SUBCONTRACT (SHORT FORM)

Transcription

1 SUBCONTRACTOR: PHONE SUBCONTRACT (SHORT FORM) PROJECT: LOCATION: This agreement is made and effective, by and between SUN CONSTRUCTION & FACILITY SERVICES, INC. (Contractor) and (Subcontractor) which are collectively the Parties. OWNER: DESIGN PROFESSIONAL: CONTRACTOR: Page 1 of 12 JOB NO.: COST CODE: PRICE: SUN CONSTRUCTION & FACILITY SERVICES, INC. 1. SUBCONTRACT WORK To the extent terms of the agreement between the Owner and Contractor (prime agreement) apply to the work of the Subcontractor, the Contractor assumes toward the Subcontractor all obligations, rights, duties, and redress that the Owner assumes toward the Contractor. In an identical way, the Subcontractor assumes toward the Contractor all obligations, rights, duties, and redress that the Contractor assumes toward the Owner and others under the prime agreement. In the event of conflicts or inconsistencies between provisions of this Agreement and the prime agreement, the more strict provision shall govern. The Subcontractor shall perform the Subcontract Work under the general direction of the Contractor and shall cooperate with the Contractor so the Contractor may fulfill obligations to the Owner. The Subcontractor shall provide the Subcontract Work for the Project in accordance with the Progress Schedule to be prepared by the Contractor after consultation with the Subcontractor, and as it may change from time to time. The Subcontractor shall give timely notices to authorities pertaining to the Subcontract Work and shall be responsible for all permits, fees, licenses, assessments, inspections, testing, and taxes necessary to complete the Subcontract Work. The Subcontractor is to provide all the necessary labor, materials, and tools to accomplish the Scope of the Work per the project documents. The Scope of the Work Includes, but is not necessarily limited to the following: - All Applicable Taxes - Compliance with all tax, licensing, permitting and reporting in the appropriate jurisdiction. - Subcontractor is responsible for all damages to existing and new materials caused by the Subcontractors operations. The Scope of work Excludes: The following are Alternates and Unit Prices: 2. SUBCONTRACT AMOUNT The Contractor agrees to pay the Subcontractor for satisfactory and timely performance and completion of the Subcontract Work:. Retainage shall be %. 3. ATTACHMENTS The following exhibits are made part of this Agreement: - Attachment A dated January 14, Fully executed on file? If no, Attachment A has been attached for signature. - Attachment B : Subcontract Documents, including drawings, specifications, addenda, general, and other conditions issued by the Design Professional as detailed. - Attachment C : Progress Schedule 4. WARRANTY Subcontractor warrants its work against all deficiencies and defects in materials and/or workmanship and agrees to satisfy same without cost to Owner or Contractor for a period of one (1) year from the date of Substantial Completion of the Project or per Contract Documents, whichever is longer. 5. SCHEDULE OF WORK Time is of the essence. Subcontractor shall provide Contractor with any requested scheduling information of Subcontractor's Work. The Schedule of Work, including that of this Subcontract shall be prepared by Contractor and may be revised as the Work progresses. Subcontractor recognizes that changes may be made in the Schedule of Work and agrees to comply with such changes without additional compensation. Subcontractor shall coordinate its work with all other contractors, subcontractors, and suppliers on the Project so as not to delay or damage their performance, work, or the Project. 6. CHANGES Contractor, without nullifying this Agreement, may direct Subcontractor in writing to make changes to Subcontractor's Work. Adjustment, if any, in the contract price or contract time resulting from such changes shall be set forth in a Subcontract Change Order pursuant to the Contract Documents. No adjustments shall be made for any changes performed by the Subcontractor that have not been ordered by the Contractor.

2 7. PAYMENT 7.1. SCHEDULE OF VALUES As a condition precedent to payment, the Subcontractor shall provide a schedule of values satisfactory to the Contractor not more than fifteen (15) days from the date of this Agreement PROGRESS AND FINAL PAYMENTS Progress payments, less retainage of %, shall be made to Subcontractor for Work satisfactorily performed no later than seven (7) days after receipt by Contractor of payment from Owner for Subcontractor's Work. Final payment of the balance due shall be made to Subcontractor no later than seven (7) days after receipt by Contractor of final payment from Owner for Subcontractor's Work. These payments are subject to receipt of such lien waivers, affidavits, warranties, and guarantees required by the Contract Documents or Contractor and other requirements as noted in Attachment A. 8. INSURANCE Prior to the start of Subcontractor's Work, Subcontractor shall procure and maintain in force for the duration of the Work, Worker's Compensation Insurance, Employer's Liability Insurance, Comprehensive General Liability Insurance and all insurance required of Contractor under the Contract Documents. Contractor, Owner and Architect shall be named as additional insureds on each of these policies, except for Worker's Compensation. Is a job specific insurance certificate required for this project?? If yes, please submit with the executed subcontract agreement and prior to starting work onsite. 9. BONDS Performance and Payment Bonds are not required of the Subcontractor. If required, such bonds shall be issued by a surety admitted in the state in which the Project is located and must be acceptable to the Contractor. The Contractor's acceptance shall not be withheld without reasonable cause. The penal sum of the Payment Bond and of the Performance Bond shall each be in the full Subcontract Amount. 10. LIMITED MUTUAL WAIVER OF CONSEQUENTIAL DAMAGES Except for any (a) liquidated, consequential, or other damages that the Owner is entitled to recover against the Contractor under the prime agreement, and (b) losses covered by insurance required by the Subcontract Documents, the Contractor and Subcontractor mutually waive all claims against each other for consequential damages, including damages for loss of business, loss of financing related to the Project, loss of profits not related to this Project, loss of bonding capacity, loss of reputation, or insolvency. Similarly, the Subcontractor shall obtain in another agreement from its subcontractors mutual waivers of consequential damages that correspond to the Subcontractor's waiver of consequential damages herein. The provisions of this section shall also apply to and survive termination of this Agreement. 11. NOTICE TO CURE AND TERMINATION FAILURE OF PERFORMANCE Should the Subcontractor fail to satisfy contractual deficiencies or to commence and continue satisfactory correction of the default with diligence or promptness within three (3) business days from receipt of the Contractor's written notice, then the Contractor, without prejudice to any right or remedies, shall have the right to take whatever steps it deems necessary to correct deficiencies and charge the cost thereof to the Subcontractor, who shall be liable for such payment, including reasonable overhead, profit, and attorneys' fees. In the event of an emergency affecting safety of persons or property, the Contractor may proceed as above without notice, but the Contractor shall give the Subcontractor notice promptly after the fact as a precondition of cost recovery TERMINATION BY OWNER Should the Owner terminate the prime agreement or any part which includes Subcontract Work, the Contractor shall notify the Subcontractor in writing within three (3) business days of termination and, upon written notification, this Agreement shall be terminated and the Subcontractor shall immediately stop the Subcontract Work, follow all of the Contractor's instructions, and mitigate all costs. In the event of Owner termination, Contractor liability to the Subcontractor shall be limited to the extent of Contractor recovery on the Subcontractor's behalf under the prime agreement. The Contractor agrees to cooperate with the Subcontractor, at the Subcontractor's expense, in the prosecution of any Subcontractor claim arising out of Owner termination and to permit the Subcontractor to prosecute the claim, in the name of the Contractor, for the use and benefit of the Subcontractor, or assign the claim to the Subcontractor TERMINATION BY CONTRACTOR If the Subcontractor fails to commence and satisfactorily continue correction of a default within three (3) business days after written notification issued under section 11.1, then the Contractor may, in lieu of or in addition to section 11.1, issue a second written notification to the Subcontractor and its surety, if any. Such notice shall state that if the Subcontractor fails to commence and continue correction of a default within seven (7) days of the written notification, the Agreement will be deemed terminated. A written notice of termination shall be issued by the Contractor to the Subcontractor at the time the Subcontractor is terminated. The Contractor may furnish those materials or equipment or employ such workers or subcontractors as the Contractor deems necessary to maintain the orderly progress of the Contractor's work. All costs incurred by the Contractor in performing the Subcontract Work and for any other breach of this Agreement, including reasonable overhead, profit, and attorneys' fees, costs, and expenses, shall be deducted from any monies due or to become due the Subcontractor. The Subcontractor shall be liable for payment of any amount by which such expense may exceed the unpaid balance of the Subcontract Amount. At the Subcontractor's request, the Contractor shall provide a detailed accounting of the costs to finish the Subcontract Work. 12. MISCELLANEOUS EXTENT OF AGREEMENT Except as expressly provided, this Agreement and Attachments as Noted in Article 3 is for the exclusive benefit of the Parties and not for the benefit of any third party. This Agreement represents the entire and integrated agreement between the Parties, and supersedes all prior negotiations, representations, or agreements, either written or oral. Page 2 of 12

3 12.2. ASSIGNMENT The Subcontractor shall not assign the whole or any part of the Subcontract Work or this Agreement without prior written approval of the Contractor. SUBCONTRACTOR SUN CONSTRUCTION & FACILITY SERVICES, INC. CONTRACTOR BY (Type or print signer s name and title) BY AUTHORIZED SIGNATURE AUTHORIZED SIGNATURE DATE DATE Subcontractor s Federal Tax ID Number: Please return one signed copy to: Sun Construction & Facility Services, Inc Boston Avenue, Longmont, CO Phone Fax - Contracts@sunconstruction.com IMPORTANT! - Please use the attached Application for Payment. All payment requests must be submitted on our form. Invoices should be sent to ap@sunconstruction.com Thank you! Page 3 of 12

4 Sun Construction & Facility Services, Inc. Attachment A Revised January 14, 2015 In consideration for Sun Construction & Facility Services, Inc. s agreement to do business with the Subcontractor and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, or if Subcontractor is identified as a subcontractor on a building permit issued to Sun Construction & Facility Services, Inc., Subcontractor acknowledges and agrees that the requirements set forth herein shall apply to all work performed by Subcontractor for Sun Construction & Facility Services, Inc. regardless of when or where the work is performed and regardless of the specific project on which the work is performed. This Agreement and all Contracts hereunder shall be governed and interpreted under the laws of the State of Colorado, and venue shall be maintainable in Boulder County, Colorado. Subcontractor hereby agrees that the terms of any other agreement between the parties will not extinguish or supersede the requirements set forth herein. CONTRACT PAYMENT Subcontractor s electronic monthly progress billings projected through the end of the month must be received in our office no later than the 25th of each month unless another date is specified in the contract. Failure to do so will result in your request for payment to be delayed 30 days, or until date of next draw, whichever comes first. Your first Payment Application must include a copy of your Schedule of Values for this Project. We will be withholding 10% retainage unless noted otherwise in the subcontract from each billing until the final punch list is complete and retainage is released to us. Payments will be made within seven days after we receive payment from the owner. All payment requests must be submitted on Sun Construction s Subcontractor s Application for Payment form to be accepted for payment. Your electronic invoice may be submitted to Sun Construction & Facility Services, Inc. via or fax. Paper invoices will not be accepted and will not be processed. Fax: E mail: AP@SunConstruction.com PAYMENTS WITHHELD The Contractor may reject a Subcontractor payment application or nullify a previously approved Subcontractor payment application, in whole or in part, as may reasonably be necessary to protect the Contractor from loss or damage based upon the following to the extent that the Subcontractor is responsible: (a) failure to timely perform the Subcontract Work, (b) failure to properly pay its subcontractors or suppliers, (c) failure to promptly correct rejected, defective, or nonconforming Subcontract Work, or (d) uninsured third party claims involving the Subcontractor or reasonable evidence demonstrating that third party claims are likely to be filed unless and until the Subcontractor furnishes the Contractor with adequate security in the form of a surety bond, letter of credit, or other collateral or commitment which are sufficient to discharge such claims if established. WAIVER OF CLAIMS Final payment shall constitute a waiver of all claims by the Subcontractor relating to the Subcontract Work, but shall in no way relieve the Subcontractor of liability for warranties, or for nonconforming or defective work discovered after final payment. PROJECT CLOSEOUT PROCEDURES Upon receiving the Sun Construction & Facility Services, Inc. Closeout Request Form, Subcontractors and Material Suppliers will be required to submit the required information, warranties, test reports, and as built drawings within 10 working days of stated date contained in the form. SUBMITTALS The Subcontractor shall begin the SUBMITTALS/ SHOP DRAWINGS process as directed by the Project specifications upon receipt of a Subcontract or Letter of Intent. JOBS WITH PERMITS IF THE PROJECT IS A PERMIT JOB IN WHICH CITY AND COUNTY TAX HAS BEEN COLLECTED AT THE TIME THE PERMIT WAS PURCHASED, SUBCONTRACTOR IS RESPONSIBLE FOR PAYING ALL OTHER APPLICABLE SALES TAXES. Additionally, Subcontractor, sub subcontractor, and major supplier will complete Project Cost Reconciliation Form (located on Sun s FTP site) upon completion of project. Page 4 of 12

5 ETHICS The Parties shall perform their obligations with integrity, ensuring at a minimum that each: (a) avoids conflicts of interest and promptly discloses any to the other Party; and (b) warrants that they have not and shall not pay nor receive any contingent fees or gratuities to or from the other Party, including their subcontractors, agents, officers, employees, or others for whom they may be liable, to secure preferential treatment. COMPLIANCE WITH LAWS The Subcontractor shall comply with all Laws at its own cost. The Subcontractor shall be liable to the Contractor for all loss, cost, or expense (including reasonable attorney fees), attributable to any acts or omissions by the Subcontractor, its employees, subcontractors, and agents for failure to comply with Laws, including fines, penalties, or corrective measures. SAFETY, HEALTH AND ENVIRONMENT Subcontractor agrees to use Sun Construction & Facility Services, Inc. s Environmental Health and Safety Manual as the minimum standard for all work performed. The Subcontractor agrees that this will be a critical contractual obligation for all work performed. In the event that the Subcontractor s Environmental Health and Safety standards exceed or is equal to Sun Construction s, then those standards will be acceptable. The Subcontractor shall keep the Project site clean and free from debris resulting from the Subcontractor s Work. The Subcontractor understands and agrees to report all accidents/incidents that occurred on a jobsite during the course of Subcontractor s performance of the work to the Contractor within 24 hours of the occurrence. INSURANCE AND INDEMNIFICATION Subcontractor shall maintain worker s compensation, general liability, automobile, and umbrella insurance for the minimum amount required by the general contract that this subcontract applies to or as outlined below, whichever limits and coverages are higher. Insurance certificates shall be provided. Attached to each certificate of insurance shall be a copy of the Additional Insured Endorsement that is part of the Subcontractor s Commercial General Liability Policy. These certificates and the insurance policies shall contain a provision that coverage afforded under the policies will not be cancelled or allowed to expire until 30 days prior written notice has been given to Sun Construction & Facility Services, Inc. The Owner, Architect, Engineer and Sun Construction & Facility Services, Inc. shall be named as an additional insured on a primary and non contributory basis on all liability and excess policies. Coverage for Sun Construction & Facility Services, Inc. shall include completed operations coverage. Minimum Required Insurance Limits (coverage on an occurrence basis): Subcontractor shall purchase and maintain at all times during the performance of this Contract the following types of insurance with minimum limits of liability as stated below. A. Workers Compensation for protection of Subcontractor, its owners, partners and employees as required by law and Employer s Liability Insurance with the following limits: 1. Each Accident $1,000, Each Occupational Disease $1,000, Occupational Disease Aggregate $1,000,000 B. Commercial General Liability Insurance (CGL) to include all operations under this Contract with limits set below and provide coverage as follows: occurrence form; ongoing operations; products and completed operations; personal injury liability, contractual liability; and broad form property damage. Minimum limits of liability provided by this coverage shall be: 1. General Aggregate $2,000, Products and Completed Operations Aggregate $2,000, Personal & Advertising Injury $1,000, Each Occurrence $1,000,000 Contractor and Owner shall be listed as an additional insureds, including without limitation for ongoing operations and products and completed operations. The insurance for the additional insureds shall be as broad as the coverage provided for the named insured. The insurance shall include a provision that such insurance afforded by the policy for the benefit of the additional insureds shall be primary and non contributory to any insurance or self insurance maintained by the additional insureds. The insurance shall include a Per Project Aggregate. Subcontractor shall maintain coverage for itself and all additional insureds for the duration of the project and maintain completed operations coverage required herein in full force and effect until the statute of limitations or statute of repose, whichever is longer, applicable to the Subcontractor s work has lapsed. C. Automobile Liability insurance covering the use, operation and maintenance of any automobiles, trucks, trailers, or other vehicles owned, hired, or non owned by Subcontractor providing bodily injury, including death, and property damage coverage. Minimum limits of liability provided by this coverage shall be: 1. Combined Single Limit: $1,000,000 Contractor and Owner shall be listed as an additional insureds. Such insurance shall be primary and non contributory to any insurance or self insurance maintained by the additional insureds. Page 5 of 12

6 D. Umbrella Excess Liability excess of the liability coverages listed above in the amount of $1,000,000. Contractor and Owner shall be listed as an additional insured. Such insurance shall be primary and non contributory to any insurance or self insurance maintained by the additional insureds. E. Subcontractor and its insurers, under all policies listed above, shall waive all rights of subrogation against Contractor and Owner. F. Insurance shall be obtained from a carrier authorized to do business in the jurisdiction in which the project is located and having a current A.M. Best rating of A VII or better. G. Subcontractor shall furnish Contractor with a certificate of insurance along with additional insured endorsements, primary and non contributory endorsements and waivers of subrogation, or, in Contractor s sole discretion, copies of the policies, evidencing that the required coverage has been obtained. Failure of Contractor to obtain a certificate of insurance shall not be deemed a waiver of any of the insurance requirements set forth herein nor will it be deemed a waiver of Contractor s rights for breach of this Contract. H. Each insurance policy shall state that Contractor will receive thirty (30) days prior written notice of any cancellation, non renewal, or material alteration of the policies. Indemnification: To the fullest extent permitted by law, Subcontractor shall indemnify, defend and hold harmless Contractor from and against claims, damages, losses and expenses, including but not limited to attorneys fees, arising out of or resulting from performance of the work, provided that such claim, damage, loss or expense is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property including loss of use resulting therefrom, but only to the extent caused in whole or in part by negligent acts or omissions of Subcontractor. RISK OF LOSS Except to the extent a loss is covered by applicable insurance, risk of loss or damage to the Subcontract Work shall be upon the Subcontractor until the Date of Substantial Completion, unless otherwise agreed to by the Parties. DISPUTE MITIGATION AND RESOLUTION A. CLAIMS RELATING TO CONTRACTOR The Subcontractor shall give the Contractor written notice of all claims within seven (7) days of the Subcontractor's knowledge of facts giving rise to the event for which claim is made; otherwise, such claims shall be deemed waived. All unresolved claims, disputes, and other matters in question between the Contractor and Subcontractor shall be resolved in the manner provided in this Agreement. B. DAMAGES If the prime agreement provides for liquidated or other damages for delay beyond the completion date set forth in this Agreement, and such damages are assessed, the Contractor may assess a share of the damages against the Subcontractor in proportion to the Subcontractor's share of responsibility for the delay. However, the amount of such assessment shall not exceed the amount assessed against the Contractor. Nothing in this Agreement shall be construed to limit the Subcontractor's liability to the Contractor for the Contractor's actual delay damages caused by the Subcontractor's delay. 1. CONTRACTOR CAUSED DELAY Nothing in this Agreement shall preclude the Subcontractor's recovery of delay damages caused by the Contractor. C. WORK CONTINUATION AND PAYMENT Unless otherwise agreed in writing, the Subcontractor shall continue the Subcontract Work and maintain the Progress Schedule during any dispute resolution proceedings. If the Subcontractor continues to perform, the Contractor shall continue to make payments in accordance with this Agreement. D. MULTIPARTY PROCEEDING The Parties agree, to the extent permitted by the prime agreement, that all Parties necessary to resolve a claim shall be Parties to the same dispute resolution proceeding. To the extent disputes between the Contractor and Subcontractor involve in whole or in part disputes between the Contractor and Owner, disputes between the Subcontractor and Contractor shall be decided by the same tribunal and in the same forum as disputes between the Contractor and Owner. E. DISPUTE MITIGATION THROUGH DIRECT DISCUSSION If a dispute arises out of or relates to this Agreement or its breach, the Parties shall endeavor to settle the dispute through direct discussion. Within five (5) business days, the Parties' representatives, who shall possess the necessary authority to resolve such matter and who shall record the date of first discussions, shall conduct direct discussions and make a good faith effort to resolve such dispute. F. MEDIATION Disputes between the Subcontractor and Contractor not resolved by direct discussion shall be submitted to mediation under the auspices of the Judicial Arbiter Group (JAG) of Denver, Colorado or, if JAG is no longer in existence, or if the parties agree otherwise, then under the auspices of a recognized established mediation service within the State of Colorado.. The Parties shall select the mediator within fifteen (15) days of the request for mediation. Engaging in mediation is a condition precedent to any form of binding dispute resolution. G. BINDING DISPUTE PROCESSES If neither direct discussions nor mediation successfully resolves the dispute, the Parties shall submit the matter to the binding dispute resolution procedure noted below: ARBITRATION Unless the Parties mutually agree otherwise in writing, all claims, disputes and matters in question arising out of, or relating to, this Agreement shall be decided by arbitration under the auspices of the Judicial Arbiter Group (JAG) of Denver, Page 6 of 12

7 Colorado or, if JAG is no longer in existence, or if the parties agree otherwise, then under the auspices of a recognized established mediation service within the State of Colorado.. This agreement to arbitrate shall be specifically enforceable under the prevailing arbitration law. An award entered in an arbitration proceeding shall be final, and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction. 1. COSTS The costs of any binding dispute resolution procedures and reasonable attorneys fees shall be borne by the nonprevailing Party, as determined by the adjudicator of the dispute. 2. VENUE The venue of any binding dispute resolution procedure shall be the location of the Project, unless the Parties agree on a mutually convenient location. 3. Neither Party may commence arbitration if the claim or cause of action would be barred by the applicable statute of limitations and statutes of repose had the claim or cause of action been filed in a state or federal court. Receipt of a demand for arbitration by the person or entity administering the arbitration shall constitute the commencement of legal proceedings for the purposes of determining whether a claim or cause of action is barred by the applicable statute of limitations. SUB S SUB CONTRACTORS & MAJOR SUPPLIERS At the request of Sun Construction and Facility Services, Inc., Subcontractor shall provide a list of sub subcontractors and major suppliers being used to provide services, equipment or materials on a specific project. This list must include contact information and must be provided prior to the release of the first payment for that project to the subcontractor. We automatically request 3rd tier subcontractor and supplier information for subcontracts that are awarded in excess of $100,000. Accounting Procedures, Lien Waivers, AIA G702 & G703, Project Cost Reconciliation, and other referenced documents can be viewed and downloaded on Sun Construction s FTP site. ftp://docs.sunconstruction.com user name: subcontractordocs case sensitive password: Subs2015 Subcontractor Company: Tax identification No. (TIN) Contractor License No., if applicable Signed: Printed: To be signed by a duly authorized representative of the subcontractor Date: Page 7 of 12

8 Sun Construction & Facility Services, Inc. Attachment B List of Drawings Sheet No. Title Date Page 8 of 12

9 Sun Construction & Facility Services, Inc. Attachment C Project Schedule Page 9 of 12

10 Sun Construction & Facility Services, Inc Boston Avenue Longmont, CO Phone: / Fax ap@sunconstruction.com Subcontractor s Application for Payment Date: Payment Request No. Sun Construction Project Number: Project Name: From: PHONE FAX Accounting Billing Period: thru 1. Original Contract Amount: $ Approved Change Orders: 2. No. $ 3. No. $ 4. No. $ 5. No. $ Total Revised Contract Amount (Items 1 thru 5): $ Gross Amount Completed to Date (Including Retainage): $ Less Prior Gross Billings (Including Retainage): $ Amount Billed This Application: $ Less 10% Retainage This Application: $ Payment Due This Application: $ For Sun Office Use Only Job Cost Code Category Retainage Y Approved Voucher N IMPORTANT! - All payment requests MUST be submitted on this form. Thank you! Page 10 of 12

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12 SUBCONTRACTOR INSURANCE COMPLIANCE STATEMENT Subcontractor: Project: The purpose of this form is to request your assistance in confirming that the insurance requirements contained in the Subcontract Agreement between your client and Sun Construction & Facility Services, Inc. has been met. Please answer each question by completing/checking the appropriate box: Yes No N/A Commercial General Liability Insurance (CGL) a. Does the CGL provide Additional Insureds for all indemnities, including for ongoing operations and completed operations? (Have you included copies?) b. Does the CGL General Aggregate limit apply separately to this project? c. Does the CGL provide coverage for: i. Explosion, Collapse and Underground Hazards (XCU)? ii. Contractual Liability? iii. Subsidence? iv. Residential or Habitational? Commercial Automobile Insurance Policy a. Does Commercial Automobile Policy cover liability arising out of Any Auto? b. Does Commercial Automobile Policy include all Indemnities as Additional Insured? Umbrella/Excess a. Are the Indemnities included as additional insureds on the Umbrella/Excess Policy? b. Do the Umbrella/Excess Liability Policy follow the form of the primary CGL, Commercial Automobile, and/or Employer s Liability Policies as applicable? Mandatory Provisions a. Is all insurance primary and noncontributory? b. Do the Subcontractor s CGL, Commercial Automobile, and WC policies include waivers of subrogation endorsements in favor of Contractor and other Indemnitees? c. Does Insurance Carrier have a current A.M. Best Rating of A-VII or better and have authority to do business in the jurisdiction of the project? Contractor requires this form to be completed for the purpose of ensuring Subcontractor s compliance with the insurance requirements contained in the Subcontract Agreement and is relying on the representations contained herein. I certify that I am an authorized agent or representative of each of the insurance companies providing insurance on behalf of the Subcontractor pursuant to the Subcontract Agreement, and I have the authority to execute this form. Signed: Print Name: SUBCONTRACTOR S INSURANCE REP. Firm Name: SUBCONTRACTOR S BROKER Telephone: Date: Title: Please Return to: Address: Page 12 of 12