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HomeMy WebLinkAboutFI Runway Crack Repair & Sealing ProjectRESOLUTION 2010-877 ADOPTED DOC ID: 6336 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-877 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 4, 2010: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute Supplemental Agreement #3 between the Town of Southold and the New York State Department of Transportation in connection with Contract #K006887 for the Runway Crack Repair and Sealing~ Phase II (design and construction) Project at Elizabeth Field Airport~ Fishers Island~ New York~ subject to the approval oftbe Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Vincent Orlando, Scott Russell SECONDER: Albert Krupski Jr., Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Evans, Russell PROJECT NO. 0913.18 CONTRACT NO. K006887 ADDS NEW SCHEDULE A-9 Elizabeth Field Airport SUPPLEMENTAL AGREEMENT # 3 This supplemental agreement, made as of this 2nd day of September 2010, by and between the People &the State of New York (hereinafter referred to as the "State"), acting by and through the New York State Department of Transportation (the "Depathnent"), having its principal office at 50 Wolf Road, Albany, New York 12232 and the Town of Southold (hereinafter referred to as "Grantee"), whose principal office is located at Southold, New York. W1TNESSETH: WHEREAS, the parties entered into Contract K006887 dated April 1, 2008 pursuant to which the Grantee shall undertake a Project with State financial assistance in the form ora capital grant pursuant to Article 2 of the Transportation Law; and WHEREAS, the parties desire to amend Contract K006887 by amending Schedule A of said Contract to add eligible projects to be funded pursuant to the Agreement and/or increase the amount of the grant funds available for a project indicated in Schedule A. NOW, THEREFORE, in consideration of the mutual covenants herein set forth, the Department and the Grantee agree as follows: SECTION 1. Contract K006887 is hereby amended to adc/Schedule(s) A-9 attached hereto which supplements Contract K006887. SECTION 2. All of the terms and conditions of Contract K006887 not specifically amended herein shall remain in full fome and effect. Contract: Grantee: Facility: K006887 Town of Southold ELIZABETH FIELD Schedule A-9 PIN Project Description Estimated Total Cost Federal Sham Local Sham State Sham 0913.18 Runway Crock Repair and Sealing - $226,000.00 $214,700.00 $5,650.00 $5,650.00 Phase Ii (Design & Construction) Maximum State Sham Payable* $6,497.50 The State share payable under this Agreement is 50% of the non-federal sham of eligible costs, in accordance with the separate federal grant referenced herein, the federal share shown above may be increased administratively, upon request of the grantee based on increases in eligible costs, to a maximum of 15%. If and when the federal sham increases, the State sham shall be increased proportionately, without further amendment to this Agreement, up to the maximum amount shown above. IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Agreement to be executed by their duly authorized officers as of the date herein above set forth. Department of Transportation Certification "In addition to the acceptance of this contract, I also certify that original copies of this signature page will be attached to all other exact copies of this contract." NEW YORK STATE DEPARTMENT OF TRANSPORTATION GRANTEE By: Commissioner of Transportation DATE: By: DATE: APPROVED AS TO FORM: STATE OF NEW YORK ATTORNEY GENERAL APPROVED: BY: Assistant Attorney General DATE: For the New York State Comptroller pursuant to Section 112 of the State Finance Law DATE: Sponsor ACKNOWLEDGMENT STATE OF NEW YORK ) COUNTY OF s.: On this _ day of .A)o oe~,o'~/oe....e~ ,2010__, before me personally came ~e~e-,'4'~ ,4. ~ ~ <'~ e~{ { _ , to me know, and known to me to be the 3 t.~..~ge.q~ b't~_a'6 W' ofthe~oa/~/ ~.~ _T',o ~-P~,.-, l d ,thesamepersondescribed in and ~ho executed the foregoing instrument; that she,0a~is authorized to execute the foregoing instrument on behalf of the oP .ff o pursuant to and as provided by statute. Notary Public RESOLUTION 2010-716 ADOPTED DOC ID: 6181 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-716 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON SEPTEMBER 7, 2010: RESOLVED that the Town Board of the Town of $outhold, at the request of the Fishers island Ferry District and recommendation of C&S Companies, hereby accepts the bid of Axtell's~ Inc. of Jermyn PA~ for the contract titled "lr, liT~beth Field Airport Runway Crack Repair and Sealin~ - Phase II" FAA AlP No. 3-36-0029-18-10 (D&C), NYSDOT Project No. 0913.18 (D&C) in the amount of $172,796.00, all in accordance with thc Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Christopher Talbot, Councilman SECONDER: William Ruland, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Evans, Russell RESOLUTION 2010-717 ADOPTED DOC ID: 6182 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-717 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON SEPTEMBER 7, 2010: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Agreement between the Town of Southold and Axtells~ Inc. for the Fishers Island Elizabeth Field Airport Runway Crack Repair and Sealing Project-Phase Il in the amount of $172,796.00 in connection with NYS DOT Project Nos. 0913.18(D&C) and FAA AIP Nos. 3-36-0029-18-10(D&C), subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: William Ruland, Councilman SECONDER: Christopher Talbot, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Evans, Russell AGREEMENT THIS AGREEMENT, madeeffectivethis/~rr~' dayof t~E~o~r'/' , 20 / O , is by and between the Town of Southold, a New York municipal corporation, having an address at 53095 Main Road, Southold, New York 06390, Party of the First Part and ]~$ having an address at hereinafter designated as the Contractor, Party of the Second Part. WITNESSETH: That the Parties hereto, each in consideration of the agreements on the part of the other herein contained, have mutually agreed and hereby mutually agree, that the Party of the First Part for itself and its successors, and the Party of the Second Part for itself and its successors, his/her or their executors, administrators, and assigns, as follows: Article 1. This Agreement along with the Advertisement, the Proposal, the Performance Bond, the Payment Bond, any required insurance certificates, the Specifications, the Contract Drawings, and all interpretations of or addenda to the Contract Documents issued by the Owner, or by the Engineer with the approval of the Owner shall constitute the Contract. The Table of Contents, Headings, and Titles contained herein and in said documents are solely to facilitate reference to various provisions of the Contract Documents and in no way affect, limit, or cast light on the interpretation of the provisions to which they refer. Article 2. The Contractor shall construct Runway Crack Repair & Sealing - Phase II Project in accordance with the Contract. Article 3. In consideration of the payments to be made as hereinafter provided, and of the performance by the Owner of all of the matters and things to be performed by the Owner as herein provided, the Contractor agrees, at his or its sole cost and expense, to perform all the labor and services, and to furnish ali the labor.and materials, plant, and equipment, necessary to complete, and to complete in good, substantial workmanlike and approved manner, the Work described in Article 2 hereof, within the time specified and in accordance with the terms, conditions, and provisions of the Contract and with the instructions, orders, and direction of the Engineer made in accordance with the Contract. Article 4. The Owner agrees to pay, and the Contractor agrees to accept as full compensation, for all Work done, and materials furnished, and also for all costs and expenses incurred and loss or damages sustained by reason of the action of the elements, or growing out of the nature of the Work, or from any unforeseen obstmctinn or difficulty encountered in the prosecution of the Work, and for all risks of every description connected with the suspension or discontinuance of the Work as herein specified, and for faithfully completing the Work, and the whole thereof, as herein provided, and for maintaining the Work in good condition until the final payment is made. the prices stipulated in the Proposal hereto attached. Article 5. If the Contractor shall fail to comply with any of the terms, conditions, provisions, or stipulations of the Contract, according to the true intent and meaning thereof, then the Owner may make use of any or all remedies provided in lts behalf in the Contract and shall have the right and power to proceed in accordance with the provisions thereof. Arficle 6. The following alterations and addenda have been made to and included in the Contract before it was signed by the Parties: AGR-1 IN WITNESS WHEREOF, the parties to this Agreement have hereunto set their hands and seals Agreement, and four (4) copies, the day and year first above-written. TOWN OF SOUTHOLD By: Scott A. Russell Supervisor (SEAL) CONTRACTOR: By: ~' ~- ~ (SEAL) Ti.e: AGR-2 ACKNOWLEDGMENT OF OFFICER OR OWNER ATTESTING CONTRACT STATE OF NEW YORK COUNTY OF SUFFOLK SS: SS: Onthe__ .dayof AJot/~..~be-~ in the year 20~_~, before me, theundersigned, a Notaxy Public in and for said State. personally appeared ~'(s~L.~ A. /~t. Ls-~-e~ ( ( ~personallyknowntomeorprovedtomeonthe basis of satisfactory evidence to be the individual0s~ whose name~ is (.a~-.)-subscribed to the within instrument and acknowledged to me that he/sh~gh~ executed the same in hi°-~h;r,"..~.: L- capacity(-i~), and that by his/la~gg~ signature0s~ on the instrament, the individual(~, or the person upon behalf of which the individual(~acted, executed the instrument. Notary Public ACKNOWLEDGMENT OF CONTRACTOR, IF A CORPORATION $~A~E OF ~ ~ a~ COUNTY OF ~-6 ~3~ fAl~°~J SS: OnCe / dayof ~ i~ ~e ye~ 20 ~, ~fore me, person~ly c~e ~ ~ ~ ~ ~/J ~t~ to me ~o~, who, being ~ ~ duly sworn, did depose ~d say ~at; ~at h~sh~ey is(~e) ~ehe/she/~eY reside(s) in ~e co~orafion described in ~d which executed the a~ve ins~ment; and ~at he/she/they ~ow(s) ~e seM of s~d co~orafion; that ~e seal affix~ to s~d ins~ent is such co.orate seal; ~at it w~ so affixed by au~ofi~ of ~e bo~d of dffectors of s~d co~orafion, and ~at he/shelley signed his~er/~eff n~e(s) ~ereto by like an~y. ~ AGR-3 ORIGINAL ~on~ ~o. 71004695 PERFORMANCE BOND Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): Axtell's, Inc. RR #1 Box 431 Olyphant, PA 18447 SURETY (Name and Principal Place of Business): Western Surety Company P.O. Box 5077 Sioux Falls, SD 57117 OWNER (Name and Address): Town of Southold 53095 Route 25 Southold, NY 11971 CONSTRUCTION CONTRACT Date: Amount: $172,796.00 Description (Name and Location): Runway Crack Repair & Sealing - Phase II at the Elizabeth Field Airport BOND Date (Not earlier than Construction Contract Date): October 4, 2010 Amount: $172,796.00 Modifications to this Bond: I ~' ~,lone ir- j~See other side CONTRACTOR AS PRINCIPAL Company: (Corporate Seal) Axteil's, ~nc, SCgr~ture: ~,~ I~' ~ SURETY Company: Western ~ ~ Signature: Name and Title: John D. Weisbro'e (Corpora:e Seal) Abtorney-in-Fact (FOR INFORMATION ONLY - Name, Address and Telephone) AGENT or BROKER: JW Bond Consultants, inc. 6023A Kellers Church Road Pipersville, PA 18947 (215)766-1990 - Phone (215)766-1225 - Fax OWNER'S REPRESENTATIVE (Architect, Engineer or other party): Printed in cooperation with the American thst~tut~ of Architects (AIA) by the CNA Insurance Companies. The language in this document conforms exactly to the language used in AIA Document A312 - Performance Bond - December 1984 edition. % Bond NO 71004695 ORIGINAL PAYMENT BOND Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): Axtell's, Inc. RR #1 Box 431 Olyphant, PA 18447 SURETY (Name and Principal Place of Business): Western Surety Company P.O. Box 5077 Sioux Falls, SD 57117 OWNER (Name and Address): Town of Southold 53095 Route 25 Southold, NY 11971 CONSTRUCTION CONTRACT Date: Amount: $172,796.00 Description (Name and Location): Runway Crack Repair & Sealing - Phase II at the Elizabeth Field Airport BOND Date (Not earlier than Construction Contract Date): October 4, 2010 Amount: $172,796.00 Modifications to this Bond: [] None [] See other side CONTRACTOR AS PRINCIPAL Company: (Corporate Seal) Axte~l's, Inc. Name and Tit~..... SURETY Company: (Corporate Ses}) Western Surety Company Signature: __~ Name and Title: .John 13. Weisbrot Attorney-in-Fact (FOR INFORMATION ONLY - Name, Address and Telephone) AGENT or BROKER: OWNER'S REPRESENTATIVE (Architect, Engineer or other party): JW Bond Consultants, Inc. 6023A Kellers Church Road Pipersville, PA 18947 (215)766-1990 - Phone (215)766-1225 - Fax Printed in cooperation with the American Institute of Architects (AIA) by the CNA Insurance Companies The language in this document conforms exactly to the language used in AIA Document A312 - Payment Bond - December 1984 Edition t(now All Men by These Presents: (X~evo~able) No. SP- 63389067 That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That Western Surety Company, a corporation, dces hereby make, constitute and appoint the following Iai authorized individuals: AUTHORIZED INDIVIDUALS AUTHORIZED INDIVIDUALS JOHN D WEISBROT PATRICIA A TINSMAN awful Attorney(s) in }*act wtt~ fu ~power and authority hereby conferred, to' s~gh~'¢~echt~,'ac~v~dge and deliver for and on its behalf as Surety, the following described bond: ONE CONTRACT SURETY: BID, PERFORMANCE AND PAYMENT BOND, UNDERTAKING, OR OTHER OBLIGATORY INSTRUMENT OF A SIMILAR NATURE IN AMOUNTS NOT EXCEEDING ONE MILLION AND NO/I00 DOLLARS (~1,000,000.00)o The ac~owle~ment ~d execution ~ such bond by ~e s~d Attorney in Fact sh~l be as bin~ng u~n ~s Comply as if such ~nd h~ been execu~d ~d ac~owledged by ~e re~l~y elected officers of ~is Comply. All au~ofity ~reby con~ed shall expire ~d mrminate, wi~out notice, u~ess used before ~ig~ of J U L Y ....... x ~ '~ n a ~ , but until such time shall be irrevocable and in full force and effect. d~yo~ December 2006 WESTERN SURETY COMPANY OF , eulo Vi;e ~ ~s 11~ day of December . m ~e y~r 2~6 , ~fore me, a No~ ~b~c, ~on~y .*- * . .... No~ry ~blic, Sou~ D~o~ Intesfimonywhe~of, Ihavehc~unmsetmyh~d~d~cseMofWestemS~tyComp~y~s* q~ dayof ~~, ~ I 1 · IMPORT~T: ~s date must be filled in before it is attached to ~e bond ~d it must be ~e sine date as ~e bond. By ~~ WESTERN SURETY COMPANY Sioux Falls, South Dakota Statement of Condition and Affairs December 31, 2009 ASSETS Bonds Stocks Cash and short-term investments Uncollected premiums and agents' balances Amounts recoverable from reinsurers Funds held by or deposited with reinsured companies Net deferred tax asset Electronic data processing equipment and software Investment income due and accrued Other assets Total Assets $1,193,435,614 22,759,271 29,157,255 33,002,353 (3,057,290) 26,355,884 19,445,837 3,117,199 15,587,378 $1,342,021,061 LIABILITIES AND SURPLUS Losses Loss adjustment expense Contingent and other commissions payable Other expense Taxes, licenses and fees Federal and foreign income taxes payable Unearned premiums Retroactive reinsurance reserve assumed Other liabilities Total Liabilities $269,022,299 70,589,857 5,229,781 29,445,697 2,337,499 13,593,490 241,078,902 11,093,043 20,328,654 662,719,222 Surplus Account: Capital paid up Gross paid in and contributed surplus Unassigned funds ,regards policyholders $&000,000 176,435,232 498.866.607 $679,301~839 $1~342~0217061 ~:~ b President and Treasurer of Western Surety Company hereby certify that the 7 of the financial statement of the Company dated December 31, 2009, as filed with and is atme and correct statement of the condition of Western Surety date. Subscribed and sworn to me this My commission expires: KATHRYN J. $CHROeDER My Commission Expires 7-21-2015 10th day of Western Surety Company Vice Presi~q~lt, Treasurer March .2010. Notary ~ublic 0 0' ACORD. CERTIFICATE OF LIABILITY INSURANCE OP,D = I AXTEL-2 09/23/10 PRODUCER THIS CERTIfiCATE IS ISSUED AS A M~TTI:K OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE F~owles Associates T.. T.. C HOLDER. THIS CERTIRCATE DOES NOT AMEND, EXTEND OR 316 Penn Ave. ALTER THE COVERAGE AFFORDED BY THE POU~ES BELOW. Scranton PA 18503 Phone: 570-342-3214 Fax: 570-342-3125 INSURERS AFFORDING COVERAGE N/UC# INSURED ~NSURERA State Auto Insurance Co. 25127 Axte11' s Inc. Robert Butts INSURER C 1586 Heart Lake Road [NSURERD Jermyn PA 18433 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD iNDICATED NO%'VI~HSTANDIN B ANY REQUIREMENT TERM OR CONDITION OF ANY CONT~T OR OTHE~ DOCUMENT WITH RESPECT TO WHICH THIS CEBTIFICATE MAY BE ISSUED MAY PERTAIN THE INSURANCE AFFORDED E~Y 7dB POLICIES DESORIBED HEREIN IS SUBJECT TO ALL ~E TERMS, E~CLUSIONS AND CONDITIONS OF SUCH L~ NBIK TYPE OF IN~URAN~ p(;3UCy N~ DATE (MI~/YY) DA~ iMM/DD/YYi LIMITS GENERAL bLa, glUTf EACH OCCURRENCE $ 1000000 A X X C0MME~C~E~E~LL~A~[U~ SOC2464113 01/22/10 01/22/11 = PREM~$ESU~c ,u~c.~U(Eaoccurence) $ 100000 I C~IMS~E [] occu~ ~vEDEXP(Aqyor~person) $ 5000 PERSONAL & ADV INJURY $1000000 BENERALAGGREBaTE $ 2000000 OEN,L AC_GREGATE L]M[T,evoPLiBB pER PRODUCTS- COMP/OR AGO $ 2000000 --~ POL[CY ~ PRO- ~ LOCJ~CT AUTO~O~UE LI~ COMBINED $1NSLE LIMIT $ 1000000 A X ANY~gTO BAP2283672 01/22/10 01/22/11 /Eaeccident) A.L OWNED ADTOS BODILY INJURY $ -- (Pe~ person) EXOESSAJMBRELLA LiaBILITY EACH OCCURRENCE $ A ~ occu~ [] cu~sw~os SOC2464113 04/12/10 01/22/11 AGGREGATE $ 4 /000 / 000 $ RETENTION EMPLOTERS'UABILrP/ i AM04092003 04/13/10 04/13/11 B ~ E~.HACCIDEkrT $ 500,000 D ANY p~OPRIETOR~ART~E~EXECUTIVE OFFICER/MEMSERE×CLU~E0? EL DISE~E-EAEMPLOYEE $500,000 SPECIAL P~OVIS~0NS below E L DISEASE * POLICY LIMIT $ 500 ~ 000 OTHER DEBCRIP~ON OF OPERA~ONS I LOCA~ONS i VEHICLES I EXCLUSE)NS ADDED ~Y ENOORSBMENT / SPEC~L PRO%~SlONS Town of Southhold NY, C&S Engineers, Ins, FAA, NYSDOT is listed as additional insured in relations toElizabeth Field Airport, Fishers Island, Runway Crack Repair & Sealing -Phase II, FAA project 3-36-0029-18-10. Coverage includes XCU hazards. CERTIFICATE HOLDER Town of Southold 53095 Route 25 PO Box 1179 Southold NY 11971 SOUTHOL ACORD 25 (2001/08) ORIGINAL CANCELLATION ~ ACORD CORPORATION t988 RESOLUTION 2010-625 ADOPTED DOC ID: 6110 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-625 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 10, 2010: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Application for Federal Assistance in connection with the Fishers Island Airport Runway Crack Repair and Sealing Proiect, Phase II~ Design and Construction, subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Christopher Talbot, Councilman SECONDER: William Ruland, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Evans, Russell 'APPLI~CATION FOR ,. DATE SUBM~ED ~nl~J ~IOENTiFIER FEDE~ ASSISTANCE 07/301~0 OB8 P~pp~n 0913. ~. DATE RECEDED BY FEDE~ AGENCY FEDE~ IDENTIFIER ~ Non~ns~n ~ N~ns~n 3-36~029- 5. ~PLIC~ INFORMATION Town of Southold DEPARTMENT: Fishers Island Fe~ Distri~ 056638588 Town Hall, 53095 Main Road =REFIX: JFIRST NAME: PO Box 1179 Mr.J Thomas Southold Suffolk Dohe~y ~TATE: ZIP CODE SUFFIX: New York 11971 COU~RY: E~IL: United S~tes mg~ fe~flshemlsland.net ~ ~ck of ~ ~r descH~n of ~m.) ~ ~ ~1Ol- I~lOl ~ Tl~ (N~E OF PR~}: Runway Crock Repair and Sealing - Phase II N~o~ Improve~nt Program (Design & Constru~lon) Flshem Island 2nd 2nd e. F~eml $ .00 c. S=~ $ .00 Date: submlffed 512~20t0 g. TOT~ $ .00 ~ Yes. If~es,"a~ane~na~n. ~ No a. A~O~ Re~five Pm~ Fimt Na~ Middle Na~ Mr. Scott ~ ~ Na~ S~x Russell ~ b. ~fle / / =. Tele~ Nu~r (give ama ~e) Town Su~lsor / / ~ (631} 765-188g Previous Editions Usa Autho~d for Local Reproduction Standard Form 424 (REV.9-2003) Prescr~ed by OMB Cimu~ar A-102 '~SPORTATION - FEDERAL AVIATION ADMINISTRATION OMB NO. 60-RO184 PART III - BUDGET INFORMATION - CONSTRUCTION SECTION A - GENERAL 1. Federal Domestic Assistance Catalog No .................. 20-106 2. Functional or Other Breakout ........................... SECTION B - CALCULATION OF FEDERAL GRANT Fishers Island - Elizabeth Field Use only for revisions Runway Crack Repair and Sealing - Phase II Total (Design & Construction) Latest Approved Adjustment Amount ~A4AIP3-36-O029- Amount + or (-) Required Cost Classification 1.!~,dministraflon expense $2,360 2.~. Praliminary expense $0 3. Land, structures, right-of-way $0 4. Architectural engineering basic fees $15,600 5. Other architectural engineering fees $0 6~. project inspection fees $34,900 7.~.. ~-and development $0 8. Relocation Expenses $0 9.~;~;~elocation payments to Individuals and Businesses $0 10. Demolition and removal $0 11_._.: Construction & project improvement (Base Bid, Add-on #1, Add-on #2) $276,140 12_.._: Equipment $0 13._~ Miscellaneous $0 14. Total (Lines 1 through 13) $329,000 15. Estimated Income (if applicable) $0 16. Net Project Amount (Line 14 minus 15) $329,000 17. Less: Ineligible Exclusions $0 18. Add: Contingencies $0 19..Total Project Amt. (Excluding Rehabilitation Grants) $329,000 20, ~Federal Share requested of Line 19 95.00% $312,550 ~ 21. Add Rehabilitation Grants Requested (100 Percent) $0 22. Total Federal grant requested (Lines 20 & 21) $312,550 23. Grantee sham 2.50% $8,225 24. Other shams 2.50% $8,225 25, Total project (Lines 22, 23 & 24) $329,000 FAA Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100 - 10 PAGES 1 THRU 7 Page 4 ~4ENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION O M B N O. 80-R O 184 SECTION C - EXCLUSIONS Classification ineligible for Excluded from Participation Contingency Provision 26, (1) (2) b. d. f. g. Totals ; SECTION D - PROPOSED METHOD OF FINANCING NON-FEDERAL SHARE Z7 Grantee Share a. Securities b. Mortgages c. Appropriation (By Applicant) d. Bonds e. Tax Levies f. Non Cash g. Other (Explain) 2.50% h. TOTAL - Grantee share $8,225 28. 3ther Shams a. State 2.50% $8,225 i' b. Other ~ c. Total Other Shares 29. TOTAL $16,450 SECTION E - REMARKS I PART IV PROGRAM NARRATIVE (Attach-See Instructions) Page 5 FA)~ Form 5100-100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 Part IV: PROGRAM STATEMENT JuLy 30, 2010 ELIZABETH FIELD AIRPORT Project Narrative Statement Runway Crack Repair and Sealing - Phase II (Design & Construction) Description: This project will consist of crack sealing and repairs on outer edges of the existing Runway 12-30 & 7-25. Crack Sealing and Rejuvenation would include the sealing of all additional cracks not addressed in the odginal work as well as the application of a coal-tar rejuvenator, (add-on #1 ) to the entire runway pavement. It would also include the repainting of the shoulder chevrons and overrun chevron markings, (add-on #2), which were not done in the previous phase. The newly painted markings can be worked around by masking or localized hand application and do not have to be removed or repainted if the rejuvenator is specified. Shoulder crack repair and rejuvenator on shoulder areas are not included. Justification: The Airport has maintained the pavement by sealing longitudinal and transverse cracks. Recently, some of the cracks have developed to a point where they cannot be sealed by normal maintenance efforts. Due to the harsh coastal climate and extreme temperatures experienced at Elizabeth Field Airport, maintenance methods other than normal crack sealing need to be employed to improve the runway's pavement performance. Dudng construction this spdng of the Runway Crack Repair and Sealing project at Elizabeth Field Airport, it was found that there were a large number of cracks that developed in the pavement during the time between design mapping and construction. The existing pavement is 18 years old, and the rate of deterioration is faster than expected. To stay within the original grant amount, the decision was made to repair the cracks on the keel section (inner 26-30ft, each side of centeriine) of the runways only. A second phase of the project is required to address the remaining cracks in the pavement. Consistency with ALP/FAA Standards These projects are consistent with the recommendations included in the current approved Master Plan and Airport Layout Plan. Consultation with Users Primary users of the airport have been consulted and are aware of the proposed development project. Displaced Persons Statement The airport projects proposed in this aid application do not involve the displacement or relocation of persons residing on land needed for such development. Specific Opposition Statement Fisher's Island Ferry District is not aware of any significant community opposition to the proposed projects. May 26,2010 Michael E. White, Executive Director Long Island Regional Planning Council 1864 Muttontown Road Syosset, New York 11791 Re: Fisher's Island - Elizabeth Field FY-2010 Federal Catalog No. 20-106 File: 211 Enclosed please find the following: One copy of Standard Form 424, a project description and justification, a CIP, cost estimate, and General Plan for your review and clearance, for the following proposed project: · Runway Crack Repair and Sealing - Phase II (Design & Construction) Remarks If you have any questions or need additional information, please do not hesitate to contact us. Very truly yours, C&S ENGINEERS, INC. Kelli R. Walters Grants Administrator TLM Enclosures cc: Mr. Thomas Doherty ACoRD® CERTIFICATE OF LIABILITY INSURANCE ~ 8/30/2011 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(iLs) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endomement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(sI, PRODUCER CONTACT NAME: Elizabeth Phil lids Haylor, Freyer & Coon, Inc. PHONE , FAX 231 Salina Meadows Parkway E-MAIL P.O. BOX 4743 ADDRESS:eDhilliDs@haylor.com Syracuse NY 13221-4743 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURERA:National Fi~e Ins Co of Hartfor~ 7000 INSURED INSURERS:National Union Fire Ins CO of Pitts L9445 Hi-Lite Markings Inc lNSURERC:Continental Casualty Company ~0443 18249 Hi-Lite Drive INSURERD: Adams Center NY 13606 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2138791039 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVlTHSTANDING 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, ADDLISUBR POLICY EFF POLICY EXP INSR LI~ TYPE OF INSURANCE INSR ~ WVD POLICY NUMBER IMM/DD/YYYY} (MMIDD/YYYY) LIMiTS I CLAIMS-MADE [] OCCUR ~ UEDEXP(Anyoneperson) $15,000 ~ AUTOS ~ AUTOS ! DED I I RETENTION $ $ Forms Enclosed: G-140331-C31 (10/10), G-18652-I31 (07/09), CA 20 48 (02/99), 9-23186 A (05/89), 105514 (05/10), 90269 (11/09), and WC 00 03 13 (4/84) Project: (HLM#59-2363); Elizabeth Field, Runway Crack Repair and Sealing, FAA AIP No. 3-36-0029-17-09 CERTIFICATE HOLDER CANCELLATION Town of Southold 53095 Route 25 Southold NY 11971 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CNA G-140331-C31 (Ed. 10/10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED . OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below,) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1, The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf in the performance of your ongoing operations specified in the "written contract"; or c. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included Jn the "products-completed operations hazard," and only if: (1) The "written contract" requires you to provide the additional insured such (2) This Coverage Pad provides such coverage. 2. We will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. Required by the '~ritten contract"; b. Described in B.1. above; or c. Afforded to you under this policy. 3. This insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the "written contract," this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 4. The insurance provided 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, G-140331 -C31 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 2 (Ed. 10/10) CNA (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. C. SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1, The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any ctaim or "suit" that does result; (2) Except as provided in Paragraph B.3 of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit"; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non- contributory, this provision (4) does not G-140331-C31 (Ed. 10/10) apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or pay on behalf of an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." 2. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph 4.a, of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance a. Primary Insurance This insurance is primary and non- contributory except when rendered excess by endorsement G-140331-C31, or when Paragraph b, below applies. On})/for the purpose of the insurance provided by this endorsement, SECTION V - 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: 1. Is currently in effect or becomes effective during the term of this poJicy; and 2. Was executed prior to: a. The "bodily injury" or "property damage"; or b The offense that caused the "personal and advertising injury" for which the additional insured seeks coverage under this Coverage Part. G-140331 -C31 Ir, dudes copyrighted material of Insurance Services Office, inc., w~th its permission Page 2 of 2 (Ed. 10/10) CNA G-18652-131 (Ed. 07~09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, CONTRACTORS' GENERAL LIABILITY EXTENSION ENDORSEMENT - NEW YORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. SCHEDULE Coverages are summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding poticy provisions in the body of this endorsement. 1. Miscellaneous Additional Insureds 13, Liberalization Clause 7 additional insured extensions. 2. Employees As Insureds - Health Care Services 3. Joint Ventures/Partnership/Limited Liability Companies Coverage for your interest in such terminated or ended organizations. 4. Expanded Personal And Advertising Injury 5. Medical Payments Limits increased to $15,000. Reporting increased to three years from the date of accident. 6. Legal Liability And Borrowed Equipment Extended perils. Limit increased to $200.000 for Damage to Premises Rented To You 7. Non-owned Watercraft Increased to 55 feet. 8. Non-owned Aircraft Coverage 9. Contractual Liability For Personal And Advertising Injury t0. Supplementary Payments Cost of bail bonds increased to $2,500, Dai~y loss of earnings increased to $1 11. Liquor Liability Coverage Extension 12. Newly Formed Or Acquired Organizations Coverage extended to the end of the policy period, 14. Unintentional Failure To Disclose Hazards 15. Notice of Occurrence 16. Broad Knowledge of Occurrence 17. Aggregate Limits Per Project 18. Bodily Injury- Extension of Coverage 19, Expected Or Intended Injury Reasonable force - bodily injury or property damage. 20. Wrap-Up Extension 21. Contractual Liability - Railroads Expanded definition of "insured contract." 22. Blanket Waiver of Subrogation Waiver of subrogation where required by written contract or written agreement. 23. In Rem Actions G-18652-131 includes copyrighted material of Insurance Services Office, Inc., with its permission. Page I of 8 (Ed. 07/09) G-18652-131 MISCELLANEOUS ADDITIONAL INSUREDS Section II Who is An Insured is amended to include as an insured any person or organization (called additional insured) described in Paragraphs 2.a. through 2.g. below whom you are required to add as an additional insured on this policy under a written contract or written agreement. However, the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury," "property damage" or "personal injury and advertising injury," but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. State or Governmental Agency or Subdivision or Political Subdivisions A state or governmental agency or subdivision or political subdivision subject to the following provisions: (1) This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent, or controt and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or lb) The construction, erection, or removal of elevators; or (2) This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization, This insurance does not apply to "bodily b. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. c. Managers or Lessors of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. d. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by yOU. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. e. Owners/Other interests - Land is Leased An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land teased to you and subject to the fotlowing additional exclusions: This insurance does not apply to: injury,'',~ ~,. ,-*;.~,... ;; ,.,., -..;~..... + ¢"pr°perty damage" or "personal (1) Any "occurrence" which takes place government, state or municipality. G-18652-131 includes copyrighted matedal of insurance Services Office, Inc,, with its permission. Page 2 of 8 (Ed, 07/09) CNA G-18652q31 (Ed. 07/09) (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. f. Co-owner of Insured Premises A co-owner of a premises co-owned by you and covered under this insurance but only with respect to the co-owners liability as co-owner of such premises. g. Lessor of Equipment Any person or organization from whom you lease equipment. Such person or organization are insureds only with respect to their liability adsing out of the maintenance, operation or use by you of equipment leased to you by such person or organization. A person's or organization's status as an insured under this endorsement ends when their written contract or written agreement with you for such leased equipment ends. With respect to the insurance afforded these additional insureds, the following additional exclusions apply: This insurance does not apply: (1) To any "occurrence" which takes place after the equipment tease expires; or (2) To "bodily injury," "properly damage," or "personal and advertising injury" arising out of the sole negligence of such additional insured. Any insurance provided to an additional insured designated under Paragraphs a. through g. above does not apply to "bodily injury" or "property damage" included within the "products-completed operations hazard." As respects the coverage provided under this provision, Paragraph 4.b.(1) of Section IV - Commercial General Liability Conditions is deleted and replaced with the following: 4. Other Insurance b. Excess Insurance (1) This insurance is excess over: Any other insurance naming the additional insured as an insured this insurance be either primary or primary and noncontributing. Where required by written contract or written agreement, we will consider any other insurance maintained by the additional insured for injury or damage covered by this endorsement to be excess and noncontributing with this insurance. EMPLOYEES AS INSUREDS - HEALTH CARE SERVICES Paragraph 2.a.(1)(d) of Section II - Who Is An Insured is deleted. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANY COVERAGE A. The following is added to Section II - Who Is An Insured: 4. You are an insured when you had an interest in a joint venture, partnership or limited liability company which terminated or ended prior to or during this policy period but only to the extent of your interest in such joint venture, partnership or limited liability company. This coverage does not apply: a. Pdor to the termination date of any joint venture, partnership or limited liability company; or b. If there is other valid and collectibIe insurance purchased specifically to insure the partnership, joint venture or limited liability company. c. To a joint venture, partnership or limited liability company which is or was insured under a "consolidated (wrap-up) insurance program." "Consolidated (wrap-up) insurance program" means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, otherwise referred to as an Owner Controlled Insurance Program (O.C.LP.) or Contractor Controlled Insurance Program (C.C.I.P.). B. The last paragraph of Section II - Who Is An Insured is deleted and replaced by the following: Except as provided in Paragraph 4. above, no whether primary, excess, person or organization is an insured with contingent or on any other basis * + ~k .... .4,.~. ~¢ .. ,,rrc, nt ~'~' ~' G-18652-I31 Includes copyrighted matedal of Insurance Services Office, Inc., with its permission. Page 3 of 8 (Ed. 07/09) C/iCA G-18652-131 (Ed. 07/09) company that is not shown as a Named Insured in the Declarations. 4. EXPANDED PERSONAL AND ADVERTISING INJURY A. The following is added to Section V - Definitions, the definition of "Personal and advertising injuw": h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any insured. B. Exclusions of Section I - Coverage B - Personal and Advertising Injury Liability is amended to inctude the following: Discrimination Relating To Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured. Fines Or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. D. This provision 4. (EXPANDED PERSONAL AND ADVERTISING INJURY COVERAGE) does not apply if Section I - Coverage B - Personal And Advertising Injury Liability is excluded either by the provisions of the Coverage Part or by endorsement. MEDICAL PAYMENTS A. Paragraph 7. Medical Expense Limit, of Section III - Limits of Insurance is deleted and replaced by the following: Limit is the most we will pay under Section - I - Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Medical Expense Limit is the greater of; (1) $15,000; or (2) The amount shown in the Declarations for Medical Expense Limit. B. This provision 5, (Medical Payments) does not apply if Section I - Coverage C Medical Payments is excluded either by the provisions of the Coverage Part or by endorsement. C, Paragraph 1.a.(3)(b) of Section I Coverage C - Medical Payments, is replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident; and LEGAL LIABILITY AND BORROWED EQUIPMENT A. Under Section I - Coverage A - Bodily Injury and Property Damage 2. Exclusions, Exclusion j. is replaced by the following. "Property damage" to: (1) Property you own, rent, or occupy; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property Ioaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. ................... ~oourrence:~EirniO% [h~cal= Expense:: :: ....... 8~bl~s~o~:8o not a-p~l~ (8! ............. G-18652-131 Includes copyrighted matedal of Insurance Services Office. Inc., with its permission. Page 4 of 8 Ed. O7/09) G-18652-[31 (i) "property damage" to tools or equipment loaned to you if the tools or equipment are not being used to perform operations at the time of loss; or (ii) "property damage" (other than damage by fire) to premises rented to you or temporarily occupied by you with the permission of the owner, or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section Ill - Limits Of insurance. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products-completed operations hazard." Under Section I - Coverage A - Bodily Injury and Property Damage the last paragraph of 2. Exclusions is deleted and replaced by the following. Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance, Paragraph 6. Damage To Premises Rented To You Limit of Section III - Limits Of Insurance is replaced by the following: 6, Subject to Paragraph 5, above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most we will pay under Section - I - Coverage A for damages because of "property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period Damage To Premises Rented To You Limit is the greater of: a. $200,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations. D. Paragraph 4.b.(1)(a)(ii) of Section IV - Commercial General Liability Conditions is deleted and replaced by the following: (ii) That is property insurance for premises rented to you or temporarily occupied by you with the permission of the owner; or E. This provision 6. (LEGAL LIABILITY AND BORROWED EQUIPMENT) does not apply if Damage To Premises Rented To You Liability under Section I - Coverage A is excluded either by the provisions of the Coverage Part or by endorsement. 7. NON-OWNED WATERCRAFT Under Section I - Coverage A, Exclusion 2.g., subparagraph (2) is deleted and replaced by the following. (2) A watercraft you do not own that is: (a) Less than 55 feet long; and (b) Not being used to carry persons or property for a charge. 8. NON-OWNED AIRCRAFT Exclusion 2.g. of Section 1 - Coverage A - Bodily Injury and Property Damage, does not apply to an aircraft you do not own, provided that: 1. The pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. It is rented with a trained, paid crew; and 3. It does not transport persons or cargo for a charge. 9. CONTRACTUAL LiABiLITY FOR PERSONAL AND ADVERTISING INJURY Exclusion e. Contractual Liability of Section I - Coverage B is deleted. 10. SUPPLEMENTARY PAYMENTS A. Under Section I - Supplementary Payments - Coverages A and B, Paragraph l.b., the limit of $250 shown for the cost of bail bonds is replaced by $2,500: ...................... ~aity Ioss ot ear~ihgs'~¢ r~l~iS-ed by $1:1000. .... G-18652-131 Includes copyrighted material of Insurance Services Office, Inc, with its permission. Page 5 of 8 (Ed. 07/09) CNA 11. LIQUOR LIABILITY Exclusion c. of Section I - Coverage A is deleted. 12. NEWLY FORMED OR ACQUIRED ORGANIZATIONS Paragraph 3,a. of Section II - Who Is An Insured is deleted and replaced by the following: Coverage under this provision is afforded only until the end of the policy period or the next anniversary of this policy's effective date after you acquire or form the organization, whichever is earlier. 13. LIBERALIZATION CLAUSE If we adopt a change hq our forms or roles which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy wilt automatically provide the additional coverages as of the date the revision is effective in yoor state. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Based on our reliance on your representations as to existing hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. 15. NOTICE OF OCCURRENCE The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - Duties In The Event of Occurrence, Offense, Claim or Suit: Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an "occurrence," offense, claim or "suit" and that failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence," offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence," offense claim or "suit." 16, BROAD KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - Duties in The Event of Occurrence, Offense, Claim or Suit: You must give us or our authorized representative notice of an "occurrence," offense, claim, or "suit" only when the "occurrence," offense, claim or "suit" is known to: (1) You, if you are an individual; G-18652-131 (Ed. 07/09) (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or (4) A manager, if you are a limited liability company. 17. AGGREGATE LIMITS PER PROJECT A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: 1. A separate Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard," and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits G-18652-131 Includes copyrighted material of insurance Services Office, Inc., with its permission. Page 6 of 8 (Ed. 07/09) CNA G-18652-131 (Ed. 07/09) 18. 19. Construction Project Genera[ Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Single Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the Genera[ Aggregate Limit nor the Single Construction Project General Aggregate Limit. D. If a single construction project away from premises owned by or rented to the insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E, The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. EXPANDED BODILY INJURY Section V - Definitions, the definition of "bodily iniury" is changed to read: "Bodily Injury" means bodily injury, sickness, shock, humiliation, disability or disease, mental injury or mental anguish sustained by a person, including death resulting from any of these, EXPECTED OR INTENDED INJURY Exclusion a, of Section I - Coverage A - Bodily Injury and Property Damage Liability is replaced by the following: exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 20. OWNER CONTROLLED INSURANCE PROGRAM, CONTRACTOR CONTROLLED INSURANCE PROGRAM OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS The endorsement EXCLUSION- CONSTRUCTION WRAP-UP PROGRAM which is attached to this policy is amended as follows: A. If the endorsement EXCLUSION - CONSTRUCTION WRAP-UP or another exclusionary endorsement pertaining to Owner Control[ed Insurance Programs (O.C.LP,) or Contractor Controlled Insurance Programs (C,C.I.P.) is attached to this po[icy, then it is amended to add the following: With respect to a "consolidated (wrap-up) insurance program" project in which you are or were involved, this exclusion does not apply to: 1. Your liability for "bodily injury," "property damage," or "personal or advertising injury" that occurs during your ongoing operations at the project, or during such operations of anyone acting on your behalf; 2. Your liability for "bodily injury" or "property damage" included within the "products- completed operations hazard" that arises out of those portions of the project that are not "residential structures." B. The fo[lowing is added to Paragraph 4.b.(1) of Section IV-Commercial General Liability Conditions This insurance is excess over: (c) Any of the other valid and collectible insurance whether primary, excess, contingent or any other basis that is insurance available to you as a result of your being a participant in a "consolidated (wrap-up) insurance program," but only as respects your involvement in that "consolidated (wrap- up) insurance program." C. The fo[lowing is added to Section V Definitions: "Consolidated (wrap-up) insurance program" means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering a. "Bodily injury" or "property damage" an Owner Controlled Insurance Program G-18652-131 Includes copyrighted matedat of Insurance Services Office, inc., with its permission. Page 7 of 8 (Ed. 07/09) CNA G-18652-131 (Ed. 07/09) (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.I.P.). "Residential structure" means any structure where 30% or more of the square foot area is used or is intended to be used for human residency including but not limited to single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments and also includes their common areas and/or appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). When there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels, or motels. Residential structure also does not include hospitals or prisons. 21, CONTRACTUAL LIABILITY - RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of "insured contract" in Section V - Definitions is replaced by the following: "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; A sidetrack agreement; ¢. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort ~iability of another party to pay for "bodily injury" or *'property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and s upervisofy, inspection, architectural or engineering activities. 22. BLANKET WAIVER OF SUBGROGATION The Transfer Of Rights Of Recovery Against Others To Us Condition (Section IV - Commercial General Liability Conditions) is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products- corn pleted operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. 23. IN REM ACTIONS Any action in rem against any vessel owned, operated by or for, or chartered by or for you will be treated in the same manner as though the action were in personam against you. G-18652-131 includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 (Ed. 07/09) POLICY NUMBER: U4016505674 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGEFORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form, This endorsement does not alter coverage provided in the Coverage Form, This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 09/01/11 Countersigned By: Named Insured: Hi-Lite Markings inc. ~-,¢/~..,..~-- ~,¢,.~.~ /- (Authorized Representative SCHEDULE Name ofPerson(s)orOrgan~ation(s): PRIMARY NON-CONTRIBUTORY BASIS AS REQUIRED BY WRITTEN COntRACT. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an 'insured" for Uabitity Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who ts An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page I of I 9-23186-A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name of Person or Organization: BLANKET (if no entry appears above, informaf~on required to complete this endorsement will be shown in the Declarations as applicable to Ibis endorsement.) We waive any right of recovery we may have against the damage must arise out of your activities under a contract person or organization shown in the Schedule because of with that person or organization. The waiver applies only to payments we make for the injury or damage. This injury or the parson or organization shown in the Schedule. 9-23186-A Page 1 of 1 (Ed. 05/89) ENDORSE~ENTNo, 3 This endorsement, effective 12:O1 AM: September 1. 2011 Forms a pert of policy no: BE 061566698 Issued to: HI-LITE MARKINGS tNC By: NATIONAL UNION FIRE iNSURANCE COMPANY OF PITTSBURGH, PA. Prime Expresssr~ Additional Insured Endorsement -- Primary and Non-Contributory This policy is amended as follows: Section VII. DEFINITIONS, Paragraph N. is amended to include the fotlowiog additional provision: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organiza'don is an additional insured on your policy, but only if such person or organization is included under the coverage provided by Scheduled Underlying Insurance. Such person or organization is an additional insured only with respect to liability arising out of Your Work at the location(s) designated in such contract or agreement. This provision does not apply to liability arising out of the sole negligence of such person or organization for its o~ acts or omissions or those of its employees or anyone else acting on its behalf. Coverage afforded to Ii, ese additional insured par~Jes wit[ be primary to, and non~contributory with, any other insurance available to that person or organization. Ail other terms, definitions, conditions, and exclusions of this policy remain unchanged. ~:~ '~'~'~ :A,, DA~D~ ~F THE ~W 10~ ~AHCE ~W AND ~GLIU~T]O~L 2 - 13000 Christopher G. Kepser Authorized Representative or Countersignature (Where Applicable) BE 061566698 L. Maiateaance of Scheduled Underlying Insurance You agree that during the Policy Period: you will keep Scheduled Underlying Insurance in full force and effecT; 2. tile terms, definitions, condi~ons and exclusions of Scheduled Underlying Insurance win not materially change; 3, the total applicable limits of Scheduled Underlying Insurance ~11 not decrease, except for any reduc~on or exhausSon o[ aggrega~ limits by payment of Lass to ~ich ~is policy applies; and 4. any rene~ls or replacemenm of Scheduled Underlying Insurance ~lt provide equivalent coverage to and afford limi~ of insurance equal to or greater than ~e policy being rene~d or replaced. If you fail to comply ~ Dose requirements, ~ ~11 be liable only to the same e~ent that ~ v~uld have, had you tully complied ~ these requirement, M. Other Insurance If ogler valid and collectible insurance applies to damages ~at are also covered by ~is policy, ~is policy ~II apply excess of the O~er Insurance. Hoover, this provision ~11 not apply if the Other Insurance is specifically ~i~en to be excess of ~is policy. N. Premium The first Named Insured designated in I~em 1 of ~e Declarations ~11 be responsible for payment of all premiums ~en due. The premium for this policy ~11 be computed on the basis set forth in Item 6 of the Declarations. At the beginning of the Policy Period, you mus~ pay us g~e ~vance Premium sho~ in Item 6 of the Declarations, ~en this policy expires or if it is cancelled, ~ ~ compu~ ~e earned premium for ~e ~me ~is policy ~s in ~orce. If this policy is subject to audit adjus~ent, ~e actual e~osure base ~11 be used to compute ~e earned premium. If the earned premium is grea~r ~an the Advance Premium, you ~11 prompgy pay us ~e difference, If ~e earned premium is tess than the Advance Premium, ~ ~1~ re~rn g~e difference ~ you. But in any event, ~ ~1~ retaio ~e Minimum Premium as sho~ in Item 6 of the Dectara~ons for each ~lve months of ~e Policy Period, O. Separation of Insureds Except ~ respec~ to ~e Limi~ of insurance of this policy and righ~ or du~es specifically assigned to the firs~ Named Insured designated in Item t of the Declarations, ~is insurance applies: 1. as if each Named Insured ~re the only Named Insured; and 2. separately to each Insured against ~om claim is made or Suit is b~ought. P. Transfer of Rights of Recovery 1. If any Insured has righ~ to recover alt or part of any payment ~ have made under ~is policy, those rights ar loss to impair t~ese righ~ and must help us enforc LAW AN[) REGUL~FI'ION~L Page 2 - 13000 ~ 2~ of 26 2hartis Services Office, inc. v~th its permission. BE 061566698 1. it incorporates Your Product or Your Work that is knov~ or thought to be defective, deficient, inadequate or dangerous; or 2. you have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by: 1. the repair, replacement, adjustment or removal of Your Product or Your Work; or 2. your fulfilling the terms of Tt~e contract or agreement. N. Insured means: 1, the Named Insured; if you are designated in the declarations as: a. an individual, you and your spouse are insureds, but only with respect to the conduct of e business of vCr~ich you are the sole oyster; b. a partnership or joint venture, you are an insured. Your members, your par£ners, and their spouses are also insureds, but only with respect to the conduct of your business. c. a limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers; d, an organization o~her than a partnership, joint venture or limited liabiliLy company, you are an insured. Your executive officers and directors are insureds, but only w{th respect to their duties as your officers or directors. Your stockholders are aisc insureds, but only with respect to their liability as stockholders; e. a trust, you are an insured, Your trustees are also insureds, but only with respect to their dudes as trustees; 3. your employees other than your executive officers (if you are an organization other than a partnership, joint veeture or limited liability company) or your managers (if you are a limited liabiflty company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business; 4, your volunteer workers only wi~ile performing duties related to the conduct of your business; 5. any person (other then your employee or volunLeer worker) or organization while aclJng as your real estate manager; 6. your legal representative if you die, but only with respect to duties as such. That representative wilt have ,,,our rights and dulJes under this policy; 7, any person or organization, oti~er than the Named Insured, included as ar) additional insured under Scheduled Underlying Insurance, but not for broader coverage than wguJd be afforded by such Scheduled Underlying Insurance. Notwithstanding any of the above: ~ ~a,~.R~o,g__)~ _r~n or organiza~on is an Insured ~ res ~ND ~ E GU~,'~OI~4S. Page I 2- 13000 ~ct to the conduct of any current, past or newly formed hat is not designated as a Named Insured in Item 1 of ti~e , of 26 ;hartis , Inc. with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABlUTY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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 applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) 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 CONTP~ACT OR AGREEMENT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information betow is required enly when this endorsement is issued subsequent to preparatio~ of the policy.) Endorsement EffeC. ive 09/01/11 Policy No, WC4016505660 Endorsement No. Insured Hi-Lite Markings Inc. insurance Company National Fire Ins. Co. of Hartford Countersigned by Haylor, Freyer & Coon, Inc. Attention Certificate Holder: We are providing you a Certificate of insurance using the latest ACORD 25 (2009/09 ed.) as required by the ACORD licensing agreement with participating insurance carriers. Prior editions have been withdrawn and their use phased out. There are several changes in the form that we would like to point out. The more important ones have been made to satisfy regulatory concerns that Certificates were being stretched into policy forms, which they are not. The form no longer includes a notice of cancellation provision. It is left for the policy itself to state the specifics regarding cancellation of the policy. If the policy is endorsed to amend the standard cancellation provisions, the exact wording of the amendment may be shown on the Certificate. The "Description" box has been modified to limit its use to a description of operations, locations or vehicles to which the Certificate applies. No longer will you see Exclusions added by Endorsement or Special Provisions. In place of this wording you may f'md copies of pertinent policy endorsements that will be enclosed with the Certificate. An ACORD 101 (2008/01 ed.) will be included listing the endorsements that accompany the Certificate. You will also note that columns have been added in the "Coverages" section for indicating if Additional Insured status or a Waiver of Subrogation has been granted by the policy. Please note that the new edition of the ACORD 25 is now a one-page document.