survival. All warranties, representations, and indemnifications by Consultant must
survive the completion or termination of this Agreement.
5.29 Modification. Except as expressly provided herein to the contrary, no supplement,
modification, or amendment of any term of this Agreement will be deemed binding or
effective unless in writing and signed by the Parties.
5.30 Severability. If any provision of this Agreement or the application to any person or
circumstance may be invalid, illegal or unenforceable to any extent, the remainder of this
Agreement and the application will not be affected and will be enforceable to the fullest
extent permitted by law.
5.31 Integration. This Agreement contains the full agreement of the Parties. Any prior or
contemporaneous written or oral agreement between the Parties regarding the subject
City of Chandler Professional Services Agreement
Page 10
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
matter is merged and superseded.
5.32 Time is of the Essence. Time of each of the terms, covenants, and conditions of this
Agreement is hereby expressly made of the essence.
5.33 Date of Performance. If the date of performance of any obligation or the last day of any
time period provided for should fall on a Saturday, Sunday, or holiday for City, the obligation
will be due and owing, and the time period will expire, on the first day after which is not a
Saturday, Sunday or legal City holiday. Except as may otherwise be set forth in this
Agreement, any performance provided for herein will be timely made if completed no later
than 5:00 p.m. (Chandler time) on the day of performance.
5.34 Third Party Beneficiary. Nothing under this Agreement will be construed to give any
rights or benefits in the Agreement to anyone other than City and Consultant, and all duties
and responsibilities undertaken pursuant to this Agreement will be for the sole and exclusive
benefit of City and Consultant and not for the benefit of any other party.
5.35 Conflict in Language. All work performed must conform to all applicable City of Chandler
codes, ordinances, and requirements as outlined in this Agreement. If there is a conflict in
interpretation between provisions in this Agreement and those in Exhibit "A", the provisions
in this Agreement prevail.
5.36 Document/Information Release. Documents and materials released to Consultant,
which are identified by City as sensitive and confidential, are City’s property. The
document/material must be issued by and returned to City upon completion of the services
under this Agreement. Consultant secondary distribution, disclosure, copying, or duplication
in any manner is prohibited without City’s prior written approval. The document/material
must be kept secure at all times. This directive applies to all City documents, whether in
photographic, printed, or electronic data format.
5.37 Exhibits. The following exhibits are made a part of this Agreement and are incorporated
by reference:
Exhibit A - Scope of Services / Schedule
Exhibit B - Compensation and Fees
Exhibit C - Insurance Requirements
Exhibit D - Special Conditions
Exhibit E – Federal Requirements (if applicable)
5.38 Special Conditions. As part of the services Consultant provides under this Agreement,
Consultant agrees to comply with and fully perform the special terms and conditions set forth
in Exhibit “D”, which is attached to and made a part of this Agreement.
5.39 Non-Discrimination and Anti-Harassment Laws. Consultant must comply with all
applicable City, state, and federal non-discrimination and anti-harassment laws, rules, and
regulations.
City of Chandler Professional Services Agreement
Page 11
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
5.40 Licenses and Permits. Beginning with the Effective Date and for the full term of this
Agreement, Consultant must maintain all applicable City, state, and federal licenses and
permits required to fully perform Consultant’s services under this Agreement.
5.41 Warranties. Consultant must furnish a one-year warranty on all work and services
performed under this Agreement. Consultant must furnish, or cause to be furnished, a two-
year warranty on all fixtures, furnishings, and equipment furnished by Consultant,
subconsultants or suppliers under this Agreement. Any defects in design, workmanship, or
materials that do not comply with this Agreement must be corrected by Consultant (including,
but not limited to, all parts and labor) at Consultant’s sole cost and expense. All written
warranties and redlines for as-built conditions must be delivered to City on or before City’s
final acceptance of Consultant’s services under this Agreement.
5.42 Cooperative Purchasing Agreement (S.A.V.E. – Strategic Alliance for Volume
Expenditures). In addition to City of Chandler and with the approval of Consultant, this
Agreement may be extended for use by other municipalities, school districts, and government
agencies of the State. Any such usage by other entities must be in accordance with the
ordinance, charter, or procurement rules and regulations of the respective political entity.
5.43 Budget Approval into Next Fiscal Year. This Agreement will commence on the Effective
Date and continue in full force and effect until it is terminated or expires in accordance with
the provisions of this Agreement. The Parties recognize that the continuation of this
Agreement after the close of the City's fiscal year, which ends on June 30 of each year, is
subject to the City Council's approval of a budget that includes an appropriation for this item
as an expenditure. The City does not represent that this budget item will be actually adopted.
This determination is solely made by the City Council.
SIGNATURE PAGE TO FOLLOW
February 16, 2022
Karl G. Obergh, PE
Principal
kobergh@rpaeng.com
for
City of Chandler Professional Services Agreement – Exhibit “A”
Page A-1
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
EXHIBIT “A”
SCOPE OF SERVICES/SCHEDULE
1
EXHIBIT “A”
CONSTRUCTION MANAGEMENT
SCOPE OF SERVICES
(FHWA FUNDED PROJECTS)
PROJECT TASKS
1.
PRE-CONSTRUCTION ASSISTANCE
A. Task 1.1 Preconstruction Assistance
i. Consultant must attend the pre-construction meeting.
ii. Consultant must attend the pre-construction public meeting.
iii. Consultant must attend one (1) meeting with the Public Outreach Consultant to
review improvements and properties requiring specific outreach efforts.
2.
CONSTRUCTION MANAGEMENT
A. Task 2.1 Weekly Construction Meetings
i. Consultant must conduct weekly construction meetings. Each meeting includes
agenda and minutes; Request for Information (RFI); Shop Drawing; Request for
Information (RFI); Field Directive (FD); Material Certification; and Allowance Logs.
Consultant assumes eighty (80) weekly meetings will be held.
B. Task 2.2 CPM Schedule
i. Consultant must review and evaluate Contractor’s initial CPM schedule and
provide recommendations for acceptance.
ii. Consultant must review Contractor’s monthly CPM schedule updates submitted
with each payment application, identify CPM tasks behind schedule that may affect
critical path items, project substantial and final completion dates and initiate
correspondence to City regarding those tasks. Consultant assumes twenty (20)
reviews of updated CPM schedule.
C. Task 2.3 Requests for Information (RFI’s)
i. Consultant must review, evaluate, and respond to Contractor Requests for
Information (RFI’s); and prepare and maintain a submittal log of all RFI’s.
Consultant assumes a maximum of eighty (80) RFI responses.
D. Task 2.4 Shop Drawing Submittals
i. Consultant must review, evaluate, and respond to Contractor shop drawing
submittals; and prepare and maintain a submittal log of all shop drawing
submittals. Consultant assumes a maximum of forty-five (45) reviews.
E. Task 2.5 Requests for Proposal (RFP)
i. Consultant must prepare Requests for Proposal (RFP) documents detailing
requested additional work tasks; review and evaluate Contractor RFP responses
(cost derivations) with approval recommendations; and prepare and maintain a
submittal log list of all RFP’s. Consultant assumes a maximum of twenty (20)
RFPs.
ii. Consultant must review Contractor Time and Materials (T&M) cost submittals
and provide recommendations for approval. CM CONSULTANT assumes a
maximum of twenty (20) T&Ms, with two (2) reviews each.
F. Task 2.6 Field Directives (FD’s)
i. Consultant must prepare Field Directive (FD) documents detailing requested
additional work tasks; review and evaluate Contractor FD responses with approval
2
recommendations; and prepare and maintain a submittal log list of all FD’s.
Consultant assumes a maximum of seventy-five (75) FD’s.
G. Task 2.7 Contractor Payment Applications
i. Consultant must review and evaluate Contractor monthly payment applications
and make recommendation for payment; maintain a weekly record of constructed
pay quantities and compile monthly totals; and coordinate payment application
with the City quantity report and the inspectors’ daily logs. Consultant assumes a
maximum of eighteen (20) payment applications, with two (2) reviews each.
H. Task 2.8 Public Outreach
i. Consultant must provide public outreach services, whether by Consultant or
subconsultant. Tasks will include: create and maintain project website; maintain a
24-hour bilingual project hotline to respond to inquiries, complaints and maintain a
call log; public weekly email updates; public interactions with property owners as
a liaison between property owners and the City; coordination meetings; project
meetings; public meeting coordination; federal funds required partnering process
(project team partnering meeting, maintaining status).
3.
CONSTRUCTION ADMINISTRATION
A. Task 3.1 Federal Compliance Administration
i. Consultant must conduct Contractor and Sub-contractor laborer interviews.
B. Task 3.2 Administrative Support
i. Consultant must provide administrative support to City staff for federal reporting
requirements. Consultant assumes one administrative assistant for seventy two
(72) weeks at 40 hours per week.
4.
CONSTRUCTION INSPECTION
A. Task 4.1 Inspection Services
i. Consultant must provide weekly construction inspection to verify materials and
installations conform to construction documents; prepare daily inspection reports
documenting Contractor construction activities and progress during field
inspection visits; and perform intermittent erosion control inspections. Consultant
assumes one (1) inspector full time 48 hours per week for twenty (20) months and
an additional one (1) inspector for 40 hours per week for sixteen (16) weeks as
needed for multiple concurrent crews, night work, weekend work, additional
closures, etc.
B. Task 4.2 Landscape / Irrigation Inspection Services
i. Consultant must provide Irrigation system layout and installation observations;
attend and observe irrigation system pressure tests; and attend a nursery visit to
tag and inspect plant material. Consultant assumes six (6) site visits.
C. Task 4.3 Project Closeout
i. Consultant must compile non-conformance list prior to Substantial Completion;
schedule and conduct Substantial Completion inspection; prepare Substantial
Completion punch list generated from Substantial Completion inspection; track
items on punch list and note completed items; and complete and distribute
Substantial Completion certificates.
ii. Consultant must schedule and conduct Final Completion inspection; and complete
and distribute Final Completion certificates.
3
5.
UTILITY COORDINATION
A. Task 5.1 Utility Coordination
i. Consultant must coordinate with utility representatives to complete relocations,
new electrical (SRP) service connections and RWCD relocations.
ii. Consultant must complete Approval of Construction (AOC) applications and
submit to MCESD for water line relocations.
6.
MATERIALS TESTING
A. Task 6.1 Quality Control (QC) Test Program
i. Consultant must review and verify Contractor’s Quality Control material test type
and frequencies are consistent with City, MAG, and ADOT requirements; review
and evaluate Contractor’s QC test schedule and provide recommendations on
acceptance; and review and evaluate all Contractor sampling, test, and inspection
results for conformance with construction documents.
B. Task 6.2 Quality Assurance (QA) Test Program
i. Consultant must prepare and maintain a materials Quality Assurance plan per City,
MAG, and ADOT requirements. QA plan will be reviewed and approved by ADOT
prior to initiating construction activities. QA testing, material certification, and cover
letter will be reviewed and approved by ADOT after all testing has been completed.
ii. Consultant will coordinate with IA 3rd party tester to complete sampling and testing
of materials to be installed on the project, collaborate with the QA and QC testing
parties and review results.
iii. Consultant must coordinate with Contractor’s testing representative to obtain
required QA tests and sample; complete sampling and compaction testing of
subgrade (including lime-stabilized subgrade base), aggregate base and asphalt
concrete materials in new asphalt concrete pavement areas; complete sampling
and compaction testing of subgrade, aggregate base (where required) and
concrete for new curbs, gutters, sidewalks and concrete pavement and structures;
and complete sampling and compaction testing of backfill for new irrigation, sewer,
water, storm drain pipe, and dry utilities.
C. Task 6.3 Material Certifications
i. Consultant must review and verify material certifications are met including “Buy
America” requirements; and prepare and maintain materials certificate and “Buy
America” requirement submittal log.
D. Task 6.4 Independent Assurance (IA) Test Program
i. Consultant must provide 3rd party independent quality assurance sampling and
testing per the approved QA program produced in task 6.B.i.
7.
RECORD DRAWINGS
A. Task 7.1 Record Drawings
i. Review and monitor Contractor’s weekly updates on red-line drawing set. Review
Contractor’s submitted as-built Record Drawings.
8.
PROJECT MANAGEMENT
A. Task 8.1 Project Monitoring
i. Consultant must prepare regular monthly progress reports
ii. Consultant must perform regular budget monitoring.
iii. Pay applications will be submitted monthly. Invoices will be broken down to the
same level of detail as the attached fee schedule.
B. Task 8.2 Manage Sub-Consultants
i. Consultant must monitor all sub-consultants schedule and work products and
ensure that all activities are coordinated.
4
ASSUMPTION, CLARIFICATIONS, AND EXCLUSIONS
1.
Application fees for City reviews and permits will be paid by CITY.
2.
The following items are excluded from this scope of work:
a. Special Inspections
b. Aerial Mapping and photography
c. Environmental Investigation
d. Potholing and survey for potholing
e. Private and public utility relocation design
f.
Drainage analysis or design
g. Pavement design
h. GIS survey or data processing
i.
Preparing and producing displays, exhibits, engineering designs or details required for public
meetings or information.
j.
Documentation of existing property conditions, project signage or traffic signage by Public
Outreach (MakPro).
3.
The Owner’s Allowance will only be utilized with prior written approval from the City representative.
4.
The Direct Expense Allowance will be used for normal reimbursable expenses on the project.
Items must be billed at cost and backup must be provided with pay applications.
5.
Contract work must be performed in accordance with Exhibit D Title VI Assurances Appendix A
and Exhibit E Title VI Assurances Appendix E.
6
SUBCONSULTANT FEE DERIVATIONS
111 SOUTH WEBER DRIVE, SUITE 1
WWW.ATEKEC.COM
P (480) 659-8065
CHANDLER, AZ 85226
F (480) 656-9658
January 11, 2022
Proposal No.: 220009
Mr. Keith Drunasky, PE, Senior Project Manager
Ritoch-Powell & Associates
1001 North Central Avenue, Suite 900
Phoenix, AZ 85004
kdrunasky@RPAENG.COM
SUBJECT:
Proposal for Quality Assurance Materials Testing
Chandler Heights Road Improvements McQueen Road to Gilbert Road
COC Project No.: ST1614.401
Federal Aid No.: CHN-0(240)
ADOT No.: T0099 01C:
Chandler, Arizona
Dear Mr. Drunasky:
ATEK Engineering Consultants, LLC (ATEK) is pleased to present this proposal. This proposal
was developed after review of Project Plans (ST1614.401) dated 5/17/21 and Construction Bid
document (ST1614.401) and is a preliminary understanding of the Quality Assurance Materials
Testing Services for the subject project.
ATEK is committed to providing a high level of service to its clients, commensurate with their
wants and needs. If a portion of this proposal does not meet your needs, or if those needs have
changed, ATEK will consider appropriate modifications, subject to the standards of care to which
we adhere as professionals. We look forward to the opportunity to provide professional services
to this project.
PROJECT UNDERSTANDING
The proposed project consists of roadway improvements for Chandler Heights Road from
McQueen Road to Gilbert Road in Chandler, Arizona
We have based our proposal on the following information:
•
Review of the Project Plans (ST1614.401) dated 5/17/21 prepared by Kimley Horn.
•
Construction Bid document (ST1614.401) prepared by the City of Chandler
•
ADOT Materials Quality Assurance Program (ADOT MQAP), November 24, 2020.
•
At the time of this proposal a project schedule was not available, though contract days in
the contract are 540 days. Information from the project schedule may have an impact on
our estimated fee for this project.
Our scope of services for the referenced project includes the following:
Field Density Testing-Site Utilities & Pavement Areas
Field density testing will be performed on a part-time basis, by an Engineering Technician, for
compaction testing of backfill material for site utility trenches; pavement subgrades and base
Chandler Heights Road – McQueen Road to Gilbert Road
January 11, 2022
Proposal 220009
Page 2 of 6
course materials. The field services will be supported by appropriate laboratory evaluation of
soils and aggregates used as fill on the project site. The testing frequencies are estimated based
on section 203 and 303 of the ADOT MQAP and assume appropriate contractor quality control
will be provided by others.
Concrete Services
An ACI Level I Engineering Technician will be provided on a part time basis to sample the plastic
concrete for concrete such as curb, gutter, sidewalks and light pole foundations and other
miscellaneous concrete structures. Concrete is anticipated to be sampled every 50 yards. The
concrete will be tested for slump and temperature at the time of placement. Sets of four (4)
cylinders will be molded at each sampling.
Samples will be field cured at the site and returned to the laboratory for moist curing prior to
compressive strength testing. Compressive strength testing will be conducted at 28-days (4
cylinders).
Asphalt Concrete Services
ATEK will provide an Engineering Technician to sample asphalt paving for laboratory testing, and
obtain AC cores for density and thickness testing (assumes QC will performing the coring
operations). We anticipate taking 45 samples (sampling at every 500 tons) and 201 cores (20
cores per 2000 tons) based on ADOT MQAP Specification 416.
Project Management/Coordination Services
ATEK’s Project Manager will conduct periodic site visits for consultation with onsite personnel and
review ATEK’s project documentation and laboratory testing results during construction. If
requested, the Project Manager will prepare a summary presentation of the results of our field
and laboratory tests and observations performed during project construction. In addition, the
ATEK project manager will review project quality control reports as provided by the construction
administration team. .The project manager or project engineer will attend weekly meeting to
discuss ongoing testing requirements and address and non-conformance issues.
ATEK will also provide the following administrative services:
•
Dispatching and scheduling of field personnel;
•
Word processing by administrative staff; and
•
Reproduction and distribution of reports.
ESTIMATED PROJECT FEES
The above-mentioned services will be performed on an hourly and unit rate basis from portal to
portal. The attached costs are estimates only and are based on time schedules, our experience
with similar projects, and other information provided to us regarding this project. ATEK has no
control over the project submittal process and schedule, project construction schedule and/or
materials and methods which can affect the total cost of the services provided. The actual cost
will depend on the amount of work requested, the contractor’s schedule, delays due to weather,
etc. This estimate is based on a normal 40-hour workweek. If this information or time schedule
should change, please contact us immediately so we may adjust our fee accordingly.
A detailed cost estimate is included as an attachment at the end of this proposal.
Chandler Heights Road – McQueen Road to Gilbert Road
January 11, 2022
Proposal 220009
Page 3 of 6
SAFETY
The safety of our employees is of paramount concern to ATEK. You will be notified if project
conditions represent a potential safety concern to our employees. Unsafe conditions for fieldwork
will require a modification of our estimated scope of work and associated fees. If necessary, we
will advise you of any additional costs required to mitigate these unanticipated conditions. Job
site safety will be the sole responsibility of the contractor.
SCHEDULE
We request that our dispatch office be contacted at least 48 hours in advance of any necessary
tests and observations. We will perform this work at the rates presented. If additional services
are requested which were not presented, they will be charged at our current fee schedule rate.
ATEK personnel will not direct, lay out, or supervise the construction operations for the project,
nor will we alter or change the project plans, specifications or reports. In addition, an onsite pre-
construction meeting with all involved parties is also requested.
AUTHORIZATION
The work will be conducted in accordance with the attached General Conditions. Your signature
on this proposal may indicate your acceptance of these Conditions and authorization for ATEK to
proceed with the Scope of Work outlined herein. If this proposal is acceptable, we can begin work
as soon as we receive an ORIGINAL signature in the “acceptance” field.
If there is a need for any change in the scope of services or schedule described in the proposal,
please call us immediately. Changes may require revision of the proposed fee, which will be
communicated to you upon assessment of the requested changes effect on the fee.
LIMITATIONS
Construction testing and special inspection observation are techniques employed to reduce the
risk of problems arising during construction. Provision of these services by ATEK is not insurance,
nor does it constitute a warranty or guarantee of any type. Even with diligent construction testing
and special inspection observation, some latent construction defects may be missed. In all cases,
contractors shall retain responsibility for the quality of their work, for adhering to plans and
specifications, and for repairing defects regardless of when they are found. In the absence of
continuous observations by ATEK personnel during site earthwork, we are not able to express an
opinion regarding the adequacy of site preparation or overall fill composition or compaction.
ATEK will perform its services in a manner consistent with the standards of care and
skill ordinarily exercised by members of the profession practicing under similar
conditions in the geographic vicinity and at the time the services will be performed.
No warranty or guarantee, express or implied, is provided as part of the services offered
by this proposal. This proposal neither makes nor intends a warrantee or guarantee,
express or implied, nor does it create a fiduciary responsibility to Client by Consultant.
TERMS AND CONDITIONS
All terms and conditions indicated in this proposal and in the attached General
Conditions will be considered by both parties to be in effect from the effective date of
the signed proposal through completion of the project. The proposal will remain in
Chandler Heights Road – McQueen Road to Gilbert Road
January 11, 2022
Proposal 220009
Page 4 of 6
effect for 30 days from its date, and thereafter shall be null and void unless it has been
signed for the work proposed.
We sincerely appreciate the opportunity to be of service and look forward to working
with you on this project.
Sincerely,
ATEK Engineering Consultants, LLC.
Armando Ortega, PE
Principal
Enclosure: General Conditions 2020
Client agrees to the Scope of Work described in this Proposal and Cost Estimate and the
General Conditions attached and incorporated herein.
By:
__________________________
RITOCH-POWELL & Associates, Inc.
Title: __________________________
Date: __________________________
Chandler Heights Road – McQueen Road to Gilbert Road
January 11, 2022
Proposal 220009
Page 5 of 5
ATEK GENERAL CONDITIONS 2020 (PROFESSIONAL SERVICES)
This PROFESSIONAL SERVICES AGREEMENT is made by and between Ritoch-Powell & Associates hereinafter referred to as CLIENT, and ATEK Engineering Consultants, LLC,
hereinafter called ATEK.
The PROFESSIONAL SERVICES AGREEMENT between the parties consists of these terms and conditions, the attached PROPOSAL identified as ATEK Proposal No. 220009, dated
1/11/2022, and any exhibits or attachments noted in the PROPOSAL. Together, these elements will constitute the entire AGREEMENT superseding any and all prior negotiations,
correspondence, or agreements either written or oral. Any changes to this PROFESSIONAL SERVICES AGREEMENT must be mutually agreed to in writing.
SECTION 1 - SCOPE OF WORK
ATEK shall perform pursuant to the terms and conditions of this PROFESSIONAL SERVICES AGREEMENT the services as set forth in the accompanying PROPOSAL.
SECTION 2 - PERMITS & UTILITIES
1. Unless otherwise stated in the PROPOSAL, CLIENT shall apply for and obtain all required permits and licenses. CLIENT shall make all necessary arrangements for right of entry
to provide ATEK access to the site for all equipment and personnel at no charge to ATEK.
2.
While ATEK will take all reasonable precautions to minimize any damage to the property, CLIENT agrees to hold ATEK harmless for any damages to structures or any damage
required for right of entry, in the absence of willful and gross misconduct by ATEK.
SECTION 3 - SAMPLES
Samples collected during this study will be retained for approximately 30 days after the report is submitted and then disposed.
SECTION 4 - INVOICES
ATEK will submit an invoice to CLIENT each month. Payment is due upon presentation of invoice and is past due thirty (30) days from invoice date.
SECTION 5 - OWNERSHIP OF DOCUMENTS
1.
All reports, field data, field notes, calculations, estimates and other documents prepared by ATEK, as instruments of service, shall remain the property of ATEK.
2.
CLIENT agrees that all reports and other work furnished to CLIENT or his agents, which are not paid for, will be returned upon demand and will not be used by CLIENT for any
purpose whatsoever.
3.
ATEK will retain all pertinent records relating to the services performed for a period of five years following submission of the report, during which period the records will be
made available to CLIENT at reasonable times.
SECTION 6 - DISPUTES
In an effort to resolve any conflicts that arise during the design or construction of the Project or following the completion of the Project, the CLIENT and ATEK agree that all disputes
arising between them out of or relating to this Agreement or the Project shall be submitted to non-bonding mediation unless the parties mutually agree otherwise.
SECTION 7 - STANDARD OF CARE & NOTIFICATION
1.
Services performed by ATEK under this PROFESSIONAL SERVICES AGREEMENT will be conducted in a manner consistent with that level of care and skill ordinarily
exercised by members of the profession currently practicing under similar conditions. No warranty express or implied is made.
2.
ATEK agrees to notify CLIENT when unanticipated hazardous materials or suspected hazardous materials are encountered. CLIENT agrees to make any disclosures required
by law to the appropriate governing agencies.
3.
ATEK will be responsible for data, interpretations, and recommendations, but shall not be responsible for the interpretation by others of the information developed.
SECTION 8 - LIMITATION OF LIABILITY
1.
CLIENT agrees to limit ATEK’s liability to CLIENT and all third parties arising from ATEK’s negligent acts, errors or omissions, such that the total aggregate liability of ATEK to all
those named shall not exceed our fees for the project or $50,000, whichever is greater. Neither CLIENT nor any third parties assume any liability for damages to others, which
may arise solely on account of ATEK's negligent acts, errors or omissions.
2.
As part of the consideration ATEK requires for provision of the Services indicated herein, CLIENT agrees that any claim for damages filed against ATEK by CLIENT or any
contractor or subcontractor hired directly or indirectly by CLIENT will be filed solely against ATEK or its successors or assigns and that no individual person shall be made
personally liable or liable for damages, in whole or in part.
SECTION 9 - INSURANCE
ATEK represents and warrants that it and its agents, staff and consultants employed by it are protected by worker's compensation insurance and that ATEK has such coverage under
public liability and property damage insurance policies which ATEK deems to be adequate. Certificates for all such policies of insurance will be provided to CLIENT, if requested.
Within the limits and conditions of such insurance, ATEK agrees to indemnify and hold CLIENT harmless from and against any loss, damage, or liability arising from any negligent acts
by ATEK, it agents, staff, and consultants employed by it. ATEK shall not be responsible for any loss, damage or liability arising from any acts by CLIENT, its agents, staff, and other
consultants employed by it.
SECTION 10 - TERMINATION
1.
This CONSULTING SERVICES AGREEMENT may be terminated by either party upon seven (7) days’ written notice in the event of substantial failure by the other party to
perform in accordance with the terms hereof, or in the event of the parties' failure to agree upon an adjustment to this PROFESSIONAL SERVICES AGREEMENT in accordance
with Section 6. Such termination shall not be effective if that substantial failure has been remedied before expiration of the period specified in the written notice. In the event of
termination, ATEK shall be paid for services performed to the termination notice date plus reasonable termination expenses.
2.
In the event of termination or suspension for more than three (3) months prior to completion of all reports contemplated by this PROFESSIONAL SERVICES AGREEMENT,
ATEK may complete such analyses and records as are necessary to complete ATEK's Project files and may also complete a report on the services performed to the date of
notice of termination or suspension. The expenses of termination or suspension shall include all direct costs of ATEK in completing such analyses, records and reports.
SECTION 11 - ENTIRE AGREEMENT
1.
This PROFESSIONAL SERVICES AGREEMENT along with the exhibits and/or proposals appended hereto constitute the entire PROFESSIONAL SERVICES AGREEMENT of
the parties with respect to the subject matter hereof.
2.
The Parties have read the foregoing, understand completely the terms and conditions, and willingly enter into this PROFESSIONAL SERVICES AGREEMENT which will become
effective on the date signed by the CLIENT in the “acceptance” field in the proposal.
Chandler Heights Road Construction Management: Hours Schedule
1/16/2022
J2 Engineering and Environmental Design, LLC
Task
Number
Task:
Senior
Project
Landscape
Architect
Project
Landscape
Architect
Landscape
Designer
Administrative
Staff
Total
2
C
2.3 (i)
CM Consultant shall review and respond to contractor
Requests
for
Information
(RFI's).
CM
Consultant
assumes
a
maximum
of
six
(6)
RFI's
relating
to
landscape and landscape irrigation.
2
6
4
0
12
D
2.4 (i)
CM Consultant shall review contractor shop drawing
submittals
and
provide
comments.
CM
Consultant
assumes a maximum of six (6) submittal reviews
relating to landscape and landscape irrigation.
4
8
6
0
18
3
B
3.2 (i)
CM Consultant shall provide administrative effort for
DBE reporting and federal compliance requirements
monthly for the J2 scope of work.
0
0
0
18
18
4
B
4.2 (i)
CM Consultant shall provide irrigation system layout
and installation observations including irrigation
pressure tests. CM Consultant assumes six (6) site
visits.
4
14
6
0
24
4.2 (ii)
CM Consultant shall attend nursery visits (multiple
locations) to inspect and tag plant material. CM
Consultant assumes two (2) nursery visits within a 65-
mile radius of the site. Task includes photo summary of
tagged plant materials.
4
12
0
0
16
4.2 (iii)
CM Consultant shall review plant material staking
layout (flagged locations). CM Consultant assumes
eight (8) landscape layout site visits.
0
16
8
0
24
C
4.3 (i)
CM Consultant shall schedule and conduct substantial
completion inspection.
0
8
8
0
16
Construction Administration
Task 3.2 Administrative Support
Task 4.3 Project Closeout
Construction Management
Task 2.3 Requests for Information (RFI's)
Task 2.4 Shop Drawing Submittals
Construction Inspection
Task 4.2 Landscape / Irrigation Inspection Services
Man Hours
J2 Fee Ch Hts 01-17-22.xls
Chandler Heights Road Construction Management: Hours Schedule
1/16/2022
J2 Engineering and Environmental Design, LLC
Task
Number
Task:
Senior
Project
Landscape
Architect
Project
Landscape
Architect
Landscape
Designer
Administrative
Staff
Total
4.3 (ii)
CM Consultant shall prepare substantial completion
punch list generated from substantial completion
inspection. CM Consultant shall track items on the
punch list and note the completed items.
2
4
4
0
10
4.3 (iii)
CM Consultant shall schedule and conduct final
completion inspection.
0
6
6
0
12
A
7.1 (i)
Review Contractor's red-line drawing set through the
construction efforts.
3
3
7.1 (ii)
Consultant shall transfer red-line comments to City's
construction plans. Consultant shall provide landscape
architect stamp on cover sheet. (No cad work is
included in this scope).
1
5
6
7.1 (iv)
Consultant shall deliver record drawings to the City.
Submittal shall include full size copy of each sheet and
digital copies(PDF) of each sheet. (No cad work is
included in this scope).
3
3
Grand Total Hours:
16
78
50
18
162
Task 7.1 Record Drawings
Man Hours
J2 Fee Ch Hts 01-17-22.xls
January 11, 2022
Keith L. Drunasky, PE
Email: kdrunasky@rpaeng.com
Senior Project Manager/Ambassador
RPA
1001 North Central Avenue, Suite 900
Phoenix, AZ 85004
623.910.9112
Re:
Chandler Heights Road Improvements Scope and Fee
(McQueen Road to Gilbert Road)
Project No. ST1614.401 - Federal No. CHN-0(240)D - ADOT No. T009901C
CEI Project No: 01220001.00
Dear Mr. Drunasky:
Consultant Engineering Inc. (CEI) is pleased to be part of your Construction Management team with the City of Chandler for
ST1614.401 Chandler Heights Road CM: McQueen to Gilbert. We kindly submit our work scope and fee proposal for your review
and consideration.
WORK SCOPE:
CM CONSULTANT/CEI shall provide administrative support to City staff for federal reporting requirements. CM CONSULTANT
assumes 20 hours per week. Administrative support services shall include but not limited to:
•
Review contractors’ certified payrolls in LCP tracker for labor compliance with Davis-Bacon and Related Act, including
researching possible violations, and working with contractor to resolve a reporting dispute
•
Maintain certified payroll and employee interview tracking logs
•
Verify the inspectors’ employee interviews with the certified payroll for labor compliance
•
Review the monthly DBE reporting in the LPA DBE System (B2Gnow) for the contractor
verify and maintain contractor subcontracts
FEE PROPOSAL:
Enclosed please find our cost proposal. The proposal is based on the above-mentioned scope of work at 20 hours/week effort.
We appreciate the opportunity to assist RPA in the construction management of this project. If you have any questions please
feel free to contact me at 480.258.4829 or mosman@cei-az.com. CEI looks forward to working with you and the City of
Chandler on this work assignment.
Sincerely,
CONSULTANT ENGINEERING, INC.
Maher N. Osman, P.E.
Executive Vice President
Attachments:
CEI Fee Schedule
cc:
Contract Administration (CEI #01220001.00)
40
ARIZONA
TEXAS
NEW MEXICO
OKLAHOMA
3610 N 44th Street, Suite 100, Phoenix, AZ 85018
(602) 618-0406 | www.leeengineering.com
Page 1 of 2
CONSTRUCTION MANAGEMENT ASSISTANCE
TRAFFIC ENGINEERING
SCOPE OF WORK
Chandler Heights Road Improvements (McQueen Rd to Gilbert Rd)
Lee Engineering (LEE) will serve as a subconsultant to Ritoch-Powell and Associates (RPA) for the
traffic engineering components of the Construction Management services being provided for the
project to provide improvements on Chandler Heights Road (McQueen Rd to Gilbert Rd), based on
design plans by others. This project uses Federal funds.
The Chandler Heights Road project will provide at least four thru lanes, turn lanes, bike lanes, raised
landscaped median, curb, gutter, and sidewalk, including ADA upgrades, traffic signals, LED street
light, storm drainage, irrigation, wet utilities, including rehabilitation, and dry utilities, including
extension of fiber. Anticipated traffic engineering elements include signing and pavement markings,
traffic signals, signal interconnect and street lighting.
The general scope of effort for Lee Engineering will be to review equipment submittals, address field
issues & adjustments, generally related to field conditions. Lee Engineering will not provide or be
responsible for daily inspection services, but will conduct field visits and participate in issue
resolutions upon request by RPA, as described in the following Scope of Work. The original
designers will remain in the process to conduct any necessary plan revisions caused by any such
issues mitigation.
Scope of Work:
1.
PRE-CONSTRUCTION ASSISTANCE
1.1 MEETINGS
1.1.1 Preconstruction Meetings
1.1.1.1 LEE will attend a virtual the Preconstruction Meeting.
2.
CONSTRUCTION MANAGEMENT
2.1 Weekly Construction Meetings
2.1.1 LEE will not be required to attend any weekly construction meetings.
2.2 Requests for Information (RFI’s)
2.2.1 LEE will review, evaluate, and respond to up to six (6) Contractor Requests for
Information (RFI’s). LEE assumes a total of two RFIs will require field visits, in
Page 2 of 2
Chandler.
2.3 Shop Drawing Submittals
2.3.1 LEE will review, evaluate, and respond to Contractor shop drawing submittals.
LEE assumes a maximum of four (4) submittals.
2.4 Field Directives (FD’s)
2.4.1 LEE will provide RPA input for the preparation of any Field Directive (FD)
documents detailing requested additional work tasks associated with any traffic
engineering elements, review and evaluate Contractor FD responses and
provide recommendations to RPA to be formalized by RPA. LEE assumes a
maximum of two (2) FD’s.
3.
CONSTRUCTION INSPECTION
3.1 Inspection Services
3.1.1 Upon request and direction by RPA, LEE participate in a pre-Substantial
Completion construction inspection of traffic engineering elements to verify
materials and installations conform to construction documents.
3.2 Project Closeout
3.2.1 LEE will provide input for a substantial completion punch list generated from
substantial completion inspection.
ASSUMPTION, CLARIFICATIONS, AND EXCLUSIONS
1.
Application fees for City reviews and permits will be paid by CITY.
2.
The Owner’s Allowance will only be utilized with prior written approval from the City
representative.
3.
The Direct Expense Allowance will be used for normal reimbursable expenses on the project.
Items must be billed at cost and backup must be provided with pay applications.
1/13/2022
1
CONSTRUCTION MANAGEMENT
SCOPE OF SERVICES
CHANDLER HEIGHTS ROAD (McQUEEN RD TO GILBERT RD)
PROJECT TASKS
1.
PRE-CONSTRUCTION ASSISTANCE
A. Task 1.1 Preconstruction Assistance
i. Consultant will attend the pre-construction meeting. Consultant will
coordinate with Ritoch-Powell, City, and Contractor before and after the
meeting.
ii. Consultant will attend the pre-construction public meeting. Consultant will
coordinate with the Public Outreach Consultant before and after the meeting.
iii. Consultant will attend one (1) coordination meeting with the Public Outreach
Consultant to review improvements and properties requiring specific outreach
efforts.
iv. Consultant will perform a review of all construction documents for familiarity
and for general conformance with City requirements.
2.
CONSTRUCTION MANAGEMENT
A. Task 2.1 Weekly Construction Meetings
i. Consultant will conduct weekly construction meetings. Consultant assumes
eighty (80) weekly meetings will be held.
B. Task 2.2 CPM Schedule
i. Consultant will review and evaluate Contractor’s initial CPM schedule and
provide recommendations for acceptance.
ii. Consultant will review Contractor’s monthly CPM schedule updates submitted
with each payment application, identify CPM tasks behind schedule that may
affect critical path items, project substantial and final completion dates and
initiate correspondence to City regarding those tasks. Consultant assumes
eighteen (18) reviews of updated CPM schedule.
C. Task 2.3 Requests for Information (RFI’s)
i. Consultant will review, evaluate, and respond to Contractor Requests for
Information (RFI’s). Consultant assumes a maximum of seventy-five (75) RFI
responses. Any orders authorizing variations from the Contract Documents
will be made only by Client.
D. Task 2.4 Shop Drawing Submittals
i. Consultant will review, evaluate, and respond to Contractor shop drawing
submittals. Consultant assumes a maximum of forty-five (45) reviews.
Consultant will review and take appropriate action in respect to Shop Drawings
and Samples and other data which Contractor is required to submit, but only
for general conformance with the Contract Documents. Such review and
action will not extend to means, methods, techniques, equipment choice and
usage, schedules, or procedures of construction or to related safety programs.
Any action in response to a shop drawing will not constitute a change in the
Contract Documents, which can be changed only through the Change Orders.
1/13/2022
2
E. Task 2.5 Requests for Proposal (RFP)
i. Consultant will prepare Requests for Proposal (RFP) documents detailing
requested additional work tasks; review and evaluate Contractor RFP
responses (cost derivations) with approval recommendations. Consultant
assumes a maximum of twenty (20) RFPs.
ii. Consultant will review Contractor Time and Materials (T&M) cost submittals
and provide recommendations for approval. Consultant assumes a maximum
of twenty (20) T&Ms, with two (2) reviews each.
F. Task 2.6 Field Directives (FD’s)
i. Consultant will prepare Field Directive (FD) documents detailing requested
additional work tasks; review and evaluate Contractor FD responses with
approval recommendations. Consultant assumes a maximum of seventy-five
(75) FD’s.
G. Task 2.7 Contractor Payment Applications
i. Consultant will review and evaluate Contractor monthly payment applications
and make recommendation for payment; and coordinate payment application
with the City quantity report and the inspectors’ daily logs. Consultant
assumes a maximum of eighteen (18) payment applications, with two (2)
reviews each. Recommendations will be based on Consultant’s knowledge,
information and belief, and will state whether in Consultant’s opinion
Contractor’s work has progressed to the point indicated, subject to any
qualifications stated in the recommendation. Consultant’s recommendations
will not be a representation that its observations to check Contractor's work
have been exhaustive, extended to every aspect of Contractor's work, or
involved detailed inspections.
H. Task 2.8 Public Outreach
i. Consultant will coordinate with City and Ritoch-Powell for public outreach
services.
3.
CONSTRUCTION ADMINISTRATION (NOT USED)
4.
CONSTRUCTION OBSERVATION
A. Task 4.1 Observation Services
i. Consultant will provide supplemental construction observation and site visits
to review construction progress and construction issues. Consultant assumes
two (2) site visits per week for three (3) hours per visit for eighty (80) weeks.
Consultant will make these visits to observe the progress of the work.
Observations will not be exhaustive or extend to every aspect of Contractor's
work, but will be limited to spot checking, and similar methods of general
observation. Based on the site visits, Consultant will evaluate whether
Contractor's work is generally proceeding in accordance with the Contract
Document and keep Client informed of the general progress of the work
B. Task 4.2 Project Closeout
i. Consultant will review non-conformance list prior to Substantial Completion;
schedule and conduct Substantial Completion inspection; prepare Substantial
Completion punch list generated from Substantial Completion inspection;
track items on punch list and note completed items; and complete and
distribute Substantial Completion certificates.
1/13/2022
3
ii. Consultant will schedule and conduct Final Completion inspection; and
complete and distribute Final Completion certificates.
5.
UTILITY COORDINATION
A. Task 5.1 Utility Coordination
i. Consultant will coordinate with utility representatives to schedule new
service connections and necessary relocations, including but not limited to
SRP and RWCD.
6.
MATERIALS TESTING
A. Task 6.1 Quality Control (QC) Test Program
i. Consultant will review and verify Contractor’s Quality Control material test
type and frequencies are consistent with City, MAG, and ADOT requirements;
review
and
evaluate
Contractor’s
QC
test
schedule
and
provide
recommendations on acceptance; and review and evaluate all Contractor
sampling, test, and inspection results for conformance with construction
documents.
B. Task 6.2 Quality Assurance (QA) Test Program
i. Consultant will review the materials Quality Assurance plan per City, MAG, and
ADOT requirements. QA plan will be reviewed and approved by ADOT prior to
initiating construction activities. QA testing, material certification, and cover
letter will be reviewed and approved by ADOT after all testing has been
completed.
ii. Consultant will review QA testing is consistent with Contractor’s QC testing
results.
C. Task 6.3 Material Certifications
i. Consultant will review and verify material certifications are met including “Buy
America” requirements.
D. Task 6.4 Independent Assurance (IA) Test Program
i. Consultant will review QA testing is consistent with Contractor’s QC testing
results.
7.
RECORD DRAWINGS
A. Task 7.1 Record Drawings
i. Review and monitor Contractor’s weekly updates on red-line drawing set.
ii. Review Record drawings prepared by Contractor and Design Team.
8.
PROJECT MANAGEMENT
A. Task 8.1 Project Monitoring
i. Consultant will prepare regular monthly progress reports
ii. Consultant will perform regular budget monitoring
iii. Pay applications will be submitted monthly. Invoices will be broken down to the
same level of detail as the attached fee schedule.
1/13/2022
4
ASSUMPTION, CLARIFICATIONS, AND EXCLUSIONS
1.
Application fees for City reviews and permits will be paid by CITY.
2.
The following items are excluded from this scope of work:
a. Special Inspections
b. Aerial Mapping and photography
c. Environmental Investigation
d. Potholing and survey for potholing
e. Private and public utility relocation design
f. Drainage analysis or design
g. Pavement design
h. Federal compliance administration support
i.
GIS survey or data processing
j.
Traffic Control review and approval
3.
The Owner’s Allowance will only be utilized with prior written approval from the City
representative.
4.
The Direct Expense Allowance will be used for normal reimbursable expenses on the project.
Items will be billed at cost and backup will be provided with pay applications.
5.
Kimley-Horn’s understanding is that Kimley-Horn will provide Resident Engineer services and
oversight for each of the tasks mentioned in this scope. Detailed reviews, logs, and minutes
will be completed by Ritoch-Powell.
6.
Consultant will not supervise, direct, or have control over the Contractor’s work, nor shall the
Consultant have authority to stop the work or have responsibility for the means, methods,
techniques, equipment choice and usage, schedules, or procedures of construction selected
by the Contractor, for safety programs incident to Contractor’s work, or for any failure of
Contractor to comply with any laws.
7.
Consultant does not guarantee the performance of any Contractor and has no responsibility
for the Contractor’s failure to perform its work in accordance with the Contract Documents.
City of Chandler Professional Services Agreement – Exhibit “B”
Page B-1
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
EXHIBIT “B”
COMPENSATION AND FEES
Updated 1/17/2022 8:41 AM
PHOENIX: 5727 N. 7th Street, Suite 120, Phoenix, AZ 85014 | P: 602-263-1177 | F: 602-277-6286
MESA: 63 E. Main Street, Suite 502, Mesa, AZ 85201 | P: 480-539-7497 | F: 480-539-2810
www.rpaeng.com
Sheet 1 of 3
CLASSIFICATION
MAN HOURS
UNIT
UNIT RATE
QUANTITY
TOTAL
1
Miles
0.54
$
3600
1,944.00
$
Project Manager
0
2
-
$
3
-
$
Project Manager
103
4
-
$
5
-
$
Engineer, Sr/Construction Manager
1,159
Project Engineer
96
Printing (8-1/2" x 11")
Each
0.10
$
-
$
Printing (11" x 17")
Each
0.15
$
-
$
Designer - Sr.
2,480
Bond Large Format
Each
1.44
$
-
$
Mylar Large Format
Each
12.14
$
-
$
Inspector
5,639
Exhibits
Each
250.00
$
-
$
Deliveries/Postage
Each
50.00
$
-
$
Registered Land Surveyor
0
1,944.00
$
Survey Tech/Operator 2
0
SUBCONSULTANT
TASK
FEE
2-Person Survey Crew
0
1
211,484.00
$
2
15,580.00
$
Project Coordinator
508
3
17,940.00
$
4
45,000.00
$
0
0
5
293,760.00
$
6
8,306.00
$
0
0
7
374,074.16
$
8
-
$
9
-
$
Overhead Rate
178.04%
10
-
$
Fixed Capital Cost of Money (FCCM)
0.00%
966,144.16
$
Fixed Fee
10%
CONSULTANT/EXPENSES
TASK
FEE
1
46,000.00
$
2
50,000.00
$
3
-
$
4
-
$
5
-
$
96,000.00
$
LUMP SUM
X
TIME AND MATERIALS
600
(CALENDAR DAYS)
X
SOLICITATION / DIRECT SELECT
ON-CALL TASK ORDER
N/A
Signature
Date
49.50
$
(ON-CALL CONTRACT NO.)
SUBTOTAL ALLOWANCES
FEE
2018 Fed Fund Audit ALCP
(RPA RATE TABLE NAME)
CONTRACT DURATION
PROCUREMENT METHOD
Total Contract Fee & Allowances
2,351,150.56
$
Subtotal Subconsultants
Total Contract Fee
Subtotal Allowances
1,287,062.40
$
1,944.00
$
966,144.16
$
2,255,150.56
$
96,000.00
$
Subtotal Contract Labor
Subtotal Direct and Outside Expenses
68.97
$
68.97
$
-
$
-
$
-
$
81,889.60
$
237,232.73
$
-
$
7,103.91
$
63.51
$
39.65
$
20.37
$
COST PROPOSAL SUMMARY
PROJECT NAME:
FEDERAL PROJECT NO.:
PROJECT NO.:
HOURLY RATES
LABOR COSTS
CONTRACT LABOR
DIRECT AND OUTSIDE EXPENSES
TRACS NO.:
Chandler Heights Improvments (McQueen Road to Gilber Road)
ST1614.451
CHN-0(240)D
T009901C
DESCRIPTION
43.50
$
33.02
$
42.07
$
-
$
-
$
TOTAL DIRECT LABOR
SUBTOTAL CONTRACT LABOR
420,823.17
$
1,287,062.40
$
4,176.00
$
749,233.56
$
117,005.67
$
OVERHEAD
CONTRACT TERMS
PAYMENT METHOD
Personal Vehicle Mileage
REPRODUCTIONS - AT COST (Estimates Only)
73,611.21
$
16,809.72
$
-
$
-
$
ATEK
RAMM
J2
Makpro
CEI
Lee
Kimley Horn
SUBTOTAL DIRECT AND OUTSIDE EXPENSES
SUBCONSULTANTS FEE
QA Testing
Additional Services
FCCM
-
$
SUBTOTAL SUBCONSULTANTS FEE
ALLOWANCES
PROCORE
Software Lease (1 year)
IA Testing
Landscape / Irrigation
Public Outreach
Federal Admin Assist
Traffic
Resident Engineer
33.09
$
Updated 1/17/2022 8:41 AM
PHOENIX: 5727 N. 7th Street, Suite 120, Phoenix, AZ 85014 | P: 602-263-1177 | F: 602-277-6286
MESA: 63 E. Main Street, Suite 502, Mesa, AZ 85201 | P: 480-539-7497 | F: 480-539-2810
www.rpaeng.com
Sheet 2 of 3
# of Sheets
Project Manager
Project Manager
Engineer,
Sr/Construction
Manager
Project
Engineer
Designer - Sr.
Inspector
Registered Land
Surveyor
Survey
Tech/Operator 2
2-Person
Survey Crew
Project
Coordinator
Hourly Rate
68.97
$
68.97
$
63.51
$
43.50
$
33.02
$
42.07
$
39.65
$
20.37
$
49.50
$
33.09
$
-
$
-
$
1
PRE-CONSTRUCTION ASSISTANCE
1.1
Pre-Construction Assistance
0
$0.00
i
Pre-Construction Meeting
4
4
4
4
16
$686.77
ii
Pre-Construction Public Meeting
6
6
6
18
$831.62
iii
Public Outreach Coordination Meeting
4
6
4
14
$620.45
0
0
14
0
16
14
0
0
0
4
0
0
48
$2,138.84
2
CONSTRUCTION MANAGEMENT
2.1
Weekly Construction Meetings
0
$0.00
i
Conduct Weekly Construction Meetings
60
150
200
410
$20,269.10
ii
Prepare Agenda and Minutes
40
160
120
320
$11,794.51
2.2
CPM Schedule
0
$0.00
i
Review Baseline CPM schedule
10
12
22
$1,031.37
ii
Review Monthly CPM Schedule Updates
160
160
$10,162.03
2.3
Requests for Information (RFI's)
0
$0.00
i
Review and Respond to RFI's
40
120
160
$6,502.91
ii
Prepare and Maintain RFI Log
80
80
$2,641.60
2.4
Shop Drawing Submittals
0
$0.00
i
Review Shop Drawing Submittals
23
90
113
$4,432.59
ii
Prepare and Maintain Shop Drawing Log
45
45
$1,485.90
2.5
RFPs, T&Ms & FDs
0
$0.00
i
Prepare & review RFP Documents
30
60
90
$3,886.58
ii
Review Contractor T&M Submittals
20
60
80
$3,251.45
ii
Prepare & review FDs
38
150
188
$7,366.48
iV
Prepare and Maintain RFP, T&M, FD & AUR
Logs
160
160
$5,283.20
2.6
Contractor Payment Applications
0
$0.00
i
Review Monthly Payment Applications
36
80
116
$4,928.06
ii
Maintain Weekly Record of Pay Qtys
40
40
$1,320.80
iii
Coordinate with City Qty Report
26
26
$858.52
2.7
Public Outreach
0
$0.00
i
Public Outreach Assistance
ii
Public Outreach Services
64
56
128
248
$11,298.89
0
60
611
0
1,339
128
0
0
0
120
0
0
2,258
$96,513.99
3
CONSTRUCTION ADMINISTRATION
3.1
Federal Compliance Administration
36
36
$1,191.24
3.2
Administrative Support
0
0
0
0
0
0
0
0
0
0
36
0
0
36
$1,191.24
4
CONSTRUCTION INSPECTION
4.1
Inspection Services
0
$0.00
i
Weekly Construction Inspection
213
425
4,960
5,598
$236,228.90
ii
Prepare Daily Inspection Reports
128
128
$5,384.96
iii
Perform Erosion Control Inspection
255
255
$10,727.85
4.2
Landscape / Irrig Inspection Services
0
$0.00
i
Observe Irrig System Layout and Install
0
ii
Observe Irrig System Pressure Tests
0
$0.00
iii
Attend Nursery Visit to Tag Plant Material
0
$0.00
4.3
Project Closeout
0
$0.00
i
Conduct Substantial Complete Inspection
12
12
12
36
$1,663.23
ii
Prepare Substantial Punch List
12
12
24
$901.08
iii
Conduct Final Complete Inspection
8
8
$336.56
iv
Substantial and Final Complete Certificates
6
6
2
8
22
$928.06
0
0
231
0
455
5,377
0
0
0
8
0
0
6,071
$256,170.64
5
UTILITY COORDINATION
5.1
Utility Coordination
0
$0.00
i
Coordinate New Services and Relocates
48
32
80
$3,144.64
ii
MCESD AOC Application
1
4
8
2
15
$567.85
Total Hours By
Task
Task
Description
SUBTOTAL CONSTRUCTION ADMINISTRATION
SUBTOTAL CONSTRUCTION INSPECTION
SUBTOTAL CONSTRUCTION MANAGEMENT
SERVICES TO BE PERFORMED BY J2
SERVICES TO BE PERFORMED BY CEI
SERVICES TO BE PERFORMED BY MAKPRO
Total Cost By
Task
DERIVATION OF COST PROPOSAL SUMMARY
SUBTOTAL PRE-CONSTRUCTION ASSISTANCE
Updated 1/17/2022 8:41 AM
PHOENIX: 5727 N. 7th Street, Suite 120, Phoenix, AZ 85014 | P: 602-263-1177 | F: 602-277-6286
MESA: 63 E. Main Street, Suite 502, Mesa, AZ 85201 | P: 480-539-7497 | F: 480-539-2810
www.rpaeng.com
Sheet 3 of 3
# of Sheets
Project Manager
Project Manager
Engineer,
Sr/Construction
Manager
Project
Engineer
Designer - Sr.
Inspector
Registered Land
Surveyor
Survey
Tech/Operator 2
2-Person
Survey Crew
Project
Coordinator
Hourly Rate
68.97
$
68.97
$
63.51
$
43.50
$
33.02
$
42.07
$
39.65
$
20.37
$
49.50
$
33.09
$
-
$
-
$
Total Hours By
Task
Task
Description
Total Cost By
Task
DERIVATION OF COST PROPOSAL SUMMARY
0
0
1
52
40
0
0
0
0
2
0
0
95
$3,712.49
6
MATERIALS TESTING AND QUALITY
ASSURANCE
6.1
QC Test Program
0
$0.00
i
Review QC Test Type and Frequency
2
6
8
$325.15
ii
Review QC Test Schedule
1
4
4
9
$369.59
iii
Review Weekly Results for Conformance
40
80
120
$4,381.60
6.2
QA Test Program
0
$0.00
i
Prepare and Maintain Material QA Plan
6
40
46
$1,701.88
ii
Coordinate IA Testing and Sampling
20
20
40
$1,930.65
iii
Coordinate QA Testing and Sampling
0
iv
Complete Subrade, AB, AC Testing
0
$0.00
v
Complete Concrete Testing
0
$0.00
vi
Complete Utility Backfill Testing
0
$0.00
6.3
Material Certifications
0
$0.00
i
Review and Verify Material Certifications
20
200
220
$7,874.25
ii
Prepare and Maintain Material Cert Log
80
80
$2,641.60
6.4
IA Test Program
0
$0.00
i
3rd Party IA Testing
0
0
0
49
44
430
0
0
0
0
0
0
0
523
$19,224.72
7
RECORD DRAWINGS
7.1
Record Drawings
0
$0.00
i
Review and Monitor Contractor Redlines
40
200
120
360
$14,192.91
0
0
40
0
200
120
0
0
0
0
0
0
360
$14,192.91
8
PROJECT MANAGEMENT
8.1
Project Monitoring
21
85
170
277
$12,541.22
8.2
Manage Sub-Consultants
21
128
168
317
$15,137.11
0
43
213
0
0
0
0
0
0
338
0
0
594
$27,678.33
0
103
1,159
96
2,480
5,639
0
0
0
508
0
0
9,985
-
$
7,103.91
$
73,611.21
$
4,176.00
$
81,889.60
$
237,232.73
$
-
$
-
$
-
$
16,809.72
$
-
$
-
$
420,823.17
$
Total Hours
Total Dollars
SUBTOTAL UTILITY COORDINATION
SUBTOTAL MATERIALS TESTING AND QUALITY
ASSURANCE
SUBTOTAL RECORD DRAWINGS
SUBTOTAL PROJECT MANAGEMENT
SERVICES TO BE PROVIDED BY ATEK
SERVICES TO BE PROVIDED BY RAMM
ATEK Proposal No.: 220009
Service
Fee
950
hours @
$58.00 /hour
$55,100.00
24
tests @
$115.00 /test
$2,760.00
24
tests @
$72.00 /test
$1,728.00
8
tests @
$112.00 /test
$896.00
8
tests @
$70.00 /test
$560.00
16
tests @
$145.00 /test
$2,320.00
4
tests @
$88.00 /test
$352.00
3300
miles @
$0.58 /mile
$1,897.50
$65,613.50
300
hours @
$58.00 /hour
$17,400.00
( 60
4 )
240
tests @
$19.00 /test
$4,560.00
1800
miles @
$0.58 /mile
$1,035.00
$22,995.00
360
hours @
$58.00 /hour
$20,880.00
45
tests @
$175.00 /test
$7,875.00
45
tests @
$170.00 /test
$7,650.00
45
tests @
$190.00 /test
$8,550.00
8
tests @
$565.00 /test
$4,520.00
201
tests @
$30.00 /test
$6,030.00
10
tests @
$83.00 /test
$830.00
10
tests @
$88.00 /test
$880.00
10
tests @
$99.00 /test
$990.00
4
tests @
$132.00 /test
$528.00
1500
miles @
$0.58 /mile
$862.50
$59,595.50
$148,204.00
350
hours @
$95.00 /hour
$33,250.00
270
hours @
$50.00 /hour
$13,500.00
144
hours @
$110.00 /hour
$15,840.00
1200
miles @
$0.58 /mile
$690.00
$63,280.00
$211,484.00
Estimate for Site Work Services
Gyratory Bulk Density (Specific Gravity)
Ignition & Gradation of Bituminous
Subtotal
AC Unit Weight & Thickness (Per Core)
Fractured Coarse Aggregate Particles
Project Technician
Fee Estimate for Chandler Heights Rd McQueen Rd to Gilbert Rd
Max.Theoretical Specific Gravity (Rice)
Asphalt Services
Concrete Services-Site Work
Project Technician
Subtotal
Unit
Rate
Estimated
Units
One Dimensional Expansion-Remolded
Professional
Services
Vehicle Mileage
Subtotal
Project Total Estimate
Project Management/Coordination Services
Project Manager
Project Coordinator
Project Engineer
Project Management & Coordination Services
Vehicle Mileage
Subtotal
Field Density Testing-Site Utilities & Pavement Areas
Standard Proctor
Sieve Analysis
Atterberg Limits (PI) (Dry)
Atterberg Limits (PI) (Wet)
Project Technician
sets of
Concrete Comp. Strength
Vehicle Mileage
Vehicle Mileage
Ignition Oven Calibration Facor
Sand Equivalent
Fractured Coarse Aggregate Particles
Uncompacted Voids
Percent Carbonates
111 SOUTH WEBER DRIVE, SUITE 1
CHANDLER, AZ 85226
WWW.ATEKEC.COM
P (480) 659-8065
F (480) 656-9658
Page 2
City of Chandler
Chandler Heights Road Improvements
(McQueen Road to Gilbert Road)
Project No. ST1614.401
Federal No. CHN-0(240)D
ADOT No. T009901C
Title
Hourly Billing Rate
Total Hours
40 hours per week X 72
weeks)
Total Cost
Federal Compliance Administrative Support
$102.00
2,880
$293,760
Construction Mgmnt Assistance - Traffic Engineering
Chandler Heights Road (McQueen Rd to Gilbert Rd)
1/7/2022
Dave
TOTAL
TOTAL
TASKS:
Bruggeman
Clerical
HOURS
DOLLARS
1. Attend Preconstruction Meeting
2
2
$165.00
2. Attend Select Construction Meetings (0)
3. Respond to RFIs (6)
12
12
$990.00
4. Review Equipment Submittals (4)
8
8
$660.00
5. Provide Input to FDs (2)
4
4
$330.00
6. Punch List Inspection & Input
4
4
$330.00
TOTAL HOURS:
30
30
Hourly Rate:
$82.50
TOTAL DOLLARS:
$2,475.00
$2,475.00
Overhead at 201.54%
$4,988.12
Subtotal:
$7,463.12
Fee @ 10%:
$746.31
Subtotal:
$8,209.43
Direct Expenses:
Mileage @ $ 0.575/Mile
$96.60
TOTAL:
$8,306
NOTES:
1. Hourly rate taken from ADOT Contract No. 2018-006.08, Project Development On-Call.
1/13/2022
Project Name
Chandler Heights Road Construction Management
7740 N. 16th Street
Suite 300
Phoenix, AZ 85020
602.944.5500
CONTRACT LABOR
Classification
Man Hours
Billable Rates
Labor Costs
Sr Project Manager/Professional II
0
64.77
$
-
$
Senior Professional I
1,871
60.15
$
112,540.65
$
Professional
0
53.98
$
-
$
Analyst
0
43.18
$
-
$
Designer
0
38.55
$
-
$
Administrative
40
24.67
$
986.80
$
Total Direct Labor
113,527.45
$
Overhead Rate
1.94%
Total Labor and Overhead
220,765.48
$
Fixed Capital Cost of Money
0.31%
Fixed Capital Cost of Money
351.94
$
Fixed Fee
10%
Net Fee (Subtotal x 10% Fixed Fee)
33,429.29
$
Subtotal Contract Labor
368,074.16
$
DIRECT AND OUTSIDE EXPENSES
General Expenses
6,000.00
$
Subtotal Direct & Outside Expenses
6,000.00
$
TOTALS
Subtotal Contract Labor
368,074.16
$
Direct & Outside Expenses
6,000.00
$
Total Contract Fee
374,074.16
$
Detail of Consultant's Compensation
Chandler Heights Road Construction Management
January 13th, 2022
Sr. PM/Prof II
Sr. Prof.
Prof.
Analyst
Designer
Admin.
TASK DESCRIPTION
SUBTOTAL
$ 64.77 $ 60.15
$ 53.98
$ 43.18
$ 38.55
$ 24.67
1 - PRE-CONSTRUCTION ASSISTANCE
4,331
$
-
72
-
-
-
-
1.1.1 Preconstruction Meeting
361
$
6
1.1.2 Preconstruction Public Meeting
361
$
6
1.1.3 Public Outreach Coordination Meeting
361
$
6
1.1.4 Construction Document Review
3,248
$
54
2 - CONSTRUCTION MANAGEMENT
58,586
$
-
974
-
-
-
-
2.1 Weekly Construction Meetings
16,842
$
280
2.2 CPM Schedule
3,248
$
54
2.3 Requests for Information (RFI)
6,917
$
115
2.4 Shop Drawing Submittals
2,707
$
45
2.5.1 Requests for Proposal (RFP)
3,609
$
60
2.5.2 Time & Materials (T&M)
3,008
$
50
2.6 Field Directives (FD)
11,429
$
190
2.7 Contractor Payment Applications
4,331
$
72
2.8 Public Outreach
6,496
$
108
3 - CONSTRUCTION ADMINISTRATION (NOT USED)
-
$
-
-
-
-
-
-
4 - CONSTRUCTION OBSERVATION
31,278
$
-
520
-
-
-
-
4.1 Observation Services
28,872
$
480
4.2 Project Closeout
2,406
$
40
5 - UTILITY COORDINATION
6,496
$
-
108
-
-
-
-
5.1 Utility Coordination
6,496
$
108
6 - MATERIALS TESTING
7,038
$
-
117
-
-
-
-
6.1 Quality Control (QC) Test Program
1,805
$
30
6.2 Quality Assurance (QA) Test Program
902
$
15
6.3 Material Certifications
3,850
$
64
6.4 Independent Assurance (QA) Test Program
481
$
8
7 - RECORD DRAWINGS
2,406
$
-
40
-
-
-
-
7.1 Record Drawings
2,406
$
40
8 - Project Management
3,393
$
-
40
-
-
-
40
8.1 Project Management and Project Monitoring
3,393
$
40
40
SUBTOTAL DIRECT LABOR
113,527
$
0
1,871
0
0
0
40
City of Chandler Professional Services Agreement – Exhibit “C”
Page C-1
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev 10/28/2021
EXHIBIT “C”
INSURANCE REQUIREMENTS
1.
General.
1.1 At the same time as execution of this Agreement, Consultant must furnish City a certificate
of insurance on a standard insurance industry ACORD form. The ACORD form must be
issued by an insurance company authorized to transact business in the State of Arizona
possessing a current A.M. Best, Inc. rating of A-7, or better and legally authorized to do
business in the State of Arizona with policies and forms satisfactory to City. Provided,
however, the A.M. Best rating requirement will not be deemed to apply to required Workers’
Compensation coverage.
1.2 Consultant and any of its subconsultants must procure and maintain, until all of their
obligations have been discharged, including any warranty periods under this Agreement are
satisfied, the insurances set forth below.
1.3 The insurance requirements set forth below are minimum requirements for this Agreement
and in no way limit the indemnity covenants contained in this Agreement.
1.4 City in no way warrants that the minimum insurance limits contained in this Agreement are
sufficient to protect Consultant from liabilities that might arise out of the performance of
the Agreement services under this Agreement by Consultant, its agents, representatives,
employees, subconsultants, and Consultant is free to purchase any additional insurance as
may be determined necessary.
1.5 Failure to demand evidence of full compliance with the insurance requirements in this
Agreement or failure to identify any insurance deficiency will not relieve Consultant from,
nor will it be considered a waiver of its obligation to maintain the required insurance at all
times during the performance of this Agreement.
1.6 Use of subconsultants: If any work is subcontracted in any way, Consultant must execute a
written contract with subconsultant containing the same Indemnification Clause and
Insurance Requirements as City requires of Consultant in this Agreement. Consultant is
responsible for executing the Agreement with the subconsultant and obtaining Certificates
of Insurance and verifying the insurance requirements.
2.
Minimum Scope and Limits of Insurance. Consultant must provide coverage with limits of
liability not less than those stated below.
2.1 Professional Liability. If the Agreement is the subject of any professional services or work
performed by Consultant, or if Consultant engages in any professional services or work
adjunct or residual to performing the work under this Agreement, Consultant must maintain
Professional Liability insurance covering errors and omissions arising out of the work or
services performed by Consultant, or anyone employed by Consultant, or anyone whose
acts, mistakes, errors and omissions Consultant is legally liable, with a liability limit of
$1,000,000 each claim and $2,000,000 all claims. In the event the Professional Liability
City of Chandler Professional Services Agreement – Exhibit “C”
Page C-2
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev 10/28/2021
insurance policy is written on a “claims made” basis, coverage must extend for 3 years past
completion and acceptance of the work or services, and Consultant, or its selected Design
Professional will submit Certificates of Insurance as evidence the required coverage is in
effect. The Design Professional must annually submit Certificates of Insurance citing that the
applicable coverage is in force and contains the required provisions for a 3 year period.
2.2 Commercial General Liability-Occurrence Form. Consultant must maintain “occurrence” form
Commercial General Liability insurance with a limit of not less than $2,000,000 for each
occurrence, $4,000,000 aggregate. Said insurance must also include coverage for products
and completed operations, independent contractors, personal injury and advertising injury.
If any Excess insurance is utilized to fulfill the requirements of this paragraph, the Excess
insurance must be “follow form” equal or broader in coverage scope than underlying
insurance.
2.3 Automobile Liability-Any Auto or Owned, Hired and Non-Owned Vehicles
Vehicle Liability: Consultant must maintain Business/Automobile Liability insurance with a
limit of $1,000,000 each accident on Consultant owned, hired, and non-owned vehicles
assigned to or used in the performance of Consultant’s work or services under this
Agreement. If any Excess or Umbrella insurance is utilized to fulfill the requirements of this
paragraph, the Excess or Umbrella insurance must be “follow form” equal or broader in
coverage scope than underlying insurance.
2.4 Workers Compensation and Employers Liability Insurance: Consultant must maintain Workers
Compensation insurance to cover obligations imposed by federal and state statutes having
jurisdiction of Consultant employees engaged in the performance of work or services under
this Agreement and must also maintain Employers’ Liability insurance of not less than
$1,000,000 for each accident and $1,000,000 disease for each employee.
3.
Additional Policy Provisions Required.
3.1 Self-Insured Retentions or Deductibles. Any self-insured retentions and deductibles must be
declared and approved by City. If not approved, City may require that the insurer reduce or
eliminate any deductible or self-insured retentions with respect to City, its officers, officials,
agents, employees, and volunteers.
3.1.1. Consultant’s insurance must contain broad form contractual liability coverage.
3.1.2. Consultant’s insurance coverage must be primary insurance with respect to City, its
officers, officials, agents, and employees. Any insurance or self-insurance maintained
by City, its officers, officials, agents, and employees will be in excess of the coverage
provided by Consultant and must not contribute to it.
3.1.3. Consultant’s insurance must apply separately to each insured against whom claim is
made or suit is brought, except with respect to the limits of the insurer's liability.
City of Chandler Professional Services Agreement – Exhibit “C”
Page C-3
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev 10/28/2021
3.1.4. Coverage provided by Consultant must not be limited to the liability assumed under
the indemnification provisions of this Agreement.
3.1.5. The policies must contain a severability of interest clause and waiver of subrogation
against City, its officers, officials, agents, and employees, for losses arising from Work
performed by Consultant for City. (Does not apply to Professional Liability coverage.)
3.1.6. Consultant, its successors and or assigns, are required to maintain Commercial
General Liability insurance as specified in this Agreement for a minimum period of 3
years following completion and acceptance of the Work. Consultant must submit a
Certificate of Insurance evidencing Commercial General Liability insurance during this
3-year period containing all the Agreement insurance requirements, including
naming City of Chandler, its agents, representatives, officers, directors, officials and
employees as Additional Insured as required.
3.1.7. If a Certificate of Insurance is submitted as verification of coverage, City will
reasonably rely upon the Certificate of Insurance as evidence of coverage but this
acceptance and reliance will not waive or alter in any way the insurance requirements
or obligations of this Agreement.
3.2. Insurance Cancellation During Term of Contract/Agreement.
3.2.1. If any of the required policies expire during the life of this Agreement, Consultant
must forward renewal or replacement Certificates to City within 10 days after the
renewal date containing all the required insurance provisions.
3.2.2. Each insurance policy required by the insurance provisions of this Agreement must
provide the required coverage and must not be suspended, voided or canceled
except after thirty (30) days prior written notice has been given to City, except when
cancellation is for non-payment of premium, then ten (10) days prior notice may be
given. Such notice must be sent directly to Chandler Law-Risk Management
Department, Post Office Box 4008, Mailstop 628, Chandler, Arizona 85225. If any
insurance company refuses to provide the required notice, Consultant or its
insurance broker must notify City of any cancellation, suspension, non-renewal of any
insurance within seven (7) days of receipt of insurers’ notification to that effect.
3.3
City as Additional Insured. The policies are to contain, or be endorsed to contain, the following
provisions:
3.3.1. The Commercial General Liability and Automobile Liability policies are to contain, or
be endorsed to contain, the following provisions: City, its officers, officials, agents,
and employees are additional insureds with respect to liability arising out of activities
performed by, or on behalf of, Consultant; Products and Completed operations of
Consultant; and automobiles owned, leased, hired, or borrowed by Consultant.
3.3.2. City, its officers, officials, agents, and employees must be additional insureds to the
full limits of liability purchased by Consultant even if those limits of liability are in
excess of those required by this Agreement.
City of Chandler Professional Services Agreement – Affidavit of Lawful Presence
Page AFF-1
Public Works & Utilities Department, Capital Projects Division
Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 11/1/19
EXHIBIT “D”
SPECIAL CONDITIONS
Work within City's Right-of-Way. All work performed within City's Right-of-Way by Consultant
and Consultant’s subconsultants must comply with City of Chandler requirements.
E-1
City of Chandler Professional Services Agreement – Exhibit “E” Public Works & Utilities Department, Capital Projects
Division Project Name: CHANDLER HEIGHTS ROAD IMPROVEMENT (MCQUEEN ROAD TO GILBERT ROAD)
Project No.: ST1614.451; CHN-0(240)D; ADOT NO.: T009901C
Rev. 10/28/2021
EXHIBIT “E”
FEDERAL REQUIREMENTS
FEDERAL REQUIREMENTS
AND
DOCUMENTS / FORMS
FOR
SOQ - PROFESSIONAL SERVICES
DBE Goal 0% – Race Neutral
This is a federal funded contract with Federal Highway Administration (FHWA)
and must comply with all related federal requirements.
FEDERAL DOCUMENTS
TABLE OF CONTENTS
TABLE OF CONTENTS
(for Professional Services Contract - DBE Goal 0% - Race Neutral)
1.0
Consultant Requirements for SOQ Submittal
2.0
City SOQ Proposal Certifications Form .............................. Submitted with SOQ
3.0
Lobby Certification .............................................................. Submitted with SOQ
4.0
Prompt Pay Provisions
5.0
Title VI Assurance, Appendix A and E
6.0
Records Retention
7.0
Federal Immigration and Nationality Act
8.0
Buy America Requirements
9.0
DBE EPrise
10.0
DBE Documents
10.1
DBE Documents Instructions / Guide
10.2
ADOT On-Line Bidders-Proposers List ............................... Submitted with SOQ
10.3
DBE Form 3210PS DBE Certification of Final Payments to DBE
11.0
Payment Requests
11.1
Pay Application Request Form
11.2
Subconsultant Summary Form
12.0
Subconsultant Subcontracts Requirements
12.1
Subconsultant Approval Request Form (SARF)
12.2
Subconsultant Federal Compliance Acknowledgement Form
12.3
Subrecipient DBE Assurance (DBE EPrise for DBE Subconsultants)
1.0
CONSULTANT REQUIREMENTS
FOR SOQ SUBMITTAL
(2 Pages)
2020-04-27
Consultant Requirements for SOQ Submittal-Pg 1 of 2
1.0
CONSULTANT REQUIREMENTS
FOR SOQ SUBMITTAL
This contract is a federal funded contract with Federal Highway Administration (FHWA) and must comply
with all related federal requirements.
1.1
REQUIRED LICENSURE AND REGISTRATION
SOQs will be accepted from any prime Consultant prequalified through the Arizona Department of
Transportation (ADOT) Engineering Consultants Section (ECS) and properly registered with the Arizona
Board of Technical Registration (BTR) at the time the SOQ is submitted to the City. This contract does
require a Principal or Officer of the Firm responsible for this contract that is properly registered with the
BTR at the time of SOQ submittal. It is the prime Consultant’s responsibility to verify that all
Subconsultants, in the SOQ submittal, have the proper Arizona licenses and registrations, and DBE
certification if applicable, for the services to be performed under this contract.
1.2
PRE-QUALIFICATION
In order to submit an SOQ, the prime Consultant must have on file with ADOT ECS a current
Prequalification Application/Statement. Subconsultants are not required by ADOT ECS or the City to be
prequalified, but are encouraged to do so. ADOT ECS currently prequalifies firms on a bi-annual basis.
Further information regarding the prequalification process can be found at the following ADOT ECS
website:
https://www.azdot.gov/business/engineering-consultants/consultant-prequalification
Obtaining prequalification does not mean the firm is under contract or entitled to receive a contract.
Obtaining prequalification means the firm has met minimum requirements to submit qualifications to be
considered/evaluated for this project.
The City will review prequalification status with ADOT ECS at the time of SOQ due date. If the firm is not
prequalified on the SOQ submittal date, the SOQ will be rejected.
1.3
AUDIT & ANALYSIS REQUIREMENTS
Within two (2) weeks after receiving notice of selection, the selected prime Consultant(s) and its
Subconsultant(s) must submit financial documentation to ADOT Office of Audit & Analysis (A&A). If the
selected prime Consultant(s) and its Subconsultant(s) have recently submitted their most current
financial documents to ADOT A&A, contact ADOT A&A at (602) 712-7042 to inquire if you need to
resubmit financial documents. Additionally, the selected prime Consultant(s) and its Subconsultant(s)
are required to comply with ADOT Consultant Audit Guidelines.
To review the ADOT Consultant Audit Guidelines, use the following link:
http://www.azdot.gov/docs/default-source/ecs/consultant-audit-guidelines.pdf
To review the ADOT Consultant Audit Criteria (Information Bulletins 08-03 & 09-04), use the following
links:
http://www.azdot.gov/docs/businesslibraries/08-03.pdf
http://www.azdot.gov/docs/businesslibraries/09-04.pdf
Prime Consultants and its Subconsultants that propose on an overhead basis must have their Schedule
of Indirect Costs and Financial Statements available for review by ADOT A&A within six (6) months of
the completion of the Consultant’s preceding fiscal year-end (FYE). For example, a Consultant
with December 31, 2013, FYE must have the required information available no later than June 30,
2014. Noncompliance with this requirement will be considered failed negotiations unless
waived in writing by the State.
The items outlined above represent the information needed to begin the audit review process. Additional
information and supporting documentation may be requested. Failure to comply with audit requirements
2020-04-27
Consultant Requirements for SOQ Submittal-Pg 2 of 2
within the established timeframes may be considered failed negotiations. Questions regarding ADOT’s
audit requirements or related information must be directed to ADOT A&A at (602) 712-7042.
The Consultant understands that a compliant accounting system is required in accordance with
Generally Accepted Accounting Principles (GAAP), Federal Acquisition Regulation (FAR) of Title 48,
Code of Federal Regulations (CFR)-Part 31, applicable Cost Accounting Standards (CAS), and ADOT
Advance Agreement Guideline.
1.4
STATE OF ARIZONA LOCAL OFFICE REQUIREMENTS
All selected prime Consultant(s) must establish a local office in the State of Arizona prior to the contract
Notice to Proceed (NTP) date if a local office does not already exist.
1.5
NOT ALLOWED IN SOQ SUBITTAL
Inclusion of cost, work-hour, and plan-sheet estimates are not allowed in the SOQ.
After contract award, a firm may request a debriefing with the City’s Project Manager.
2.0
SOQ PROPOSAL CERTIFICATION FORM
3.0
LOBBY CERTIFICATION FORM
(SUBMIT WITH SOQ)
(1 Page Form, 1 Page Instructions)
DISCLOSURE OF LOBBYING ACTIVITIES
Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post-award
For Material Change Only:
d. loan
year _________ quarter _________
e. loan guarantee
date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
and Address of Prime:
Tier ______, if known :
Congre
6. Federa
8. Federa
10. a. Nam
(if individual, last name, first name, MI):
different from No. 10a)
(last name, first name, MI):
Prime
Subawardee
11.
Signature:
Print Name:
Title:
Telephone No.: _______________________
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
Information requested through this form is authorized by title 31 U.S.C. section
1352. This disclosure of lobbying activities is a material representation of fact
upon which reliance was placed by the tier above when this transaction was made
or entered into.
This disclosure is required pursuant to 31 U.S.C. 1352.
This
information
will be available for public inspection.
required disclosure shall be subject to a
not more than $100,000 for each such failure.
Federal Use Only:
Date:
who fails to file the
Any person
$10,000 and
than
civil penalty of not less
APPENDIX: ATTACHMENT 3 - Lobby Certification
RPA
essional District, if known :
Con
on
on
o gr
gres
e sional District, if known :
al Department/Agency:
7. Federal Program Name/Description:
CFDA Num
umbe
ber,r,r,r, ifififififififif app
pp
pp
pp
pp
pp
pp
pp
p lilililililililil ca
ca
ca
c blblblb e: _____________
al Act
c ion Number, if known :
9.
9 Awa
w rd Amount, if known :
$
me n
an
an
an
an
a d Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Addr
dr
dr
dr
dr
dr
dr
d es
es
es
e s of
o Lobbying Registrant
b. Individuals Performing Services (including address if
di idid
l l
t
fi
t
MI)
diff
t f
N
10 )
4c
N/A
10/20/2021
Karl Obergh
CEO
(602) 263-1177
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make
payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof
Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reportingentity. Include CongressionalDistrict, if known. Check the appropriateclassification
of the reportingentity that designatesif it is, or expects to be, a prime or subawardrecipient. Identify the tier of the subawardee,e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.
4.0
PROMPT PAY PROVISION
(5 Pages)
Prompt Pay and Payment Reporting Provisions- 1/5
CONSTRUCTION AND PROFESSIONAL SERVICES/DESIGN CONTRACTS
PROMPT PAY AND PAYMENT REPORTING PROVISIONS
(09/20/2016)
MEASUREMENTS AND PAYMENT:
Partial Payments:
If satisfactory progress is being made, the contractor will receive a payment based on the
amount of work completed. Progress payments may be made by the LPA/ Subrecipient
Procurement Office to the contractor on the basis of an approved estimate of the work
performed during a preceding period of time. The progress payments shall be paid on or
before 14 days after the estimate of the work is approved. The estimate of the work shall be
deemed received by the LPA/Subrecipient Procurement Office on submission to the person
designated by the LPA/Subrecipient Procurement Office for the submission, review or
approval of the estimate of the work. The LPA/Subrecipient Procurement Office by mutual
agreement may make progress payments on contracts of less than 90 days and shall make
monthly progress payments on all other contracts. Payment to the contractor on the basis of
a duly certified and approved estimate of the work performed during the preceding calendar
month under the contract may include payment for material and equipment.
An estimate of the work submitted shall be deemed approved and certified for payment after
seven days from the date of submission unless before that time the LPA/Subrecipient
Procurement Office or Designee prepares and issues a specific written finding setting forth
those items in detail in the estimate of the work that are not approved for payment under the
contract. The contractor shall work with the LPA/Subrecipient or the LPA/Subrecipient
Designee to finalize monthly estimate. The progress payments shall be paid on or before
14 days after the estimate of the work is certified and approved in accordance with Arizona
Revised Statutes Section 34-221.
The contractor shall pay to the contractor's subcontractors or material suppliers and each
subcontractor shall pay to the subcontractor's subcontractor or material supplier, within
seven days of receipt of each progress payment the respective amounts allowed the
contractor or subcontractor on account of the work performed by the subcontractors, to the
extent of each subcontractor's interest, except that no contract for construction services may
materially alter the rights of any contractor, subcontractor or material supplier to receive
prompt and timely payment.
A subcontractor may notify the LPA/Subrecipient Procurement Office in writing requesting
that the subcontractor be notified by the Subrecipient Procurement Office in writing within
five days from payment of each progress payment made to the contractor.
Prompt Pay and Payment Reporting Provisions- 2/5
Subcontractor Payments:
(1)
Retention:
If the prime contract does not provide for retention, the contractor and each subcontractor of
any tier shall not withhold retention on any subcontract. If the prime contract provides for
retention, the prime contractor and each subcontractor of any tier shall not retain a higher
percentage than the LPA/Subrecipient may retain under the prime contract.
(2)
No Set-offs Arising from Other Contracts:
If a subcontractor is performing work on multiple contracts for the same contractor or
subcontractor of any tier, the contractor or subcontractor of any tier shall not withhold or
reduce payment from its subcontractors on the contract because of disputes or claims on
another contract.
(3)
Partial Payment:
The contractor and each subcontractor of any tier shall make prompt partial payments to its
subcontractors within seven days of receipt of payment from the LPA/Subrecipient
Procurement Office. Notwithstanding any provision of Arizona Revised Statutes Section 34-
221, the parties may not agree otherwise.
(4)
Final Payment:
The contractor and each subcontractor of any tier shall make prompt final payment to each
of its subcontractors. The contractor and each subcontractor of any tier shall pay all
monies, including retention, due to its subcontractor within seven days of receipt of
payment. Notwithstanding any provision of Arizona Revised Statutes Section 34-221, the
parties may not agree otherwise.
(5) Payment Reporting:
For the purposes of this subsection “Reportable Contracts” means any subcontract, of any
tier, DBE or non-DBE, by which work shall be performed on behalf of the contractor and any
contract of any tier with a DBE material supplier.
The requirements of this subsection apply to all Reportable Contracts.
Payment Reporting for all Reportable Contracts shall be done through the LPA DBE System
which can be accessed at AZ UTRACS on the Arizona Transportation Business Portal at
www.azutracs.com. No later than fifteen calendar days after the preconstruction conference,
the contractor shall log into the system and enter or verify the name, contact information,
and subcontract amounts for Reportable Contracts on the project. As Reportable Contracts
are approved over the course of the contract, the contractor shall enter the subcontractor
information in the LPA DBE System. Reportable contracts information shall be entered into
Prompt Pay and Payment Reporting Provisions- 3/5
the system no later than five calendar days after approval by the LPA/Subrecipient
Procurement Office.
The contractor shall report on a monthly basis indicating the amounts actually paid and the
dates of each payment under any Reportable Contract on the project. The contractor shall
provide information for payments made on all Reportable Contracts during the previous
month by the last day of the current month. In the event that no payments were made during
a given month, the contractor shall identify that by entering a dollar value of zero. If the
contractor does not pay the full amount of any invoice from a subcontractor, the contractor
shall note that and provide the reasons in the comment section of the Monthly Payment
Audit of the LPA DBE System.
In addition, the contractor shall require that all participants in any Reportable Contract
electronically verify receipt of payment on the contract within 15 days of receipt of electronic
payment notification and the contractor shall actively monitor the system to ensure that the
verifications are input. The contractor shall proactively work to resolve any payment
discrepancies in the system between payment amounts it reports and payment confirmation
amounts reported by others.
The contractor shall ensure that all Reportable Contract payment activity is in the LPA DBE
System. This includes all lower-tier Reportable Contracts.
The contractor shall maintain records for each payment explaining the amount requested by
the subcontractor, and the amount actually paid pursuant to the request, which may include
but are not limited to, estimates, invoices, pay requests, copies of checks or wire transfers,
and lien waivers in support of the monthly payments in the system.
The contractor shall ensure that a copy of this Subsection is included in every Reportable
Contract of every tier.
(a)
Sanctions for Inadequate Reporting:
For each Reportable Contract on which the contractor fails to submit timely and complete
payment information the LPA/Subrecipient Procurement Office will retain $1,000.00 as
liquidated damages, from the monies due to the contractor. Liquidated damages will be
deducted each month for each Reportable Contract on which the contractor fails to submit
payment information until the contractor provides the required information as described
herein. After 90 consecutive days of non-reporting, the liquidated damages will increase to
$2,000.00 for each subsequent month, for each Reportable Contract on which the
contractor fails to report until the information is provided. These liquidated damages shall
be in addition to all other retention or liquidated damages provided for elsewhere in the
contract.
(6)
Completion of Work:
A subcontractor's work is satisfactorily completed when all the tasks called for in the
subcontract have been accomplished, documented, and accepted by the LPA/Subrecipient
Procurement Office.
Prompt Pay and Payment Reporting Provisions- 4/5
(7)
Disputes:
If there is a discrepancy between what is reported by the contractor in the LPA DBE System
and what the subcontractor indicates, an alert email will automatically be sent to the
contractor. The email will be sent to the email address provided by the contractor in the
LPA DBE System. It is the contractor’s responsibility to ensure that the email address in the
system is kept current.
The contractor shall provide a verifiable explanation of the discrepancy in the LPA DBE
System as early as practicable but in no case later than seven days after the date of the
alert email.
The LPA/Subrecipient will determine whether the contractor has acted in good faith
concerning any such explanations. The LPA/Subrecipient and ADOT BECO reserves the
right to request and receive documents from the contractor and all subcontractors of any
tier, in order to determine whether prompt payment requirements are met.
The contractor shall implement and use the dispute resolution process outlined in the
subcontract or by following the LPA/Subcrecipient escalation process, to resolve payment
disputes.
(8)
Non-compliance:
Failure to make prompt partial payment, or prompt final payment including any retention,
within the time frames established above, will result in remedies, as the LPA/Subrecipient
Procurement Office deems appropriate, which may include but are not limited to:
(a) Liquidated Damages: These liquidated damages shall be in addition to all
other retention or liquidated damages provided for elsewhere in the
contract.
(i) The LPA/Subrecipient Procurement Office will withhold two times the
disputed dollar amount not paid to each subcontractor.
(ii) If full payment is made within 30 days of the LPASubrecipient
Procurement Office’s payment to the contractor, the amount withheld
by the LPA/Subrecipient Procurement Office will be released.
(iii) If full payment is made after 30 days of the LPA/Subrecipient
Procurement Office’s payment to the contractor, the LPA/Subrecipient
Procurement Office will release 75 percent of the funds withheld. The
LPA/Subrecipient Procurement Office will retain 25 percent of the
monies withheld as liquidated damages.
(b) Additional Remedies. If the contractor fails to make prompt payment for
three consecutive months, or any four months over the course of one
Prompt Pay and Payment Reporting Provisions- 5/5
project, or if the contractor fails to make prompt payment on two or more
projects within 24 months, the LPA/Subrecipient Procurement Office may,
in addition, invoke the following remedies:
(i) Withhold monthly progress payments until the issue is resolved and full
payment has been made to all subcontractors, subject to the liquidated
damages described in paragraph (a) above,
(ii) Terminate the contract for default,
(iii) Disqualify
the
contractor
from
future
bidding, temporarily
or
permanently, depending on the number and severity of violations, if
applicable.
In determining whether liquidated damages will be assessed, the extent of the liquidated
damages, or additional remedies assessed, the LPA/Subrecipient will consider whether
there have been other violations on this or other federal-aid contracts, whether the failure to
make prompt payment was due to circumstances beyond the contractor’s control, and other
circumstances. The contractor may, within 15 calendar days of receipt of the decision of the
LPA/Subrecipient, escalate the decision according to the contract’s escalation process.
5.0
TITLE VI
-
TITLE VI ASSURANCE (3 Pages)
-
TITLE VI APPENDIX A (1 Page)
-
TITLE VI APPENDIX E (1 Page)
6.0
RECORDS RETENTION
(1 Page)
RECORDS RETENTION
Contractor and Subcontractor Project Records
(Reference to A.R.S.35-214)
The contractor, subcontractors and all suppliers shall keep and maintain all books, papers, records, files,
accounts, reports, bid documents with backup data, including electronic data, and all other material relating to the
contract and project for five (5) years following completion and acceptance of the work.
All of the above material shall be made available for auditing, inspection, and copying and shall be produced upon
request to the Agency.
The City of Chandler – Capital Projects
215 E Buffalo Street, Mail Stop 407
Chandler, Arizona 85225.
The contractor shall insert the above requirement in each subcontract purchase order and lease agreement and
shall also include in all subcontracts, a clause requiring subcontractors to include the above requirement in any
lower-tier subcontract, purchase order, or lease agreement.
7.0
FEDERAL IMMIGRATION
AND
NATIONALITY ACT
(1 Page)
Federal Immigration and Nationality Act
(Reference to Arizona Executive Order 2005-30)
The contractor, including all subcontractors, shall comply with all federal, state and local immigration laws and
regulations, as set forth in Arizona Executive Order 2005-30, relating to the immigration status of their employees
who perform services on the contract during the duration of the contract. The Agency (City of Chandler) shall
retain the right to perform random audits of contractor and subcontractor records or to inspect papers of any
employee thereof to ensure compliance.
By submission of a bid, the contractor warrants that the contractor and all prosed subcontractors are and shall
remain in compliance with all federal, state, and local immigration laws and regulations relating to the immigration
status of their employees who perform services on the contract. The Agency may, at its sole discretion, require
evidence of compliance from the contractor or subcontractor. Should the Agency request evidence of
compliance, the contractor or subcontractor shall have ten (10) working days from receipt of the request to supply
adequate information. The Department and Agency (City of Chandler) will accept, as evidence of compliance, a
showing by the contractor or subcontractor, that it has followed the employment verification provisions of the
Federal Immigration and Nationality Act as set forth in Sections 274A and 274B of that Act, including
implementation of regulations and agreements between the Department of Homeland Security and the Social
Security Administration's verification service. The contractor shall include the requirements of this provision in all
subcontracts for this project.
Failure to comply with the immigration laws or to submit proof of compliance constitutes a material breach of
contract. The Agency will recue the contractor's compensation by $10,000 for the initial instance of non-
compliance by the contractor or a subcontractor. Should the same contractor or subcontractor commit
subsequent violations within a two (2) year time period from the initial violation, the contractor's compensation will
be reduced by $50,000 for each violation. The third instance by the same contractor or subcontractor within a two
(2) year period may result, in addition to the $50,000 reduction in compensation, in removal of the offending
contractor of subcontractor, suspension of work in whole or in part or, in the case of a third violation by the
contractor, termination of the contract for default in addition, the Department may debar a contractor or
subcontractor who has committed three (3) violations within a two (2) year period for up to one (1) year. For
purposes of this paragraph, a violation by a subcontractor does not count as a violation by the contractor.
Any delay resulting from a sanction under this subsection is a non-excusable delay. The contractor is not entitled
to any compensation or extension of time for any delays or additional costs resulting from a sanction under this
subsection.
8.0
BUY AMERICA REQUIREMENTS
(5 Pages)
Material Certifications-Buy America Requirements
Page 1 of 5
MATERIAL CERTIFICATION REQUIREMENTS
And
BUY AMERICA REQUIREMENTS
A.
REGULATIONS
1.
FHWA - BUY AMERICA - CLARIFICATION OF FEDERAL REGULATION
https://www.transportation.gov/sites/dot.gov/files/docs/buy_america_provisions_side_by_side.pdf)
Federal Highway Administration (FHWA) - 23 U.S.C. § 313 – Buy America; 23 C.F.R. § 635.410
The Secretary of Transportation shall not obligate any funds unless steel, iron, and manufactured products
used In such project are produced in the United States.
Applies to iron and steel products and their coatings that are to be permanently incorporated into the project.
The FHWA, in its 1983 rulemaking, determined that Buy America did not apply to raw materials and waived its
application to manufactured products, although in the statute, based on the public interest. Lake of adequate
domestic supply resulted in a 1995 nationwide waiver for iron ore, pig iron, and reduced/processed/pelletized
iron ore. In 1994, a nationwide waiver for specific ferryboat parts came into effect.
2.
MAG SPECIFICATION SECTION 106.2.1
3.
ADOT SPECIFICATION 106.05 AND 106.15
B.
PROCEDURE FOR MATERIAL CERTIFICATION REQUIREMENTS – CITY OF CHANDLER
1.
All material for a federal funded project must have a material certification.
2.
All material delivered to jobsite must be accompanied by a material certification.
3.
Material Certifications must be submitted to the City of Chandler representative for review and approval and is
not deemed accepted until City of Chandler representative approval.
4.
Buy America Material – All Iron and Steel products. (See Item A above)
5.
Buy America Material Installation: All Buy America Iron and Steel Products MUST NOT be installed without
Material Certification received and approval from City of Chandler.
6.
All non-Buy America Material Installation: All non-Buy America material, if installed without material certification
receipt and approval is at the Prime Contractor's risk and WILL NOT BE PAID until approval of material
certification for that material.
C.
MATERIAL CERTIFICATIONS – DOCUMENTATION REQUIRED PER FHWA, MAG SPECIFICATION, ADOT
SPECIFICATION AND CITY OF CHANDLER:
ALL MATERIAL – Items 1-11
1.
Project Name
2.
City Project Number
3.
Federal Project Number
4.
ADOT Number (previously known as Tracs Number) (if FHWA funded project)
5.
Supplier Information: Name, Address, Telephone Number
6.
Description of the material supplied
7.
Quantity of material represented by the certificate
8.
Means of material identification, such as label, lot number, or marking
9.
A Statement that the material complies in all respects with the requirements of the cited specifications.
Certificates shall state compliance with the cited specification, such as AASHTO M 320, ASTM C 494; or
specific table or subsection of the Arizona Department of Transportation Standard Specifications or Special
Provisions. Certificates may cite both, if applicable.
10. Authorization Signature Statement: A statement that the individual signing has the legal authority to bind the
manufacturer or the supplier of the material.
11. The name, title, signature, and date of signature of the signing-responsible individual.
BUY AMERICA IRON & STEEL PRODUCTS – Items 1-11 above AND Item 12 Below:
12. Buy America Verification Statement – statement that certifies material was made in America.
a.
Examples: "Made in America", "This product complies with Buy America requirements".
Material Certifications-Buy America Requirements
Page 2 of 5
FHWA – CFR (Code of Federal Regulations) Title 23 – Section 635.410 Highways - BUY AMERICA
Volume: 1 Date: 2013-04-01, Original Date: 2013-04-01
CHAPTER I - FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION. SUBCHAPTER G -
ENGINEERING AND TRAFFIC OPERATIONS. PART 635 - CONSTRUCTION AND MAINTENANCE. Subpart D -
General Material Requirements.
§ 635.410 Buy America requirements.
(a) The provisions of this section shall prevail and be given precedence over any requirements of this subpart which are
contrary to this section. However, nothing in this section shall be construed to be contrary to the requirements of §
635.409(a) of this subpart.
(b) No Federal-aid highway construction project is to be authorized for advertisement or otherwise authorized to
proceed unless at least one of the following requirements is met:
(1) The project either: (i) Includes no permanently incorporated steel or iron materials, or (ii) if steel or iron materials
are to be used, all manufacturing processes, including application of a coating, for these materials must occur in the
United States. Coating includes all processes which protect or enhance the value of the material to which the coating
is applied.
(2) The State has standard contract provisions that require the use of domestic materials and products, including
steel and iron materials, to the same or greater extent as the provisions set forth in this section.
(3) The State elects to include alternate bid provisions for foreign and domestic steel and iron materials which comply
with the following requirements. Any procedure for obtaining alternate bids based on furnishing foreign steel and iron
materials which is acceptable to the Division Administrator may be used. The contract provisions must (i) require all
bidders to submit a bid based on furnishing domestic steel and iron materials, and (ii) clearly state that the contract
will be awarded to the bidder who submits the lowest total bid based on furnishing domestic steel and iron materials
unless such total bid exceeds the lowest total bid based on furnishing foreign steel and iron materials by more than
25 percent.
(4) When steel and iron materials are used in a project, the requirements of this section do not prevent a minimal use
of foreign steel and iron materials, if the cost of such materials used does not exceed one-tenth of one percent (0.1
percent) of the total contract cost or $2,500, whichever is greater. For purposes of this paragraph, the cost is that
shown to be the value of the steel and iron products as they are delivered to the project.
(c)
(1) A State may request a waiver of the provisions of this section if;
(i) The application of those provisions would be inconsistent with the public interest; or
(ii) Steel and iron materials/products are not produced in the United States in sufficient and reasonably available
quantities which are of a satisfactory quality.
(2) A request for waiver, accompanied by supporting information, must be submitted in writing to the Regional
Federal Highway Administrator (RFHWA) through the FHWA Division Administrator. A request must be submitted
sufficiently in advance of the need for the waiver in order to allow time for proper review and action on the request.
The RFHWA will have approval authority on the request.
(3) Requests for waivers may be made for specific projects, or for certain materials or products in specific geographic
areas, or for combinations of both, depending on the circumstances.
(4) The denial of the request by the RFHWA may be appealed by the State to the Federal Highway Administrator
(Administrator), whose action on the request shall be considered administratively final.
(5) A request for a waiver which involves nationwide public interest or availability issues or more than one FHWA
region may be submitted by the RFHWA to the Administrator for action.
(6) A request for waiver and an appeal from a denial of a request must include facts and justification to support the
granting of the waiver. The FHWA response to a request or appeal will be in writing and made available to the public
upon request. Any request for a nationwide waiver and FHWA's action on such a request may be published in the
Federal Register for public comment.
(7) In determining whether the waivers described in paragraph (c)(1) of this section will be granted, the FHWA will
consider all appropriate factors including, but not limited to, cost, administrative burden, and delay that would be
imposed if the provision were not waived.
(d) Standard State and Federal-aid contract procedures may be used to assure compliance with the requirements of
this section.
[48 FR 53104, Nov. 25, 1983, as amended at 49 FR 18821, May 3, 1984; 58 FR 38975, July 21, 1993]
Material Certifications-Buy America Requirements
Page 3 of 5
MAG (MARICOPA ASSOCIATION OF GOVERNMENTS) 106.2.1
106.2.1 Certificate of Compliance: A Certificate of Compliance shall be submitted on the manufacturer’s or supplier’s
official letterhead, and shall contain the following information:
1. The current name, address, and phone number of the manufacturer or supplier of the material or equipment.
2.
A description of the material or equipment supplied.
3.
Quantity of material represented by the certificate.
4.
Means of material identification, such as label, lot number, or marking.
5.
A statement that the material complies in all respects with the requirements of the cited specifications.
Certificates shall state the name of the specific cited specifications, such as AASHTO M-320, ASTM C494, or
specific table or subsection of the Specifications or Special Provisions.
6.
A statement that the individual identified in item eight below has the legal authority to bind the manufacturer or
the supplier of the material.
7.
Project identification: Project name and all associated numbers (agency, Federal, and ADOT TRACS).
8.
The name, title, and signature of the responsible individual. The date of the signature shall also be given.
9.
Each of the first six items specified above shall be completed prior to the signing of the certificate as defined in
item eight. No certificate will be accepted that has been altered, added to, or changed in any way after the
authorized signature has been affixed to the original certificate. However, notations related to project specifics
such as project identification, contractor, or quantity shipped are acceptable, provided the basic requirements
of the certificate (items one through six) are not affected.
10. A copy or facsimile reproduction of the original certificate will be acceptable; however, the original certificate
shall be made available upon request.
106.2.2 Certificate of Analysis: A Certificate of Analysis shall include all the information required for a Certificate
of Compliance and, in addition, shall include the results of all tests required by the specifications.
Revised 2017
Material Certifications-Buy America Requirements
Page 4 of 5
ADOT STANDARD SPECIFICATION 106.05 (09/14/12)
106.05 Certificates: of the Standard Specifications is revised to read:
(A) General:
The contractor shall submit to the Engineer an original or copy of either a Certificate of Compliance or a Certificate of
Analysis, as required, prior to the use of any materials or manufactured assemblies for which the specifications require
that such a certificate be furnished.
Certificates shall be specifically identified as either a "Certificate of Compliance" or a "Certificate of Analysis".
The Engineer may permit the use of certain materials or manufactured assemblies prior to, or without, sampling and
testing if accompanied by a Certificate of Compliance or Certificate of Analysis, as herein specified. Materials or
manufactured assemblies for which a certificate is furnished may be sampled and tested at any time, and, if found not
in conformity with the requirements of the plans and the specifications, will be subject to rejection, whether in place or
not.
Certificates of Compliance and Certificates of Analysis shall comply with the requirements specified herein, the ADOT
Materials Testing Manual, and applicable ADOT Materials Policy and Procedure Directives.
(B) Certificate of Compliance:
A Certificate of Compliance shall be submitted on the manufacturer’s or supplier’s official letterhead, and shall contain
the following information:
(1) The current name, address, and phone number of the manufacturer or supplier of the material.
(2) A description of the material supplied.
(3) Quantity of material represented by the certificate.
(4) Means of material identification, such as label, lot number, or marking.
(5) A statement that the material complies in all respects with the requirements of the cited specifications.
Certificates shall state compliance with the cited specification, such as AASHTO M 320, ASTM C 494; or
specific table or subsection of the Arizona Department of Transportation Standard Specifications or
Special Provisions. Certificates may cite both, if applicable.
(6) A statement that the individual identified in item seven below has the legal authority to bind the
manufacturer or the supplier of the material.
(7) The name, title, and signature of the responsible individual. The date of the signature shall also be given.
Each of the first six items specified above shall be completed prior to the signing of the certificate as defined in item
seven. No certificate will be accepted that has been altered, added to, or changed in any way after the authorized
signature has been affixed to the original certificate. However, notations of a clarifying nature, such as project number,
contractor, or quantity shipped are acceptable, provided the basic requirements of the certificate are not affected.
A copy or facsimile reproduction of the original certificate will be acceptable; however, the original certificate shall be
made available upon request.
(C) Certificate of Analysis:
A Certificate of Analysis shall include all the information required for a Certificate of Compliance and, in addition, shall
include the results of all tests required by the specifications.
Material Certifications-Buy America Requirements
Page 5 of 5
ADOT STANDARD SPECIFICATION 106.15 (02/15/11) – BUY AMERICA
Section 106 -Control of Materials: of the Standard Specifications is modified to read as follows:
106.15 Domestic Materials and Products
Steel and iron materials and products used on all projects shall comply with the current “Buy America” requirements of
23 CFR 635.410.
All manufacturing processes to produce steel and iron products used on this project shall occur in the United States.
Raw materials used in manufacturing the steel and iron products may be foreign or domestic. Steel or iron not meeting
these requirements may be used in products on this project provided that the invoiced cost to the contractor for such
steel products incorporated into the work does not exceed either one-tenth of one percent of the total (final) contract
cost or $2,500, whichever is greater.
Any process which involves the application of a coating to iron or steel shall occur in the United States. These
processes include epoxy coating, galvanizing, painting, or any other coating which protects or enhances the value of
covered material.
The requirements specified herein shall only apply to steel and iron products permanently incorporated into the project.
“Buy America” provisions do not apply to temporary steel items, such as sheet piling, temporary bridges, steel
scaffolding and falsework, or to materials which remain in place at the contractor’s convenience.
The contractor shall furnish the Engineer with Certificates of Compliance, conforming to the requirements of Subsection
106.05, which state that steel or iron products incorporated in the project meet the requirements specified. Certificates
of Compliance shall also certify that all manufacturing processes to produce steel or iron products, and any application
of a coating to iron or steel, occurred in the United States.
Convict-produced materials may not be used unless the materials were produced prior to July 1, 1991 at a prison
facility specifically producing convict-made materials for Federal-aid construction projects.
9.0
DBE EPRISE
FOR DBE GOAL 0% RACE NEUTRAL
(12 Pages)
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 1/12
PROFESSIONAL SERVICES
DBE PROVISIONS
(PROJECT SPECIFIC - CONTRACTS)
FOR USE ON LPA/SUBRECIPIENT FEDERAL AID PROJECTS WITHOUT DBE GOALS
*
NOTE: REFER TO EDITING INSTRUCTIONS IN SECTIONS 13.0 *
(LPA PS EPRISE, 8/26/2016)
DISADVANTAGED BUSINESS ENTERPRISES:
1.0
Policy:
The Arizona Department of Transportation (hereinafter the Department) has established a
Disadvantaged Business Enterprise (DBE) program in accordance with the regulations of the
U.S. Department of Transportation (USDOT), 49 CFR Part 26. The Department has received
Federal financial assistance from the U.S. Department of Transportation and as a condition of
receiving this assistance, the Department has signed an assurance that it will comply with 49
CFR Part 26.
It is the policy of the Department to ensure that DBEs, as defined in Part 26, have an equal
opportunity to receive and participate in USDOT-assisted contracts. It is also the policy of the
Department:
1. To ensure nondiscrimination in the award and administration of USDOT-assisted
contracts;
2. To create a level playing field on which DBEs can compete fairly for
USDOT-assisted contracts;
3. To ensure that the DBE program is narrowly tailored in accordance with applicable
law;
4. To ensure that only firms that fully meet 49 CFR Part 26 eligibility standards are
counted as DBEs;
5. To help remove barriers to the participation of DBEs in USDOT-assisted contracts;
6. To assist in the development of firms that can compete successfully in the market
place outside the DBE program; and
7. To promote the use of DBEs in all types of federally-assisted contracts and
procurement activities.
It is also the policy of the Department to facilitate and encourage participation of Small
Business Concerns (SBCs), as defined in Subsection 3.0, in USDOT-assisted contracts. The
Department encourages consultants to take reasonable steps to eliminate obstacles to SBCs’
participation and to utilize SBCs in performing contracts.
Local Public Agencies (LPA) and or Subrecipients of Federal financial assistance will
administer and manage the contracts from advertising, consultant selection, negotiation,
contract execution, processing payment reports and contract modifications, audits, DBE
compliance (e.g., reporting and monitoring) through contract closeout.
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 2/12
2.0
Assurances of Non-Discrimination:
The consultant, subrecipient, or subconsultant shall not discriminate on the basis of race,
color, sex or national origin in the performance of this contract. The consultant shall carry out
applicable requirements of 49 CFR Part 26 in the award and administration of DOT-assisted
contracts. Failure by the consultant to carry out these requirements is a material breach of this
contract, which may result in the termination of this contract or such other remedy as the the
LPA/Subrecipient with the Department’s concurrence deems appropriate, which may include,
but are not limited to:
1. Withholding monthly progress payments;
2. Assessing sanctions;
3. Liquidated damages;
4. Disqualifying the consultant from submitting SOQs, or any other forms of proposals, as
non-responsible;
5. Cancellation, termination, or suspension of the Contract, in whole or in part.
The consultant, subrecipient, or subconsultant shall ensure that all subcontract agreements
contain this non-discrimination assurance.
3.0
Definitions:
(A) Commercially Useful Function (CUF): Commercially Useful Function is defined fully in
49 CFR 26.55, which definition is incorporated herein by reference.
(B) Disadvantaged Business Enterprise (DBE): a for-profit small business concern which
meets both of the following requirements:
(1)
Is at least 51 percent owned by one or more socially and economically
disadvantaged individuals or, in the case of any publicly owned business, at least 51
percent of the stock is owned by one or more such individuals; and,
(2)
Whose management and daily business operations are controlled by one or more of
the socially and economically disadvantaged individuals who own it.
(C) NAICS Code: The North American Industry Classification System (NAICS) is the
standard used by Federal statistical agencies in classifying business establishments for
the purpose of collecting, analyzing, and publishing statistical data related to the U.S.
business economy.
(D) Non-DBE: any firm that is not a DBE.
(E) Race-Conscious (RC): a measure or program focused specifically on assisting only
DBEs, including women-owned DBEs.
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 3/12
(F) Race-Neutral (RN): a measure or program used to assist all small businesses. For the
purposes of this part, race-neutral includes gender-neutrality.
(G) Small Business Concern (SBC): a business that meets all of the following conditions:
(1)
Operates as a for-profit business registered to do business in Arizona;
(2) Operates a place of business primarily within the U.S., or makes a significant
contribution to the U.S. economy through payment of taxes or use of American
products, materials, or labor;
(3)
Is independently owned and operated;
(4) Is not dominant in its field on a national basis; and
(5) Does not have annual gross receipts that exceed the Small Business
Administration size standards average annual income criteria for its primary North
American Industry Classification System (NAICS) code.
(I) Socially and Economically Disadvantaged Individuals: any individual who is a
citizen (or lawfully admitted permanent resident) of the United States and who is:
(1) Any individual who is found to be a socially and economically disadvantaged
individual on a case-by-case basis.
(2) Any individual in the following groups, members of which are rebuttably presumed
to be socially and economically disadvantaged:
(i) "Black Americans," which includes persons having origins in any of the Black
racial groups of Africa;
(ii) "Hispanic Americans," which includes persons of Mexican, Puerto Rican,
Cuban, Dominican, Central or South American, or other Spanish or
Portuguese culture or origin, regardless of race;
(iii) "Native Americans," which includes persons who are enrolled members of
federally or State recognized Indian tribe, Alaskan Natives or Native
Hawaiians;
(iv) “Asian-Pacific Americans,” which includes persons whose origins are from
Japan, China, Taiwan, Korea, Burma (Myanmar), Vietnam, Laos, Cambodia
(Kampuchea), Thailand, Malaysia, Indonesia, the Philippines, Brunei,
Samoa, Guam, the U.S. Trust Territories of the Pacific Islands (Republic of
Palau), the Republic of the Northern Marianas Islands, Macao, Fiji, Tonga,
Kiribati, Tuvalu, Nauru, Federated States of Micronesia, or Hong Kong;
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 4/12
(v)
“Subcontinent Asian Americans,” which includes persons whose origins are
from India, Pakistan, Bangladesh, Bhutan, the Maldives Islands, Nepal or Sri
Lanka;
(vi)
"Women;"
(vii)
Any additional groups whose members are designated as socially and
economically disadvantaged by the Small Business Administration (SBA), at
such time as the SBA designation becomes effective.
4.0
Working with DBEs:
The Department works with DBEs and assists them in their efforts to participate in the highway
construction program. All proposers should contact the Department’s Business Engagement
and Compliance Office (BECO) by phone, through email, or at the address shown below, for
assistance in their efforts to use DBEs in the highway construction industry. BECO contact
information is as follows:
Arizona Department of Transportation
Business Engagement and Compliance Office
1801 W. Jefferson St, Suite 101, Mail Drop 154A
Phoenix, AZ 85007
Phone (602) 712-7761
FAX (602) 712-8429
Email: ContractorCompliance@azdot.gov
Website : www.azdot.gov/bec
4.01
Mentor-Protège Program
The Department has established a Mentor-Protégé program as an initiative to encourage and
develop disadvantaged businesses in the highway construction industry. The program
encourages prime consultants to provide certain types of assistance to certified DBE
subconsultants. ADOT encourages consultants and certified DBE subconsultants to engage in a
Mentor-Protégé agreement under certain conditions. Such an agreement must be mutually
beneficial to both parties and to ADOT in fulfilling requirements of 49 CFR Part 23. For guidance
regarding this program refer to the Mentor-Protégé Program Guidelines available on the BECO
website.
The Mentor-Protégé program is intended to increase legitimate DBE activities and is not
intended to diminish nor circumvent existing DBE rules or regulations.
5.0
Applicability:
The Department has established an overall annual goal for DBE participation on Federal-aid
contracts. The Department intends for the goal to be met with a combination of race conscious
efforts and race neutral efforts. Race conscious participation occurs when the consultant uses
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 5/12
a percentage of DBEs, as defined herein, to meet the contract-specified goal. Race neutral
efforts are those that are, or can be, used to assist all small businesses or increase
opportunities for all small businesses. The regulation, 49 CFR 26, defines race neutral as
when a DBE wins a prime contract through customary competitive procurement procedures or
is awarded a subcontract on a prime contract that does not carry a DBE contract goal.
The DBE provisions are applicable to all consultants including DBE consultants.
6.0
Certification and Registration:
6.01
DBE Certification:
Certification as a DBE shall be predicated on:
(1) The completion and execution of an application for certification as a "Disadvantaged
Business Enterprise."
(2) The submission of documents pertaining to the firm(s) as stated in the application(s),
including but not limited to a statement of social disadvantage and a personal financial
statement.
(3) The submission of any additional information which the Department or the applicable
Arizona Unified Certification (UCP) agency may require to determine the firm's eligibility to
participate in the DBE program.
(4) The information obtained during the on-site visits to the offices of the firm and to active
job-sites.
Applications for certification may be filed online with the Department or the applicable UCP
agency at any time through the Arizona Unified Transportation Registration and Certification
System (AZ UTRACS) website at http://www.azutracs.com.
DBE firms and firms seeking DBE certification shall cooperate fully with requests for
information relevant to the certification process. Failure or refusal to provide such information
is a ground for denial or removal of certification.
ADOT is a member of the AZ Unified Certification Program (AZUCP). Only DBE firms that are
certified by the AZUCP are eligible for credit on ADOT projects. A list of DBE firms certified by
AZUCP is available on the internet at http://www.azutracs.com. The list will indicate contact
information and specialty for each DBE firm, and may be sorted in a variety of ways. However,
ADOT does not guarantee the accuracy and/or completeness of this information, nor does
ADOT represent that any licenses or registrations are appropriate for the work to be done.
The Department’s certification of a DBE is not a representation of qualifications and/or abilities
nor does it mean that a DBE firm is guaranteed or entitled to receive or be awarded a contract.
Being certified simply means that a firm has met the criteria for DBE certification as outlined in
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 6/12
49 CFR Part 26. The consultant bears all risks of ensuring that DBE firms selected by the
consultant are able to perform the work.
6.02
SBC Registration:
To comply with 49 CFR Part 26.39, ADOT’s DBE Program incorporates contracting
requirements to facilitate participation by Small Business Concerns (SBCs) in federally
assisted contracts. SBCs are for-profit businesses authorized to do businesses in Arizona that
meet the Small Business Administration (SBA) size standards for average annual revenue
criteria for its primary North American Industry Classification System (NAICS) code
While the SBC component of the DBE program does not require utilization of goals on
projects, ADOT and the LPA/Subrecipient strongly encourages consultants to utilize small
businesses that are registered in AZ UTRACS on their contracts, in addition to DBEs meeting
the certification requirement. The consultant may use the AZ UTRACS website to search for
certified DBEs and registered SBCs that can be used on the contract. However, SBCs that are
not DBEs will not be counted toward the DBE participation.
SBCs can register online at the AZ UTRACS website.
The Department’s registration of SBCs is not a representation of qualifications and/or abilities
nor does it mean that an SBC firm is guaranteed or entitled to receive or be awarded a contract.
Being SBC registered simply means that a firm has met the criteria for SBC registration as
outlined in 49 CFR Part 26. The consultant bears all risks of ensuring that SBC firms selected
by the consultant are able to perform the work.
7.0
DBE Financial Institutions:
The Department thoroughly investigates the full extent of services offered by financial institutions
owned and controlled by socially and economically disadvantaged individuals in its service area
and makes reasonable efforts to use these institutions. The Department encourages prime
consultants to use such institutions on USDOT assisted contracts. However, use of DBE
financial institutions will not be counted toward the DBE participation.
The Department and the LPA/Subrecipient encourages prime consultants to research the
Federal Reserve Board website at www.federalreserve.gov to identify minority-owned banks in
Arizona derived from the Consolidated Reports of Condition and Income filed quarterly by banks
(FFIEC 031 and 041) and from other information on the Board’s National Information Center
database.
8.0
Time is of the Essence:
TIME IS OF THE ESSENCE IN RESPECT TO THE DBE PROVISIONS
9.0
Computation of Time:
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 7/12
In computing any period of time described in this DBE special provision, such as calendar
days, the day from which the period begins to run is not counted, and when the last day of the
period is a Saturday, Sunday, Federal or State holiday, the period extends to the next day that
is not a Saturday, Sunday, Federal or State holiday. In circumstances where the
LPA/Subrecipient Procurement Office is closed for all or part of the last day, the period extends
to the next day on which the LPA / Subrecipient Procurement Office is open.
10.0
Consultant and Subconsultant Requirements:
10.01
General:
The consultant shall establish a DBE program that will ensure nondiscrimination in the award
and administration of contracts and subcontracts.
Agreements between the proposer and a DBE in which the DBE promises not to provide
subcontracting quotations to other proposers are prohibited.
10.02
DBE Liaison:
The consultant shall designate a DBE Liaison responsible for the administration of the
consultant’s DBE program. The name of the designated DBE Liaison shall be included on the
DBE Intended Participation Affidavit Summary.
11.0
DBE Goal:
The Department has not established contract goals for DBE participation in this contract.
Consultants are still encouraged to employ reasonable means to obtain DBE participation.
Consultants must retain records in accordance with these DBE specifications. The consultant
is notified that this record keeping is important to the Department so that it can track DBE
participation where only race neutral efforts are employed.
12.0 Bidders/Proposers List and AZ UTRACS Registration Requirement:
Under Title 49 CFR of the Code of Federal Regulations, Part 26.11, DOTs are required to collect
certain information from all consultants and subconsultants who seek to work on federally-
assisted contracts in order to set overall and contract DBE goals. ADOT collects this information
when firms register their companies on the Arizona Unified Transportation Registration and
Certification System (AZ UTRACS) web portal at http://www.azutracs.com/ a centralized
database for companies that seek to do business with ADOT. This information will be maintained
as confidential to the extent allowed by federal and state law.
Prime consultants and all subconsultants, including DBEs listed in the SOQ must be registered
in AZ UTRACS. Proposers may verify that their firm and each subconsultant is registered using
the AZ UTRACS website.
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 8/12
Proposers may obtain additional information at the AZ UTRACS website or by contacting the
LPA/Subrecipient.
All proposers shall create a Bidders/Proposers list in the AZ UTRACS by selecting all firms,
service providers, and vendors that expressed interest or submitted proposals or quotes for this
contract. The Bidders/Proposers List form must be complete and must include the names for all
subconsultants, service providers, and vendors that submitted proposals or quotes on this
project regardless of the proposer’s intentions to use the those firms on the project.
All proposers must complete and submit the Bidders/Proposers List online at AZ UTRACS prior
to Cost Proposal submittal. A confirmation email will be generated by the system. This email
confirmation shall be submitted with the Cost Proposal.
FAILURE TO SUBMIT THE REQUIRED BIDDERS/PROPOSERS LIST CONFIRMATION
EMAIL WITH THE COST PROPOSAL BY THE STATED TIME AND IN THE MANNER HEREIN
SPECIFIED AND AS OUTLINED IN THE RFQ SHALL BE CAUSE FOR THE PROPOSER’S
COST PROPOSAL TO BE REJECTED.
13.0
Payment Reporting:
The consultant shall report on a monthly basis indicating the amounts paid to all subconsultants,
of all tiers, working on the project. Reporting shall be in accordance with Prompt Pay
and Payment Reporting requirements section of the contract specifications.
14.0
Crediting DBE Participation:
14.01
General Requirements:
To count toward DBE participation, the DBE firms must be certified at the time of Cost Proposal
submission in each NAICS code applicable to the kind of work the firm will perform on the
contract. NAICS for each DBE can be found on the AZ UTRACS website. General descriptions
of all NAICS codes can be found at http://www.naics.com/search/.
Credit towards the consultant’s DBE participation is given only after the DBE has been paid for
the work performed.
The entire amount of a contract that is performed by the DBE’s own forces, including the cost of
supplies and materials purchased by the DBE for the work on the contract and equipment leased
by the DBE will be credited toward DBE participation. Supplies and equipment the DBE
subconsultant purchases or leases from the prime consultant or its affiliate will not be credited
toward DBE participation.
The consultant bears the responsibility to determine whether the DBE possesses the proper
consultant’s license(s) to perform the work and, if DBE credit is requested, that the DBE
subconsultant is certified for the requested type of work.
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 9/12
The Department’s certification is not a representation of a DBE’s qualifications and/or abilities.
The consultant bears all risks that the DBE may not be able to perform its work for any reason.
A DBE may participate as a prime consultant, subconsultant, or as a vendor of materials or
supplies. The dollar amount of work to be accomplished by DBEs, including partial amount of a
lump sum or other similar item, shall be on the basis of subcontract, purchase order, hourly rate,
rate per ton, etc., as agreed to between parties.
DBE credit may be obtained only for specific work done for the project, supply of equipment
specifically for physical work on the project, or supply of materials to be incorporated in the work.
DBE credit will not be allowed for costs such as overhead items, capital expenditures (for
example, purchase of equipment), and office items.
The consultant may credit second-tier subcontracts issued to DBEs by non-DBE subconsultants.
Any second-tier subcontract to a DBE must meet the requirements of a first-tier DBE
subcontract.
A prime consultant may credit the entire amount of that portion of a contract that is performed
by the DBE’s own forces. The cost of supplies and materials obtained by the DBE for the work
of the contract can be included so long as that cost is reasonable. Leased equipment may
also be included. No credit is permitted for supplies purchased or equipment leased from the
prime consultant or its affiliate(s).
When a DBE subcontracts a part of the work of its contract to another firm, the value of the
subcontract may be credited towards the DBE participation only if the DBE’s subconsultant is
itself a DBE and performs the work with its own forces. Work that a DBE subcontracts to a
non-DBE firm does not count toward a DBE participation.
A prime consultant may credit the entire amount of fees or commissions charged by a DBE
firm for providing a bona fide service, such as professional, technical, consulting, or
managerial services, or for providing bonds or insurance specifically required for the
performance of a USDOT-assisted contract, provided the fees are reasonable and not
excessive as compared with fees customarily allowed for similar services.
14.02
Effect of Loss of DBE Eligibility:
If a DBE is deemed ineligible (decertified) or suspended in accordance with 49 CFR 26.87 and
26.88, the DBE may not be considered to count toward DBE participation on a new contract, but
may be considered to count toward DBE participation under a subcontract that was executed
before the DBE suspension or decertification is effective.
When a DBE firm or a DBE prime consultant loses its DBE eligibility and a subcontract or
contract has not been executed before a decertification notice is issued to the DBE firm by its
certifying agency, the ineligible firm does not count toward DBE participation.
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 10/12
When a subcontract is executed with the DBE firm before the Department notified the firm of its
ineligibility, the consultant may continue to use the firm on the contract and may continue to
receive DBE participation credit for the firm’s work.
14.03
Notifying the Consultant of DBE Certification Status:
Each DBE contract at any tier shall require any DBE subconsultant or supplier that is either
decertified or certified during the term of the contract to immediately notify the consultant and
all parties to the DBE contract in writing, with the date of decertification or certification. The
consultant shall require that this provision be incorporated in any contract of any tier in which a
DBE is a participant.
14.04
Police Officers:
DBE credit will not be permitted for procuring DPS officers. For projects on which officers from
other agencies are supplied, DBE credit will be given only for the broker fees charged, and will
not include amounts paid to the officers. The broker fees must be reasonable.
14.05
Commercially Useful Function:
A prime consultant can credit expenditures to a DBE subconsultant toward DBE participation
only if the DBE performs a Commercially Useful Function (CUF).
A DBE performs a CUF when it is responsible for execution of the work of a contract and
carries out its responsibilities by actually performing, managing, and supervising the work
involved. To perform a commercially useful function, the DBE must also be responsible, with
respect to materials and supplies on the contract, for negotiating price, determining quality and
quantity, ordering the material, and installing (where applicable) and paying for the material
itself that it uses on the project. To determine whether a DBE is performing a commercially
useful function, the LPA/Subrecipient will evaluate the amount of work subcontracted, industry
practices, whether the amount the firm is to be paid under the contract is commensurate with
the work it is actually performing and the DBE credit claimed for its performance of the work,
and other relevant factors.
A DBE will not be considered to perform a commercially useful function if its role is limited to
that of an extra participant in a transaction, contract, or project through which funds are passed
in order to obtain the appearance of DBE participation. In determining whether a DBE is such
an extra participant, the LPA/Subrecipient will examine similar transactions, particularly those
in which DBEs do not participate.
If a DBE does not perform or exercise responsibility for at least 30 percent of the total cost of
its contract with its own work force, or if the DBE subcontracts a greater portion of the work of
a contract than would be expected on the basis of normal industry practice for the type of work
involved, LPA/Subrecipient will presume that the DBE is not performing a commercially useful
function.
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 11/12
When a DBE is presumed not to be performing a commercially useful function as provided
above, the DBE may present evidence to rebut this presumption. The Department will
determine if the firm is performing a CUF given the type of work involved and normal industry
practices.
The LPA/Subrecipient will notify the consultant, in writing, if it determines that the consultant’s
DBE subconsultant is not performing a CUF. The consultant will be notified within seven
calendar days of the LPA/Subrecipient’s decision.
Decisions on CUF may be appealed to the ADOT BECO. The appeal must be in writing and
personally delivered or sent by certified mail, return receipt requested, to the ADOT BECO.
The appeal must be received by ADOT BECO no later than seven calendar days after the
LPA/Subrecipient’s decision. LPA/Subrecipient’s decision remains in place unless and until
the ADOT BECO reverses or modifies LPA/Subrecipient’s decision. ADOT BECO will promptly
consider any appeals under this subsection and notify the consultant of the ADOT BECO
findings and decisions. Decisions on CUF matters are not administratively appealable to
USDOT.
The LPA/Subrecipient may conduct project site visits on the contract to confirm that DBEs are
performing a CUF. The consultant shall cooperate during the site visits and the
LPA/Subrecipient staff will make every effort not to disrupt work on the project.
15.0
Required Provisions for DBE Subcontracts:
All subcontracts of any tier, all supply contracts, and any other contracts in which a DBE is a
participant shall include as a physical attachment, DBE Subconsultant Compliance Assurances
available from the LPA/Subrecipient and all of the Uniform Terms and Conditions set forth in
other sections of this contract.
Consultants executing agreements with subconsultants, DBE or non-DBE, that materially
modify federal regulation and state statutes such as, prompt payment and retention
requirements, through subcontract terms and conditions will be found in breach of contract
which may result in termination of the contract, or any other such remedy as the
LPA/Subrecipient and ADOT deem appropriate as outlined in DBE Subsection 2.0.
The LPA/Subrecipient reserves the right to conduct random reviews of DBE and non-DBE
subcontract documentation to ensure compliance with federal requirements.
The consultant shall ensure that all subcontracts or agreements with DBEs to supply labor or
materials require that the subcontract and all lower tier subcontracts be performed in accordance
with 49 CFR Part 26 provisions.
The Consultant shall provide electronic copies of signed subcontract agreements for all DBE
Subconsultants listed on the DBE Intended Participation Affidavit Summary by uploading them
within 15 calendar days of an approved contract to the LPA DBE System.
16.0
Certification of Final DBE Payments:
Professional Services DBE Special Provisions 08/26/2016
LPA PS EPRISE - 12/12
DBE participation on the contract is measured by actual payments made to the DBEs. The
consultant shall submit the “Certification of Final DBE Payments” form for each DBE firm
working on the contract. This form shall be signed by the consultant and the relevant DBE, and
submitted to the LPA/Subrecipient no later than 30 days after the DBE completes its work.
The LPA/Subrecipient and ADOT will use this certification and other information available to
determine applicable DBE credit allowed to date by the Prime Consultant and the extent to
which the DBE firms were fully paid for that work. By the act of filing the forms, the consultant
acknowledges that the information is supplied in order to justify the payment of state and
federal funds to the consultant.
The consultant will not be released from the obligations of the contract until the “Certification of
Final DBE Payments” forms are received and deemed acceptable by the LPA/Subrecipient.
17.0
False, Fraudulent, or Dishonest Conduct:
In addition to any other remedies or actions, the Department will bring to the attention of the
US Department of Transportation any appearance of false, fraudulent, or dishonest conduct in
connection with the DBE program, so that USDOT can take steps such as referral to the
Department of Justice for criminal prosecution, referral to the USDOT Inspector General for
possible initiation of suspension and debarment proceedings against the offending parties or
application of “Program Fraud and Civil Penalties” rules provided in 49 CFR Part 31.
10.0
DBE
FORMS/DOCUMENTS
-
BIDDERS PROPOSERS LIST (2 Pages)
-
DBE FORM 3210PS (1 Page)
APPENDIX: ATTACHMENT 3 - ADOT On-Line Bidders Proposers List Email Confirmation
RPA
Ritoch-Powell & Associates, AZUTRACS Number: 10953 has submitted a Bidder/Proposer list for
T009901C-CM on 10/19/2021 at 6:33 PM MST (UTC - 07:00).
Bidders/Proposers for this firm include:
Firm
Name
AZUTRACS
#
Expiration
Date
Email
Address
Phone
Number
ATEK Engineering Consultants, LLC.
11395
08/12/2022
aortega@atekec.com
480-659-
8065
Consultant Engineering, Inc.
10192
03/31/2024
ayaiva@cei-az.com
602-499-
6972
Corral Design Group, Inc.
10207
10/28/2022
ecorral@corraldesigngroup.com 602-222-
9822
Kimley-Horn & Associates, Inc.
10608
10/28/2022
ahmad.omais@kimley-
horn.com
602-906-
1328
Lee Engineering,L.L.C.
15300
03/30/2024
dbruggeman@lee-eng.com
602-618-
0406
Mak Pro Services LLC
10670
10/22/2022
teresa@makprosvc.com
602-421-
3069
Ricker, Atkinson, McBee and Associates,
Inc.
10949
05/27/2023
ramm@rammeng.com
480-921-
8100
CERTIFICATION OF FINAL DISADVANTAGED BUSINESS ENTERPRISE (DBE) PAYMENTS
Professional Services Contracts
(Submit one form for each DBE involved in the contract)
The undersigned consultant on Agency Project No:
ADOT TRACS No: __________________ herby,
certifies that full payment was made, to the firm indicated for material and/or work performed under this project's contract as follows:
DBE FIRM AZ UTRACS Vendor Registration #
Name of DBE Firm
was paid the amount of
This certificate is made under Federal and State Laws concerning false statement. Supporting documentation for this
payment is subject to audit and should be retained for a minimum of three years from project acceptance date. In the
event the DBE was not paid in accordance with affidavits submitted by the prime consultant, all documentation
supporting the consultant's position should be submitted.
I DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER APPLICABLE STATE OR FEDERAL LAWS
THAT THE STATEMENT MADE ON THIS DOCUMENT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
Consultant Company Name:
Check One:
Prime Consultant
Sub Consultant
Name:
Title:
Signature:
Date:
The undersigned sub consultant/supplier/manufacturer for the above named project hereby certified that payments
were received and/or justification by consultant is correct.
I DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER APPLICABLE STATE OR FEDERAL LAWS
THAT THE STATEMENT MADE ON THIS DOCUMENT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DBE Firm Name:
Check One:
Sub Consultant/Supplier/Manufacturer
Lower-tier Sub Consultant/Supplier/Manufacturer
Name:
Title:
Signature:
Date:
3210PS - LPA 1.3.2017
City of Chandler
Clear
SIGN
SIGN
11.0
PAY REQUESTS
-
PAYMENT APPLICATION (1 Page)
-
SUBCONSULTANT SUMMARY FORM (1 Page)
name
name
name
name
name
name
name
-
$
-
$
-
$
-
$
-
$
-
$
-
$
Pay App
#
Work Mo
Pay Mo
DBE Rpt
Mo
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
Total To Date
Bal Remaining
Month
Subconsultants (add name, x if DBE)
DBE-> (x) =yes
Contract Amt
Change Order(s):
Total Contract:
Lower Tier --> (x)
Lower Tier to:
Project Numbers
PROFESSIONAL SERVICES PAY APP BACKUP - (REQUIRED)
Consultant
Project Name
12.0
SUBCONSULTANT SUBCONTRACTS
-
SUBCONTRACT REQUIREMENTS (1 Page)
-
SUBCONSULTANT APPROVAL REQUEST FORM (SARF) (1 Page)
-
SUBCONSULTANT FEDERAL COMPLIANCE ACKNOWLEDGEMENT (1 Page)
-
SUBRECIPIENT DBE ASSURANCE (8 Pages)
-
**Other subcontract required documents listed in the “Subcontract Requirements”
document (listed above) will be provided, but are also documents included in the
Prime RFQ/Contract, See “Subcontract Requirements”.
Rev: 05-17-2021
Subconsultant / Subcontracts for Professional Services Subcontracts
(For contracts with a No-DBE Goal - Race Neutral)
IMPORTANT NOTES:
1.
The “Joint Check” process – where a Prime pays a subconsultant’s lower tier or vendor is not
allowed on FHWA Federal Funded Professional Services contracts.
2.
Subconsultants will be required to be approved by the City (Submittal of Subcontract, SARF,
Federal Compliance Acknowledgement Form. The City will verify required licenses/registrations,
UTracs registration/profile, DBE System profile, DBE Certifications, SAM verification for
unresolved federal tax liens and any debarment status, etc.
3.
Subconsultants for QA/QC/IA Testing – must be on the ADOT Accredited Laboratories / ADOT
Accredited Material Testing Laboratories List.
https://azdot.gov/business/engineering-and-construction/materials/materials-quality-assurance/adot-accredited
SUBCONTRACTS
All Subcontracts:
During Scope and Fee, a copy of each of these documents will be provided by the City of Chandler to
ensure correct and current forms and documents for the City are utilized. The following is a list of
required documents that must be included in all Subconsultant Subcontracts.
1.
SARF (Subconsultant Approval Request Form)
2.
Federal Compliance Acknowledgement Form
3.
Prompt Pay Provision
4.
Title VI Assurance, Title VI Appendix A, Title VI Appendix E
5.
Records Retention Requirements
Federal Immigration and Nationality Act
DBE Subconsultant Subcontracts:
The following is a list of required documents that must be included in DBE Subconsultant Subcontracts.
1.
LPA DBE Subrecipient Compliance Assurance (or DBE EPrise)
2.
DBE Form 3210PS Final Payment
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
SARF Rev 2021-08-31 City Reviewed/Approved/Date: _______________________________________________ (For City Tracking/Audit Backup)
SUBCONSULTANT APPROVAL REQUEST
Instructions: Form must be filled out completely. When Subconsultant is approved, Prime will receive an email notice. Subconsultant must be
approved prior to billable work start. Subconsultants must have an active non-expired 5-digit UTracs registration. All Subconsultants must
have a DBE reporting representative listed who is listed in Subconsultant Profile in the ADOT Doors DBE Reporting System.
DATE
PRIME
PROJECT NAME
PROJECT # (City/Fed/ADOT)
1
Subconsultant Company
Name/Address/Tel
Name
Address
Telephone
2
Subconsultant Main Contact
Name
Email
3
Utracs No (5 digit)
4
Contract Amount
5
Work Description of tasks related to Prime
Contract and NAICS Codes
(attach separate sheet if necessary)
6
QA Subconsultant/Testing(must be on ADOT
approved list & will be verified)
Yes:
OR
No:
7a
Is Subconsultant a DBE
Yes:
OR
No:
7b
NAICS Code(s) if a DBE
8a
Is Subconsultant a Lower Tier
Yes:
OR
No:
8b
If Lower Tier, to what Subconsultant
9
Subconsultant Contact for Monthly DBE
Reporting (All Subconsultants on a federal
funded project must report into this system
monthly. Please ensure that this name
/contact info is in your DBE System Profile)
(DBE System help: 888-635-0336)
Name
Tel
Email
10
Subconsultant Contact for the Monthly
Invoice Preparation to the Prime
Name
Tel
Email
______________________________________________
Lower Tier Subconsultant Signature (if applicable) / Date
______________________________________________
______________________________________________
Subconsultant Representative Signature / Date:
Prime Signature / Date
Subconsultant Federal Compliance Acknowledgement 2020-09-24
SUBCONSULTANT FEDERAL REQUIREMENTS ACKNOWLEDGEMENT
Project Name
Project Numbers
1.
If federal compliance discrepancies re-occur without correction, Subconsultant and Prime may be required to meet with
the City to review federal requirements. If federal compliance discrepancies continue, subconsultant may be removed
from working on this contract/project.
2.
UTracs: Subconsultant must have an AZ UTracs Registration/5 Digit Number. (https://utracs.azdot.gov)
3.
DBE:
a.
Subconsultant must be registered with ADOT DBE System (links are provided on the UTracs webpage)
b.
Subconsultant must review profile and ensure updated company and contact information is correct.
c.
Subconsultant agrees to monthly payment reporting in the ADOT DBE System:
d.
City of Chandler is a CA Agency and reports into the DBE System.
e.
This reporting is due by the Prime by the 10th, and the Subconsultants by the 30th of each month
f.
Subconsultant understands reporting include $0 payments until subcontract is complete.
g.
Subconsultant understands to NEVER upload any documents into this system for this project/contract. The City
will upload any required documents to ensure correct federal requirements which avoids audit discrepancies.
h.
Help Number for reporting assistance: 888-635-0336
4.
Records Retention Requirements for CA Agency federal funded contracts is five (5) years.
5.
Title VI and Federal Immigration and Nationality Act compliance is required
6.
Subconsultant understands that all documents, emails, reports, invoices must have the Project Name and Project
Numbers (City, Federal, ADOT).
a.
Prime/Consultant related documents
STxxx-451 / CHN0xxxD / T0xxx01C
b.
Construction related documents (example: plans,submittals tech specs)
STxxx-401 / CHN0xxxD / T0xxx01C
7.
Invoicing/Billing: Federal funded contracts require by calendar month for all work occurred in that given calendar month.
a.
Subconsultant understands and agrees to submit invoices to Prime monthly, no later than the 5th working day of
the following month, if work occurred.
b.
If an expense has been missed and needs to be added to the following month, FHWA requires that an
explanation be added to that document explaining why it was not included in the applicable billing month. (Note:
FHWA does not allow this as on-going, please keep to minimum occurrences).
8.
Prompt Pay Provisions – Payments by Prime to Subconsultants, and Subconsultant to Lower Tiers must be made within
7 days from the actual date that payment was received.
a.
The Date the City pays the Prime – Prime has 7 days to process payment to Subconsultant.
b.
The Date Subconsultant receives that payment from Prime, Subconsultant has 7 days to process payment to
lower tier. (this means the date mail was actually delivered, or bank received direct deposit; does not mean the
date identified in bank statement, or the date mail was opened).
9.
No work by Subconsultant can occur on this contract/project until approved by the City of Chandler.
10. Subconsultants for work task Quality Assurance/QA/Materials Testing: Subconsultant must be on the ADOT Approved
list: https://azdot.gov/business/engineering-and-construction/construction-and-materials/materials-quality-assurance/adot
11. Subcontract must include current documents (provided by City): Prompt Pay Provision, City of Chandler Title VI
Assurance, Title VI Appendix A, Title VI Appendix E, Records Retention, Federal Immigration & Nationality Act, and if a
DBE will include items listed below in #12-a.
12. DBE Subconsultant only:
a.
DBE Subcontracts must include:
i.
LPA/Subrecipient EPrise Assurance, DBE Form 3210PS
b.
DBE Subcontract must show dollars applied to each work task description.
c.
DBE Subconsultant and Prime must fill out, sign, and submit DBE Form 3210PS to City of Chandler at
completion of subcontract work.
By signing below, I confirm I have read the above requirements for working on this federal funded contract
Subconsultant Name
Subconsultant Signature/Date
Prime Signature/Date
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 1/8
(PROJECT SPECIFIC - CONTRACTS)
LPA/SUBRECIPIENT FEDERAL AID CONTRACT WITH OR WITHOUT DBE GOAL
1.
Assurances of Non-Discrimination:
(LPA PS EPRISE 2.0)
The consultant, subrecipient, or subconsultant shall not discriminate on the basis of race, color, sex or national
origin in the performance of this contract. The consultant shall carry out applicable requirements of 49 CFR Part
26 in the award and administration of DOT-assisted contracts. Failure by the consultant to carry out these
requirements is a material breach of this contract, which may result in the termination of this contract or such
other remedy as the the LPA/Subrecipient with the Department’s concurrence deems appropriate, which may
include, but are not limited to:
(1)
Withholding monthly progress payments;
(2)
Assessing sanctions;
(3)
Liquidated damages;
(4)
Disqualifying the consultant from future proposals as non-responsible.
The consultant, subrecipient, or subconsultant shall ensure that all subcontract agreements contain this non-
discrimination assurance.
2.
Time is of the Essence:
(LPA PS EPRISE 8.0)
TIME IS OF THE ESSENCE IN RESPECT TO THE DBE PROVISIONS
3. Computation of Time:
(LPA PS EPRISE 9.0)
In computing any period of time described in this DBE special provision, such as calendar days, the day from which
the period begins to run is not counted, and when the last day of the period is a Saturday, Sunday, Federal or State
holiday, the period extends to the next day that is not a Saturday, Sunday, Federal or State holiday. In
circumstances where the LPA/Subrecipient Procurement Office is closed for all or part of the last day, the period
extends to the next day on which the LPA / Subrecipient Procurement Office is open.
4.
Crediting DBE Participation Toward Meeting Goals:
(LPA PS EPRISE 17.0)
General Requirements:
To count toward meeting the goal, the DBE firms must be certified at the time of Cost Proposal submission in each
NAICS code applicable to the kind of work the firm will perform on the contract. NAICS for each DBE can be found on
the AZ UTRACS website. General descriptions of all NAICS codes can be found at http://www.naics.com/search/.
Credit towards the consultant’s DBE goal is given only after the DBE has been paid for the work performed.
The entire amount of a contract that is performed by the DBE’s own forces, including the cost of supplies and
materials purchased by the DBE for the work on the contract and equipment leased by the DBE will be credited
toward DBE participation. Supplies and equipment the DBE subconsultant purchases or leases from the prime
consultant or its affiliate will not be credited toward DBE participation.
The consultant bears the responsibility to determine whether the DBE possesses the proper consultant’s license(s) to
perform the work and, if DBE credit is requested, that the DBE subconsultant is certified for the requested type of
work.
If a DBE cannot complete its work due to failure to obtain or maintain its licensing, the consultant bears the
responsibility to notify the LPA/Subrecipient, immediately after the consultant becomes aware of the situation, and
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 2/8
request approval to replace the DBE with another DBE. The consultant shall follow the DBE termination/substitution
requirements described in Subsection 22.0 of these DBE provisions.
The Department’s certification is not a representation of a DBE’s qualifications and/or abilities. The consultant bears
all risks that the DBE may not be able to perform its work for any reason.
A DBE may participate as a prime consultant, subconsultant, or as a vendor of materials or supplies. The dollar
amount of work to be accomplished by DBEs, including partial amount of a lump sum or other similar item, shall be
on the basis of subcontract, purchase order, hourly rate, rate per ton, etc., as agreed to between parties.
DBE credit may be obtained only for specific work done for the project, supply of equipment specifically for physical
work on the project, or supply of materials to be incorporated in the work. DBE credit will not be allowed for costs
such as overhead items, capital expenditures (for example, purchase of equipment), and office items.
The consultant may credit second-tier subcontracts issued to DBEs by non-DBE subconsultants. Any second-tier
subcontract to a DBE used to meet the goal must meet the requirements of a first-tier DBE subcontract.
A prime consultant may credit the entire amount of that portion of a contract that is performed by the DBE’s own
forces. The cost of supplies and materials obtained by the DBE for the work of the contract can be included so
long as that cost is reasonable. Leased equipment may also be included. No credit is permitted for supplies
purchased or equipment leased from the prime consultant or its affiliate(s).
When a DBE subcontracts a part of the work of its contract to another firm, the value of the subcontract may be
credited towards the DBE goal only if the DBE’s subconsultant is itself a DBE and performs the work with its own
forces. Work that a DBE subcontracts to a non-DBE firm does not count toward a DBE goal.
A prime consultant may credit the entire amount of fees or commissions charged by a DBE firm for providing a
bona fide service, such as professional, technical, consulting, or managerial services, or for providing bonds or
insurance specifically required for the performance of a USDOT-assisted contract, provided the fees are
reasonable and not excessive as compared with fees customarily allowed for similar services.
DBE Prime Consultant:
When a certified DBE firm proposes on a contract that contains a DBE goal, the DBE firm is responsible for meeting
the DBE goal on the contract or making good faith efforts to meet the goal, just like any other proposer. In most
cases, a DBE proposer on a contract will meet the DBE goal by virtue of the work it performs on the contract with
its own forces. However, all the work that is performed by the DBE proposer or any other DBE subconsultants and
DBE suppliers will count toward the DBE goal. The DBE proposer shall list itself along with any DBE subconsultants
and suppliers, on the DBE Intended Participation Affidavit Individual and Summary in order to receive credit
toward the DBE goal.
Effect of Loss of DBE Eligibility:
If a DBE is deemed ineligible (decertified) or suspended in accordance with 49 CFR 26.87 and 26.88, the DBE may not
be considered to meet a contract goal on a new contract, but may be considered to meet the contract goal under a
subcontract that was executed before the DBE suspension or decertification is effective.
When the consultant makes a commitment to use an ineligible DBE firm or the LPA/Subrecipient, made a
commitment to use an ineligible DBE prime consultant, but a subcontract or contract has not been executed before a
decertification notice is issued to the DBE firm by its certifying agency, the ineligible firm does not count toward the
contract goal. The consultant must meet the contract goal with an eligible DBE firm or demonstrate good faith effort.
When a subcontract is executed with the DBE firm before the Department notified the firm of its ineligibility, the
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 3/8
consultant may continue to use the firm on the contract and may continue to receive credit toward the DBE goal for
the firm’s work.
Notifying the Consultant of DBE Certification Status:
Each DBE contract at any tier shall require any DBE subconsultant or supplier that is either decertified or certified
during the term of the contract to immediately notify the consultant and all parties to the DBE contract in writing,
with the date of decertification or certification. The consultant shall require that this provision be incorporated in
any contract of any tier in which a DBE is a participant.
Police Officers:
DBE credit will not be permitted for procuring DPS officers. For projects on which officers from other agencies are
supplied, DBE credit will be given only for the broker fees charged, and will not include amounts paid to the
officers. The broker fees must be reasonable.
Commercially Useful Function:
A prime consultant can credit expenditures to a DBE subconsultant toward DBE goals only if the DBE performs a
Commercially Useful Function (CUF).
A DBE performs a CUF when it is responsible for execution of the work of a contract and carries out its
responsibilities by actually performing, managing, and supervising the work involved. To perform a commercially
useful function, the DBE must also be responsible, with respect to materials and supplies on the contract, for
negotiating price, determining quality and quantity, ordering the material, and installing (where applicable) and
paying for the material itself that it uses on the project. To determine whether a DBE is performing a
commercially useful function, the LPA/Subrecipient will evaluate the amount of work subcontracted, industry
practices, whether the amount the firm is to be paid under the contract is commensurate with the work it is
actually performing and the DBE credit claimed for its performance of the work, and other relevant factors.
A DBE will not be considered to perform a commercially useful function if its role is limited to that of an extra
participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance
of DBE participation. In determining whether a DBE is such an extra participant, the LPA/Subrecipient will examine
similar transactions, particularly those in which DBEs do not participate.
If a DBE does not perform or exercise responsibility for at least 30 percent of the total cost of its contract with its
own work force, or if the DBE subcontracts a greater portion of the work of a contract than would be expected on
the basis of normal industry practice for the type of work involved, LPA/Subrecipient will presume that the DBE is
not performing a commercially useful function.
When a DBE is presumed not to be performing a commercially useful function as provided above, the DBE may
present evidence to rebut this presumption. The Department will determine if the firm is performing a CUF given
the type of work involved and normal industry practices.
The LPA/Subrecipient will notify the consultant, in writing, if it determines that the consultant’s DBE subconsultant
is not performing a CUF. The consultant will be notified within seven calendar days of the LPA/Subrecipient’s
decision.
Decisions on CUF may be appealed to the ADOT BECO. The appeal must be in writing and personally delivered or
sent by certified mail, return receipt requested, to the ADOT BECO. The appeal must be received by ADOT BECO
no later than seven calendar days after the LPA/Subrecipient’s decision. LPA/Subrecipient’s decision remains in
place unless and until the ADOT BECO reverses or modifies LPA/Subrecipient’s decision. ADOT BECO will promptly
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 4/8
consider any appeals under this subsection and notify the consultant of the ADOT BECO findings and decisions.
Decisions on CUF matters are not administratively appealable to USDOT.
The LPA/Subrecipient may conduct project site visits on the contract to confirm that DBEs are performing a CUF.
The consultant shall cooperate during the site visits and the LPA/Subrecipient staff will make every effort not to
disrupt work on the project.
5.
Effect of Contract Changes:
(LPA PS EPRISE 18.0)
The consultant acknowledges that uncertainties can occur during the performance of the work and if for any
reason it becomes apparent that the DBE goal will not be met then the consultant shall: (1) immediately notify
the LPA/Subrecipient of the potential or actual decrease in DBE compensation, and (2) make good faith efforts to
obtain DBE participation to meet or exceed the project DBE goal. Good faith efforts required under the provisions
of this section may vary, depending on the time available, the nature of the change, and other factors as
determined by LPA/Subrecipient.
LPA/Subrecipient will approve or deny the consultant’s good faith efforts with BECO concurrence.
The consultant is not required to take work committed to another subconsultant and assign it to a DBE
subconsultant in order to meet the committed DBE percentage.
If the resulting change increases the scope or quantity of work being done by a DBE subconsultant, the DBE shall
be given the opportunity to complete the additional work and receive additional compensation beyond their
original subcontract amount.
6.
DBE Participation Above the Goal (Race-Neutral Participation):
(LPA PS EPRISE 19.0)
Additional DBE participation above the DBE participation required to meet the contract DBE goal is an important
aspect of the Department’s DBE program. The consultant is strongly encouraged to use additional DBEs above the
DBE goal requirement in the contract to assist the Department in meeting its overall DBE goal and help the
Department to meet the maximum feasible portion of its DBE goals through race neutral participation as outlined in
49 CFR Part 26.
There are fewer administrative requirements on the part of the consultant when using race neutral DBEs (DBEs not
listed on the DBE Intended Participation Affidavit Summary). For example, if a DBE is not listed on the DBE Intended
Participation Affidavit Summary, the DBE does not have to submit an Affidavit, and the subcontract approval process
follows the same process of any other subcontract. The consultant does not have to replace the DBE with another
DBE subconsultant if the DBE fails to perform. Therefore these DBEs are treated as any other subconsultant on the
project.
7.
Required Provisions for DBE Subcontracts:
(LPA PS EPRISE 20.0)
All subcontracts of any tier, all supply contracts, and any other contracts in which a DBE is a participant shall
include as a physical attachment, DBE Subconsultant Compliance Assurances available from the LPA/Subrecipient
and all of the Uniform Terms and Conditions set forth in other sections of this contract.
Consultants executing agreements with subconsultants, DBE or non-DBE, that materially modify federal regulation
and state statutes such as, prompt payment and retention requirements, through subcontract terms and
conditions will be found in breach of contract which may result in termination of the contract, or any other such
remedy as the LPA/Subrecipient and ADOT deem appropriate as outline in DBE Subsection 2.0.
The LPA/Subrecipient reserves the right to conduct random reviews of DBE and non-DBE subcontract
documentation to ensure compliance with federal requirements.
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 5/8
The consultant shall ensure that all subcontracts or agreements with DBEs to supply labor or materials require that
the subcontract and all lower tier subcontracts be performed in accordance with 49 CFR Part 26 provisions.
The Consultant shall provide electronic copies of signed subcontract agreements for all DBE Subconsultants listed
on the DBE Intended Participation Affidavit Summary by uploading them within 15 calendar days of an approved
contract to the LPA DBE System.
8.
Contract Performance:
(LPA PS EPRISE 21.0)
Contract items of work designated by the consultant to be awarded to DBEs shall be performed by the designated
DBE or a LPA/Subrecipient, with BECO concurrence, approved DBE substitute. The Consultant or a non-DBE
Subconsultant shall not perform DBE contract work items without prior approval by LPA/Subrecipient, with BECO
concurrence.. The DBE must perform a commercially useful function; that is, the DBE must manage, perform, and
supervise a distinct element of work.
The consultant is required to use DBEs identified in the SOQ to meet the contract goal, so the prime consultant is
responsible for ensuring that the DBEs are available to meet scheduling, work and other requirements on the
contract.
The LPA/Subrecipient will visit the consultant’s office to conduct reviews to ensure compliance with CUF and other
DBE requirements. The reviews may include, among other activities, interview of DBEs and their employees and
the consultant and its employees. The consultant shall cooperate in the review and make its employees available.
The consultant shall inform the LPA/Subrecipient in advance when each DBE will be working on the project to help
facilitate reviews.
The LPA/Subrecipient reserves the right to request and inspect all records of the consultant and all records of the
DBEs and non-DBE subconsultants concerning this contract. The consultant must make available a copy of all
documents related to all contracts the LPA/Subrecipient upon request.
Use of every DBE listed on the DBE Intended Participation Affidavit Summary is a condition of this contract. The
consultant shall utilize the specific DBEs listed to perform the work and supply the materials for which each is
listed on the DBE Intended Participation Affidavit Summary unless the consultant obtains written consent from the
LPA/Subrecipient with BECO concurrence. The consultant shall not be entitled to any payment for work or material
that is not performed or supplied by the listed DBE unless the consultant obtains written consent from the
LPA/Subrecipient with BECO concurrence.
9.
DBE Termination/Substitution:
(LPA PS EPRISE 22.0)
General Requirements:
The consultant shall make all reasonable efforts to avoid terminating or substituting a DBE listed on the DBE
Intended Participation Affidavit Summary. At a minimum, the consultant shall negotiate in good faith, give timely
notices and/or extend deadlines to the extent that it will not jeopardize the contract with the LPA/Subrecipient.
Reasonable methods to resolve performance disputes must be applied and documentation provided to the
Department and the LPA/Subrecipient before attempting to substitute or terminate a DBE.
Consultant Notice of Termination/Substitution:
All terminations, substitutions, and reductions in scope of work to be performed by DBEs listed on the DBE
Intended Participation Affidavit Summary must be approved in writing by the LPA/Subrecipient, with BECO
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 6/8
concurrence and by means of the executed contract modification. The consultant shall contact the
LPA/Subrecipient within 24 hours from the first sign of any reason for potential DBE termination/substitution.
The consultant shall not terminate a DBE subconsultant listed on the DBE Intended Participation Affidavit
Summary or complete the work contracted to the DBE with its own forces or with a non-DBE firm without the
LPA/Subrecipient written consent and BECO concurrence. Before submitting a formal request to the
LPA/Subrecipient for DBE termination/substitution, the consultant shall give written notice to the DBE
subconsultant with a copy to the LPA/Subrecipient of its intent to terminate or substitute the DBE identifying the
reason for the action. The DBE shall be allowed a minimum of five calendar days to respond to the consultant’s
notice advising the consultant, the LPA/Subrecipient of its position. Before making a determination for approval
regarding the consultant’s termination and substitution request, the LPA/Subrecipient, with BECO concurrence,
will consider both the consultant’s request and the DBE firm’s response.
Consultant Request of Termination/Substitution:
The consultant shall formally request the termination or substitution of a DBE listed on the DBE Intended
Participation Affidavit Summary by submitting the DBE Termination/Substitution Request Form and supporting
documentation to the LPA/Subrecipient; form is available from the LPA/Subrecipient. The submission shall include
the following information:
1) The date the consultant determined the DBE to be unwilling, unable or ineligible to perform.
2) A brief statement of facts describing the situation and citing specific actions or inaction by the DBE
firm giving rise to consultant’s assertion that the DBE firm is unwilling, unable, or ineligible to
perform.
3) A brief statement of the good faith efforts undertaken by the consultant to enable the DBE firm to
perform.
4) The total dollar amount currently paid for work performed by the DBE firm.
5) The total dollar amount remaining to be paid to the DBE firm for work completed, but for which the
DBE firm has not received payment, and over which the consultant and the DBE firm have no dispute.
6) The remaining work that has not been completed by the DBE and the corresponding dollar amount
7) The projected date that the consultant requires a substitution or replacement DBE to commence
work, if consent is granted to the request.
Written consent for terminating the performance of any DBE listed on the DBE Intended Participation Affidavit
Summary will be granted only where the consultant can demonstrate good cause showing that the DBE is unable,
unwilling, or ineligible to perform. Such written consent to terminate any DBE shall concurrently constitute written
consent to substitute or replace the terminated DBE. Termination or substitution of a DBE listed on the DBE
Intended Participation Summary will not be allowed based solely on a consultant's ability to negotiate a more
advantageous contract with another subconsultant. Prior to making a determination for approval regarding the
consultant’s termination and substitution request, the LPA/Subrecipient, with BECO concurrence, will consider
both the consultant’s request and the DBE firm’s response.
Good Cause:
The LPA/Subrecipient, with BECO concurrence, will make the determination of good cause by providing written
consent to the consultant after evaluating the consultant’s good cause to terminate or substitute a DBE firm. Good
cause for this purpose includes the following in relation to the listed DBE subconsultant:
1. Fails or refuses to execute a written contract.
2. Fails or refuses to perform the work of its subcontract in a way consistent with normal industry practice
standards. However, good cause does not exist if the failure or refusal of the DBE subconsultant to
perform its work on the subcontract results from the bad faith or discriminatory action of the prime
consultant.
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 7/8
3. Fails or refuses to meet the prime consultant’s reasonable, nondiscriminatory insurance/bond
requirements.
4. Becomes bankrupt, insolvent, or exhibits credit unworthiness.
5. Is ineligible to work on public works projects because of suspension and debarment proceedings pursuant
to federal or state law.
6. Is not a responsible consultant.
7. Voluntarily withdraws from the project and provides written notice of its withdrawal to the
LPA/Subrecipient.
8. Is ineligible to receive DBE credit for the type of work required
9. A DBE owner dies or becomes disabled with the result that the firm is unable to complete its work on the
contract.
10. Other documented good cause that the LPA/Subrecipient determines compels the termination or
substitution of the DBE subconsultant.
If good cause is determined, the LPA/Subrecipient and will notify the Consultant of the decision and necessary
modifications to the contract can be made.
DBE Replacement Good Faith Effort:
If the LPA/Subrecipient, with BECO concurrence, approves the termination of a DBE, the consultant shall make
good faith efforts to find another DBE subconsultant to substitute for the original DBE. The good faith efforts as
identified in DBE Subsection 17.0 shall be directed at finding another DBE to perform at least the same amount of
work under the contract as the DBE that was terminated, to the extent needed to meet the contract goal. The
good faith efforts shall be documented and provided, upon request, to the LPA/Subrecipient within seven
calendar days from the date of the request.
A prime consultant’s inability to find a replacement DBE at the original price is not alone sufficient to support a
finding that good faith efforts have been made to replace the original DBE. The fact that the consultant has the
ability and/or desire to perform the contract work with its own forces does not relieve the consultant of the
obligation to make good faith efforts to find the replacement DBE, and it is not a sound basis for rejecting a
perspective replacement DBE’s reasonable quote.
The termination of a DBE firm shall not relieve the consultant of its obligations under this Special Provision, and
the unpaid portion of the terminated DBE firm’s subcontract will not be counted toward the DBE goal. If the
LPA/Subrecipient has eliminated items of work subcontracted to a committed DBE, the prime consultant shall still
make good faith efforts to replace the DBE with another DBE to the extent necessary to meet the goal. The
LPA/Subrecipient will review the quality, thoroughness, and intensity of those efforts.
When a DBE substitution has been approved by the LPA/Subrecipient and concurred by BECO, the consultant shall
submit an amended DBE Intended Participation Affidavit Individual and Intended Participation Affidavit Summary
to the LPA/Subrecipient for approval with the substitute DBE's name, description of work, NAICS code, AZ UTRACS
registration number, and dollar value of work. Approval from LPA/Subrecipient with BECO concurrence must be
obtained prior to the execution of a contract modification and before substituted DBE can begin work.
Sanctions:
Failure by the consultant to carry out the requirements of these DBE Termination/Substitution specifications is a
material breach of contract and will result in such remedies as LPA/Subrecipient deems appropriate, with ADOT
concurrence, which will include, but are not limited to the assessment of liquidated damages. The
LPA/Subrecipient will deduct from monies due or becoming due the consultant, the dollar amount of the
wrongfully substituted/replaced DBE subcontract plus 25% of the amount remaining to be paid to the DBE as
liquidated damages. These liquidated damages shall be in addition to all other retention or liquidated damages
provided for elsewhere in the contract.
BECO Rev. 7/01/2016
LPA DBE Subcontract Assurances Professional Services - 8/8
10.
Certification of Final DBE Payments:
(LPA PS EPRISE 25.0)
The consultant’s achievement of the goal is measured by actual payments made to the DBEs. The consultant shall
submit the “Certification of Final DBE Payments” form for each DBE firm working on the contract. This form shall
be signed by the consultant and the relevant DBE, and submitted to the LPA/Subrecipient no later than 30 days
after the DBE completes its work.
The LPA/Subrecipient and ADOT will use this certification and other information available to determine applicable
DBE credit allowed to date by the Prime Consultant and the extent to which the DBE firms were fully paid for that
work. By the act of filing the forms, the consultant acknowledges that the information is supplied in order to
justify the payment of state and federal funds to the consultant.
The consultant will not be released from the obligations of the contract until the “Certification of Final DBE
Payments” forms are received and deemed acceptable by the LPA/Subrecipient.
11.
Sanctions for Not Meeting Contract DBE Goal:
(LPA PS EPRISE 24.0)
If the LPA/Subrecipient determines, with BECO concurrence, that the consultant has not met the DBE goal at the
end of the contract, the LPA/Subrecipient will, at its discretion, may assess liquidated damages up to two times
the amount of the unattained portion of the original DBE goal, based on the circumstances of the noncompliance.
Not meeting the DBE goal will also be reflected in the consultant evaluation.
The LPA/Subrecipient, with BECO concurrence, will determine whether liquidated damages will be assessed and
the amount of the liquidate damages, the LPA/Subrecipient will consider whether there have been other
violations on this or other contracts, whether the failure was due to circumstances beyond the control of the
consultant, whether the consultant has made good faith efforts to meet the goal, and other appropriate
circumstances.
In addition to any other sanctions, willful failure of the consultant, DBE or other subconsultant to comply with this
contract or with the Federal DBE regulations may result in disqualification from further contracting,
subcontracting, or other participation in the Department’s and LPA/Subrecipient projects.
12.
False, Fraudulent, or Dishonest Conduct:
(LPA PS EPRISE 27.0)
In addition to any other remedies or actions, the Department will bring to the attention of the US Department of
Transportation any appearance of false, fraudulent, or dishonest conduct in connection with the DBE program, so
that USDOT can take steps such as referral to the Department of Justice for criminal prosecution, referral to the
USDOT Inspector General for possible initiation of suspension and debarment proceedings against the offending
parties or application of “Program Fraud and Civil Penalties” rules provided in 49 CFR Part 31.
END OF FEDERAL DOCUMENTS SECTION
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR
ADDL SUBR
LTR
INSD WVD
PRODUCER
CONTACT
NAME:
FAX
PHONE
(A/C, No):
(A/C, No, Ext):
E-MAIL
ADDRESS:
INSURER A :
INSURED
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF
POLICY EXP
TYPE OF INSURANCE
LIMITS
(MM/DD/YYYY)
(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE
$
DAMAGE TO RENTED
CLAIMS-MADE
OCCUR
$
PREMISES (Ea occurrence)
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRO-
POLICY
LOC
PRODUCTS - COMP/OP AGG
JECT
OTHER:
$
COMBINED SINGLE LIMIT
$
(Ea accident)
ANY AUTO
BODILY INJURY (Per person)
$
OWNED
SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY
AUTOS
HIRED
NON-OWNED
PROPERTY DAMAGE
$
AUTOS ONLY
AUTOS ONLY
(Per accident)
$
OCCUR
EACH OCCURRENCE
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
PER
OTH-
STATUTE
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE
NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
CERTIFICATE HOLDER
CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
2/16/2022
(703) 827-2277
(703) 827-2279
20508
Ritoch-Powell & Associates Consulting Engineers, Inc.
1001 North Central Avenue
Suite 900
Phoenix, AZ 85004
20478
35289
22276
A
1,000,000
6075640222
1/1/2022
1/1/2023
1,000,000
Contractual Liab.
15,000
1,000,000
2,000,000
2,000,000
1,000,000
B
6075640236
1/1/2022
1/1/2023
15,000,000
C
6075640270
1/1/2022
1/1/2023
15,000,000
10,000
C
6075640267
1/1/2022
1/1/2023
1,000,000
N
1,000,000
1,000,000
D Professional Liab.
42-EPP-306878-04
1/1/2022
Per Claim/Aggregate
10,000,000
RE: PROJECT #ST1614.451, CHN-0(240)D, ADOT #T009901C, CONSTRUCTION MANAGEMENT SERVICES CHANDLER HEIGHTS ROAD IMPROVEMENT
(MCQUEEN ROAD TO GILBERT ROAD)
The City of Chandler, AZ is included as additional insured with respect to General Liability, Automobile Liability, and Umbrella Liability when required by
written contract. General Liability includes Additional Insured coverage for Completed Operations as required by written contract. General Liability,
Automobile Liability, and Umbrella Liability are primary and non-contributory over any existing insurance and limited to liability arising out of the operations
of the named insured and when required by written contract. General Liability, Automobile Liability, Workers Compensation, and Umbrella Liability policies
SEE ATTACHED ACORD 101
City of Chandler, AZ
PO Box 4008, Mail Stop 407
Chandler, AZ 85244-4008
ARDURRA-01
KGODWIN
Ames & Gough
8300 Greensboro Drive
Suite 980
McLean, VA 22102
admin@amesgough.com
Valley Forge Insurance Company A(XV)
National Fire Insurance Company of Hartford A(XV)
Continental Insurance Company A(XV)
Berkshire Hathaway Specialty Insurance Company
X
1/1/2023
X
X
X
X
X
X
X
X
FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ACORD 101 (2008/01)
AGENCY CUSTOMER ID:
LOC #:
AGENCY
NAMED INSURED
POLICY NUMBER
CARRIER
NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.
Ames & Gough
ARDURRA-01
SEE PAGE 1
1
SEE PAGE 1
ACORD 25
Certificate of Liability Insurance
1
SEE P 1
Ritoch-Powell & Associates Consulting Engineers, Inc.
1001 North Central Avenue
Suite 900
Phoenix, AZ 85004
SEE PAGE 1
KGODWIN
1
Description of Operations/Locations/Vehicles:
include a waiver of subrogation in favor of the additional insureds where permissible by state law and when required by written
contract. Umbrella Liability coverage sits excess over General Liability, Automobile Liability and Employers’ Liability coverage.
CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
I.
WHO IS AN INSURED is amended to include as an Insured 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, property 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 written contract; or
B.
in the performance of your work subject to such written 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.
II.
But if the written contract requires:
A.
additional insured coverage under the 11-85 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 I. above is deleted in its entirety and replaced by the following:
WHO IS AN INSURED is amended to include as an Insured 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, property damage or personal and advertising injury arising out of your work that is subject to such written
contract.
III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer 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.
IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage, or personal and advertising injury arising out of:
A.
the rendering of, or the failure to render, any professional architectural, engineering, or surveying 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 Insurance is amended to
add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage
part:
6075640222
CNA75079XX (10-16)
Policy No:
13
Page 1 of 2
Endorsement No:
The Continental Insurance Co.
Effective Date: 01/01/2022
ARDURRA GROUP, INC.
Insured Name:
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
20020002260756402222362
CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
Primary and Noncontributory Insurance
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.
VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence, Offense, Claim 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 Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2.
send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer 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 Insurer 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 Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives
written notice of a claim from the additional insured.
VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to
add the following definition:
Written 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 personal and advertising injury;
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
6075640222
CNA75079XX (10-16)
Policy No:
13
Page 2 of 2
Endorsement No:
The Continental Insurance Co.
Effective Date: 01/01/2022
ARDURRA GROUP, INC.
Insured Name:
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
,W LV XQGHUVWRRG DQG DJUHHG WKDW WKLV HQGRUVHPHQW DPHQGV WKH &200(5&,$/ *(1(5$/ /,$%,/,7< &29(5$*( 3$57
DV IROORZV ,I DQ\ RWKHU HQGRUVHPHQW DWWDFKHG WR WKLV SROLF\ DPHQGV DQ\ SURYLVLRQ DOVR DPHQGHG E\ WKLV HQGRUVHPHQW
WKHQ WKDW RWKHU HQGRUVHPHQW FRQWUROV ZLWK UHVSHFW WR VXFK SURYLVLRQ DQG WKH FKDQJHV PDGH E\ WKLV HQGRUVHPHQW ZLWK
UHVSHFW WR VXFK SURYLVLRQ GR QRW DSSO\
7$%/( 2) &217(176
$GGLWLRQDO ,QVXUHGV
$GGLWLRQDO ,QVXUHG 3ULPDU\ $QG 1RQ&RQWULEXWRU\ 7R $GGLWLRQDO ,QVXUHG
V ,QVXUDQFH
$GGLWLRQDO ,QVXUHG ± ([WHQGHG &RYHUDJH
%RDWV
%RGLO\ ,QMXU\ ± ([SDQGHG 'HILQLWLRQ
%URDG .QRZOHGJH RI 2FFXUUHQFH 1RWLFH RI 2FFXUUHQFH
%URDG 1DPHG ,QVXUHG
&RQWUDFWXDO /LDELOLW\ ± 5DLOURDGV
(VWDWHV /HJDO 5HSUHVHQWDWLYHV DQG 6SRXVHV
([SHFWHG 2U ,QWHQGHG ,QMXU\ ± ([FHSWLRQ IRU 5HDVRQDEOH )RUFH
*HQHUDO $JJUHJDWH /LPLWV RI ,QVXUDQFH ± 3HU /RFDWLRQ
,Q 5HP $FWLRQV
,QFLGHQWDO +HDOWK &DUH 0DOSUDFWLFH &RYHUDJH
-RLQW 9HQWXUHV3DUWQHUVKLS/LPLWHG /LDELOLW\ &RPSDQLHV
/HJDO /LDELOLW\ ± 'DPDJH 7R 3UHPLVHV
/LTXRU /LDELOLW\
0HGLFDO 3D\PHQWV
1RQRZQHG $LUFUDIW &RYHUDJH
1RQRZQHG :DWHUFUDIW
3HUVRQDO $QG $GYHUWLVLQJ ,QMXU\ ± 'LVFULPLQDWLRQ RU +XPLOLDWLRQ
3HUVRQDO $QG $GYHUWLVLQJ ,QMXU\ &RQWUDFWXDO /LDELOLW\
3URSHUW\ 'DPDJH ± (OHYDWRUV
5HWLUHG 3DUWQHUV 0HPEHUV 'LUHFWRUV $QG (PSOR\HHV
6XSSOHPHQWDU\ 3D\PHQWV
8QLQWHQWLRQDO )DLOXUH 7R 'LVFORVH +D]DUGV
:DLYHU RI 6XEURJDWLRQ ± %ODQNHW
:UDS8S ([WHQVLRQ 2&,3 &&,3 RU &RQVROLGDWHG :UDS8S ,QVXUDQFH 3URJUDPV
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
$'',7,21$/ ,1685('6
D
:+2 ,6 $1 ,1685(' LV DPHQGHG WR LQFOXGH DV DQ ,QVXUHG DQ\ SHUVRQ RU RUJDQL]DWLRQ GHVFULEHG LQ SDUDJUDSKV
$ WKURXJK , EHORZ ZKRP D 1DPHG ,QVXUHG LV UHTXLUHG WR DGG DV DQ DGGLWLRQDO LQVXUHG RQ WKLV &RYHUDJH 3DUW
XQGHU D ZULWWHQ FRQWUDFW RU ZULWWHQ DJUHHPHQW SURYLGHG VXFK FRQWUDFW RU DJUHHPHQW
LV FXUUHQWO\ LQ HIIHFW RU EHFRPHV HIIHFWLYH GXULQJ WKH WHUP RI WKLV &RYHUDJH 3DUW DQG
ZDV H[HFXWHG SULRU WR
D WKH ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH RU
E WKH RIIHQVH WKDW FDXVHG WKH SHUVRQDO DQG DGYHUWLVLQJ LQMXU\
IRU ZKLFK VXFK DGGLWLRQDO LQVXUHG VHHNV FRYHUDJH
E
+RZHYHU VXEMHFW DOZD\V WR WKH WHUPV DQG FRQGLWLRQV RI WKLV SROLF\ LQFOXGLQJ WKH OLPLWV RI LQVXUDQFH WKH ,QVXUHU
ZLOO QRW SURYLGH VXFK DGGLWLRQDO LQVXUHG ZLWK
D KLJKHU OLPLW RI LQVXUDQFH WKDQ UHTXLUHG E\ VXFK FRQWUDFW RU DJUHHPHQW RU
FRYHUDJH EURDGHU WKDQ UHTXLUHG E\ VXFK FRQWUDFW RU DJUHHPHQW DQG LQ QR HYHQW EURDGHU WKDQ WKDW GHVFULEHG
E\ WKH DSSOLFDEOH SDUDJUDSK $ WKURXJK , EHORZ
$Q\ FRYHUDJH JUDQWHG E\ WKLV HQGRUVHPHQW VKDOO DSSO\ RQO\ WR WKH H[WHQW SHUPLVVLEOH E\ ODZ
$
&RQWUROOLQJ ,QWHUHVW
$Q\ SHUVRQ RU RUJDQL]DWLRQ ZLWK D FRQWUROOLQJ LQWHUHVW LQ D 1DPHG ,QVXUHG EXW RQO\ ZLWK UHVSHFW WR VXFK SHUVRQ RU
RUJDQL]DWLRQ
V OLDELOLW\ IRU ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI
VXFK SHUVRQ RU RUJDQL]DWLRQ
V ILQDQFLDO FRQWURO RI D 1DPHG ,QVXUHG RU
SUHPLVHV VXFK SHUVRQ RU RUJDQL]DWLRQ RZQV PDLQWDLQV RU FRQWUROV ZKLOH D 1DPHG ,QVXUHG OHDVHV RU
RFFXSLHV VXFK SUHPLVHV
SURYLGHG WKDW WKH FRYHUDJH JUDQWHG E\ WKLV SDUDJUDSK GRHV QRW DSSO\ WR VWUXFWXUDO DOWHUDWLRQV QHZ FRQVWUXFWLRQ RU
GHPROLWLRQ RSHUDWLRQV SHUIRUPHG E\ RQ EHKDOI RI RU IRU VXFK DGGLWLRQDO LQVXUHG
%
&RRZQHU RI ,QVXUHG 3UHPLVHV
$ FRRZQHU RI D SUHPLVHV FRRZQHG E\ D 1DPHG ,QVXUHG DQG FRYHUHG XQGHU WKLV LQVXUDQFH EXW RQO\ ZLWK UHVSHFW
WR VXFK FRRZQHU
V OLDELOLW\ IRU ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DV FRRZQHU
RI VXFK SUHPLVHV
&
(QJLQHHUV $UFKLWHFWV RU 6XUYH\RUV (QJDJHG %\ <RX
$Q DUFKLWHFW HQJLQHHU RU VXUYH\RU HQJDJHG E\ WKH 1DPHG ,QVXUHG EXW RQO\ ZLWK UHVSHFW WR OLDELOLW\ IRU ERGLO\
LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ FDXVHG LQ ZKROH RU LQ SDUW E\ WKH 1DPHG ,QVXUHG
V
DFWV RU RPLVVLRQV RU WKH DFWV RU RPLVVLRQV RI WKRVH DFWLQJ RQ WKH 1DPHG ,QVXUHG
V EHKDOI
D
LQ FRQQHFWLRQ ZLWK WKH 1DPHG ,QVXUHG
V SUHPLVHV RU
E
LQ WKH SHUIRUPDQFH RI WKH 1DPHG ,QVXUHG
V RQJRLQJ RSHUDWLRQV
%XW WKH FRYHUDJH KHUHE\ JUDQWHG WR VXFK DGGLWLRQDO LQVXUHGV GRHV QRW DSSO\ WR ERGLO\ LQMXU\ SURSHUW\ GDPDJH
RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI WKH UHQGHULQJ RI RU IDLOXUH WR UHQGHU DQ\ SURIHVVLRQDO VHUYLFHV
E\ RQ EHKDOI RI RU IRU WKH 1DPHG ,QVXUHG LQFOXGLQJ EXW QRW OLPLWHG WR
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
WKH SUHSDULQJ DSSURYLQJ RU IDLOLQJ WR SUHSDUH RU DSSURYH PDSV VKRS GUDZLQJV RSLQLRQV UHSRUWV VXUYH\V
ILHOG RUGHUV FKDQJH RUGHUV RU GUDZLQJV DQG VSHFLILFDWLRQV RU
VXSHUYLVRU\ LQVSHFWLRQ DUFKLWHFWXUDO RU HQJLQHHULQJ DFWLYLWLHV
'
/HVVRU RI (TXLSPHQW
$Q\ SHUVRQ RU RUJDQL]DWLRQ IURP ZKRP D 1DPHG ,QVXUHG OHDVHV HTXLSPHQW EXW RQO\ ZLWK UHVSHFW WR OLDELOLW\ IRU
ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ FDXVHG LQ ZKROH RU LQ SDUW E\ WKH 1DPHG
,QVXUHG
V PDLQWHQDQFH RSHUDWLRQ RU XVH RI VXFK HTXLSPHQW SURYLGHG WKDW WKH RFFXUUHQFH JLYLQJ ULVH WR VXFK
ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU WKH RIIHQVH JLYLQJ ULVH WR VXFK SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ WDNHV SODFH
SULRU WR WKH WHUPLQDWLRQ RI VXFK OHDVH
(
/HVVRU RI /DQG
$Q\ SHUVRQ RU RUJDQL]DWLRQ IURP ZKRP D 1DPHG ,QVXUHG OHDVHV ODQG EXW RQO\ ZLWK UHVSHFW WR OLDELOLW\ IRU ERGLO\
LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI WKH RZQHUVKLS PDLQWHQDQFH RU XVH
RI VXFK ODQG SURYLGHG WKDW WKH RFFXUUHQFH JLYLQJ ULVH WR VXFK ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU WKH RIIHQVH
JLYLQJ ULVH WR VXFK SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ WDNHV SODFH SULRU WR WKH WHUPLQDWLRQ RI VXFK OHDVH
7KH
FRYHUDJH JUDQWHG E\ WKLV SDUDJUDSK GRHV QRW DSSO\ WR VWUXFWXUDO DOWHUDWLRQV QHZ FRQVWUXFWLRQ RU GHPROLWLRQ
RSHUDWLRQV SHUIRUPHG E\ RQ EHKDOI RI RU IRU VXFK DGGLWLRQDO LQVXUHG
)
/HVVRU RI 3UHPLVHV
$Q RZQHU RU OHVVRU RI SUHPLVHV OHDVHG WR WKH 1DPHG ,QVXUHG RU VXFK RZQHU RU OHVVRU
V UHDO HVWDWH PDQDJHU EXW
RQO\ ZLWK UHVSHFW WR OLDELOLW\ IRU ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI
WKH RZQHUVKLS PDLQWHQDQFH RU XVH RI VXFK SDUW RI WKH SUHPLVHV OHDVHG WR WKH 1DPHG ,QVXUHG DQG SURYLGHG WKDW
WKH RFFXUUHQFH JLYLQJ ULVH WR VXFK ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH RU WKH RIIHQVH JLYLQJ ULVH WR VXFK SHUVRQDO
DQG DGYHUWLVLQJ LQMXU\ WDNHV SODFH SULRU WR WKH WHUPLQDWLRQ RI VXFK OHDVH 7KH FRYHUDJH JUDQWHG E\ WKLV
SDUDJUDSK GRHV QRW DSSO\ WR VWUXFWXUDO DOWHUDWLRQV QHZ FRQVWUXFWLRQ RU GHPROLWLRQ RSHUDWLRQV SHUIRUPHG E\ RQ
EHKDOI RI RU IRU VXFK DGGLWLRQDO LQVXUHG
*
0RUWJDJHH $VVLJQHH RU 5HFHLYHU
$ PRUWJDJHH DVVLJQHH RU UHFHLYHU RI SUHPLVHV EXW RQO\ ZLWK UHVSHFW WR VXFK PRUWJDJHH DVVLJQHH RU UHFHLYHU
V
OLDELOLW\ IRU ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI WKH 1DPHG
,QVXUHG
V RZQHUVKLS PDLQWHQDQFH RU XVH RI D SUHPLVHV E\ D 1DPHG ,QVXUHG
7KH FRYHUDJH JUDQWHG E\ WKLV SDUDJUDSK GRHV QRW DSSO\ WR VWUXFWXUDO DOWHUDWLRQV QHZ FRQVWUXFWLRQ RU GHPROLWLRQ
RSHUDWLRQV SHUIRUPHG E\ RQ EHKDOI RI RU IRU VXFK DGGLWLRQDO LQVXUHG
+
6WDWH RU *RYHUQPHQWDO $JHQF\ RU 6XEGLYLVLRQ RU 3ROLWLFDO 6XEGLYLVLRQV ± 3HUPLWV
$ VWDWH RU JRYHUQPHQWDO DJHQF\ RU VXEGLYLVLRQ RU SROLWLFDO VXEGLYLVLRQ WKDW KDV LVVXHG D SHUPLW RU DXWKRUL]DWLRQ EXW
RQO\ ZLWK UHVSHFW WR VXFK VWDWH RU JRYHUQPHQWDO DJHQF\ RU VXEGLYLVLRQ RU SROLWLFDO VXEGLYLVLRQ
V OLDELOLW\ IRU ERGLO\
LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI
WKH IROORZLQJ KD]DUGV LQ FRQQHFWLRQ ZLWK SUHPLVHV D 1DPHG ,QVXUHG RZQV UHQWV RU FRQWUROV DQG WR ZKLFK
WKLV LQVXUDQFH DSSOLHV
D
WKH H[LVWHQFH PDLQWHQDQFH UHSDLU FRQVWUXFWLRQ HUHFWLRQ RU UHPRYDO RI DGYHUWLVLQJ VLJQV DZQLQJV
FDQRSLHV FHOODU HQWUDQFHV FRDO KROHV GULYHZD\V PDQKROHV PDUTXHHV KRLVWDZD\ RSHQLQJV VLGHZDON
YDXOWV VWUHHW EDQQHUV RU GHFRUDWLRQV DQG VLPLODU H[SRVXUHV RU
E
WKH FRQVWUXFWLRQ HUHFWLRQ RU UHPRYDO RI HOHYDWRUV RU
F
WKH RZQHUVKLS PDLQWHQDQFH RU XVH RI DQ\ HOHYDWRUV FRYHUHG E\ WKLV LQVXUDQFH RU
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
WKH SHUPLWWHG RU DXWKRUL]HG RSHUDWLRQV SHUIRUPHG E\ D 1DPHG ,QVXUHG RU RQ D 1DPHG ,QVXUHG
V EHKDOI
7KH FRYHUDJH JUDQWHG E\ WKLV SDUDJUDSK GRHV QRW DSSO\ WR
D
%RGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI RSHUDWLRQV SHUIRUPHG
IRU WKH VWDWH RU JRYHUQPHQWDO DJHQF\ RU VXEGLYLVLRQ RU SROLWLFDO VXEGLYLVLRQ RU
E
%RGLO\ LQMXU\ RU SURSHUW\ GDPDJH LQFOXGHG ZLWKLQ WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG
:LWK UHVSHFW WR WKLV SURYLVLRQ
V UHTXLUHPHQW WKDW DGGLWLRQDO LQVXUHG VWDWXV PXVW EH UHTXHVWHG XQGHU D ZULWWHQ
FRQWUDFW RU DJUHHPHQW WKH ,QVXUHU ZLOO WUHDW DV D ZULWWHQ FRQWUDFW DQ\ JRYHUQPHQWDO SHUPLW WKDW UHTXLUHV WKH
1DPHG ,QVXUHG WR DGG WKH JRYHUQPHQWDO HQWLW\ DV DQ DGGLWLRQDO LQVXUHG
,
7UDGH 6KRZ (YHQW /HVVRU
:LWK UHVSHFW WR D 1DPHG ,QVXUHG
V SDUWLFLSDWLRQ LQ D WUDGH VKRZ HYHQW DV DQ H[KLELWRU SUHVHQWHU RU GLVSOD\HU
DQ\ SHUVRQ RU RUJDQL]DWLRQ ZKRP WKH 1DPHG ,QVXUHG LV UHTXLUHG WR LQFOXGH DV DQ DGGLWLRQDO LQVXUHG EXW RQO\
ZLWK UHVSHFW WR VXFK SHUVRQ RU RUJDQL]DWLRQ
V OLDELOLW\ IRU ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG
DGYHUWLVLQJ LQMXU\ FDXVHG E\
D
WKH 1DPHG ,QVXUHG
V DFWV RU RPLVVLRQV RU
E
WKH DFWV RU RPLVVLRQV RI WKRVH DFWLQJ RQ WKH 1DPHG ,QVXUHG
V EHKDOI
LQ WKH SHUIRUPDQFH RI WKH 1DPHG ,QVXUHG
V RQJRLQJ RSHUDWLRQV DW WKH WUDGH VKRZ HYHQW SUHPLVHV GXULQJ WKH
WUDGH VKRZ HYHQW
7KH FRYHUDJH JUDQWHG E\ WKLV SDUDJUDSK GRHV QRW DSSO\ WR ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH LQFOXGHG ZLWKLQ
WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG
$'',7,21$/ ,1685(' 35,0$5< $1' 121&2175,%8725< 72 $'',7,21$/ ,1685('
6 ,1685$1&(
7KH 2WKHU ,QVXUDQFH &RQGLWLRQ LQ WKH &200(5&,$/ *(1(5$/ /,$%,/,7< &21',7,216 6HFWLRQ LV DPHQGHG WR
DGG WKH IROORZLQJ SDUDJUDSK
,I WKH 1DPHG ,QVXUHG KDV DJUHHG LQ ZULWLQJ LQ D FRQWUDFW RU DJUHHPHQW WKDW WKLV LQVXUDQFH LV SULPDU\ DQG QRQ
FRQWULEXWRU\ UHODWLYH WR DQ DGGLWLRQDO LQVXUHG
V RZQ LQVXUDQFH WKHQ WKLV LQVXUDQFH LV SULPDU\ DQG WKH ,QVXUHU ZLOO QRW
VHHN FRQWULEXWLRQ IURP WKDW RWKHU LQVXUDQFH )RU WKH SXUSRVH RI WKLV 3URYLVLRQ WKH DGGLWLRQDO LQVXUHG
V RZQ
LQVXUDQFH PHDQV LQVXUDQFH RQ ZKLFK WKH DGGLWLRQDO LQVXUHG LV D QDPHG LQVXUHG 2WKHUZLVH DQG QRWZLWKVWDQGLQJ
DQ\WKLQJ WR WKH FRQWUDU\ HOVHZKHUH LQ WKLV &RQGLWLRQ WKH LQVXUDQFH SURYLGHG WR VXFK SHUVRQ RU RUJDQL]DWLRQ LV H[FHVV
RI DQ\ RWKHU LQVXUDQFH DYDLODEOH WR VXFK SHUVRQ RU RUJDQL]DWLRQ
$'',7,21$/ ,1685(' ± (;7(1'(' &29(5$*(
:KHQ DQ DGGLWLRQDO LQVXUHG LV DGGHG E\ WKLV RU DQ\ RWKHU HQGRUVHPHQW DWWDFKHG WR WKLV &RYHUDJH 3DUW :+2 ,6 $1
,1685(' LV DPHQGHG WR PDNH WKH IROORZLQJ QDWXUDO SHUVRQV ,QVXUHGV
,I WKH DGGLWLRQDO LQVXUHG LV
D
$Q LQGLYLGXDO WKHQ KLV RU KHU VSRXVH LV DQ ,QVXUHG
E
$ SDUWQHUVKLS RU MRLQW YHQWXUH WKHQ LWV SDUWQHUV PHPEHUV DQG WKHLU VSRXVHV DUH ,QVXUHGV
F
$ OLPLWHG OLDELOLW\ FRPSDQ\ WKHQ LWV PHPEHUV DQG PDQDJHUV DUH ,QVXUHGV RU
G
$Q RUJDQL]DWLRQ RWKHU WKDQ D SDUWQHUVKLS MRLQW YHQWXUH RU OLPLWHG OLDELOLW\ FRPSDQ\ WKHQ LWV H[HFXWLYH RIILFHUV
GLUHFWRUV DQG VKDUHKROGHUV DUH ,QVXUHGV
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
EXW RQO\ ZLWK UHVSHFW WR ORFDWLRQV DQG RSHUDWLRQV FRYHUHG E\ WKH DGGLWLRQDO LQVXUHG HQGRUVHPHQW
V SURYLVLRQV DQG RQO\
ZLWK UHVSHFW WR WKHLU UHVSHFWLYH UROHV ZLWKLQ WKHLU RUJDQL]DWLRQV
3OHDVH VHH WKH (67$7(6 /(*$/ 5(35(6(17$7,9(6 $1' 63286(6 SURYLVLRQ RI WKLV HQGRUVHPHQW IRU
DGGLWLRQDO FRYHUDJH DQG UHVWULFWLRQV DSSOLFDEOH WR VSRXVHV RI QDWXUDO SHUVRQ ,QVXUHGV
%2$76
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ $QG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR DGG WKH IROORZLQJ DGGLWLRQDO H[FHSWLRQ WR WKH H[FOXVLRQ HQWLWOHG $LUFUDIW $XWR RU
:DWHUFUDIW
7KLV H[FOXVLRQ GRHV QRW DSSO\ WR
$Q\ ZDWHUFUDIW RZQHG E\ WKH 1DPHG ,QVXUHG WKDW LV OHVV WKDQ IHHW ORQJ ZKLOH EHLQJ XVHG LQ WKH FRXUVH RI WKH
1DPHG ,QVXUHG
V LQVSHFWLRQ RU VXUYH\LQJ ZRUN
%2',/< ,1-85< ± (;3$1'(' '(),1,7,21
8QGHU '(),1,7,216 WKH GHILQLWLRQ RI ERGLO\ LQMXU\ LV GHOHWHG DQG UHSODFHG E\ WKH IROORZLQJ
%RGLO\ LQMXU\ PHDQV SK\VLFDO LQMXU\ VLFNQHVV RU GLVHDVH VXVWDLQHG E\ D SHUVRQ LQFOXGLQJ GHDWK KXPLOLDWLRQ VKRFN
PHQWDO DQJXLVK RU PHQWDO LQMXU\ VXVWDLQHG E\ WKDW SHUVRQ DW DQ\ WLPH ZKLFK UHVXOWV DV D FRQVHTXHQFH RI WKH SK\VLFDO
LQMXU\ VLFNQHVV RU GLVHDVH
%52$' .12:/('*( 2) 2&&855(1&( 127,&( 2) 2&&855(1&(
8QGHU &21',7,216 WKH FRQGLWLRQ HQWLWOHG 'XWLHV LQ 7KH (YHQW RI 2FFXUUHQFH 2IIHQVH &ODLP RU 6XLW LV DPHQGHG
WR DGG WKH IROORZLQJ SURYLVLRQV
$
%52$' .12:/('*( 2) 2&&855(1&(
7KH 1DPHG ,QVXUHG PXVW JLYH WKH ,QVXUHU RU WKH ,QVXUHU
V DXWKRUL]HG UHSUHVHQWDWLYH QRWLFH RI DQ RFFXUUHQFH
RIIHQVH RU FODLP RQO\ ZKHQ WKH RFFXUUHQFH RIIHQVH RU FODLP LV NQRZQ WR D QDWXUDO SHUVRQ 1DPHG ,QVXUHG WR D
SDUWQHU H[HFXWLYH RIILFHU PDQDJHU RU PHPEHU RI D 1DPHG ,QVXUHG RU WR DQ HPSOR\HH GHVLJQDWHG E\ DQ\ RI WKH
DERYH WR JLYH VXFK QRWLFH
%
127,&( 2) 2&&855(1&(
7KH 1DPHG ,QVXUHG
V ULJKWV XQGHU WKLV &RYHUDJH 3DUW ZLOO QRW EH SUHMXGLFHG LI WKH 1DPHG ,QVXUHG IDLOV WR JLYH
WKH ,QVXUHU QRWLFH RI DQ RFFXUUHQFH RIIHQVH RU FODLP DQG WKDW IDLOXUH LV VROHO\ GXH WR WKH 1DPHG ,QVXUHG
V
UHDVRQDEOH EHOLHI WKDW WKH ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH LV QRW FRYHUHG XQGHU WKLV &RYHUDJH 3DUW +RZHYHU
WKH 1DPHG ,QVXUHG VKDOO JLYH ZULWWHQ QRWLFH RI VXFK RFFXUUHQFH RIIHQVH RU FODLP WR WKH ,QVXUHU DV VRRQ DV WKH
1DPHG ,QVXUHG LV DZDUH WKDW WKLV LQVXUDQFH PD\ DSSO\ WR VXFK RFFXUUHQFH RIIHQVH RU FODLP
%52$' 1$0(' ,1685('
:+2 ,6 $1 ,1685(' LV DPHQGHG WR GHOHWH LWV 3DUDJUDSK LQ LWV HQWLUHW\ DQG UHSODFH LW ZLWK WKH IROORZLQJ
3XUVXDQW WR WKH OLPLWDWLRQV GHVFULEHG LQ 3DUDJUDSK EHORZ DQ\ RUJDQL]DWLRQ LQ ZKLFK D 1DPHG ,QVXUHG KDV
PDQDJHPHQW FRQWURO
D
RQ WKH HIIHFWLYH GDWH RI WKLV &RYHUDJH 3DUW RU
E
E\ UHDVRQ RI D 1DPHG ,QVXUHG FUHDWLQJ RU DFTXLULQJ WKH RUJDQL]DWLRQ GXULQJ WKH SROLF\ SHULRG
TXDOLILHV DV D 1DPHG ,QVXUHG SURYLGHG WKDW WKHUH LV QR RWKHU VLPLODU OLDELOLW\ LQVXUDQFH ZKHWKHU SULPDU\
FRQWULEXWRU\ H[FHVV FRQWLQJHQW RU RWKHUZLVH ZKLFK SURYLGHV FRYHUDJH WR VXFK RUJDQL]DWLRQ RU ZKLFK ZRXOG KDYH
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
SURYLGHG FRYHUDJH EXW IRU WKH H[KDXVWLRQ RI LWV OLPLW DQG ZLWKRXW UHJDUG WR ZKHWKHU LWV FRYHUDJH LV EURDGHU RU
QDUURZHU WKDQ WKDW SURYLGHG E\ WKLV LQVXUDQFH
%XW WKLV %52$' 1$0(' ,1685(' SURYLVLRQ GRHV QRW DSSO\ WR
D DQ\ SDUWQHUVKLS OLPLWHG OLDELOLW\ FRPSDQ\ RU MRLQW YHQWXUH RU
E DQ\ RUJDQL]DWLRQ IRU ZKLFK FRYHUDJH LV H[FOXGHG E\ DQRWKHU HQGRUVHPHQW DWWDFKHG WR WKLV &RYHUDJH 3DUW
)RU WKH SXUSRVH RI WKLV SURYLVLRQ PDQDJHPHQW FRQWURO PHDQV
$
RZQLQJ LQWHUHVWV UHSUHVHQWLQJ PRUH WKDQ RI WKH YRWLQJ DSSRLQWPHQW RU GHVLJQDWLRQ SRZHU IRU WKH
VHOHFWLRQ RI D PDMRULW\ RI WKH %RDUG RI 'LUHFWRUV RI D FRUSRUDWLRQ RU
%
KDYLQJ WKH ULJKW SXUVXDQW WR D ZULWWHQ WUXVW DJUHHPHQW WR SURWHFW FRQWURO WKH XVH RI HQFXPEHU RU WUDQVIHU RU
VHOO SURSHUW\ KHOG E\ D WUXVW
:LWK UHVSHFW WR RUJDQL]DWLRQV ZKLFK TXDOLI\ DV 1DPHG ,QVXUHGV E\ YLUWXH RI 3DUDJUDSK DERYH WKLV LQVXUDQFH
GRHV QRW DSSO\ WR
D
ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH WKDW ILUVW RFFXUUHG SULRU WR WKH GDWH RI PDQDJHPHQW FRQWURO RU WKDW ILUVW
RFFXUV DIWHU PDQDJHPHQW FRQWURO FHDVHV QRU
E
SHUVRQDO RU DGYHUWLVLQJ LQMXU\ FDXVHG E\ DQ RIIHQVH WKDW ILUVW RFFXUUHG SULRU WR WKH GDWH RI PDQDJHPHQW
FRQWURO RU WKDW ILUVW RFFXUV DIWHU PDQDJHPHQW FRQWURO FHDVHV
7KH LQVXUDQFH SURYLGHG E\ WKLV &RYHUDJH 3DUW DSSOLHV WR 1DPHG ,QVXUHGV ZKHQ WUDGLQJ XQGHU WKHLU RZQ QDPHV
RU XQGHU VXFK RWKHU WUDGLQJ QDPHV RU GRLQJEXVLQHVVDV QDPHV GED DV DQ\ 1DPHG ,QVXUHG VKRXOG FKRRVH WR
HPSOR\
&2175$&78$/ /,$%,/,7< ± 5$,/52$'6
:LWK UHVSHFW WR RSHUDWLRQV SHUIRUPHG ZLWKLQ IHHW RI UDLOURDG SURSHUW\ WKH GHILQLWLRQ RI LQVXUHG FRQWUDFW LV UHSODFHG
E\ WKH IROORZLQJ
,QVXUHG &RQWUDFW PHDQV
D
$ FRQWUDFW IRU D OHDVH RI SUHPLVHV +RZHYHU WKDW SRUWLRQ RI WKH FRQWUDFW IRU D OHDVH RI SUHPLVHV WKDW LQGHPQLILHV
DQ\ SHUVRQ RU RUJDQL]DWLRQ IRU GDPDJH E\ ILUH WR SUHPLVHV ZKLOH UHQWHG WR D 1DPHG ,QVXUHG RU WHPSRUDULO\
RFFXSLHG E\ D 1DPHG ,QVXUHG \RX ZLWK SHUPLVVLRQ RI WKH RZQHU LV QRW DQ LQVXUHG FRQWUDFW
E
$ VLGHWUDFN DJUHHPHQW
F
$Q\ HDVHPHQW RU OLFHQVH DJUHHPHQW
G
$Q REOLJDWLRQ DV UHTXLUHG E\ RUGLQDQFH WR LQGHPQLI\ D PXQLFLSDOLW\ H[FHSW LQ FRQQHFWLRQ ZLWK ZRUN IRU D
PXQLFLSDOLW\
H
$Q HOHYDWRU PDLQWHQDQFH DJUHHPHQW
I
7KDW SDUW RI DQ\ RWKHU FRQWUDFW RU DJUHHPHQW SHUWDLQLQJ WR WKH 1DPHG ,QVXUHG
V EXVLQHVV LQFOXGLQJ DQ
LQGHPQLILFDWLRQ RI D PXQLFLSDOLW\ LQ FRQQHFWLRQ ZLWK ZRUN SHUIRUPHG IRU D PXQLFLSDOLW\ XQGHU ZKLFK WKH 1DPHG
,QVXUHG DVVXPHV WKH WRUW OLDELOLW\ RI DQRWKHU SDUW\ WR SD\ IRU ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH WR D WKLUG SHUVRQ
RU RUJDQL]DWLRQ 7RUW OLDELOLW\ PHDQV D OLDELOLW\ WKDW ZRXOG EH LPSRVHG E\ ODZ LQ WKH DEVHQFH RI DQ\ FRQWUDFW RU
DJUHHPHQW
3DUDJUDSK I GRHV QRW LQFOXGH WKDW SDUW RI DQ\ FRQWUDFW RU DJUHHPHQW
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
7KDW LQGHPQLILHV DQ DUFKLWHFW HQJLQHHU RU VXUYH\RU IRU LQMXU\ RU GDPDJH DULVLQJ RXW RI
D 3UHSDULQJ DSSURYLQJ RU IDLOLQJ WR SUHSDUH RU DSSURYH PDSV VKRS GUDZLQJV RSLQLRQV UHSRUWV VXUYH\V
ILHOG RUGHUV FKDQJH RUGHUV RU GUDZLQJV DQG VSHFLILFDWLRQV RU
E *LYLQJ GLUHFWLRQV RU LQVWUXFWLRQV RU IDLOLQJ WR JLYH WKHP LI WKDW LV WKH SULPDU\ FDXVH RI WKH LQMXU\ RU
GDPDJH
8QGHU ZKLFK WKH ,QVXUHG LI DQ DUFKLWHFW HQJLQHHU RU VXUYH\RU DVVXPHV OLDELOLW\ IRU DQ LQMXU\ RU GDPDJH
DULVLQJ RXW RI WKH LQVXUHG
V UHQGHULQJ RU IDLOXUH WR UHQGHU SURIHVVLRQDO VHUYLFHV LQFOXGLQJ WKRVH OLVWHG LQ
DERYH DQG VXSHUYLVRU\ LQVSHFWLRQ DUFKLWHFWXUDO RU HQJLQHHULQJ DFWLYLWLHV
(67$7(6 /(*$/ 5(35(6(17$7,9(6 $1' 63286(6
7KH HVWDWHV H[HFXWRUV KHLUV OHJDO UHSUHVHQWDWLYHV DGPLQLVWUDWRUV WUXVWHHV EHQHILFLDULHV DQG VSRXVHV RI DQ\
QDWXUDO SHUVRQ ,QVXUHG RU OLYLQJ WUXVW VKDOO DOVR EH LQVXUHG XQGHU WKLV SROLF\ SURYLGHG KRZHYHU FRYHUDJH LV DIIRUGHG
WR VXFK HVWDWHV H[HFXWRUV KHLUV OHJDO UHSUHVHQWDWLYHV DGPLQLVWUDWRUV WUXVWHHV EHQHILFLDULHV DQG VSRXVHV RQO\ IRU
FODLPV DULVLQJ VROHO\ RXW RI WKHLU FDSDFLW\ RU VWDWXV DV VXFK DQG LQ WKH FDVH RI D VSRXVH ZKHUH VXFK FODLP VHHNV
GDPDJHV IURP PDULWDO FRPPXQLW\ SURSHUW\ MRLQWO\ KHOG SURSHUW\ RU SURSHUW\ WUDQVIHUUHG IURP VXFK QDWXUDO SHUVRQ
,QVXUHG WR VXFK VSRXVH 1R FRYHUDJH LV SURYLGHG IRU DQ\ DFW HUURU RU RPLVVLRQ RI DQ HVWDWH KHLU OHJDO
UHSUHVHQWDWLYH RU VSRXVH RXWVLGH WKH VFRSH RI VXFK SHUVRQ
V FDSDFLW\ RU VWDWXV DV VXFK SURYLGHG KRZHYHU WKDW WKH
VSRXVH RI D QDWXUDO SHUVRQ 1DPHG ,QVXUHG DQG WKH VSRXVHV RI PHPEHUV RU SDUWQHUV RI MRLQW YHQWXUH RU SDUWQHUVKLS
1DPHG ,QVXUHGV DUH ,QVXUHGV ZLWK UHVSHFW WR VXFK VSRXVHV
DFWV HUURUV RU RPLVVLRQV LQ WKH FRQGXFW RI WKH 1DPHG
,QVXUHG
V EXVLQHVV
(;3(&7(' 25 ,17(1'(' ,1-85< ± (;&(37,21 )25 5($621$%/( )25&(
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ $QG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR GHOHWH WKH H[FOXVLRQ HQWLWOHG ([SHFWHG RU ,QWHQGHG ,QMXU\ DQG UHSODFH LW ZLWK WKH IROORZLQJ
7KLV LQVXUDQFH GRHV QRW DSSO\ WR
([SHFWHG RU ,QWHQGHG ,QMXU\
%RGLO\ LQMXU\ RU SURSHUW\ GDPDJH H[SHFWHG RU LQWHQGHG IURP WKH VWDQGSRLQW RI WKH ,QVXUHG 7KLV H[FOXVLRQ GRHV QRW
DSSO\ WR ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH UHVXOWLQJ IURP WKH XVH RI UHDVRQDEOH IRUFH WR SURWHFW SHUVRQV RU SURSHUW\
*(1(5$/ $**5(*$7( /,0,76 2) ,1685$1&( 3(5 /2&$7,21
$
$ VHSDUDWH /RFDWLRQ *HQHUDO $JJUHJDWH /LPLW HTXDO WR WKH DPRXQW RI WKH *HQHUDO $JJUHJDWH /LPLW LV WKH PRVW WKH
,QVXUHU ZLOO SD\ IRU WKH VXP RI
$OO GDPDJHV XQGHU &RYHUDJH $ H[FHSW GDPDJHV EHFDXVH RI ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH LQFOXGHG LQ
WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG DQG
$OO PHGLFDO H[SHQVHV XQGHU &RYHUDJH &
WKDW DULVH IURP RFFXUUHQFHV RU DFFLGHQWV ZKLFK FDQ EH DWWULEXWHG VROHO\ WR RQJRLQJ RSHUDWLRQV DW WKDW ORFDWLRQ
6XFK SD\PHQWV VKDOO QRW UHGXFH WKH *HQHUDO $JJUHJDWH /LPLW VKRZQ LQ WKH 'HFODUDWLRQV QRU WKH /RFDWLRQ *HQHUDO
$JJUHJDWH /LPLW RI DQ\ RWKHU ORFDWLRQ
%
$OO
'DPDJHV XQGHU &RYHUDJH % UHJDUGOHVV RI WKH QXPEHU RI ORFDWLRQV LQYROYHG
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
'DPDJHV XQGHU &RYHUDJH $ FDXVHG E\ RFFXUUHQFHV ZKLFK FDQQRW EH DWWULEXWHG VROHO\ WR RQJRLQJ
RSHUDWLRQV DW D VLQJOH ORFDWLRQ H[FHSW GDPDJHV EHFDXVH RI ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH LQFOXGHG LQ
WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG DQG
0HGLFDO H[SHQVHV XQGHU &RYHUDJH & FDXVHG E\ DFFLGHQWV ZKLFK FDQQRW EH DWWULEXWHG VROHO\ WR RQJRLQJ
RSHUDWLRQV DW D VLQJOH ORFDWLRQ
ZLOO UHGXFH WKH *HQHUDO $JJUHJDWH /LPLW VKRZQ LQ WKH 'HFODUDWLRQV
&
)RU WKH SXUSRVH RI WKLV *(1(5$/ $**5(*$7( /,0,76 2) ,1685$1&( 3(5 /2&$7,21 3URYLVLRQ
ORFDWLRQ PHDQV
D SUHPLVHV WKH 1DPHG ,QVXUHG RZQV RU UHQWV RU
D SUHPLVHV QRW RZQHG RU UHQWHG E\ DQ\ 1DPHG ,QVXUHG DW ZKLFK WKH 1DPHG ,QVXUHG LV SHUIRUPLQJ
RSHUDWLRQV SXUVXDQW WR D FRQWUDFW RU ZULWWHQ DJUHHPHQW
,I RSHUDWLRQV DW VXFK D ORFDWLRQ KDYH EHHQ
GLVFRQWLQXHG DQG WKHQ UHVWDUWHG RU LI WKH DXWKRUL]HG SDUWLHV GHYLDWH IURP SODQV EOXHSULQWV GHVLJQV
VSHFLILFDWLRQV RU WLPHWDEOHV WKH ORFDWLRQ ZLOO VWLOO EH GHHPHG WR EH WKH VDPH ORFDWLRQ
)RU WKH SXUSRVH RI GHWHUPLQLQJ WKH DSSOLFDEOH DJJUHJDWH OLPLW RI LQVXUDQFH SUHPLVHV LQYROYLQJ WKH VDPH RU
FRQQHFWLQJ ORWV RU SUHPLVHV ZKRVH FRQQHFWLRQ LV LQWHUUXSWHG RQO\ E\ D VWUHHW URDGZD\ ZDWHUZD\ RU ULJKWRIZD\
RI D UDLOURDG VKDOO EH FRQVLGHUHG D VLQJOH ORFDWLRQ
'
7KH OLPLWV VKRZQ LQ WKH 'HFODUDWLRQV IRU (DFK 2FFXUUHQFH IRU 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX DQG IRU
0HGLFDO ([SHQVH FRQWLQXH WR DSSO\ EXW ZLOO EH VXEMHFW WR HLWKHU WKH /RFDWLRQ *HQHUDO $JJUHJDWH /LPLW RU WKH
*HQHUDO $JJUHJDWH /LPLW GHSHQGLQJ RQ ZKHWKHU WKH RFFXUUHQFH FDQ EH DWWULEXWHG VROHO\ WR RQJRLQJ RSHUDWLRQV DW
D SDUWLFXODU ORFDWLRQ
(
:KHQ FRYHUDJH IRU OLDELOLW\ DULVLQJ RXW RI WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG LV SURYLGHG DQ\ SD\PHQWV
IRU GDPDJHV EHFDXVH RI ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH LQFOXGHG LQ WKH SURGXFWVFRPSOHWHG RSHUDWLRQV
KD]DUG UHJDUGOHVV RI WKH QXPEHU RI ORFDWLRQV LQYROYHG ZLOO UHGXFH WKH 3URGXFWV&RPSOHWHG 2SHUDWLRQV
$JJUHJDWH /LPLW VKRZQ LQ WKH 'HFODUDWLRQV
)
7KH SURYLVLRQV RI /,0,76 2) ,1685$1&( QRW RWKHUZLVH PRGLILHG E\ WKLV *(1(5$/ $**5(*$7( /,0,76 2)
,1685$1&( 3(5 /2&$7,21 3URYLVLRQ VKDOO FRQWLQXH WR DSSO\ DV VWLSXODWHG
,1 5(0 $&7,216
$ TXDVL LQ UHP DFWLRQ DJDLQVW DQ\ YHVVHO RZQHG RU RSHUDWHG E\ RU IRU WKH 1DPHG ,QVXUHG RU FKDUWHUHG E\ RU IRU
WKH 1DPHG ,QVXUHG ZLOO EH WUHDWHG LQ WKH VDPH PDQQHU DV WKRXJK WKH DFWLRQ ZHUH LQ SHUVRQDP DJDLQVW WKH 1DPHG
,QVXUHG
,1&,'(17$/ +($/7+ &$5( 0$/35$&7,&( &29(5$*(
6ROHO\ ZLWK UHVSHFW WR ERGLO\ LQMXU\ WKDW DULVHV RXW RI D KHDOWK FDUH LQFLGHQW
$
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ $QG 3URSHUW\ 'DPDJH /LDELOLW\ WKH ,QVXULQJ $JUHHPHQW LV
DPHQGHG WR UHSODFH 3DUDJUDSKV E DQG E ZLWK WKH IROORZLQJ
E
7KLV LQVXUDQFH DSSOLHV WR ERGLO\ LQMXU\ SURYLGHG WKDW WKH SURIHVVLRQDO KHDOWK FDUH VHUYLFHV DUH LQFLGHQWDO WR
WKH 1DPHG ,QVXUHG
V SULPDU\ EXVLQHVV SXUSRVH DQG RQO\ LI
VXFK ERGLO\ LQMXU\ LV FDXVHG E\ DQ RFFXUUHQFH WKDW WDNHV SODFH LQ WKH FRYHUDJH WHUULWRU\
WKH ERGLO\ LQMXU\ ILUVW RFFXUV GXULQJ WKH SROLF\ SHULRG $OO ERGLO\ LQMXU\ DULVLQJ IURP DQ RFFXUUHQFH ZLOO
EH GHHPHG WR KDYH RFFXUUHG DW WKH WLPH RI WKH ILUVW DFW HUURU RU RPLVVLRQ WKDW LV SDUW RI WKH RFFXUUHQFH
DQG
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
%
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ $QG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR
L
DGG WKH IROORZLQJ WR WKH (PSOR\HUV /LDELOLW\ H[FOXVLRQ
7KLV H[FOXVLRQ DSSOLHV RQO\ LI WKH ERGLO\ LQMXU\ DULVLQJ IURP D KHDOWK FDUH LQFLGHQW LV FRYHUHG E\ RWKHU
OLDELOLW\ LQVXUDQFH DYDLODEOH WR WKH ,QVXUHG RU ZKLFK ZRXOG KDYH EHHQ DYDLODEOH EXW IRU H[KDXVWLRQ RI LWV
OLPLWV
LL
GHOHWH WKH H[FOXVLRQ HQWLWOHG &RQWUDFWXDO /LDELOLW\ DQG UHSODFH LW ZLWK WKH IROORZLQJ
7KLV LQVXUDQFH GRHV QRW DSSO\ WR
&RQWUDFWXDO /LDELOLW\
WKH ,QVXUHG
V DFWXDO RU DOOHJHG OLDELOLW\ XQGHU DQ\ RUDO RU ZULWWHQ FRQWUDFW RU DJUHHPHQW LQFOXGLQJ EXW QRW
OLPLWHG WR H[SUHVV ZDUUDQWLHV RU JXDUDQWHHV
LLL WR DGG WKH IROORZLQJ DGGLWLRQDO H[FOXVLRQV
7KLV LQVXUDQFH GRHV QRW DSSO\ WR
'LVFULPLQDWLRQ
DQ\ DFWXDO RU DOOHJHG GLVFULPLQDWLRQ KXPLOLDWLRQ RU KDUDVVPHQW LQFOXGLQJ EXW QRW EH OLPLWHG WR FODLPV EDVHG
RQ DQ LQGLYLGXDO
V UDFH FUHHG FRORU DJH JHQGHU QDWLRQDO RULJLQ UHOLJLRQ GLVDELOLW\ PDULWDO VWDWXV RU VH[XDO
RULHQWDWLRQ
'LVKRQHVW\ RU &ULPH
$Q\ DFWXDO RU DOOHJHG GLVKRQHVW FULPLQDO RU PDOLFLRXV DFW HUURU RU RPLVVLRQ
0HGLFDUH0HGLFDLG )UDXG
DQ\ DFWXDO RU DOOHJHG YLRODWLRQ RI ODZ ZLWK UHVSHFW WR 0HGLFDUH 0HGLFDLG 7ULFDUH RU DQ\ VLPLODU IHGHUDO VWDWH
RU ORFDO JRYHUQPHQWDO SURJUDP
6HUYLFHV ([FOXGHG E\ (QGRUVHPHQW
$Q\ KHDOWK FDUH LQFLGHQW IRU ZKLFK FRYHUDJH LV H[FOXGHG E\ HQGRUVHPHQW
&
'(),1,7,216 LV DPHQGHG WR
L
DGG WKH IROORZLQJ GHILQLWLRQV
+HDOWK FDUH LQFLGHQW PHDQV DQ DFW HUURU RU RPLVVLRQ E\ WKH 1DPHG ,QVXUHG
V HPSOR\HHV RU YROXQWHHU
ZRUNHUV LQ WKH UHQGHULQJ RI
D
SURIHVVLRQDO KHDOWK FDUH VHUYLFHV RQ EHKDOI RI WKH 1DPHG ,QVXUHG RU
E
*RRG 6DPDULWDQ VHUYLFHV UHQGHUHG LQ DQ HPHUJHQF\ DQG IRU ZKLFK QR SD\PHQW LV GHPDQGHG RU UHFHLYHG
3URIHVVLRQDO KHDOWK FDUH VHUYLFHV PHDQV DQ\ KHDOWK FDUH VHUYLFHV RU WKH UHODWHG IXUQLVKLQJ RI IRRG
EHYHUDJHV PHGLFDO VXSSOLHV RU DSSOLDQFHV E\ WKH IROORZLQJ SURYLGHUV LQ WKHLU FDSDFLW\ DV VXFK EXW VROHO\ WR
WKH H[WHQW WKH\ DUH GXO\ OLFHQVHG DV UHTXLUHG
D
3K\VLFLDQ
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
E
1XUVH
F
1XUVH SUDFWLWLRQHU
G
(PHUJHQF\ PHGLFDO WHFKQLFLDQ
H
3DUDPHGLF
I
'HQWLVW
J
3K\VLFDO WKHUDSLVW
K
3V\FKRORJLVW
L
6SHHFK WKHUDSLVW
M
2WKHU DOOLHG KHDOWK SURIHVVLRQDO RU
3URIHVVLRQDO KHDOWK FDUH VHUYLFHV GRHV QRW LQFOXGH DQ\ VHUYLFHV UHQGHUHG LQ FRQQHFWLRQ ZLWK KXPDQ FOLQLFDO
WULDOV RU SURGXFW WHVWLQJ
LL
GHOHWH WKH GHILQLWLRQ RI RFFXUUHQFH DQG UHSODFH LW ZLWK WKH IROORZLQJ
2FFXUUHQFH PHDQV D KHDOWK FDUH LQFLGHQW $OO DFWV HUURUV RU RPLVVLRQV WKDW DUH ORJLFDOO\ FRQQHFWHG E\ DQ\
FRPPRQ IDFW FLUFXPVWDQFH VLWXDWLRQ WUDQVDFWLRQ HYHQW DGYLFH RU GHFLVLRQ ZLOO EH FRQVLGHUHG WR FRQVWLWXWH D
VLQJOH RFFXUUHQFH
LLL DPHQG WKH GHILQLWLRQ RI ,QVXUHG WR
D
DGG WKH IROORZLQJ
WKH 1DPHG ,QVXUHG
V HPSOR\HHV DUH ,QVXUHGV ZLWK UHVSHFW WR
ERGLO\ LQMXU\ WR D FRHPSOR\HH ZKLOH LQ WKH FRXUVH RI WKH FRHPSOR\HH
V HPSOR\PHQW E\ WKH
1DPHG ,QVXUHG RU ZKLOH SHUIRUPLQJ GXWLHV UHODWHG WR WKH FRQGXFW RI WKH 1DPHG ,QVXUHG
V
EXVLQHVV DQG
ERGLO\ LQMXU\ WR D YROXQWHHU ZRUNHU ZKLOH SHUIRUPLQJ GXWLHV UHODWHG WR WKH FRQGXFW RI WKH
1DPHG ,QVXUHG
V EXVLQHVV
ZKHQ VXFK ERGLO\ LQMXU\ DULVHV RXW RI D KHDOWK FDUH LQFLGHQW
WKH 1DPHG ,QVXUHG
V YROXQWHHU ZRUNHUV DUH ,QVXUHGV ZLWK UHVSHFW WR
ERGLO\ LQMXU\ WR D FRYROXQWHHU ZRUNHU ZKLOH SHUIRUPLQJ GXWLHV UHODWHG WR WKH FRQGXFW RI WKH
1DPHG ,QVXUHG
V EXVLQHVV DQG
ERGLO\ LQMXU\ WR DQ HPSOR\HH ZKLOH LQ WKH FRXUVH RI WKH HPSOR\HH
V HPSOR\PHQW E\ WKH 1DPHG
,QVXUHG RU ZKLOH SHUIRUPLQJ GXWLHV UHODWHG WR WKH FRQGXFW RI WKH 1DPHG ,QVXUHG
V EXVLQHVV
ZKHQ VXFK ERGLO\ LQMXU\ DULVHV RXW RI D KHDOWK FDUH LQFLGHQW
E
GHOHWH 6XESDUDJUDSKV D E F DQG G RI 3DUDJUDSK D RI :+2 ,6 $1 ,1685('
'
7KH 2WKHU ,QVXUDQFH FRQGLWLRQ LV DPHQGHG WR GHOHWH 3DUDJUDSK E LQ LWV HQWLUHW\ DQG UHSODFH LW ZLWK WKH
IROORZLQJ
2WKHU ,QVXUDQFH
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
E
([FHVV ,QVXUDQFH
7R WKH H[WHQW WKLV LQVXUDQFH DSSOLHV LW LV H[FHVV RYHU DQ\ RWKHU LQVXUDQFH VHOI LQVXUDQFH RU ULVN WUDQVIHU
LQVWUXPHQW ZKHWKHU SULPDU\ H[FHVV FRQWLQJHQW RU RQ DQ\ RWKHU EDVLV H[FHSW IRU LQVXUDQFH SXUFKDVHG
VSHFLILFDOO\ E\ WKH 1DPHG ,QVXUHG WR EH H[FHVV RI WKLV FRYHUDJH
-2,17 9(1785(6 3$571(56+,3 /,0,7(' /,$%,/,7< &203$1,(6
$
3DVW -RLQW 9HQWXUHV 3DUWQHUVKLSV /LPLWHG /LDELOLW\ &RPSDQLHV
7KH IROORZLQJ LV DGGHG WR :+2 ,6 $1 ,1685('
,I WKH 1DPHG ,QVXUHG ZDV D MRLQW YHQWXUHU SDUWQHU RU PHPEHU RI D OLPLWHG OLDELOLW\ FRPSDQ\ DQG VXFK MRLQW
YHQWXUH SDUWQHUVKLS RU OLPLWHG OLDELOLW\ FRPSDQ\ WHUPLQDWHG SULRU WR RU GXULQJ WKH SROLF\ SHULRG VXFK 1DPHG
,QVXUHG LV DQ ,QVXUHG ZLWK UHVSHFW WR LWV LQWHUHVW LQ VXFK MRLQW YHQWXUH SDUWQHUVKLS RU OLPLWHG OLDELOLW\ FRPSDQ\ EXW
RQO\ WR WKH H[WHQW WKDW
D
DQ\ RIIHQVH JLYLQJ ULVH WR SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ RFFXUUHG SULRU WR VXFK WHUPLQDWLRQ GDWH DQG WKH
SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DULVLQJ RXW RI VXFK RIIHQVH ILUVW RFFXUUHG DIWHU VXFK WHUPLQDWLRQ GDWH
E
WKH ERGLO\ LQMXU\ RU SURSHUW\ GDPDJH ILUVW RFFXUUHG DIWHU VXFK WHUPLQDWLRQ GDWH DQG
F
WKHUH LV QR RWKHU YDOLG DQG FROOHFWLEOH LQVXUDQFH SXUFKDVHG VSHFLILFDOO\ WR LQVXUH WKH SDUWQHUVKLS MRLQW YHQWXUH
RU OLPLWHG OLDELOLW\ FRPSDQ\
,I WKH MRLQW YHQWXUH SDUWQHUVKLS RU OLPLWHG OLDELOLW\ FRPSDQ\ LV RU ZDV LQVXUHG XQGHU D FRQVROLGDWHG ZUDSXS
LQVXUDQFH SURJUDP WKHQ VXFK LQVXUDQFH ZLOO DOZD\V EH FRQVLGHUHG YDOLG DQG FROOHFWLEOH IRU WKH SXUSRVH RI
SDUDJUDSK F DERYH %XW WKLV SURYLVLRQ ZLOO QRW VHUYH WR H[FOXGH ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG
DGYHUWLVLQJ LQMXU\ WKDW ZRXOG RWKHUZLVH EH FRYHUHG XQGHU WKH $UFKLWHFWV (QJLQHHUV $QG 6XUYH\RUV *HQHUDO
/LDELOLW\
([WHQVLRQ
(QGRUVHPHQW
SURYLVLRQ
HQWLWOHG
:5$383
(;7(16,21
2&,3
&&,3
25
&2162/,'$7(' :5$383 ,1685$1&( 352*5$06 3OHDVH VHH WKDW SURYLVLRQ IRU WKH GHILQLWLRQ RI
FRQVROLGDWHG ZUDSXS LQVXUDQFH SURJUDP
%
3DUWLFLSDWLRQ ,Q &XUUHQW 3URIHVVLRQDO -RLQW 9HQWXUHV
7KH IROORZLQJ LV DGGHG WR :+2 ,6 $1 ,1685('
7KH 1DPHG ,QVXUHG LV DOVR DQ ,QVXUHG IRU SDUWLFLSDWLRQ LQ D FXUUHQW MRLQW YHQWXUH WKDW LV QRW QDPHG RQ WKH
'HFODUDWLRQV EXW RQO\ LI VXFK MRLQW YHQWXUH PHHWV DOO RI WKH IROORZLQJ FULWHULD
D
(DFK DQG HYHU\ RQH RI WKH 1DPHG ,QVXUHG
V FRYHQWXUHUV DUH DUFKLWHFWXUDO HQJLQHHULQJ RU VXUYH\LQJ ILUPV
RQO\ DQG
E
7KHUH LV QR RWKHU YDOLG DQG FROOHFWLEOH LQVXUDQFH SXUFKDVHG VSHFLILFDOO\ WR LQVXUH WKH MRLQW YHQWXUH
+RZHYHU WKH 1DPHG ,QVXUHG LV DQ ,QVXUHG RQO\ IRU WKH FRQGXFW RI VXFK 1DPHG ,QVXUHG
V EXVLQHVV ZLWKLQ VXFK
D MRLQW YHQWXUH 7KH 1DPHG ,QVXUHG LV QRW LQVXUHG IRU OLDELOLW\ DULVLQJ RXW RI WKH DFWV RU RPLVVLRQV RI RWKHU FR
YHQWXUHUV QRU RI WKHLU SDUWQHUV PHPEHUV RU HPSOR\HHV
&
:+2 ,6 $1 ,1685(' LV DPHQGHG WR GHOHWH LWV ODVW SDUDJUDSK DQG UHSODFH LW ZLWK WKH IROORZLQJ
([FHSW
DV
SURYLGHG
XQGHU
WKLV
$UFKLWHFWV
(QJLQHHUV
$QG
6XUYH\RUV
*HQHUDO
/LDELOLW\
([WHQVLRQ
(QGRUVHPHQW RU E\ WKH DWWDFKPHQW RI DQRWKHU HQGRUVHPHQW LI DQ\ QR SHUVRQ RU RUJDQL]DWLRQ LV DQ ,QVXUHG ZLWK
UHVSHFW WR WKH FRQGXFW RI DQ\ FXUUHQW RU SDVW SDUWQHUVKLS MRLQW YHQWXUH RU OLPLWHG OLDELOLW\ FRPSDQ\ WKDW LV QRW
VKRZQ DV D 1DPHG ,QVXUHG LQ WKH 'HFODUDWLRQV
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
/(*$/ /,$%,/,7< ± '$0$*( 72 35(0,6(6 $/,(1$7(' 35(0,6(6 3523(57< ,1 7+( 1$0('
,1685('
6 &$5( &8672'< 25 &21752/
$
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ DQG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR GHOHWH H[FOXVLRQ M 'DPDJH WR 3URSHUW\ LQ LWV HQWLUHW\ DQG UHSODFH LW ZLWK WKH IROORZLQJ
7KLV LQVXUDQFH GRHV QRW DSSO\ WR
M
'DPDJH WR 3URSHUW\
3URSHUW\ GDPDJH WR
3URSHUW\ WKH 1DPHG ,QVXUHG RZQV UHQWV RU RFFXSLHV LQFOXGLQJ DQ\ FRVWV RU H[SHQVHV LQFXUUHG E\ \RX
RU DQ\ RWKHU SHUVRQ RUJDQL]DWLRQ RU HQWLW\ IRU UHSDLU UHSODFHPHQW HQKDQFHPHQW UHVWRUDWLRQ RU
PDLQWHQDQFH RI VXFK SURSHUW\ IRU DQ\ UHDVRQ LQFOXGLQJ SUHYHQWLRQ RI LQMXU\ WR D SHUVRQ RU GDPDJH WR
DQRWKHU
V SURSHUW\
3UHPLVHV WKH 1DPHG ,QVXUHG VHOOV JLYHV DZD\ RU DEDQGRQV LI WKH SURSHUW\ GDPDJH DULVHV RXW RI DQ\
SDUW RI WKRVH SUHPLVHV
3URSHUW\ ORDQHG WR WKH 1DPHG ,QVXUHG
3HUVRQDO SURSHUW\ LQ WKH FDUH FXVWRG\ RU FRQWURO RI WKH ,QVXUHG
7KDW SDUWLFXODU SDUW RI UHDO SURSHUW\ RQ ZKLFK WKH 1DPHG ,QVXUHG RU DQ\ FRQWUDFWRUV RU VXEFRQWUDFWRUV
ZRUNLQJ GLUHFWO\ RU LQGLUHFWO\ RQ WKH 1DPHG ,QVXUHG
V EHKDOI DUH SHUIRUPLQJ RSHUDWLRQV LI WKH SURSHUW\
GDPDJH DULVHV RXW RI WKRVH RSHUDWLRQV RU
7KDW SDUWLFXODU SDUW RI DQ\ SURSHUW\ WKDW PXVW EH UHVWRUHG UHSDLUHG RU UHSODFHG EHFDXVH \RXU ZRUN ZDV
LQFRUUHFWO\ SHUIRUPHG RQ LW
3DUDJUDSKV DQG RI WKLV H[FOXVLRQ GR QRW DSSO\ WR SURSHUW\ GDPDJH RWKHU WKDQ GDPDJH E\ ILUH WR
SUHPLVHV UHQWHG WR WKH 1DPHG ,QVXUHG RU WHPSRUDULO\ RFFXSLHG E\ WKH 1DPHG ,QVXUHG ZLWK WKH SHUPLVVLRQ RI
WKH RZQHU QRU WR WKH FRQWHQWV RI SUHPLVHV UHQWHG WR WKH 1DPHG ,QVXUHG IRU D SHULRG RI RU IHZHU
FRQVHFXWLYH GD\V $ VHSDUDWH OLPLW RI LQVXUDQFH DSSOLHV WR 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX DV GHVFULEHG
LQ /,0,76 2) ,1685$1&(
3DUDJUDSK RI WKLV H[FOXVLRQ GRHV QRW DSSO\ LI WKH SUHPLVHV DUH \RXU ZRUN
3DUDJUDSKV DQG RI WKLV H[FOXVLRQ GR QRW DSSO\ WR OLDELOLW\ DVVXPHG XQGHU D VLGHWUDFN
DJUHHPHQW
3DUDJUDSK RI WKLV H[FOXVLRQ GRHV QRW DSSO\ WR SURSHUW\ GDPDJH LQFOXGHG LQ WKH SURGXFWVFRPSOHWHG
RSHUDWLRQV KD]DUG
3DUDJUDSKV DQG RI WKLV H[FOXVLRQ GR QRW DSSO\ WR SURSHUW\ GDPDJH WR
L
WRROV RU HTXLSPHQW WKH 1DPHG ,QVXUHG ERUURZV IURP RWKHUV QRU
LL
RWKHU SHUVRQDO SURSHUW\ RI RWKHUV LQ WKH 1DPHG ,QVXUHG
V FDUH FXVWRG\ RU FRQWURO ZKLOH EHLQJ XVHG LQ WKH
1DPHG ,QVXUHG
V RSHUDWLRQV DZD\ IURP DQ\ 1DPHG ,QVXUHG
V SUHPLVHV
+RZHYHU WKH FRYHUDJH JUDQWHG E\ WKLV H[FHSWLRQ WR 3DUDJUDSKV DQG GRHV QRW DSSO\ WR
D
SURSHUW\ DW D MRE VLWH DZDLWLQJ RU GXULQJ VXFK SURSHUW\
V LQVWDOODWLRQ IDEULFDWLRQ RU HUHFWLRQ
E
SURSHUW\ WKDW LV PRELOH HTXLSPHQW OHDVHG E\ DQ ,QVXUHG
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
F
SURSHUW\ WKDW LV DQ DXWR DLUFUDIW RU ZDWHUFUDIW
G
SURSHUW\ LQ WUDQVLW RU
H
DQ\ SRUWLRQ RI SURSHUW\ GDPDJH IRU ZKLFK WKH ,QVXUHG KDV DYDLODEOH RWKHU YDOLG DQG FROOHFWLEOH
LQVXUDQFH RU ZRXOG KDYH VXFK LQVXUDQFH EXW IRU H[KDXVWLRQ RI LWV OLPLWV RU EXW IRU DSSOLFDWLRQ RI RQH RI LWV
H[FOXVLRQV
$ VHSDUDWH OLPLW RI LQVXUDQFH DQG GHGXFWLEOH DSSO\ WR VXFK SURSHUW\ RI RWKHUV 6HH /,0,76 2) ,1685$1&(
DV DPHQGHG EHORZ
%
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ DQG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR GHOHWH LWV ODVW SDUDJUDSK DQG UHSODFH LW ZLWK WKH IROORZLQJ
([FOXVLRQV F WKURXJK Q GR QRW DSSO\ WR GDPDJH E\ ILUH WR SUHPLVHV ZKLOH UHQWHG WR D 1DPHG ,QVXUHG RU
WHPSRUDULO\ RFFXSLHG E\ D 1DPHG ,QVXUHG ZLWK SHUPLVVLRQ RI WKH RZQHU QRU WR GDPDJH WR WKH FRQWHQWV RI
SUHPLVHV UHQWHG WR D 1DPHG ,QVXUHG IRU D SHULRG RI RU IHZHU FRQVHFXWLYH GD\V
$ VHSDUDWH OLPLW RI LQVXUDQFH DSSOLHV WR WKLV FRYHUDJH DV GHVFULEHG LQ /,0,76 2) ,1685$1&(
&
7KH IROORZLQJ SDUDJUDSK LV DGGHG WR /,0,76 2) ,1685$1&(
6XEMHFW WR DERYH LV WKH PRVW WKH ,QVXUHU ZLOO SD\ XQGHU &RYHUDJH $ IRU GDPDJHV DULVLQJ RXW RI DQ\
RQH RFFXUUHQFH EHFDXVH RI WKH VXP RI DOO SURSHUW\ GDPDJH WR ERUURZHG WRROV RU HTXLSPHQW DQG WR RWKHU
SHUVRQDO SURSHUW\ RI RWKHUV LQ WKH 1DPHG ,QVXUHG
V FDUH FXVWRG\ RU FRQWURO ZKLOH EHLQJ XVHG LQ WKH 1DPHG
,QVXUHG
V RSHUDWLRQV DZD\ IURP DQ\ 1DPHG ,QVXUHG
V SUHPLVHV 7KH ,QVXUHU
V REOLJDWLRQ WR SD\ VXFK SURSHUW\
GDPDJH GRHV QRW DSSO\ XQWLO WKH DPRXQW RI VXFK SURSHUW\ GDPDJH H[FHHGV 7KH ,QVXUHU KDV WKH ULJKW EXW
QRW WKH GXW\ WR SD\ DQ\ SRUWLRQ RI WKLV LQ RUGHU WR HIIHFW VHWWOHPHQW ,I WKH ,QVXUHU H[HUFLVHV WKDW ULJKW WKH
1DPHG ,QVXUHG ZLOO SURPSWO\ UHLPEXUVH WKH ,QVXUHU IRU DQ\ VXFK DPRXQW
'
3DUDJUDSK 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX /LPLW RI /,0,76 2) ,1685$1&( LV GHOHWHG DQG UHSODFHG E\
WKH IROORZLQJ
6XEMHFW WR 3DUDJUDSK DERYH WKH (DFK 2FFXUUHQFH /LPLW WKH 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX /LPLW
LV WKH PRVW WKH ,QVXUHU ZLOO SD\ XQGHU &RYHUDJH $ IRU GDPDJHV EHFDXVH RI SURSHUW\ GDPDJH WR DQ\ RQH
SUHPLVHV ZKLOH UHQWHG WR WKH 1DPHG ,QVXUHG RU WHPSRUDULO\ RFFXSLHG E\ WKH 1DPHG ,QVXUHG ZLWK WKH
SHUPLVVLRQ RI WKH RZQHU LQFOXGLQJ FRQWHQWV RI VXFK SUHPLVHV UHQWHG WR WKH 1DPHG ,QVXUHG IRU D SHULRG RI
RU IHZHU FRQVHFXWLYH GD\V 7KH 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX /LPLW LV WKH JUHDWHU RI
D
RU
E
7KH 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX /LPLW VKRZQ LQ WKH 'HFODUDWLRQV
(
3DUDJUDSK E D LL RI WKH 2WKHU ,QVXUDQFH &RQGLWLRQ LV GHOHWHG DQG UHSODFHG E\ WKH IROORZLQJ
LL 7KDW LV SURSHUW\ LQVXUDQFH IRU SUHPLVHV UHQWHG WR WKH 1DPHG ,QVXUHG IRU SUHPLVHV WHPSRUDULO\ RFFXSLHG E\
WKH 1DPHG ,QVXUHG ZLWK WKH SHUPLVVLRQ RI WKH RZQHU RU IRU SHUVRQDO SURSHUW\ RI RWKHUV LQ WKH 1DPHG
,QVXUHG
V FDUH FXVWRG\ RU FRQWURO
/,4825 /,$%,/,7<
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ DQG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR GHOHWH WKH H[FOXVLRQ HQWLWOHG /LTXRU /LDELOLW\
7KLV /,4825 /,$%,/,7< 3URYLVLRQ GRHV QRW DSSO\ WR DQ\ SHUVRQ RU RUJDQL]DWLRQ ZKR RWKHUZLVH TXDOLILHV DV DQ
DGGLWLRQDO LQVXUHG RQ WKLV &RYHUDJH 3DUW
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
0(',&$/ 3$<0(176
$
/,0,76 2) ,1685$1&( LV DPHQGHG WR GHOHWH 3DUDJUDSK WKH 0HGLFDO ([SHQVH /LPLW DQG UHSODFH LW ZLWK WKH
IROORZLQJ
6XEMHFW WR 3DUDJUDSK DERYH WKH (DFK 2FFXUUHQFH /LPLW WKH 0HGLFDO ([SHQVH /LPLW LV WKH PRVW WKH
,QVXUHU ZLOO SD\ XQGHU &RYHUDJH & IRU DOO PHGLFDO H[SHQVHV EHFDXVH RI ERGLO\ LQMXU\ VXVWDLQHG E\ DQ\ RQH
SHUVRQ 7KH 0HGLFDO ([SHQVH /LPLW LV WKH JUHDWHU RI
XQOHVV D GLIIHUHQW DPRXQW LV VKRZQ KHUH
1111111111
RU
WKH DPRXQW VKRZQ LQ WKH 'HFODUDWLRQV IRU 0HGLFDO ([SHQVH /LPLW
%
8QGHU &29(5$*(6 WKH ,QVXULQJ $JUHHPHQW RI &RYHUDJH & ± 0HGLFDO 3D\PHQWV LV DPHQGHG WR UHSODFH
3DUDJUDSK D E ZLWK WKH IROORZLQJ
E 7KH H[SHQVHV DUH LQFXUUHG DQG UHSRUWHG WR WKH ,QVXUHU ZLWKLQ WKUHH \HDUV RI WKH GDWH RI WKH DFFLGHQW DQG
1212:1(' $,5&5$)7
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ DQG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG DV IROORZV
7KH H[FOXVLRQ HQWLWOHG $LUFUDIW $XWR RU :DWHUFUDIW LV DPHQGHG WR DGG WKH IROORZLQJ
7KLV H[FOXVLRQ GRHV QRW DSSO\ WR DQ DLUFUDIW QRW RZQHG E\ DQ\ 1DPHG ,QVXUHG SURYLGHG WKDW
WKH SLORW LQ FRPPDQG KROGV D FXUUHQWO\ HIIHFWLYH FHUWLILFDWH LVVXHG E\ WKH GXO\ FRQVWLWXWHG DXWKRULW\ RI WKH 8QLWHG
6WDWHV RI $PHULFD RU &DQDGD GHVLJQDWLQJ WKDW SHUVRQ DV D FRPPHUFLDO RU DLUOLQH WUDQVSRUW SLORW
WKH DLUFUDIW LV UHQWHG ZLWK D WUDLQHG SDLG FUHZ WR WKH 1DPHG ,QVXUHG DQG
WKH DLUFUDIW LV QRW EHLQJ XVHG WR FDUU\ SHUVRQV RU SURSHUW\ IRU D FKDUJH
1212:1(' :$7(5&5$)7
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ DQG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR GHOHWH VXESDUDJUDSK RI WKH H[FOXVLRQ HQWLWOHG $LUFUDIW $XWR RU :DWHUFUDIW DQG
UHSODFH LW ZLWK WKH IROORZLQJ
7KLV H[FOXVLRQ GRHV QRW DSSO\ WR
D ZDWHUFUDIW WKDW LV QRW RZQHG E\ DQ\ 1DPHG ,QVXUHG SURYLGHG WKH ZDWHUFUDIW LV
D OHVV WKDQ IHHW ORQJ DQG
E QRW EHLQJ XVHG WR FDUU\ SHUVRQV RU SURSHUW\ IRU D FKDUJH
3(5621$/ $1' $'9(57,6,1* ,1-85< ±',6&5,0,1$7,21 25 +80,/,$7,21
$
8QGHU '(),1,7,216 WKH GHILQLWLRQ RI SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ LV DPHQGHG WR DGG WKH IROORZLQJ WRUW
'LVFULPLQDWLRQ RU KXPLOLDWLRQ WKDW UHVXOWV LQ LQMXU\ WR WKH IHHOLQJV RU UHSXWDWLRQ RI D QDWXUDO SHUVRQ
%
8QGHU &29(5$*(6 &RYHUDJH % ± 3HUVRQDO DQG $GYHUWLVLQJ ,QMXU\ /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR
GHOHWH WKH ([FOXVLRQ HQWLWOHG .QRZLQJ 9LRODWLRQ 2I 5LJKWV 2I $QRWKHU DQG UHSODFH LW ZLWK WKH IROORZLQJ
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
7KLV LQVXUDQFH GRHV QRW DSSO\ WR
.QRZLQJ 9LRODWLRQ RI 5LJKWV RI $QRWKHU
3HUVRQDO DQG DGYHUWLVLQJ LQMXU\ FDXVHG E\ RU DW WKH GLUHFWLRQ RI WKH ,QVXUHG ZLWK WKH NQRZOHGJH WKDW WKH DFW
ZRXOG YLRODWH WKH ULJKWV RI DQRWKHU DQG ZRXOG LQIOLFW SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ 7KLV H[FOXVLRQ VKDOO QRW
DSSO\ WR GLVFULPLQDWLRQ RU KXPLOLDWLRQ WKDW UHVXOWV LQ LQMXU\ WR WKH IHHOLQJV RU UHSXWDWLRQ RI D QDWXUDO SHUVRQ EXW
RQO\ LI VXFK GLVFULPLQDWLRQ RU KXPLOLDWLRQ LV QRW GRQH LQWHQWLRQDOO\ E\ RU DW WKH GLUHFWLRQ RI
D WKH 1DPHG ,QVXUHG RU
E DQ\ H[HFXWLYH RIILFHU GLUHFWRU VWRFNKROGHU SDUWQHU PHPEHU RU PDQDJHU LI WKH 1DPHG ,QVXUHG LV D
OLPLWHG OLDELOLW\ FRPSDQ\ RI WKH 1DPHG ,QVXUHG
DGG WKH IROORZLQJ H[FOXVLRQV
7KLV LQVXUDQFH GRHV QRW DSSO\ WR
(PSOR\PHQW 5HODWHG 'LVFULPLQDWLRQ
GLVFULPLQDWLRQ RU KXPLOLDWLRQ GLUHFWO\ RU LQGLUHFWO\ UHODWHG WR WKH HPSOR\PHQW SURVSHFWLYH HPSOR\PHQW SDVW
HPSOR\PHQW RU WHUPLQDWLRQ RI HPSOR\PHQW RI DQ\ SHUVRQ E\ DQ\ ,QVXUHG
3UHPLVHV 5HODWHG 'LVFULPLQDWLRQ
GLVFULPLQDWLRQ RU KXPLOLDWLRQ DULVLQJ RXW RI WKH VDOH UHQWDO OHDVH RU VXEOHDVH RU SURVSHFWLYH VDOH UHQWDO
OHDVH RU VXEOHDVH RI DQ\ URRP GZHOOLQJ RU SUHPLVHV E\ RU DW WKH GLUHFWLRQ RI DQ\ ,QVXUHG
1RWZLWKVWDQGLQJ WKH DERYH WKHUH LV QR FRYHUDJH IRU ILQHV RU SHQDOWLHV OHYLHG RU LPSRVHG E\ D JRYHUQPHQWDO HQWLW\
EHFDXVH RI GLVFULPLQDWLRQ
7KH FRYHUDJH SURYLGHG E\ WKLV 3(5621$/ $1' $'9(57,6,1* ,1-85< ±',6&5,0,1$7,21 25 +80,/,$7,21
3URYLVLRQ GRHV QRW DSSO\ WR DQ\ SHUVRQ RU RUJDQL]DWLRQ ZKRVH VWDWXV DV DQ ,QVXUHG GHULYHV VROHO\ IURP
3URYLVLRQ $'',7,21$/ ,1685(' RI WKLV HQGRUVHPHQW RU
DWWDFKPHQW RI DQ DGGLWLRQDO LQVXUHG HQGRUVHPHQW WR WKLV &RYHUDJH 3DUW
3(5621$/ $1' $'9(57,6,1* ,1-85< &2175$&78$/ /,$%,/,7<
$
8QGHU &29(5$*(6 &RYHUDJH % ±3HUVRQDO DQG $GYHUWLVLQJ ,QMXU\ /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG WR GHOHWH WKH H[FOXVLRQ HQWLWOHG &RQWUDFWXDO /LDELOLW\
%
6ROHO\ IRU WKH SXUSRVH RI WKH FRYHUDJH SURYLGHG E\ WKLV 3(5621$/ $1' $'9(57,6,1* ,1-85< /,0,7('
&2175$&78$/
/,$%,/,7<
SURYLVLRQ
WKH
IROORZLQJ
FKDQJHV
DUH
PDGH
WR
WKH
VHFWLRQ
HQWLWOHG
6833/(0(17$5< 3$<0(176 ± &29(5$*(6 $ $1' %
3DUDJUDSK G LV UHSODFHG E\ WKH IROORZLQJ
G
7KH DOOHJDWLRQV LQ WKH VXLW DQG WKH LQIRUPDWLRQ WKH ,QVXUHU NQRZV DERXW WKH RIIHQVH DOOHJHG LQ VXFK VXLW
DUH VXFK WKDW QR FRQIOLFW DSSHDUV WR H[LVW EHWZHHQ WKH LQWHUHVWV RI WKH ,QVXUHG DQG WKH LQWHUHVWV RI WKH
LQGHPQLWHH
7KH ILUVW XQQXPEHUHG SDUDJUDSK EHQHDWK 3DUDJUDSK I E LV GHOHWHG DQG UHSODFHG E\ WKH IROORZLQJ
6R ORQJ DV WKH DERYH FRQGLWLRQV DUH PHW DWWRUQH\
V IHHV LQFXUUHG E\ WKH ,QVXUHU LQ WKH GHIHQVH RI WKDW
LQGHPQLWHH QHFHVVDU\ OLWLJDWLRQ H[SHQVHV LQFXUUHG E\ WKH ,QVXUHU DQG QHFHVVDU\ OLWLJDWLRQ H[SHQVHV LQFXUUHG
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
E\ WKH LQGHPQLWHH DW WKH ,QVXUHU
V UHTXHVW ZLOO EH SDLG DV GHIHQVH FRVWV 6XFK SD\PHQWV ZLOO QRW EH GHHPHG
WR EH GDPDJHV IRU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ DQG ZLOO QRW UHGXFH WKH OLPLWV RI LQVXUDQFH
&
7KLV 3(5621$/ $1' $'9(57,6,1* ,1-85< /,0,7(' &2175$&78$/ /,$%,/,7< 3URYLVLRQ GRHV QRW DSSO\
LI &RYHUDJH % ±3HUVRQDO DQG $GYHUWLVLQJ ,QMXU\ /LDELOLW\ LV H[FOXGHG E\ DQRWKHU HQGRUVHPHQW DWWDFKHG WR WKLV
&RYHUDJH 3DUW
7KLV 3(5621$/ $1' $'9(57,6,1* ,1-85< &2175$&78$/ /,$%,/,7< 3URYLVLRQ GRHV QRW DSSO\ WR DQ\
SHUVRQ RU RUJDQL]DWLRQ ZKR RWKHUZLVH TXDOLILHV DV DQ DGGLWLRQDO LQVXUHG RQ WKLV &RYHUDJH 3DUW
3523(57< '$0$*( ± (/(9$7256
$
8QGHU &29(5$*(6 &RYHUDJH $ ± %RGLO\ ,QMXU\ DQG 3URSHUW\ 'DPDJH /LDELOLW\ WKH SDUDJUDSK HQWLWOHG
([FOXVLRQV LV DPHQGHG VXFK WKDW WKH 'DPDJH WR <RXU 3URGXFW ([FOXVLRQ DQG VXESDUDJUDSKV DQG RI
WKH 'DPDJH WR 3URSHUW\ ([FOXVLRQ GR QRW DSSO\ WR SURSHUW\ GDPDJH WKDW UHVXOWV IURP WKH XVH RI HOHYDWRUV
%
6ROHO\ IRU WKH SXUSRVH RI WKH FRYHUDJH SURYLGHG E\ WKLV 3523(57< '$0$*( ± (/(9$7256 3URYLVLRQ WKH
2WKHU ,QVXUDQFH FRQGLWLRQV LV DPHQGHG WR DGG WKH IROORZLQJ SDUDJUDSK
7KLV LQVXUDQFH LV H[FHVV RYHU DQ\ RI WKH RWKHU LQVXUDQFH ZKHWKHU SULPDU\ H[FHVV FRQWLQJHQW RU RQ DQ\ RWKHU
EDVLV WKDW LV 3URSHUW\ LQVXUDQFH FRYHULQJ SURSHUW\ RI RWKHUV GDPDJHG IURP WKH XVH RI HOHYDWRUV
5(7,5(' 3$571(56 0(0%(56 ',5(&7256 $1' (03/2<((6
:+2 ,6 ,1685(' LV DPHQGHG WR LQFOXGH DV ,QVXUHGV QDWXUDO SHUVRQV ZKR DUH UHWLUHG SDUWQHUV PHPEHUV GLUHFWRUV
RU HPSOR\HHV EXW RQO\ IRU ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ WKDW UHVXOWV IURP
VHUYLFHV SHUIRUPHG IRU WKH 1DPHG ,QVXUHG XQGHU WKH 1DPHG ,QVXUHG
V GLUHFW VXSHUYLVLRQ $OO OLPLWDWLRQV WKDW DSSO\ WR
HPSOR\HHV DQG YROXQWHHU ZRUNHUV DOVR DSSO\ WR DQ\RQH TXDOLI\LQJ DV DQ ,QVXUHG XQGHU WKLV 3URYLVLRQ
6833/(0(17$5< 3$<0(176
7KH VHFWLRQ HQWLWOHG 6833/(0(17$5< 3$<0(176 ± &29(5$*(6 $ $1' % LV DPHQGHG DV IROORZV
$
3DUDJUDSK E LV DPHQGHG WR GHOHWH WKH OLPLW VKRZQ IRU WKH FRVW RI EDLO ERQGV DQG UHSODFH LW ZLWK D
OLPLW DQG
%
3DUDJUDSK G LV DPHQGHG WR GHOHWH WKH OLPLW RI VKRZQ IRU GDLO\ ORVV RI HDUQLQJV DQG UHSODFH LW ZLWK D
OLPLW
81,17(17,21$/ )$,/85( 72 ',6&/26( +$=$5'6
,I WKH 1DPHG ,QVXUHG XQLQWHQWLRQDOO\ IDLOV WR GLVFORVH DOO H[LVWLQJ KD]DUGV DW WKH LQFHSWLRQ GDWH RI WKH 1DPHG
,QVXUHG
V &RYHUDJH 3DUW WKH ,QVXUHU ZLOO QRW GHQ\ FRYHUDJH XQGHU WKLV &RYHUDJH 3DUW EHFDXVH RI VXFK IDLOXUH
:$,9(5 2) 68%52*$7,21 %/$1.(7
8QGHU &21',7,216 WKH FRQGLWLRQ HQWLWOHG 7UDQVIHU 2I 5LJKWV 2I 5HFRYHU\ $JDLQVW 2WKHUV 7R 8V LV DPHQGHG WR
DGG WKH IROORZLQJ
7KH ,QVXUHU ZDLYHV DQ\ ULJKW RI UHFRYHU\ WKH ,QVXUHU PD\ KDYH DJDLQVW DQ\ SHUVRQ RU RUJDQL]DWLRQ EHFDXVH RI
SD\PHQWV WKH ,QVXUHU PDNHV IRU LQMXU\ RU GDPDJH DULVLQJ RXW RI
WKH 1DPHG ,QVXUHG
V RQJRLQJ RSHUDWLRQV RU
\RXU ZRUN LQFOXGHG LQ WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG
+RZHYHU WKLV ZDLYHU DSSOLHV RQO\ ZKHQ WKH 1DPHG ,QVXUHG KDV DJUHHG LQ ZULWLQJ WR ZDLYH VXFK ULJKWV RI UHFRYHU\ LQ
D ZULWWHQ FRQWUDFW RU ZULWWHQ DJUHHPHQW DQG RQO\ LI VXFK FRQWUDFW RU DJUHHPHQW
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
LV LQ HIIHFW RU EHFRPHV HIIHFWLYH GXULQJ WKH WHUP RI WKLV &RYHUDJH 3DUW DQG
ZDV H[HFXWHG SULRU WR WKH ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ JLYLQJ ULVH WR WKH
FODLP
:5$383 (;7(16,21 2&,3 &&,3 25 &2162/,'$7(' :5$383 ,1685$1&( 352*5$06
1RWH 7KH IROORZLQJ SURYLVLRQ GRHV QRW DSSO\ WR DQ\ SXEOLF FRQVWUXFWLRQ SURMHFW LQ WKH VWDWH RI 2NODKRPD QRU WR DQ\
FRQVWUXFWLRQ SURMHFW LQ WKH VWDWH RI $ODVND WKDW LV QRW SHUPLWWHG WR EH LQVXUHG XQGHU D FRQVROLGDWHG ZUDSXS
LQVXUDQFH SURJUDP E\ DSSOLFDEOH VWDWH VWDWXWH RU UHJXODWLRQ
,I WKH HQGRUVHPHQW (;&/86,21 ± &216758&7,21 :5$383 LV DWWDFKHG WR WKLV SROLF\ RU DQRWKHU H[FOXVLRQDU\
HQGRUVHPHQW SHUWDLQLQJ WR 2ZQHU &RQWUROOHG ,QVXUDQFH 3URJUDPV 2&,3 RU &RQWUDFWRU &RQWUROOHG ,QVXUDQFH
3URJUDPV &&,3 LV DWWDFKHG WKHQ WKH IROORZLQJ FKDQJHV DSSO\
$
7KH IROORZLQJ ZRUGLQJ LV DGGHG WR WKH DERYHUHIHUHQFHG HQGRUVHPHQW
:LWK UHVSHFW WR D FRQVROLGDWHG ZUDSXS LQVXUDQFH SURJUDP SURMHFW LQ ZKLFK WKH 1DPHG ,QVXUHG LV RU ZDV
LQYROYHG WKLV H[FOXVLRQ GRHV QRW DSSO\ WR WKRVH VXPV WKH 1DPHG ,QVXUHG EHFRPH OHJDOO\ REOLJDWHG WR SD\ DV
GDPDJHV EHFDXVH RI
%RGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO RU DGYHUWLVLQJ LQMXU\ WKDW RFFXUV GXULQJ WKH 1DPHG ,QVXUHG
V
RQJRLQJ RSHUDWLRQV DW WKH SURMHFW RU GXULQJ VXFK RSHUDWLRQV RI DQ\RQH DFWLQJ RQ WKH 1DPHG ,QVXUHG
V
EHKDOI QRU
%RGLO\ LQMXU\ RU SURSHUW\ GDPDJH LQFOXGHG ZLWKLQ WKH SURGXFWVFRPSOHWHG RSHUDWLRQV KD]DUG WKDW DULVHV
RXW RI WKRVH SRUWLRQV RI WKH SURMHFW WKDW DUH QRW UHVLGHQWLDO VWUXFWXUHV
%
&RQGLWLRQ 2WKHU ,QVXUDQFH LV DPHQGHG WR DGG WKH IROORZLQJ VXESDUDJUDSK E F
7KLV LQVXUDQFH LV H[FHVV RYHU
F $Q\ RI WKH RWKHU LQVXUDQFH ZKHWKHU SULPDU\ H[FHVV FRQWLQJHQW RU DQ\ RWKHU EDVLV WKDW LV LQVXUDQFH DYDLODEOH
WR WKH 1DPHG ,QVXUHG DV D UHVXOW RI WKH 1DPHG ,QVXUHG EHLQJ D SDUWLFLSDQW LQ D FRQVROLGDWHG ZUDSXS
LQVXUDQFH SURJUDP EXW RQO\ DV UHVSHFWV WKH 1DPHG ,QVXUHG
V LQYROYHPHQW LQ WKDW FRQVROLGDWHG ZUDSXS
LQVXUDQFH SURJUDP
&
'(),1,7,216 LV DPHQGHG WR DGG WKH IROORZLQJ GHILQLWLRQV
&RQVROLGDWHG ZUDSXS LQVXUDQFH SURJUDP PHDQV D FRQVWUXFWLRQ HUHFWLRQ RU GHPROLWLRQ SURMHFW IRU ZKLFK WKH
SULPH FRQWUDFWRUSURMHFW PDQDJHU RU RZQHU RI WKH FRQVWUXFWLRQ SURMHFW KDV VHFXUHG JHQHUDO OLDELOLW\ LQVXUDQFH
FRYHULQJ VRPH RU DOO RI WKH FRQWUDFWRUV RU VXEFRQWUDFWRUV LQYROYHG LQ WKH SURMHFW VXFK DV DQ 2ZQHU &RQWUROOHG
,QVXUDQFH 3URJUDP 2&,3 RU &RQWUDFWRU &RQWUROOHG ,QVXUDQFH 3URJUDP &&,3
5HVLGHQWLDO VWUXFWXUH PHDQV DQ\ VWUXFWXUH ZKHUH RU PRUH RI WKH VTXDUH IRRW DUHD LV XVHG RU LV LQWHQGHG WR
EH XVHG IRU KXPDQ UHVLGHQF\ LQFOXGLQJ EXW QRW OLPLWHG WR
VLQJOH RU PXOWLIDPLO\ KRXVLQJ DSDUWPHQWV FRQGRPLQLXPV WRZQKRXVHV FRRSHUDWLYHV RU SODQQHG XQLW
GHYHORSPHQWV DQG
WKH FRPPRQ DUHDV DQG VWUXFWXUHV DSSXUWHQDQW WR WKH VWUXFWXUHV LQ SDUDJUDSK LQFOXGLQJ SRROV KRW WXEV
GHWDFKHG JDUDJHV JXHVW KRXVHV RU DQ\ VLPLODU VWUXFWXUHV
+RZHYHU ZKHQ WKHUH LV QR LQGLYLGXDO RZQHUVKLS RI XQLWV UHVLGHQWLDO VWUXFWXUH GRHV QRW LQFOXGH PLOLWDU\ KRXVLQJ
FROOHJHXQLYHUVLW\ KRXVLQJ RU GRUPLWRULHV ORQJ WHUP FDUH IDFLOLWLHV KRWHOV RU PRWHOV 5HVLGHQWLDO VWUXFWXUH DOVR
GRHV QRW LQFOXGH KRVSLWDOV RU SULVRQV
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
&1$ 3$5$02817
$UFKLWHFWV (QJLQHHUV DQG 6XUYH\RUV *HQHUDO /LDELOLW\
([WHQVLRQ (QGRUVHPHQW
7KLV :5$383 (;7(16,21 2&,3 &&,3 25 &2162/,'$7(' :5$383 ,1685$1&( 352*5$06 3URYLVLRQ
GRHV QRW DSSO\ WR DQ\ SHUVRQ RU RUJDQL]DWLRQ ZKR RWKHUZLVH TXDOLILHV DV DQ DGGLWLRQDO LQVXUHG RQ WKLV &RYHUDJH 3DUW
$OO RWKHU WHUPV DQG FRQGLWLRQV RI WKH 3ROLF\ UHPDLQ XQFKDQJHG
7KLV HQGRUVHPHQW ZKLFK IRUPV D SDUW RI DQG LV IRU DWWDFKPHQW WR WKH 3ROLF\ LVVXHG E\ WKH GHVLJQDWHG ,QVXUHUV WDNHV HIIHFW
RQ WKH HIIHFWLYH GDWH RI VDLG 3ROLF\ DW WKH KRXU VWDWHG LQ VDLG 3ROLF\ XQOHVV DQRWKHU HIIHFWLYH GDWH LV VKRZQ EHORZ DQG
H[SLUHV FRQFXUUHQWO\ ZLWK VDLG 3ROLF\
&1$;;
3DJH RI
3ROLF\ 1R 6075640222
(QGRUVHPHQW 1R
CONTINENTAL CASUALTY COMPANY
(IIHFWLYH 'DWH 01/01/2022
KING ENGINEERING ASSOCIATES, INC.
,QVXUHG 1DPH
&RS\ULJKW &1$ $OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ
6&$ '
(G
7+,6 (1'256(0(17 &+$1*(6 7+( 32/,&< 3/($6( 5($' ,7 &$5()8//<
(;7(1'(' &29(5$*( (1'256(0(17 ± %$ 3/86
7KLV HQGRUVHPHQW PRGLILHV LQVXUDQFH SURYLGHG XQGHU WKH IROORZLQJ
%86,1(66 $872 &29(5$*( )250
,
/,$%,/,7< &29(5$*(
:KLFK DUH QR ORQJHU LQ IRUFH RU
$
:KR ,V $Q ,QVXUHG
:KRVH OLPLWV KDYH EHHQ H[KDXVWHG
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,, 3DUDJUDSK $
%
%DLO %RQGV DQG /RVV RI (DUQLQJV
:KR ,V $Q ,QVXUHG
6HFWLRQ ,, 3DUDJUDSKV $D DQG $D DUH
D
$Q\ LQFRUSRUDWHG HQWLW\ RI ZKLFK WKH 1DPHG
UHYLVHG DV IROORZV
,QVXUHG RZQV D PDMRULW\ RI WKH YRWLQJ VWRFN RQ
,Q D WKH OLPLW IRU WKH FRVW RI EDLO ERQGV LV
WKH GDWH RI LQFHSWLRQ RI WKLV &RYHUDJH )RUP
LQFUHDVHG IURP WR DQG
SURYLGHG WKDW
,Q D WKH OLPLW IRU WKH ORVV RI HDUQLQJV LV
E
7KH LQVXUDQFH DIIRUGHG E\ WKLV SURYLVLRQ $
LQFUHDVHG IURP WR D GD\
GRHV QRW DSSO\ WR DQ\ VXFK HQWLW\ WKDW LV DQ
LQVXUHG XQGHU DQ\ RWKHU OLDELOLW\ SROLF\
&
)HOORZ (PSOR\HH
SURYLGLQJ DXWR FRYHUDJH
6HFWLRQ ,, 3DUDJUDSK % GRHV QRW DSSO\
$Q\ RUJDQL]DWLRQ \RX QHZO\ DFTXLUH RU IRUP RWKHU
6XFK FRYHUDJH DV LV DIIRUGHG E\ WKLV SURYLVLRQ & LV
WKDQ D OLPLWHG OLDELOLW\ FRPSDQ\ SDUWQHUVKLS RU
H[FHVV RYHU DQ\ RWKHU FROOHFWLEOH LQVXUDQFH
MRLQW
YHQWXUH
DQG
RYHU
ZKLFK
\RX
PDLQWDLQ
PDMRULW\ RZQHUVKLS LQWHUHVW
,,
3+<6,&$/ '$0$*( &29(5$*(
7KH LQVXUDQFH DIIRUGHG E\ WKLV SURYLVLRQ $
$
7RZLQJ
D
,V HIIHFWLYH RQ WKH DFTXLVLWLRQ RU IRUPDWLRQ
6HFWLRQ ,,, 3DUDJUDSK $ LV UHYLVHG WR LQFOXGH /LJKW
GDWH DQG LV DIIRUGHG RQO\ XQWLO WKH HQG RI WKH
7UXFNV XS WR SRXQGV *9:
SROLF\ SHULRG RI WKLV &RYHUDJH )RUP RU WKH
%
7UDQVSRUWDWLRQ ([SHQVHV
QH[W
DQQLYHUVDU\
RI
LWV
LQFHSWLRQ
GDWH
ZKLFKHYHU LV HDUOLHU
6HFWLRQ ,,, 3DUDJUDSK $D LV UHYLVHG ZLWK UHVSHFW
WR WUDQVSRUWDWLRQ H[SHQVH LQFXUUHG E\ \RX WR SURYLGH
E
'RHV QRW DSSO\ WR
D
SHU GD\ LQ OLHX RI VXEMHFW WR
%RGLO\
LQMXU\
RU
SURSHUW\
GDPDJH
FDXVHG E\ DQ DFFLGHQW WKDW RFFXUUHG
E
PD[LPXP LQ OLHX RI
EHIRUH
\RX
DFTXLUHG
RU
IRUPHG
WKH
&
/RVV RI 8VH ([SHQVHV
RUJDQL]DWLRQ RU
6HFWLRQ ,,, 3DUDJUDSK $E
LV UHYLVHG ZLWK UHVSHFW
$Q\ VXFK RUJDQL]DWLRQ WKDW LV DQ LQVXUHG
WR ORVV RI XVH H[SHQVHV LQFXUUHG E\ \RX WR SURYLGH
XQGHU DQ\ RWKHU OLDELOLW\ SROLF\ SURYLGLQJ
DXWR FRYHUDJH
D
PD[LPXP LQ OLHX RI
$Q\ SHUVRQ RU RUJDQL]DWLRQ WKDW \RX DUH REOLJDWHG
'
3HUVRQDO 3URSHUW\
WR SURYLGH ,QVXUDQFH ZKHUH UHTXLUHG E\ D ZULWWHQ
FRQWUDFW RU DJUHHPHQW LV DQ LQVXUHG EXW RQO\ ZLWK
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,,, 3DUDJUDSK $
UHVSHFW WR OHJDO UHVSRQVLELOLW\ IRU DFWV RU RPLVVLRQV
F
:H ZLOO SD\ XS WR IRU ORVV WR 3HUVRQDO
RI D SHUVRQ IRU ZKRP /LDELOLW\
&RYHUDJH LV
3URSHUW\ ZKLFK LV
DIIRUGHG XQGHU WKLV SROLF\
2ZQHG E\ DQ LQVXUHG DQG
$Q HPSOR\HH RI \RXUV LV DQ LQVXUHG ZKLOH
RSHUDWLQJ DQ DXWR KLUHG RU UHQWHG XQGHU D
,Q RU RQ WKH FRYHUHG DXWR
FRQWUDFW RU DJUHHPHQW LQ WKDW HPSOR\HH
V QDPH
7KLV FRYHUDJH DSSOLHV RQO\ LQ WKH HYHQW RI D WRWDO
ZLWK \RXU SHUPLVVLRQ ZKLOH SHUIRUPLQJ GXWLHV
WKHIW RI \RXU FRYHUHG DXWR
UHODWHG WR WKH FRQGXFW RI \RXU EXVLQHVV
7KLV LQVXUDQFH LV H[FHVV RYHU DQ\ RWKHU FROOHFWLEOH
3ROLF\ DV XVHG LQ WKLV SURYLVLRQ $ :KR ,V $Q
LQVXUDQFH DQG QR GHGXFWLEOH DSSOLHV
,QVXUHG LQFOXGHV WKRVH SROLFLHV WKDW ZHUH LQ IRUFH RQ
WKH LQFHSWLRQ GDWH RI WKLV &RYHUDJH )RUP EXW
(
5HQWDO 5HLPEXUVHPHQW
6&$ '
3DJH RI
&RS\ULJKW &1$ &RUSRUDWLRQ
(G
,QFOXGHV FRS\ULJKWHG PDWHULDO RI WKH ,QVXUDQFH 6HUYLFHV 2IILFH XVHG ZLWK LWV SHUPLVVLRQ
Policy: 6075640236
6&$ '
(G
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,,, 3DUDJUDSK $
G
7KH SK\VLFDO GDPDJH FRYHUDJH DV LV SURYLGHG
E\ WKLV SURYLVLRQ ZLOO EH OLPLWHG WR WKH W\SHV RI
G
:H ZLOO SD\ IRU UHQWDO UHLPEXUVHPHQW H[SHQVHV
SK\VLFDO GDPDJH FRYHUDJH V SURYLGHG RQ
LQFXUUHG E\ \RX IRU WKH UHQWDO RI DQ DXWR EHFDXVH
\RXU RZQHG DXWRV
RI ORVV WR D FRYHUHG DXWR 3D\PHQW DSSOLHV LQ
DGGLWLRQ WR WKH RWKHUZLVH DSSOLFDEOH DPRXQW RI
H
6XFK SK\VLFDO GDPDJH FRYHUDJH IRU KLUHG
HDFK FRYHUDJH \RX KDYH RQ D FRYHUHG DXWR 1R
DXWRV ZLOO
GHGXFWLEOHV DSSO\ WR WKLV FRYHUDJH
,QFOXGH ORVV RI XVH SURYLGHG LW LV WKH
:H ZLOO SD\ RQO\ IRU WKRVH H[SHQVHV LQFXUUHG
FRQVHTXHQFH RI DQ DFFLGHQW IRU ZKLFK
GXULQJ WKH SROLF\ SHULRG EHJLQQLQJ KRXUV
WKH 1DPHG ,QVXUHG LV OHJDOO\ OLDEOH DQG
DIWHU WKH ORVV DQG HQGLQJ UHJDUGOHVV RI WKH
DV D UHVXOW RI ZKLFK D PRQHWDU\ ORVV LV
SROLF\
V H[SLUDWLRQ ZLWK WKH OHVVHU RI WKH
VXVWDLQHG
E\
WKH
OHDVLQJ
RU
UHQWDO
IROORZLQJ QXPEHU RI GD\V
FRQFHUQ
D 7KH QXPEHU RI GD\V UHDVRQDEO\ UHTXLUHG
6XFK FRYHUDJH DV LV SURYLGHG E\ WKLV
WR UHSDLU RU UHSODFH WKH FRYHUHG DXWR RU
SURYLVLRQ *H ZLOO EH VXEMHFW WR D OLPLW
RI SHU DFFLGHQW
E GD\V
*
$LUEDJ &RYHUDJH
2XU SD\PHQW LV OLPLWHG WR WKH OHVVHU RI WKH
IROORZLQJ DPRXQWV
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,,, 3DUDJUDSK %
D 1HFHVVDU\ DQG DFWXDO H[SHQVHV LQFXUUHG
7KH DFFLGHQWDO GLVFKDUJH RI DQ DLUEDJ VKDOO QRW EH
RU
FRQVLGHUHG PHFKDQLFDO EUHDNGRZQ
E SHU GD\ VXEMHFW WR D PD[LPXP RI
+
(OHFWURQLF (TXLSPHQW
6HFWLRQ ,,, 3DUDJUDSKV %F DQG %G DUH GHOHWHG
7KLV FRYHUDJH GRHV QRW DSSO\ ZKLOH WKHUH DUH
DQG UHSODFHG E\ WKH IROORZLQJ
VSDUH RU UHVHUYH DXWRV DYDLODEOH WR \RX IRU
F
3K\VLFDO 'DPDJH &RYHUDJH RQ D FRYHUHG
\RXU RSHUDWLRQV
DXWR
DOVR
DSSOLHV
WR
ORVV
WR
DQ\
,I ORVV UHVXOWV IURP WKH WRWDO WKHIW RI D
SHUPDQHQWO\ LQVWDOOHG HOHFWURQLF HTXLSPHQW
FRYHUHG DXWR RI WKH SULYDWH SDVVHQJHU W\SH
LQFOXGLQJ LWV DQWHQQDV DQG RWKHU DFFHVVRULHV
ZH ZLOO SD\ XQGHU WKLV FRYHUDJH RQO\ WKDW
G
$ SHU RFFXUUHQFH GHGXFWLEOH DSSOLHV WR
DPRXQW
RI
\RXU
UHQWDO
UHLPEXUVHPHQW
WKH FRYHUDJH SURYLGHG E\ WKLV SURYLVLRQ
H[SHQVHV ZKLFK LV QRW DOUHDG\ SURYLGHG IRU
XQGHU
WKH
3K\VLFDO
'DPDJH
&RYHUDJH
,
'LPLQXWLRQ ,Q 9DOXH
([WHQVLRQ
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,,, 3DUDJUDSK %
)
+LUHG $XWRV
6XEMHFW WR WKH IROORZLQJ WKH GLPLQXWLRQ LQ YDOXH
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,,, 3DUDJUDSK $
H[FOXVLRQ GRHV QRW DSSO\ WR
+LUHG $XWRV
D
$Q\ FRYHUHG DXWR RI WKH SULYDWH SDVVHQJHU
W\SH \RX OHDVH KLUH UHQW RU ERUURZ ZLWKRXW D
,I 3K\VLFDO 'DPDJH FRYHUDJH LV SURYLGHG XQGHU
GULYHU IRU D SHULRG RI GD\V RU OHVV ZKLOH
WKLV SROLF\ DQG VXFK FRYHUDJH GRHV QRW H[WHQG WR
SHUIRUPLQJ GXWLHV UHODWHG WR WKH FRQGXFW RI
+LUHG $XWRV WKHQ 3K\VLFDO 'DPDJH FRYHUDJH LV
\RXU EXVLQHVV DQG
H[WHQGHG WR
E
$Q\ FRYHUHG DXWR RI WKH SULYDWH SDVVHQJHU
D
$Q\ FRYHUHG DXWR \RX OHDVH KLUH UHQW RU
W\SH KLUHG RU UHQWHG E\ \RXU HPSOR\HH
ERUURZ ZLWKRXW D GULYHU DQG
ZLWKRXW D GULYHU IRU D SHULRG RI GD\V RU OHVV
E
$Q\ FRYHUHG DXWR KLUHG RU UHQWHG E\ \RXU
XQGHU
D
FRQWUDFW
LQ
WKDW
LQGLYLGXDO
HPSOR\HH ZLWKRXW D GULYHU XQGHU D FRQWUDFW
HPSOR\HH
V QDPH ZLWK \RXU SHUPLVVLRQ
LQ WKDW LQGLYLGXDO HPSOR\HH
V QDPH ZLWK
ZKLOH SHUIRUPLQJ GXWLHV UHODWHG WR WKH FRQGXFW
\RXU
SHUPLVVLRQ
ZKLOH
SHUIRUPLQJ
GXWLHV
RI \RXU EXVLQHVV
UHODWHG WR WKH FRQGXFW RI \RXU EXVLQHVV
F
6XFK
FRYHUDJH
DV
LV
SURYLGHG
E\
WKLV
F
7KH PRVW ZH ZLOO SD\ IRU DQ\ RQH DFFLGHQW RU
SURYLVLRQ LV OLPLWHG WR D GLPLQXWLRQ LQ YDOXH
ORVV LV WKH DFWXDO FDVK YDOXH FRVW RI UHSDLU
ORVV DULVLQJ GLUHFWO\ RXW RI DFFLGHQWDO GDPDJH
FRVW RI UHSODFHPHQW RU ZKLFKHYHU LV
DQG QRW DV D UHVXOW RI WKH IDLOXUH WR PDNH
OHVV
PLQXV
D
GHGXFWLEOH
IRU
HDFK
UHSDLUV IDXOW\ RU LQFRPSOHWH PDLQWHQDQFH RU
FRYHUHG DXWR 1R GHGXFWLEOH DSSOLHV WR ORVV
UHSDLUV RU WKH LQVWDOODWLRQ RI VXEVWDQGDUG
FDXVHG E\ ILUH RU OLJKWQLQJ
SDUWV
6&$ '
3DJH RI
&RS\ULJKW &1$ &RUSRUDWLRQ
(G
,QFOXGHV FRS\ULJKWHG PDWHULDO RI WKH ,QVXUDQFH 6HUYLFHV 2IILFH XVHG ZLWK LWV SHUPLVVLRQ
Policy: 6075640236
6&$ '
(G
G
7KH PRVW ZH ZLOO SD\ IRU ORVV WR D FRYHUHG
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,9 3DUDJUDSK
DXWR LQ DQ\ RQH DFFLGHQW LV WKH OHVVHU RI
$D
RU
<RXU HPSOR\HHV PD\ NQRZ RI DQ DFFLGHQW
RU ORVV 7KLV ZLOO QRW PHDQ WKDW \RX KDYH
RI WKH DXWR
V DFWXDO FDVK YDOXH
VXFK NQRZOHGJH XQOHVV VXFK DFFLGHQW RU
$&9
ORVV LV NQRZQ WR \RX RU LI \RX DUH QRW DQ
LQGLYLGXDO WR DQ\ RI \RXU H[HFXWLYH RIILFHUV RU
,,, 'ULYH 2WKHU &DU &RYHUDJH ± ([HFXWLYH 2IILFHUV
SDUWQHUV RU \RXU LQVXUDQFH PDQDJHU
7KH IROORZLQJ LV DGGHG WR 6HFWLRQV ,, DQG ,,,
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,9 3DUDJUDSK
$Q\ DXWR \RX GRQ
W RZQ KLUH RU ERUURZ LV D
$E
FRYHUHG DXWR IRU /LDELOLW\ &RYHUDJH ZKLOH EHLQJ
<RXU HPSOR\HHV PD\ NQRZ RI GRFXPHQWV
XVHG E\ DQG IRU 3K\VLFDO 'DPDJH &RYHUDJH
UHFHLYHG FRQFHUQLQJ D FODLP RU VXLW 7KLV ZLOO
ZKLOH LQ WKH FDUH FXVWRG\ RU FRQWURO RI DQ\ RI \RXU
QRW PHDQ WKDW \RX KDYH VXFK NQRZOHGJH
H[HFXWLYH RIILFHUV H[FHSW
XQOHVV UHFHLSW RI VXFK GRFXPHQWV LV NQRZQ WR
D
$Q DXWR RZQHG E\ WKDW H[HFXWLYH RIILFHU RU
\RX RU LI \RX DUH QRW DQ LQGLYLGXDO WR DQ\ RI
D PHPEHU RI WKDW SHUVRQ
V KRXVHKROG RU
\RXU H[HFXWLYH RIILFHUV RU SDUWQHUV RU \RXU
LQVXUDQFH PDQDJHU
E
$Q DXWR XVHG E\ WKDW H[HFXWLYH RIILFHU
ZKLOH
ZRUNLQJ
LQ
D
EXVLQHVV
RI
VHOOLQJ
%
&RQFHDOPHQW 0LVUHSUHVHQWDWLRQ RU )UDXG
VHUYLFLQJ UHSDLULQJ RU SDUNLQJ DXWRV
7KH IROORZLQJ LV DGGHG WR 6HFWLRQ ,9 3DUDJUDSK %
6XFK /LDELOLW\ DQGRU 3K\VLFDO 'DPDJH &RYHUDJH
<RXU IDLOXUH WR GLVFORVH DOO KD]DUGV H[LVWLQJ RQ WKH GDWH
DV LV DIIRUGHG E\ WKLV SURYLVLRQ ZLOO EH
RI LQFHSWLRQ RI WKLV &RYHUDJH )RUP VKDOO QRW SUHMXGLFH
(TXDO WR WKH JUHDWHVW RI WKRVH FRYHUDJHV
\RX ZLWK UHVSHFW WR WKH FRYHUDJH DIIRUGHG SURYLGHG
DIIRUGHG DQ\ FRYHUHG DXWR DQG
VXFK IDLOXUH RU RPLVVLRQ LV QRW LQWHQWLRQDO
([FHVV
RYHU
DQ\
RWKHU
FROOHFWLEOH
&
3ROLF\ 3HULRG &RYHUDJH 7HUULWRU\
LQVXUDQFH
6HFWLRQ
,9
3DUDJUDSKV
D
LV
UHYLVHG
WR
)RU SXUSRVHV RI WKLV SURYLVLRQ H[HFXWLYH RIILFHU
SURYLGH
PHDQV
D
SHUVRQ
KROGLQJ
DQ\
RI
WKH
RIILFHU
D
GD\V RI FRYHUDJH LQ OLHX RI GD\V
SRVLWLRQV FUHDWHG E\ \RXU FKDUWHU FRQVWLWXWLRQ E\
ODZV RU DQ\ RWKHU VLPLODU JRYHUQLQJ GRFXPHQW
,9 '(),1,7,216
DQG ZKLOH D UHVLGHQW RI WKH VDPH KRXVHKROG
LQFOXGHV WKDW SHUVRQ
V VSRXVH
6HFWLRQ 9 3DUDJUDSK & LV GHOHWHG DQG UHSODFHG E\
WKH IROORZLQJ
6XFK H[HFXWLYH RIILFHUV DUH LQVXUHGV ZKLOH
XVLQJ D FRYHUHG DXWR GHVFULEHG LQ WKLV SURYLVLRQ
%RGLO\ LQMXU\ PHDQV ERGLO\ LQMXU\ VLFNQHVV RU GLVHDVH
VXVWDLQHG E\ D SHUVRQ LQFOXGLQJ PHQWDO DQJXLVK
,9 %86,1(66 $872 &21',7,216
PHQWDO LQMXU\ RU GHDWK UHVXOWLQJ IURP DQ\ RI WKHVH
$
'XWLHV ,Q 7KH (YHQW 2I $FFLGHQW &ODLP 6XLW 2U
/RVV
6&$ '
3DJH RI
&RS\ULJKW &1$ &RUSRUDWLRQ
(G
,QFOXGHV FRS\ULJKWHG PDWHULDO RI WKH ,QVXUDQFH 6HUYLFHV 2IILFH XVHG ZLWK LWV SHUPLVVLRQ
Policy: 6075640236
CNA71527XX
(Ed. 10/12)
Policy No: 75640236
Endorsement No:
Effective Date:0122
CNA71527XX (10/12)
Page 1 of 1
Insured Name: .LQJ(QJLQHHULQJ$VVRFLDWHV,QF
Copyright CNA All Rights Reserved.
ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:
SCHEDULE
Name of Additional Insured Persons Or Organizations
Any person or organization with whom you are required to add as and additional insured or primary and non-
contributory on this policy under a written contract or agreement. You must agree to these contracts prior to the date
of loss.
1.
In conformance with paragraph A.1.c. of Who Is An Insured of Section II – LIABILITY COVERAGE, the person
or organization scheduled above is an insured under this policy.
2.
The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory
basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the
"accident" for which the additional insured seeks coverage under this policy.
All other terms and conditions of the Policy remain unchanged.
Business Auto Policy
Policy Endorsement
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is
indicated below.
Named Insured: ARDURRA GROUP, INC.
Endorsement Effective Date: 01/01/2022
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT
OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR
TO LOSS.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or
organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident"
or the "loss" under a contract with that person or organization.
Endorsement No: 12; Page: 1 of 1
Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL
60606
Form No: CA 04 44 10 13
Endorsement Effective Date:
Policy No: BUA 6075640236
Policy Effective Date: 01/01/2022
Policy Page: 75 of 345
Endorsement Expiration Date:
© Copyright Insurance Services Office, Inc., 2011
Workers Compensation And Employers Liability Insurance
Policy Endorsement
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover
from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Endorsement No: 4; Page: 1 of 1
Underwriting Company: The Continental Insurance Company, 333 S Wabash Ave, Chicago, IL 60604
Form No: WC 00 03 13 (04-1984)
Endorsement Effective Date:
Policy No: WC 6075640267
Policy Effective Date: 01/01/2022
Policy Page: 62 of 98
Endorsement Expiration Date:
Copyright 1983 National Council on Compensation Insurance.