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HomeMy WebLinkAbout09- Agreement for Engineering Services with TD & H for Story MansionCommission Memorandum REPORT TO: Honorable Mayor and City Commission FROM: James Goehrung, Director of Facility Services Chris Kukulski, City Manager SUBJECT: Award Engineering Services Contract to TD&H for Inspection Services for the Story Mansion Renovations MEETING DATE: February 17, 2009 RECOMMENDATION: Authorize the City Manager to sign the contract with TD&H for civil site inspection and survey services for construction activities related to the renovation of the Story Mansion in the amount not to exceed $5,750.00 BACKGROUND: The services to be performed under this contract are for inspection, testing, and construction surveying. This civil site work will include inspection of the fire line installation, pipe bedding, and compaction. The Engineer will provide testing and inspection at each major phase of parking lot and accesses drive improvements. The Engineer will provide surveying services for parking lot staking and finish grades stakes for the gravel base and asphalt. FISCAL EFFECTS: The cost for these services will be paid for out of the contingency funds for the mansion renovations. ALTERNATIVES: As suggested by the City Commission. Respectfully submitted, James Goehrung Director of Facility Services Attachments: Contract Chris A. Kukulski, City Manager Report compiled on February 6, 2009 _.. _ I ,. T DBc~ --- LETTER OF TRANSMITTAL TO : Bozeman Facilities Department Attn: James Goehrung PO Box 1230 Bozeman, MT 59771 We are sending you ^ Shop Drawings ^ Copy of Letter DATE : 1/27/09 JOB : Story Mansion Remodel ® Attached ^ Under separate cover via ^ Disks ^ Plans ^ Change Order ^ Specifications the following items: ^ Samples ^ Files COPIES DATE DESCRIPTION 1 1/27/09 Agreement for Engineering Services These are transmitted as checked below: ® For approval ^ No exception taken ^ Resubmit copies for approval ^ For your use ^ Make corrections noted ^ Submit copies for distribution ^ As requested ^ For review and comment ^ Return corrected prints ^ For Bids Due , 20 ^ Prints Returned After Loan To Us REMARKS: Cc: File THOM S, DEAN & HOSKINS, INC. Signed: ~i - le Scarr, E.I. 21.i West Mendenhall, Suite G 1 ~~• Bozeman, MT 5971 S •~Tel: (406) 586-0277 • Fcu: (406) X86-4951 AGREEMENT FOR ENGINEERING SERVICES CLIENT: The City of Bozeman, a Municipal Corporation Date: 1/27/09 PO Box 1230 Bozeman, MT 59771-1230 ENGINEER: THOMAS, DEAN & HOSKINS, INC. 215 West Mendenhall, Suite C-1 Bozeman, MT 59715 PROJECT DESCRIPTION: Story Mansion Inspection, Testing, and Construction Surveying Services. SERVICES TO BE PERFORMED: Fire service line inspection will include the connection with the City of Bozeman water main through the first OS&Y valve located inside the building. We are assuming the contractor will take one week to complete this task. Our inspector will be onsite approximately four hours a day to inspect and document construction. We will coordinate with the contractor to insure all aspects of installation are inspected prior to backfilling any work, as required by the City of Bozeman. Also included in this item is preparation and submittal of as-built drawings of the fire service line, as required by the City of Bozeman. Engineer will provide testing and inspection at each major phase of parking lot construction, which includes subgrade preparation, subbase course, base course, and asphalt finishing. Engineer will also coordinate with the contractor to arrive onsite after each phase has been completed for compaction testing, inspection, and quality control. Construction staking will include standard staking of the fire service line, which includes one tight stake and one offset stake to each water line fitting, bend, valve, and grade change. Parking lot staking will include minimal stripping stakes without elevations for location of the parking lot. We will also provide finished grade stakes for placement of pit run subbase gravel followed by finished grade stakes necessary to place the base course gravel and asphalt. AMOUNT OF FEE: [ X ]The estimated fees to complete the services to be performed is $5.750. The Client will be notified by the Engineer prior to performing any services that would substantially increase the estimated fee. [ ]The lump sum fee to complete the services to be performed will be $ The charge rates shall be the Thomas, Dean & Hoskins, Inc., Bozeman Office, Standard Rate Schedule, May 2008. See attached Rate Schedule. A retainer in the amount of $NA is required before beginning services. The amount of the retainer will be credited toward the final billing when the services are substantially complete. The Engineer can begin services within one day of receipt of this signed agreement. PAYMENT TO THE ENGINEER: Progress payments shall be made in proportion to the services rendered and shall be due and owing upon receipt of the Engineer's monthly statement. The Client agrees to pay interest at the maximum legal rate allowed on accounts 30 Days past due, plus a reasonable attorney's fee, court cost and actual collection of any past due amounts. This agreement consisting of this sheet plus any attachments, is hereby accepted by the respective parties 1. ENGINEER shall perform professional engineering and normal incidental service thereto. The ENGINEER is authorized to proceed as of the date of this contract unless otherwise noted. 2. PAGES ONE AND TWO of this form constitute written authorization for the ENGINEER to proceed. Following this authorization, the ENGINEER will consultfurtherwith CLIENT to clarify requirements for the Project and review available data. 3. The ENGINEER will perform its services in a manner consistent with generally accepted professional standards required of it and other design professionals providing similar services under similar conditions, in the same locale. 4. Any Opinion of the Construction Cost prepared by the ENGINEER represents hisjudgment as a design professional and is supplied for the general-guidance of the CLIENT. Since the ENGINEER has no control over the cost of labor and material, or over competitive bidding or market conditions, the ENGINEER does not guarantee the accuracyof such opinions as compared to Contractor bids or actual cost to the CLIENT. 5. ENGINEER shall not be responsible for the acts or omissions of any Contractor, or subcontractor, or any of the Contractor(s)' or subcontractor' agents or employees or any other persons (except ENGINEER's own employees and agents) at the site or otherwise performing any of Contractor(s)' work; however, nothing contained herein shall be construed to release ENGINEER from his responsibilities to properly perform duties undertaken by him as a part of this AGREEMENT. 6. CLIENT shall provide all criteria and full information as to CLIENTS requirements for the Project; designate a person act with authority on CLIENTS behalf in respect of all aspects of the Project; examine and respond promptly to ENGINEER'S submissions; and give prompt written notice to ENGINEER whenever he observes or otherwise becomes aware of any defect in the work. The ENGINEER and its consultant has the right to rely on the accuracy of CLIENT-furnished information. CLIENT shall also do the following and pay all costs incidental thereto: (1) Provide such legal, accounting and other counseling services as may be required for the project. (2) Furnish approvals and permits from all governmental authorities having jurisdiction over the Project. ENGINEER will obtain design approval from appropriate agencies. (3) Pay all costs incidental to obtaining bids or proposals from Contractor(s). (4) Pay all review and filing fees required by governmental agencies. (5) Guarantee full and free access for the ENGINEER to enter upon all property required for the performance of the ENGINEER's services under this Agreement. 7. The obligation to provide further services under this Agreement maybe terminated by either party upon seven days written notice in the event substantial failure by the other party to perform in accordance with the terms hereof through no fault of the terminating party. In the eventof anytermination, ENGINEER will be paid for all services rendered to the date of termination, all Reimbursable Expenses and termination expenses. The CLIENT may terminate this contract for their convenience by using a formal notice to the ENGINEER which completes the termination when acknowledged by the ENGINEER. The ENGINEER acknowledgement shall occur within 7 days of document receipt. 8. CLIENT and ENGINEER each binds himself and his partners, successors, executors, administrators, assigns and legal representatives to the other party of this Agreement to the partners, successors, executors, administrators, assigns and legal representatives of such other party, in respect to all covenants, agreements and obligations of this Agreement. 9. All documents including drawings/specifications provided or furnished by ENGINEER pursuant to this Agreement are instruments of service and ENGINEER shall retain an ownership and property interest therein. CLIENT may make and retain copies for information and reference in connection with the project use and occupancy. Any CLIENT reuse without ENGINEER's authorization will be at CLIENTs sole risk. 10. Dispute Resolution -The CLIENT and ENGINEER agree to negotiate in good faith for a period of thirty days from the date of notice of all disputes between them prior to exercising their rights to mediation. Mediation by aCLIENT-ENGINEER agreed upon mediator would occur after the 30 day period. If litigation does occur, it would be in the legal jurisdiction of Gallatin County, Montana. 11. Nothing herein shall be construed to give any rights or benefits hereunder to anyone otherthan CLIENT and ENGINEER. 12. ENGINEER shall carry insurance as identified in the attached certificates. CLIENT: City of Bozeman, Montana TITLE:~,- l ~4 ~tQ r DATE: ~ ( f 7 ~~ ENGINEER: HOMAS, DEAN & HOSKINS, INC. BY: ~ TITLE: ~ C.~ ~~~' c~C~"' DATE: ~ Z THOMAS, DEAN & HOSKINS, INC. BOZEMAN OFFICE STANDARD RATE SCHEDULE MAY 2008 TASK DESCRIPTION HOURLY RATE #3 Principal $170.00 #4 Senior Engineer II 146.00 #4 Senior Engineer I 126.00 #5 Engineer V 114.00 #5 Engineer IV 97.00 #5 Engineer III 89.00 #16 Engineer II 80.00 #16 Engineer I 72.00 #17 Production Manager/Construction Technician 93.00 #6 Engineering Technician 62.00 #10 Construction Manager II 115.00 #10 Construction Manager I 70.00 #8 Lab Technician/Engineering Aide 51.00 #12 CAD Drafter II 65.00 #13 Clerical 43.00 #15 Marketing/Administrative Assistant 63.00 #7 Registered Land Surveyor 80.00 #9 Construction Inspector II 68.00 #9 Construction Inspector I 57.00 #7 Survey Party Chief II 73.00 #1 Survey Party Chief I 66.00 #2 Surveyor 52.00 #14 Surveyor's Assistant 45.00 #31 Deposition & Court Testimony 250.00 Vehicle Use: $5.00 per day plus mileage @ $0.60 per mile Facsimile & Copies Out-of-pocket cost: -charged at actual cost plus 10% Sending $0.50 per page Color Laser Printing $0.70 per page Global Positionins Copy Machine $0.10 per copy Monthly Rate: $5000.00 Weekly Rate: 1650.00 Computer w/software Daily Rate: 500.00 Monthly Rate: $500.00 Weekly Rate: 180.00 Daily Rate: 60.00 Hourly Rate: 10.00 Nuclear Densometer Monthly Rate: $600.00 Plotter (In-Housel Weekly Rate: 200.00 Xerox; Black and White $0.30 / SF Daily Rate: 70.00 Bond $0.90 / SF Hourly Rate: 10.00 Mylar $3.00 / SF (Minimum Charge: $25.00) Lietz 3 with Field Book & Software Monthly Rate: $1200.00 Weekly Rate: 320.00 Daily Rate: 110.00 Hourly Rate: 20.00 Client#• 133535 25THODEAN ACORDTM CERTIFICATE OF LIABILITY INSURANCE 09/17/08DnvYY> PRODUCER Hub International 100 Park Drive South THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Great Falls, MT 59403 406 453-1464 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American Hallmark InS CO Thomas Dean & Hoskins, InC INSURER B: 1200 25th St So INSURER C: Great Falls, MT 59405 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OFINSURANCE POLICY NUMBER PDATEYMMFDD TIVE PDATE MMI D/YYON LIMITS A GENERAL LIABILITY 44CL455969 09/01/08 09/01/09 EACH OCCURRENCE $1 UQQ U00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100 000 X CLAIMS MADE ~ OCCUR MED EXP (Any one person) $5 000 PERSONAL ~ ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2 000 000 POLICY PRO LOC J ECT A AUT OMOBILE LIABILITY 44CL455969 09/01/08 09/01/09 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) 1 000,000 s ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Fire service line inspection, testing 8~ construction staking Certificate holder is additional insured as per written contract CERTIFICATE HULDER GAIVGtLLAIIVIV City of Bozeman PO Box 1230 Bozeman, MT 59771-1230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR A HD REPRESE E ~' ACORD 25 (2001/08) 1 of 2 #S42652/M30342 RTY ©AGORD CUKI'U KAI IUN 19Cif IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AcoRO 25-s (2oolloa) 2 of 2 #S42652/M30342 rro.,re• ~~~S3F 25THODEAN ACORD,M CERTIFICATE OF LIABILITY INSURANCE 09/24/08DnrYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hub International ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 100 Park Drive South ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Great Falls, MT 59403 406 453-1464 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Montana State FUnd Thomas Dean & Hoskins Inc INSURER B: 1200 25th St So INSURER C: MT 59405 Great Falls , INSURER D: INSURER E: R(1VFRAAFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT , MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MMIDDnY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE ^ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND 030659239 U7/U1/U8 07/U1/09 X WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,OOU ANY PROPRIETOR/PARTNER/EXECUTIVE 00 1 000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE , , $ If yes, describe under POLICY LIMIT DISEASE E L 00 $1 000 SPECIAL PROVISIONS below - . . , , OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS RE: Fire service line inspection, testing & construction staking CERTIFICATE HOLDER l.Arvl.tLLAI IVIv SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Bozeman DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~Q._ DAYS WRITTEN PO Box 1230 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Bozeman, MT 59771-1230 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR A HD REPRE,~ E ACORD 25 (2001108) 1 of 2 #S42650/M30924 RTY © A(:UKU I:UKrVKAI IVN l`J if if IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) 2 of 2 #S42650/M30924 f 1'un4tt• 1125Z~i 25TH~DEAN ACORDrM CERTIFICATE OF LIABILITY INSURANCE 09/17/08DnYYY) PRODUCER Hub International 100 Park Drive South THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Great Falls, MT 59403 406 453-1464 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: COntlnental CdSUBIty CO Thomas Dean & Hoskins, Inc INSURER B: 1200 25th St So INSURER C: Great Falls, MT 59405 INSURER D: INSURER E: (`(1VFRA(:FS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT , MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. p E Y ON P LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER D MMIDDIYY TE DATE MM DD/Y GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY $ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ A OTHER professional AEH113825009 09/01/08 09/01109 $1,000,000/Each occurre $1,000,000/Aggregate DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Professional Services provided by the Named Insured. City of Bozeman P O Box 1230 Bozeman, MT 59771 tLLAIIVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Hl~ ORIZED REPRE/~ E ACORD 25 (2001/08) 1 of 2 #S42651/M30377 RTY O A(:UKU CUKF'UKAI IUN 1y25i3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) 2 of 2 #S42651/M30377