Agenda Item
i. Service Agreements ~ Independent Contractor Agreements (ICA) ~ Various Services ~ Alliance Fire Protection Services, Inc., BaseSix Systems, LLC, City Demolition and Abatement, Darling Ingredients, Inc., Electronic Maintenance Associates, Inc., Johnson Controls Fire Protection, Overhead Door Company of Atlanta, Section 10, Inc., Strategic Environmental Solutions, LLC (Not to exceed $820,000)
Summary: Presented by: Mr. Erick Hofstetter, Chief Operating Officer, Division of Operations
Request: It is requested that the DeKalb County School District Board of Education (“the Board”) approve the following Independent Contractor Agreements (ICAs) that exceed $50,000 with a total contract value not-to-exceed $820,000.
Alliance Fire Protection Services, Inc., ($95,000)
BaseSix Systems, LLC. ($90,000)
City Demolition and Abatement ($90,000)
Darling Ingredients, Inc. ($95,000)
Electronic Maintenance Associates, Inc ($85,000)
Johnson Controls Fire Protection ($80,000)
Overhead Door Company of Atlanta (95,000)
Section 10, Inc. ($95,000)
Strategic Environmental Solutions ($95,000)
Why: This request is to approve the above listed ICA’s to perform various services to support the Facilities/Maintenance Department through June 2026.
Approval of the Independent Contractor Agreement meets Strategic Goal Area 6: Organizational Excellence
Details: On October 18, 2021, the Board of Education approved the revision of Board Policy DJE (IV) A.2 - Independent Contractor Agreements, to require Board approval for any Independent Contractor Agreements with a total cost of $50,000 or more.
Additionally, per Board Policy -Purchasing DJE III(C)(3) - Competitive Selection of Vendors for Non-Capital Projects - Purchases or contracts totaling $5,000+ shall require at least 2 written quotes and selected based on objective criteria (performance and execution)
The board policies can be found here:
https://simbli.eboardsolutions.com/Policy/ViewPolicy.aspx?S=4054&revid=IsVaB6Z2x9NPZkwqJm84zQ==&ptid=amIgTZiB9plushNjl6WXhfiOQ==&secid=y1ZW0qRGjEafuplusqEjNeK2Q==&PG=6&IRP=0&isPndg=false
Financial impact: The budget for services is allocated from cost code (100.2600.543000.00011.7520.000.8013.040.0000) under the Operations Division General Fund Budget not to exceed $820,000.
Contact: Mr. Erick Hofstetter, Chief Operating Officer, Division of Operations, 678.676.1447
Mr. Bobby Moncrief, Director of Facilities, Division of Operations, 678-676-1478
Effective: Upon Board Approval, effective July 1, 2025
Status: Approved by the Office of Legal Affairs
BASESYS-01 JCLARK1
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/25/2024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CONTACT Lakin Snavely, CISR
PRODUCER NAME:
The Baldwin Group Southeast LLC PHONE FAX
(A/C, No, Ext): (A/C, No):
5871 Glenridge Dr, NE, Ste 400 E-MAIL
Atlanta, GA 30328 ADDRESS: Lakin.Snavely@baldwin.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : The Hanover American Insurance Company 36064
INSURED INSURER B : The Hanover Insurance Company 22292
Basesix Systems LLC INSURER C :
2053 Franklin Way SE INSURER D :
Marietta, GA 30062
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
1,000,000
CLAIMS-MADE X OCCUR
X ZZA H247922-04 5/4/2024 5/4/2025 DAMAGE TO RENTED
PREMISES (Ea occurrence) $
1,000,000
MED EXP (Any one person) $
15,000
PERSONAL & ADV INJURY $
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
2,000,000
POLICY X PRO-
JECT X LOC PRODUCTS - COMP/OP AGG $
2,000,000
OTHER: $
B AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident) $
1,000,000
X ANY AUTO X AHA H226038-04 5/4/2024 5/4/2025 BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) $
$
A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $
10,000,000
EXCESS LIAB CLAIMS-MADE X UHA H247924-04 5/4/2024 5/4/2025 AGGREGATE $
10,000,000
DED X RETENTION $ 0 $
A WORKERS COMPENSATION X PER
STATUTE
OTH-
ER
AND EMPLOYERS' LIABILITY
Y/N WZA H225993-04 5/4/2024 5/4/2025 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? Y N/A
1,000,000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Dekalb County School District and Dekalb County Board of Education are included as additional insureds, as required by written contract or agreement, with
respect to general liability and automobile liability per the attached endorsements. Umbrella schedule of underlying policies attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Dekalb County School District ACCORDANCE WITH THE POLICY PROVISIONS.
and Dekalb County Board of Education
1701 Mountain industrial Blvd Stone
Stone Mountain, GA 30083 AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY BROADENING ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUMMARY OF COVERAGES
1. Additional Insured by Contract, Agreement or Permit Included
2. Additional Insured – Primary and Non-Contributory Included
3. Blanket Waiver of Subrogation Included
4. Bodily Injury Redefined Included
5. Broad Form Property Damage – Borrowed Equipment, Customers Goods & Use of Elevators Included
6. Knowledge of Occurrence Included
7. Liberalization Clause lncluded
8. Medical Payments – Extended Reporting Period Included
9. Newly Acquired or Formed Organizations - Covered until end of policy period Included
10. Non-owned Watercraft 51 ft.
11. Supplementary Payments Increased Limits
- Bail Bonds $2,500
- Loss of Earnings $1000
12. Unintentional Failure to Disclose Hazards Included
13. Unintentional Failure to Notify Included
This endorsement amends coverages provided under the Commercial General Liability Coverage Part through
new coverages, higher limits and broader coverage grants.
1. Additional Insured by Contract, Agreement or (1) "Your work" for the additional insured(s)
Permit designated in the contract, agreement or
The following is added to SECTION II – WHO IS permit;
AN INSURED: (2) Premises you own, rent, lease or occupy;
Additional Insured by Contract, Agreement or or
Permit (3) Your maintenance, operation or use of
a. Any person or organization with whom you equipment leased to you.
agreed in a written contract, written agreement b. The insurance afforded to such additional
or permit that such person or organization to insured described above:
add an additional insured on your policy is an (1) Only applies to the extent permitted by
additional insured only with respect to liability law; and
for “bodily injury”, “property damage”, or
“personal and advertising injury” caused, in (2) Will not be broader than the insurance
whole or in part, by your acts or omissions, or which you are required by the contract,
the acts or omissions of those acting on your agreement or permit to provide for such
behalf, but only with respect to: additional insured.
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(3) Applies on a primary basis if that is advertising injury” involved the rendering
required by the written contract, written of or failure to render any professional
agreement or permit. services by or for you.
(4) Will not be broader than coverage d. With respect to the insurance afforded to
provided to any other insured. these additional insureds, the following is
(5) Does not apply if the “bodily injury”, added to SECTION III – LIMITS OF
“property damage” or “personal and INSURANCE:
advertising injury” is otherwise excluded The most we will pay on behalf of the
from coverage under this Coverage Part, additional insured for a covered claim is the
including any endorsements thereto. lesser of the amount of insurance:
c. This provision does not apply: 1. Required by the contract, agreement or
(1) Unless the written contract or written permit described in Paragraph a.; or
agreement was executed or permit was 2. Available under the applicable Limits of
issued prior to the "bodily injury”, “property Insurance shown in the Declarations.
damage", or "personal injury and This endorsement shall not increase the
advertising injury". applicable Limits of Insurance shown in the
(2) To any person or organization included as Declarations.
an insured by another endorsement 2. Additional Insured – Primary and Non-
issued by us and made part of this Contributory
Coverage Part.
The following is added to SECTION IV –
(3) To any lessor of equipment: COMMERCIAL GENERAL LIABILITY
(a) After the equipment lease expires; or CONDITIONS, Paragraph 4. Other insurance:
(b) If the “bodily injury”, “property Additional Insured – Primary and Non-
damage”, “personal and advertising Contributory
injury” arises out of sole negligence of If you agree in a written contract, written
the lessor agreement or permit that the insurance provided to
(4) To any: any person or organization included as an
(a) Owners or other interests from. whom Additional Insured under SECTION II – WHO IS
land has been leased which takes AN INSURED, is primary and non-contributory,
place after the lease for the land ex- the following applies:
pires; or If other valid and collectible insurance is available
(b) Managers or lessors of premises if: to the Additional Insured for a loss covered under
Coverages A or B of this Coverage Part, our
(i) The occurrence takes place after obligations are limited as follows:
you cease to be a tenant in that
premises; or a. Primary Insurance
(ii) The "bodily injury", "property This insurance is primary to other insurance
damage", "personal injury" or that is available to the Additional Insured
"advertising injury" arises out of which covers the
structural alterations, new con- Additional Insured as a Named Insured. We
struction or demolition operations will not seek contribution from any other
performed by or on behalf of the insurance available to the Additional Insured
manager or lessor. except:
(5) To “bodily injury”, “property damage” or (1) For the sole negligence of the Additional
“personal and advertising injury” arising Insured;
out of the rendering of or the failure to (2) When the Additional Insured is an
render any professional services. Additional Insured under another primary
This exclusion applies even if the claims liability policy; or
against any insured allege negligence or (3) when b. below applies.
other wrongdoing in the supervision,
hiring, employment, training or monitoring If this insurance is primary, our obligations are
of others by that insured, if the not affected unless any of the other insurance
“occurrence” which caused the “bodily is also primary. Then, we will share with all
injury” or “property damage” or the offense that other insurance by the method described
which caused the “personal and in c. below.
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b. Excess Insurance insurer contributes equal amounts until it has
(1) This insurance is excess over any of the paid its applicable limit of insurance or none of
other insurance, whether primary, excess, the loss remains, whichever comes first. If any
contingent or on any other basis: of the other insurance does not permit
contribution by equal shares, we will contribute
(a) That is Fire, Extended Coverage, by limits. Under this method, each insurer's
Builder's Risk, Installation Risk or share is based on the ratio of its applicable
similar coverage for "your work"; limit of insurance to the total applicable limits
(b) That is Fire insurance for premises of insurance of all insurers
rented to the Additional Insured or 3. Blanket Waiver of Subrogation
temporarily occupied by the Additional
Insured with permission of the owner; The following is added to SECTION IV –
COMMERCIAL GENERAL LIABILITY
(c) That is insurance purchased by the CONDITIONS, Paragraph 8. Transfer Of Rights
Additional Insured to cover the Of Recovery Against Others To Us:
Additional Insured’s liability as a
tenant for "property damage" to We waive any right of recovery we may have
premises rented to the Additional against any person or organization with whom you
Insured or temporarily occupied by the have a written contract that requires such waiver
Additional with permission of the because of payments we make for damage under
owner; or this coverage form. The damage must arise out of
your activities under a written contract with that
(d) If the loss arises out of the person or organization. This waiver applies only to
maintenance or use of aircraft, "autos" the extent that subrogation is waived under a
or watercraft to the extent not subject written contract executed prior to the “occurrence”
to Exclusion g. of SECTION I – or offense giving rise to such payments.
COVERAGE A – BODILY INURY
AND PROPERTY DAMAGE 4. Bodily Injury Redefined
LIABILITY. SECTION V – DEFINITIONS, Definition 3. “bodily
(2) When this insurance is excess, we will injury” is replaced by the following:
have no duty under Coverages A or B to 3. “Bodily injury” means bodily injury, sickness or
defend the insured against any "suit" if any disease sustained by a person including death
other insurer has a duty to defend the resulting from any of these at any time. “Bodily
insured against that "suit". If no other injury” includes mental anguish or other
insurer defends, we will undertake to do mental injury resulting from “bodily injury”.
so, but we will be entitled to the insured's 5. Broad Form Property Damage – Borrowed
rights against all those other insurers. Equipment, Customers Goods, Use of
(3) When this insurance is excess over other Elevators
Insurance, we will pay only our share of a. SECTION I – COVERAGES, COVERAGE A –
the amount of the loss, if any, that BODILIY INJURY AND PROPERTY
exceeds the sum of: DAMAGE LIABILITY, Paragraph 2.
(a) The total amount that all such other Exclusions subparagraph j. is amended as
insurance would pay for the loss in the follows:
absence of this insurance; and Paragraph (4) does not apply to "property
(b) The total of all deductible and self damage" to borrowed equipment while at a
insured amounts under all that other jobsite and not being used to perform
insurance. operations.
We will share the remaining loss, if any, Paragraphs (3), (4) and (6) do not apply to
with any other insurance that is not "property damage" to "customers goods" while
described in this Excess Insurance on your premises nor do they apply to the use
provision and was not bought specifically of elevators at premises you own, rent, lease
to apply in excess of the Limits of or occupy.
Insurance shown in the Declarations of b. The following is added to SECTION V –
this Coverage Part. DEFINTIONS:
c. Method Of Sharing 24. "Customers goods" means property of
If all of the other insurance permits your customer on your premises for the
contribution by equal shares, we will follow this purpose of being:
method also. Under this approach each
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a. worked on; or 10. Non-Owned Watercraft
b. used in your manufacturing process. SECTION I – COVERAGES, COVERAGE A
c. The insurance afforded under this provision is BODILY INJURY AND PROPERTY DAMAGE
excess over any other valid and collectible LIABILITY, Paragraph 2. Exclusions,
property insurance (including deductible) subparagraph g.(2) is replaced by the following:
available to the insured whether primary, g. Aircraft, Auto Or Watercraft
excess, contingent (2) A watercraft you do not own that is:
6. Knowledge of Occurrence (a) Less than 51 feet long; and
The following is added to SECTION IV – (b) Not being used to carry persons or
COMMERCIAL GENERAL LIABILITY property for a charge;
CONDITIONS, Paragraph 2. Duties in the Event
of Occurrence, Offense, Claim or Suit: This provision applies to any person who,
with your consent, either uses or is
e. Notice of an "occurrence", offense, claim or responsible for the use of a watercraft.
"suit" will be considered knowledge of the
insured if reported to an individual named 11. Supplementary Payments Increased Limits
insured, partner, executive officer or an SECTION I – SUPPLEMENTARY PAYMENTS
"employee" designated by you to give us such COVERAGES A AND B, Paragraphs 1.b. and
a notice. 1.d. are replaced by the following:
7. Liberalization Clause 1.b. Up to $2,500 for cost of bail bonds required
The following is added to SECTION IV – because of accidents or traffic law violations
COMMERCIAL GENERAL LIABILITY arising out of the use of any vehicle to which
CONDITIONS: the Bodily Injury Liability Coverage applies.
We do not have to furnish these bonds.
Liberalization Clause
1.d. All reasonable expenses incurred by the
If we adopt any revision that would broaden the insured at our request to assist us in the
coverage under this Coverage Form without investigation or defense of the claim or “suit",
additional premium, within 45 days prior to or including actual loss of earnings up to $1000 a
during the policy period, the broadened coverage day because of time off from work.
will immediately apply to this Coverage Part.
12. Unintentional Failure to Disclose Hazards
8. Medical Payments – Extended Reporting
Period The following is added to SECTION IV –
COMMERCIAL GENERAL LIABILITY
a. SECTION I – COVERAGES, COVERAGE C – CONDITIONS, Paragraph 6. Representations:
MEDICAL PAYMENTS, Paragraph 1.
Insuring Agreement, subparagraph a.(3)(b) We will not disclaim coverage under this Coverage
is replaced by the following: Part if you fail to disclose all hazards existing as of
the inception date of the policy provided such
(b) The expenses are incurred and reported failure is not intentional.
to us within three years of the date of the
accident; and 13. Unintentional Failure to Notify
b. This coverage does not apply if COVERAGE The following is added to SECTION IV –
C – MEDICAL PAYMENTS is excluded either COMMERCIAL GENERAL LIABILITY
by the provisions of the Coverage Part or by CONDITIONS, Paragraph 2. Duties in the Event
endorsement. of Occurrence, Offense, Claim or Suit:
9. Newly Acquired Or Formed Organizations Your rights afforded under this policy shall not be
prejudiced if you fail to give us notice of an
SECTION II – WHO IS AN INSURED, Paragraph "occurrence", offense, claim or "suit", solely due to
3.a. is replaced by the following: your reasonable and documented belief that the
a. Coverage under this provision is afforded until "bodily injury" or "property damage" is not covered
the end of the policy period. under this policy.
ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED.
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. The following is added to SECTION II –
LIABILITY COVERAGE, Paragraph A.1. Who Is If you agree in a written contract, written
An Insured: agreement or written permit that the insurance
Additional Insured if Required by Contract provided to a person or organization who qualifies
If you agree in a written contract, written as an additional “insured” under SECTION II –
agreement or written permit that a person or LIABILITY COVERAGE, Paragraph A.1. Who Is
organization be added as an additional “insured” An Insured, subparagraph Additional Insured if
under this Coverage Part, such person or Required by Contract is primary and non-
organization is an “insured”; but only to the extent contributory, the following applies:
that such person or organization qualifies as an The liability coverage provided by this Coverage
“insured” under paragraph A.1.c. of this Section. Part is primary to any other insurance available to
If you agree in a written contract, written the additional “insured” as a Named Insured. We
agreement or written permit that a person or will not seek contribution from any other insurance
organization be added as an additional “insured” available to the additional “insured” except:
under this Coverage Part, the most we will pay on (1) For the sole negligence of the additional
behalf of such additional “insured” is the lesser of: “insured”; or
(1) The Limits of Insurance for liability coverage (2) For negligence arising out of the ownership,
specified in the written contract, written maintenance or use of any “auto” not owned
agreement or written permit; or by the additional “insured” or by you, unless
(2) The Limits of Insurance for Liability Coverage that “auto” is a “trailer” connected to an “auto”
shown in the Declarations applicable to this owned by the additional “insured” or by you; or
Coverage Part. (3) When the additional “insured” is also an
Such amount shall be part of and not in addition to additional “insured” under another liability
the Limits of Insurance shown in the Declarations policy.
applicable to this Coverage Part. Regardless of C. This endorsement will apply only if the “accident”
the number of covered "autos", "insureds", occurs:
premiums paid, claims made or vehicles involved 1. During the policy period;
in the "accident", the most we will pay for the total
of all damages and "covered pollution cost or 2. Subsequent to the execution of the written
expense" combined resulting from any one contract or written agreement or the issuance
"accident" is the Limit of Insurance for Liability of the written permit; and
Coverage shown in the Declarations. 3. Prior to the expiration of the period of time that
B. The following is added to SECTION IV – the written contract, written agreement or
BUSINESS AUTO CONDITIONS, Paragraph B. written permit requires such insurance to be
General Conditions, subparagraph 5. Other provided to the additional “insured”.
Insurance: D. Coverage provided to an additional “insured” will
Primary and Non-Contributory not be broader than coverage provided to any
other “insured” under this Coverage Part.
ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED.
Page 1 of 1
461-0478 12 12 Includes copyrighted material of ISO Insurance Services Office, Inc., with its permission
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO COVERAGE
BROADENING ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form
apply unless modified by the endorsement.
1. CANCELLATION EXTENSION d. Any business entity for which you
have a financial interest greater
Paragraph A. CANCELLATION 2. b. of the than 50% of the voting stock or
COMMON POLICY CONDITIONS is otherwise have a controlling
replaced with the following: interest after the effective date of
b. 60 days before the effective date this policy or that is newly
of cancellation if we cancel for acquired or formed by you during
any other reason. the term of this policy.
SECTION I - COVERED AUTOS The coverage provided by this
provision is afforded until
2. EMPLOYEE HIRED "AUTOS" expiration or termination of this
Description Of Covered Auto policy, whichever occurs earlier.
Designation Symbols; Symbol 8 is
replaced by the following: The coverage provided by this
provision does not apply to any
8 = Hired "Autos" Only - Only those "autos" business entity described in d.
you lease, hire, rent or borrow; including above that qualifies as an
"autos" your employee hires at your insured under any other
direction, for the purpose of conducting your automobile liability policy issued
business. This does not include any "auto" to that business entity as a
you lease, hire, rent, or borrow from any of named insured or would have
your "employees" or partners or members of been an insured except for the
their households. exhaustion of the policy limits or
the insolvency of the insurer.
SECTION II - LIABILITY COVERAGE
The coverage provided by this
3. BROADENED NAMED INSURED provision does not apply to
"bodily injury" nor "property
The following is added to the SECTION II - damage" arising from an
LIABILITY COVERAGE, Paragraph 1. Who accident that occurred prior to
Is An Insured provision: your acquiring or forming the
business entity described in d.
above.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Copyright, Insurance Services Office, Inc., 1996
461-0155 (9-97)
4. EMPLOYEES AS INSUREDS SECTION III - PHYSICAL DAMAGE
COVERAGE.
The following is added to the SECTION II -
LIABILITY COVERAGE, Paragraph 1. Who 7. EXPENSE OF RETURNING A STOLEN
Is An Insured provision: "AUTO" and SIGN COVERAGE
e. Any employee of yours is an The following is added to SECTION III -
"insured" while using a covered PHYSICAL DAMAGE COVERAGE, A.1.
"auto" you do not own, hire or COVERAGE:
borrow in your business or your
personal affairs. d. Expense Of Returning A Stolen
"Auto"
5. SUPPLEMENTARY PAYMENTS
We will pay for the expense of
The following amends SECTION II - returning a covered "auto" to you.
LIABILITY COVERAGE, Paragraph 2.
Coverage Extensions provision: e. Sign Coverage
Paragraph (2) is replaced by the following: We will pay for loss to signs,
(2) Up to $2500 for cost of bail bonds murals, paintings or graphics,
(including bonds for related traffic as part of equipment, which are
law violations) required because displayed on a covered "auto".
of an "accident" we cover. We do
not have to furnish these bonds. The most we will pay for "loss" in
any one "accident" is the lesser of:
Paragraph (4) is replaced by the following:
(4) All reasonable expenses incurred 1. The actual cash value of
by the "insured" at our request, the property as of the
including actual loss of earnings time of the "loss"; or
up to $500 a day because of time 2. The cost of repairing or
off from work. replacing the damaged or
stolen property with other
6. AMENDED FELLOW EMPLOYEE property of like kind and
EXCLUSION quality; or
3. $2,000.
The following is added to the SECTION II -
LIABILITY COVERAGE, B. Exclusions 8. GLASS BREAKAGE DEDUCTIBLE
Paragraph 5. Fellow Employee exclusion:
The following is added to SECTION III-
This exclusion does not apply if the PHYSICAL DAMAGE COVERAGE A.
"bodily injury" arises from the use of a COVERAGE paragraph 3. Glass
covered "auto" you own or hire. This Breakage - Hitting a Bird or Animal -
coverage is excess over any other Falling Objects or Missiles:
collectible insurance
Any deductible shown in the
Declarations as applicable to the
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Copyright, Insurance Services Office, Inc., 1996
461-0155 (9-97)
covered "auto" will not apply to glass direction, for the purpose of
breakage if such glass is repaired, conducting your business, for a
rather than replaced. period of 30 days or less, of like
kind and use as the "autos" you
9. TRANSPORTATION EXPENSE own, subject to the following:
Paragraph 4. Coverage Extension. of The most we will pay for any one
SECTION III - PHYSICAL DAMAGE loss is the lesser of the following:
COVERAGE, A. COVERAGE is replaced
with the following: a. $50,000 per accident, or
b. cash value, or
4. Coverage Extension c. the cost of repair,
We will pay up to $50 per day to a minus the deductible equal to the
maximum of $1500 for temporary lowest deductible applicable to any
transportation expense incurred by owned "auto" for that coverage.
you because of the total theft of a Any deductible shown in the
covered "auto" of the private Declarations does not apply to
passenger type. We will pay only "loss" caused by fire or lightning.
for those covered "autos" for which Subject to the limit and deductible
you carry either Comprehensive or stated above, we will provide
Specified Causes of Loss coverage equal to the broadest
Coverage. We will pay for coverage provided to any covered
temporary transportation expenses "auto" you own, that is applicable to
incurred during the period beginning the loss.
24 hours after the theft and ending,
regardless of the policy’s expiration, If the loss arises from an accident
when the covered "auto" is returned for which you are legally liable and
to use or we pay for its "loss". the lessor incurs an actual financial
loss from that accident, we will
10. HIRED AUTO PHYSICAL DAMAGE cover the lessor’s actual financial
loss of use of the hired "auto" for a
The following is added to SECTION III - period of up to seven consecutive
PHYSICAL DAMAGE COVERAGE, A. days from the date of the accident,
COVERAGE: subject to a limit of $1,000 per
accident.
5. Hired Auto Physical Damage
11. AUDIO, VISUAL AND DATA
If hired "autos" are covered "autos" ELECTRONIC EQUIPMENT
for Liability Coverage and if Physical COVERAGE
Damage Coverage of
Comprehensive, Specified Causes The following is added to SECTION III -
of Loss, or Collision is provided PHYSICAL DAMAGE COVERAGE, A.
under this Coverage Form for any COVERAGE:
"auto" you own, then the Physical
Damage Coverage(s) provided is 6. Audio, Visual and Data Electronic
extended to "autos" you hire without Equipment Coverage
a driver or your employee hires,
without a driver, at your We will pay for "loss" to any
electronic equipment that receives
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or transmits audio, visual or data
signals and that is not designed b. Permanently installed
solely for the reproduction of sound. in the opening of the dash
This coverage applies only if the or console normally used
equipment is permanently installed by the manufacturer for the
in the covered "auto" at the time of installation of a radio.
the "loss" or the equipment is
removable from a housing unit With respect to coverage herein, the
which is permanently installed in the LIMIT OF INSURANCE provision of
covered “auto’ at the time of the PHYSICAL DAMAGE COVERAGE
"loss", and such equipment is is replaced by the following:
designed to be solely operated by
use of the power from the "auto’s" 1. The most we will pay for all
electrical system, in or upon the "loss" to audio, visual or data
covered "auto", including its electronic equipment and any
antennas and other accessories. accessories used with this
However , this does not include equipment as a result of any
tapes, records or discs. one "accident" is the lesser of
The exclusions that apply to a. The actual cash value of
PHYSICAL DAMAGE COVERAGE, the damaged or stolen
except for the exclusion relating to property as of the time of
Audio, Visual and Data Electronic the "loss"; or
Equipment, also apply to coverage b. The cost of repairing or
provided herein. In addition, the replacing the damaged or
following exclusions apply: stolen property with other
property of like kind and
We will not pay , under this quality; or
coverage, for either any electronic c. $500.
equipment or accessories used with
such electronic equipment that is: 2. An adjustment for
depreciation and physical
1. Necessary for the normal condition will be made in
operation of the covered determining actual cash value
"auto" or the monitoring of at the time of the "loss".
the covered "auto’s"
operating system; or 3. Deductibles applicable to
PHYSICAL DAMAGE
2. Both: COVERAGE, do not apply
to this Audio, Visual and Data
a. An integral part of the Electronic Equipment
same unit housing any Coverage.
sound reproducing
equipment designed If there is other coverage provided
solely for the by this policy for audio, visual and
reproduction of sound if the data electronic equipment, the
sound reproducing coverage provided herein is
equipment is permanently
installed in the covered
"auto", and
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excess. However, you may elect to covered “auto". If “loss” is
apply the limit or any portion thereof caused by theft, this
of coverage provided herein to pay number of days is added
any deductible that is applicable to the number of days it
under the provisions of the other takes to locate the covered
coverage. "auto" and transport it to a
repair shop.
12. RENTAL REIMBURSEMENT and
MATERIAL TRANSFER EXPENSE 2. 60 days.
The following is added to SECTION III - Our payment is limited to the lesser
PHYSICAL DAMAGE COVERAGE, A. of the following amounts:
COVERAGE:
1. Necessary and actual
7. Rental Reimbursement and expenses incurred,
Material Transfer Expense including loss of use.
This coverage provides only those 2. $3000.
Physical Damage Coverages where
a premium is shown in the This auto rental expense coverage
Declarations. It applies only to a does not apply while there are
covered "auto" described or spare or reserve "autos" available to
designated to which the Physical you for your operations.
Damage Coverages apply.
If "loss" results from the total theft of
We will pay for auto rental expenses a covered "auto" of the private
and the expenses, incurred by you passenger type, we will pay under
because of "loss" to a covered this coverage only that amount of
"auto", to remove and transfer your your rental reimbursement
materials and equipment from the expenses which is not already
covered "auto" . Payment applies in provided for under the SECTION
addition to the otherwise applicable III - PHYSICAL DAMAGE
amount of each coverage you have COVERAGE, A. 4. Coverage
on a covered "auto". No Extension.
deductibles apply to this coverage.
13. AIRBAG COVERAGE
We will pay only for those auto
rental expenses incurred during the The following is added to SECTION III -
policy period beginning 24 hours PHYSICAL DAMAGE COVERAGE, B.
after the "loss" and ending, Exclusions, paragraph 3.
regardless of the policy’s expiration,
with the lesser of the following The portion of this exclusion relating to
number of days: mechanical or electrical breakdown does not
apply to the accidental discharge of an
1. The number of days airbag. This coverage is excess of other
reasonably required to collectible insurance or warranty. No
repair or replace the deductible applies to this Airbag Coverage.
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14. AUTO LOAN PHYSICAL DAMAGE imposed under a lease for excessive use,
EXTENSION abnormal wear and tear or high mileage;
security deposits not refunded by the lessor;
The following is added to SECTION III - cost for extended warranties, Credit Life
PHYSICAL DAMAGE COVERAGE, C. Insurance, Health, Accident or Disability
Limit Of Insurance provision: Insurance purchased with the loan; and
carry over balances from previous leases.
When a "loss" results in a total loss to a
covered auto you own for which a Loss This coverage applies only to the initial
Payee is designated in this policy, the most lease for the covered "auto" which has not
we will pay for "loss" in any one "accident" is previously been leased. This coverage is
the greater of: excess over all other collectible insurance.
1. The actual cash value of the SECTION IV - CONDITIONS
damaged or stolen property as of
the time of the "loss"; or 16. DUTIES IN THE EVENT OF
ACCIDENT, CLAIM, SUIT OR LOSS
2. The outstanding balance of the
initial loan, less any amounts for The following is added to SECTION IV -
taxes, overdue payments, overdue BUSINESS AUTO CONDITIONS, A. Loss
payment charges, penalties, Conditions, 2. Duties In The Event Of
interest , any charges for early Accident, Claim, Suit Or Loss:
termination of the loan, costs for
Credit Life Insurance, Health, d. Knowledge of any "accident",
Accident or Disability Insurance claim, "suit" or "loss" will be
purchased with the loan, and deemed knowledge by you when
carry-over balances from previous notice of such "accident",
loans. claim, "suit" or "loss" has been
received by:
15. AUTO LEASE PHYSICAL DAMAGE
EXTENSION (1) You, if you are an individual;
(2) Any partner or insurance
The following is added to SECTION III - manager if you are a
PHYSICAL DAMAGE COVERAGE, C. partnership; or
Limit Of Insurance provision: (3) An executive officer or
insurance manager if you are
If, because of damage, destruction or theft a corporation.
of a covered "auto", which is a long-term
leased "auto", the lease agreement between 17. BLANKET WAIVER OF
you and the lessor is terminated, "we" will SUBROGATION
pay the difference between the amount paid
under paragraph C. LIMIT OF INSURANCE Paragraph 5. Transfer Of Rights Of
1. or 2. and the amount due at the time of Recovery Against Others To Us,
"loss" under the terms of the lease SECTION IV - BUSINESS AUTO
agreement applicable to the leased "auto" CONDITIONS, A. Loss Conditions is
which you are required to pay: less any fees replaced by the following:
to dispose of the auto; any overdue
payments; financial penalties
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5. Transfer Of Rights Of Recovery 19. HIRED AUTO – WORLDWIDE
Against Others To Us COVERAGE
If any person or organization to or The following is added to SECTION IV -
for whom we make payment under Business Auto Conditions, B. General
this Coverage Form has rights to Conditions, paragraph 7. Policy Period,
recover damages from another, Coverage Territory provision:
which have not been waived
through the execution of an "insured e. Outside the coverage territory
contract", written agreement, or described in a., b., c., and d.
permit, prior to the "accident" or above for an "accident" or "loss"
"loss" giving rise to the payment, resulting from the use of a
those rights to recover damages covered "auto" you hire, without a
from another are transferred to us. driver, or your employee hires
That person or organization must do without a driver, at your direction,
everything necessary to secure our for the purpose of conducting your
rights and must do nothing after the business, for a period of 30 days
"accident" or "loss" to impair them. or less, provided the suit is
brought within The United States
18. UNINTENTIONAL FAILURE TO of America or its territories or
DISCLOSE INFORMATION possessions.
The following is added to SECTION IV SECTION V - DEFINITIONS
BUSINESS AUTO CONDITIONS. B.
General Conditions, paragraph 2. 20. MENTAL ANGUISH
Concealment, Misrepresentation Or
Fraud: Paragraph C. "Bodily injury", SECTION V -
DEFINITIONS is replaced by the following:
Your unintentional error in disclosing, or
failure to disclose, any material fact C. "Bodily injury" means bodily injury,
existing after the effective date of this sickness or disease sustained by a
Coverage Form shall not prejudice your person including death or mental
rights under this Coverage Form. anguish resulting from any of these.
However, this provision does not affect
our right to collect additional premium or
exercise our right of cancellation or
nonrenewal.
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SCHEDULE OF UNDERLYING POLICIES
Insured: BASESIX SYSTEMS LLC
Effective on and after 05/04/2024 12:01 A.M. Standard Time
This Schedule is part of Policy Number: UHA H247924 04
CARRIER, POLICY NUMBER & PERIOD TYPE OF POLICY APPLICABLE LIMITS OR AMOUNT OF INSURANCE
(a) Carrier: CITIZENS INSURANCE COMPANY Commercial General Liability $1,000,000 Occurrence/ Each Claim
OF AMERICA
Policy Number: ZBA H247922 04 Owned Autos $1,000,000 Personal Injury
Policy Period: 05/04/2024 TO 05/04/2025 Non-owned & Hired Autos $1,000,000 Advertising Injury
$2,000,000 General Aggregate
$2,000,000 Product/Completed Operations
Aggregate
(b) Carrier: HANOVER INSURANCE COMPANY Comprehensive Automobile Bodily Injury and Property Damage Liability Combined:
Liability including
Policy Number: AHA H226038 04 Owned Autos $1,000,000 Each Accident
Policy Period: 05/04/2024 TO 05/04/2025 Non-Owned & Hired Autos Bodily Injury
$ Each Person
$ Each Accident
Property Damage:
$ Each Accident
(c) Carrier: Garage Liability Bodily Injury and Property Damage Liability Combined:
Policy Number: Dealers Each Accident
Policy Period: Service Garage Operations
$ Auto Only
$ Other than Auto Only
$ Aggregate
Garage Operations
$ Other than Auto Only
(d) Carrier: ALLMERICA FINANCIAL BENEFITS Standard Workers’ Compensation Coverage B – Employers Liability
& Employers’ Liability
Policy Number: WZA H225993 04 Bodily Injury by Accident
Policy Period: 05/04/2024 TO 05/04/2025 $1,000,000 Each Accident
NEW YORK ONLY: Bodily Injury by Disease
The Umbrella Coverage for $1,000,000 Each Employee
Workers’ Compensation and $1,000,000 Aggregate
Employers Liability is not
applicable in situations where an
employee is subject to the New
York Workers’ Compensation Law.
An “X” marked in the box provided indicates these broadening or optional coverage are provided in the Underlying Insurance
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0027 of 0043 Original Insured
(e) Carrier: Liquor Liability $ Each Common Cause
Policy Number: $ Other
Policy Period: $ Aggregate
$ Other
(f) Carrier: Professional Liability $ Each Occurrence
Policy Number: $ Each Claim
Policy Period: $ Other
$ Aggregate
$ Other
(g) Carrier: Directors & Officers Liability $ Each Occurrence
Policy Number: $ Each Claim
Policy Period: $ Other
$ Aggregate
$ Other
(h) Carrier: Stop Gap Liability Bodily Injury by Accident
Policy Number: $ Each Accident
Policy Period: Bodily Injury by Disease
$ Each Employee
$ Aggregate
(i) Carrier: Abuse and Molestation $ Each Occurrence
Policy Number: $ Each Claim
Policy Period: $ Other
$ Aggregate
(j) Carrier: Foreign $ Each Occurrence
Policy Number: $ Each Claim
Policy Period: $ Other
$ Aggregate
(k) Carrier: CITIZENS INSURANCE COMPANY Employee Benefits Liability $ Each Occurence
OF AMERICA
Policy Number: ZBA H247922 03 $1,000,000 Each Claim
Policy Period: 05/04/2023 TO 05/04/2024 $ Other
$2,000,000 Aggregate
(l) Carrier: Other $ Each Occurrence
Policy Number: $ Each Claim
Policy Period: $ Other
$ Aggregate
An “X” marked in the box provided indicates these broadening or optional coverage are provided in the Underlying Insurance
Countersigned By:_________________________________________ Date:________________
Authorized Representative of the Company
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004193 Includes copyrighted material of Insurance Services Office, Inc. with its permission
0028 of 0043 Original Insured