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Forma Construction 4/7/2021
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Forma Construction 4/7/2021
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Entry Properties
Last modified
4/30/2021 2:01:55 PM
Creation date
4/30/2021 2:01:29 PM
Metadata
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Template:
Contracts
Contractor's Name
Forma Construction
Approval Date
4/7/2021
End Date
4/9/2021
Department
Facilities
Department Project Manager
Darcie Byrd
Subject / Project Title
Construction Work at W. Marine View Drive
Public Works WO Number
JC-20233
Tracking Number
0002885
Total Compensation
$0.00
Contract Type
Agreement
Contract Subtype
Use of Property
Retention Period
6 Years Then Destroy
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CNA63359XX <br /> (Ed. 04/12) <br /> (2) Excess over any other collectible damage, against any person or organization for <br /> insurance. whom or which you are required by written <br /> ate;_ �__ contract or agreement to obtain this waiver from <br /> 2. Ft.,' NuiNUaCS Us I uu5 prUvisiUII, CACL,UUVC officer" us. <br /> means a person holding any of the officer <br /> positions created by your charter, constitution, by- This injury or damage must arise out of your <br /> laws or any other similar governing document, activities under a contract with that person or <br /> and, while a resident of the same household, organization. <br /> includes that person's spouse. You must agree to that requirement prior to an <br /> Such "executive officers" are "insureds" while "accident"or"loss." <br /> using a covered "auto"described in this provision. C. Concealment, Misrepresentation or Fraud <br /> IV. BUSINESS AUTO CONDITIONS <br /> IVIVS The following is added to Section IV, Paragraph <br /> A. Duties In The Event Of Accident, Claim, Suit Or B.2.: <br /> Loss Your failure to disclose all hazards existing on the date <br /> The following is added to Section IV, Paragraph of inception of this Coverage Form shall not prejudice <br /> A.2.a.: you with respect to the coverage afforded provided <br /> (4) Your "employees" may know of an such failure or omission is not intentional. <br /> "accident" or "loss." This will not mean D. Other Insurance <br /> that you have V such ICI IUVYICUgC, unless The following is added to Section IV, Paragraph <br /> such "accident" or "loss" is known to you <br /> or if you are not an individual, to any of B.S.: <br /> your executive officers or partners or your Regardless of the provisions of Paragraphs 5.a. <br /> insurance manager. and 5.d. above, the coverage provided by this <br /> The following is added to Section IV, Paragraph policy shall be on a primary non-contributory <br /> A.2.b.: basis. This provision is applicable only when <br /> required by a written contract. That written <br /> (6) Your "employees" may know of contract must have been entered into prior to <br /> documents received concerning a claim "Accident" or"Loss." <br /> or"suit."This will not mean that you have E. Policy Period,Coverage Territory <br /> such knowledge, unless receipt of such <br /> documents is known to you or if you are Section IV, Paragraph B. 7.(5).(a). is revised to <br /> not an individual, to any of your executive provide: <br /> officers or partners or your insurance <br /> manager. a. 45 days of coverage in lieu of 30 days. <br /> B. Transfer Of Rights Of Recovery Against Others V. DEFINITIONS <br /> To Us <br /> Section V. Paragraph C. is deleted and replaced by <br /> The following is added to Section IV, Paragraph the following: <br /> A.5. Transfer Of Rights Of Recovery Against "Bodily injury"means bodily injury,sickness or disease <br /> Others To Us: sustained by a person, including mental anguish, <br /> We waive any right of recovery we may have, mental injury or death resulting from any of these. <br /> because of payments we make for injury or <br /> CNA63359XX Copyright,CNA Corporation,2000 Page 3 of 3 <br /> (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. <br />
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