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14-080.00 NA Degerstrom: Girder Repair Bridge 4501Contract THIS AGREEMENT, made and entered into this 5 day of 2014, between the City of Spokane Valley under and by virtue of Title 35 RCW, as a ended and N.A. Degerstrom, Inc. Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Bridge #4501 Girder Repair Project SVPW Contract 14-017 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City of Spokane Valley by reason of entering onto this contract, except as provided herein. V. The project was awarded for the bid amount of $28,250.00. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor S/23 Date , 2014. (et c if 42l A. S (r -c2 Printed Name Title v, P,, 6/4(0\1E4R I NG Signature City of Spok e Valley Z� /e 4(1-,/ ,1 /iy rimed ignature Re. ised r) 19.13 Name City of Spokane Valley Agreement For Construction Services Bridge #4501 Girder Repair 2014 2 Bid No. 14-017 304029 ACORC1 CERTIFICATE OF LIABILITY INSURANCE DATE /20/2014 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 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). Commercial Lines - (509) 358-3800 Wells Fargo Insurance Services USA, Inc - CA Lic#: OD08408 601 West Main Street, Suite 1400 Spokane, WA 99201-0635 CONTACT Dani II rarrollPRODUCER NAME PHONE - FAX 866 510-9588 IA/C No Fxt) (509 ) 3583979 IAIC No): ( ) AE-MAIDDREL e.camo ellsfa o.com SS: danielle.carroll@wellsfargo.com INSURER(S) AFFORDING COVERAGE NAIL k INSURER A: Alaska National Insurance Company 38733 INSURED N A Degerstrom, Inc. PO Box 770 Veradale, WA 99037-0770 INSURER B B. National Fire and Marine Insurance Co 20079 INSURER C : 06/30/2014 INSURER D : S 1,000.000 INSURER E: 5 100,000 INSURER F : CERTIFire Tr NUMBER: 77433 REVISION NUMBER: See below V 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. ILSR LTR TYPE OF INSURANCE ADSL INSD SUER SND POLICY NUMBER (MOMIDDDYEFF NYYYI EXP IMMIDDNYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY 13FPS09101 06/30/3013 06/30/2014 EACH OCCURRENCE S 1,000.000 DAMAGE TO RENTED PREMISES (Ea oaunence) 5 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) 5 5,000 X WA/WY Stop Gap PERSONAL P. ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY OTHER X LIMIT APPLIES JECT PER LOC PRODUCTS - COMP/OPAGG $ 2,000,000 WA/WY Stop Gap $ 1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 13FAS09101 06/30/2013 06/30/2014 COMBINED SINGLE LIMIT (Ea acodentl s 1,000,000 BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) S S B X UMBRELLA LIAR EXCESS UAB X OCCUR CLAIMS -MADE 42XSF10001701 06/30/2013 06/30/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,(100,000 S DED X RETENTIONS 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, (Mandatory in NH) SsCIeONuOnOPERATIONSbeIOW y / N NIA PER STATUTE I OOTH ER E L EACH ACCIDENT 5 E L DISEASE- EA EMPLOYEE S EL DISEASE - POLICYLIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached it more space h required) RE'Bridge #4501 Girder Repair 2014, SVPW Bid No. 14-017 - AN IC GL 1061 03 08 CG25030509 City of Spokane Valley is included as an additional insured, insurance is primary and non contributory, per project aggregate applies per forms attached as required by written contract as respects General Liability coverage. CANCELLATION City of Spokane Valley 11707 E. Sprague #106 Spokane Valley, Washington 99206 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 The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101) Ions wWW s ,a� ts 7531055 Issued on 3aM 1Rai -2014 ACORD CORPORATION. All rights reserved. Alaska National INSURANCE COMPANY ADDITIONAL. INSURED (CONTRACTORS) - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Who Is An Insured (Section II) is amended to include as an insured any person or organization (herein referred to as an additional insured), but only if you are required to add that person or organization as an insured to this policy by a written contract that is in effect prior to the "bodily injury", "property damage", or "personal and advertising injury". 2. The insurance provided to the additional insured is limited as follows: a. That person or organization is only an additional insured if, and only to the extent that, the injury or damage is caused by negligent acts or omissions of you or your subcontractor in the performance of your work" to which the written contract applies. The person or organization does not qualify as an additional insured with respect to injury or damage caused in whole or in part by independent negligent acts or omissions of such person or organization. b. The insurance provided to the additional insured does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: i. the preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design or specifications; and ii. supervisory, inspection, or engineering services. c. The insurance provided to the additional insured, referred to in paragraph 1. of this endorsement, does not cover "bodily injury' or "property damage" caused by your negligent acts and omissions in the performance of "your work" that occurs within the "products - completed operations hazard," unless the written contract, referred to in paragraph 1. of this endorsement, contains a specific requirement that you procure completed operations coverage or coverage within the "products -completed operations hazard" for the additional insured. However, even if coverage within the "products -completed operations hazard" is required by the written contract, such coverage is available to the additional insured only if the "bodily injury" or "property damage" occurs prior to the end of the time period during which you are required by the written contract to provide such coverage or the expiration date of the policy, whichever comes first. 3. If other valid and collectible insurance, whether on a primary, excess, contingent or any other basis is available to the additional insured for a loss we cover under this endorsement, then the insurance provided by this endorsement is excess over that other insurance. However, the insurance provided by this endorsement will be primary to other insurance on which the additional insured is a named insured for the covered loss if the written contract, referred to in paragraph 1. of this ANIC GL 1061 03 08 Page 1 of 2 Alaska National INSURANCE COMPANY endorsement, contains a specific requirement that this insurance be primary or primary and non- contributory. In that case we will not share with that other insurance on a pro -rata or other basis. If the other insurance available to the additional insured, whether on a primary, excess, contingent or any other basis, is coverage for which it has been named as an additional insured, then the coverage provided by this endorsement is excess over that other insurance. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement Is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured - Endorsement No. Countersigned By ANIC GL 1061 03 08 Page 2 of 2 Alaska National INSURANCE COMPANY DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All projects Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section 1 — Coverage A, and for all medical expenses caused by accidents under Section 1 — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated 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 Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 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 will be subject to the applicable Designated Construction Project General Aggregate Limit. CG 25 03 05 09 Page 1 of 2 Alaska National INSURANCE COMPANY B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section 1 — Coverage A, and for all medical expenses caused by accidents under Section 1 — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 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 Designated 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 General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or 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 111 — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Insured Countersigned By Policy No. Endorsement No. © Insurance Services Office, Inc., 2008 CG 25 03 05 09 Page 2 of 2 spot #Valley° BOND NO: 23026493 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to N.A. Deeerstrom, Inc. as Principal, a contract for the construction of the project designated as Bridge #4501 Girder Repair 2014 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and Liberty Mutual Insurance Company (Surety), a corporation, organized under the laws of Massachusetts and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley, as Obligee, in the sum of 28,250.00 total Contract amount (including Washington State sales tax), subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified; shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract; and if such performance obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL (CONTRACTOR) N.A. Degersjromc. a, /f 6/9/2014 Principal Signature R(c#A,Rh A-, syn4(2 Date Printed Name v, P, G -IA Ea NG Title '1 Signatufe Diana R. Williams Printed Name Attomey-in-Fact Title Name, address, and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W. Main, Suite 1400, Spokane, WA 99201 (509) 358-3800 City of Spokane Valley Agreement For Construction Services Bid No. 14-017 Bridge #4501 Girder Repair 2014 laners jvalley, BOND NO: 23026493 CONTRACTOR'S PAYMENT BOND (NON -FEDERALLY FUNDED PROJECT) to City of Spokane Valley, Washington The City of Spokane Valley, Washington. in Spokane County, has awarded to N.A. Degerstrom, Inc. as Principal, a contract for the construction of the project designated as Bridge #4501 Girder Repair 2014, in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to famish a payment bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and Liberty Mutual Insurance Company (Surety), a corporation organized under the laws Massachusetts and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley, as Obligee, in the sum of $28,250.00 total Contract amount (including Washington State sales tax), subject to the provisions herein. This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW, including all workers, laborers, mechanics, subcontractors, and materialmen, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work; and shall indemnify and hold harmless the Obligee from all loss, cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments; and if such payment obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. Pwsnigspimiv Principal Signature TOR) a i c .4RD Ar4 gQ 6/9/2014 Date SuretySignature Diana R. Williams 412_021 Date Printed Name Printed Name V, P. E,.I61n/ R�,J6- Title Attorney -in -Fact Title Name, address, and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W. Main, Suite 1400, Spokane, WA 99201 (509) 358-3800 City of Spokane Valley Agreement For Construction Services Bridge #4501 Girder Repair 2014 4 Bid No. 14-017 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No 6354893 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West Amencan Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire& Casualty Company and The Ohio Casualty Insurance Company we corporations duly organized under the laws of The State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duty organized under the laws of the Stale of Indiana (herein collectively caked the `Companies"), pursuant to and by authority herein set forth, does hereby name, constitute ad appoint Chris Larson; Diana R. Williams; Erin L. Repo; George C. Schroeder; H. Keith McNally; Heather Anderson; Kathy Gurley; W. W Weller; Wm Dinneen all of the city of Spokane state of WA each indr ndualty if there be more than one named, ds true ad Wvful attorney -lit -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and as undertakings, bonds, recognizances and other surety obigations, in pursuance of these presents aid shal be as binding upon the Companies as if They have been duly signed by the president aid attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscnbed by an authorized officer or official of the Companies and the corporate seats of the Companies have been affixed thereto this 19th day of November 2011 . i • f STATE OF PENNSYLVANIA ss COUNTY OF MONTGOMERY BY: American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company West American Insurance Company 4,"4117 - David M. Carey Assistant Secretary on t is 19th day of November 2013, before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authonzed so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the caporalions by himself as a duty authonzed officer. IN WITNESS WHEREOF, 1 have hereunto scbscribedlr7 and affaed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and yea first above written. 75, By: U Teresa Pastetla , Notary Public This Power of Attorney is made and executedputsuadioa 1b arthoorrity of the fokwmng By-laws and Authorizations ofAmencan Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Compaiy, aid NestAmmedsen insurance Company vAich resolutions are now in full force aid effect reading as follows: ARTICLE IV -OFFICERS- Section 12. Power ofAbomey Any officer or other official of the Corporation authorized for that purpose in tenting by the Chairman or the President, and subject to such imitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowidge ad dekveras surety any and all undertakings, bonds, recognizances and other surety obigabons. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. Wien so exerted, such insbumens shall be as binding as if signed by the President and attested to by the Secretory Any power or authority graded to any representative or attorney-in-fact under the previsions of this stick: may be revoked at any tine by the Board, the Chairman, the President or by the officer or offices granting such power or authority. ARTICLE XIII - Execution of Contracts - SECTION 5 Surety Bonds and Undertakings Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such laudations as the chairman or the president may prescnbe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the krnabons set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any sudi mstruumb aid to attach thereto the seal of the Company. Wen so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Compaq, authorizes David M Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to mance, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Connpaiys Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a cemted copy of any power of attomey issued by the Company in connection with surety bonds, shag be valid and biding upon the Company with the sam force and effect as though manually affixed I, Gregory W Davenport, the undersigned, Assistant Secretary, of Ataai,an Fire and Casualty Compaq, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, aid West American Insurance Company do hereby certify that the original power of Atemey of with the foregoing is a fuH, true and correct copy of the Power of Adomey executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set wry had and alined the seas of said Companies this 9th day of June 20 14 /� ti f �//(J/� 1 i By: y�' — r - LMS 128]3_122013 Gregory W Davenport, Assistant Secretary 91 of 250 N A DEGERSTROM I�iC https://secure.lni.wa.gov/verify/Details/liabilityCert ficate.aspx7UB... STATE OF -WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage WA UBI No. May 29, 2014 L81 Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative . Licensed Contractor? License No. License Expiration 328 042 324 2989000 N A DEGERSTROM INC N A DEGERSTROM INC Account is current. Quarter 1 of Year 2014 "51 to 75 Workers" T4 / MELVINA RAMSDELL (360)902-4814 - Email: RAMM235@Ini.wa.gov Yes DEGERNA375NO 07/02/2015 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51 .12.050 and 51.16.1 90). 1 of 1 5/29/2014 2:11 PM 304029 7 ® DATE(MM/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE r 6/25/2014 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(les) must 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). PRODUCER CONTACT Danielle Carroll NAME: Commercial Lines-(509)358-3800 PHONE FAX JA/C,No,Ext): (509)358-3979 (A/C,No): (866)510-9588 Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 E-MAIL o.comwellsfarllll i anee.carro ADDRESS: d@ g 601 West Main Street,Suite 1400 INSURER(S)AFFORDING COVERAGE _ NAIC ti Spokane,WA 99201-0635 INSURER A: Alaska National Insurance Company 38733 INSURED INSURER B: National Fire and Marine Insurance Co 20079 N.A.Degerstrom,Inc. RECEIVED JUL 01INSURER C: P�Box 770 2014 INSURER D: Veradale,WA 99037-0770 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 7889089 REVISION NUMBER: See below 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. INADDL LTR TYPE OF INSURANCE NSD sWVD POLICY NUMBER (MMIDDIYYUBR POLICY YY) (MMIDD/YYOLICY YY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 14FPS09101 06/30/3014 06/30/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrDAMAGE TO ence) $ 100,000 X WA/WY Stop Gap$1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE, LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA/WY Stop Gap $ 1,000,000 A AUTOMOBILE LIABILITY 14FAS09101 06/30/2014 06/30/2015 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS x AUTOS (Per accident) $ $ B UMBRELLA LIAB X OCCUR 42XSF100017-02 06/30/2014 06/30/2015 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVENIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CG 25 03 0509,ANIC GL 1061 0308 RE: Bridge#4501 Girder Repair 2014,SVPW Bid No.: 14-017 City of Spokane Valley is included as an additional insured,insurance is primary and non contributory,per project aggregate applies per forms attached as required by written contract as respects General Liability coverage. CERTIFICATE HOLDER CANCELLATION City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11707 E.Sprague#106 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Spokane Valley,Washington 99206 AUTHORIZED REPRESENTATIVE 9 44 1 005330 The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) (� Qil IIIIIII III VIII (III II II IIIIII IIII IIII VIII III I II II VIII ILII VIII ILII VIII III IIII 'CYB01A251002122/02106/0/0/010 If ^ ; Alaskananal INSURCE COMPANY DESIGNATED CONSTRUCTION PROJECT(S)GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All projects Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by ' damages or under Coverage C for medical "occurrences" under Section I — Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I — Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, except General Aggregate Limit shown in the damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard", and for medical General Aggregate Limit. 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". CG 25 03 05 09 Page 1 of 2 005331 11111 III IIII IIII I II I IIII VIII VIII II II VIII IIII VIII III I I III VIII HD IIII •creola2er002122ro3ro6/0/0roro• Alaska National , INSURANCE COMPANY B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard" is "occurrences" under Section I — Coverage A, and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury"or "property damage" included in the under Section I — Coverage C, which cannot be "products-completed operations hazard" will attributed only to ongoing operations at a single reduce the Products-completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned and under the General Aggregate Limit or the then restarted, or if the authorized contracting Products-completed Operations Aggregate parties deviate from plans, blueprints, designs, Limit,whichever is applicable; and specifications or timetables, the project will still be 2. Such payments shall not reduce any deemed to be the same construction project. Designated Construction Project General E. The provisions of Section III— Limits Of Insurance Aggregate Limit. not otherwise modified by this endorsement shall continue to apply as stipulated. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective 6/30/2014 Policy No. 14 FPS 0 9101 Insured N.A. Degerstrom, Inc. Endorsement No. Countersigned By ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 Page 2 of 2 005332 111 III II III II 10 11 II III 1111!III II 1111 III 0111 IIIII III II 11 II LII TYBOIn25/002122J04ro6ao,oro- I I Alaska National ' INSURANCE COMPANY ADDITIONAL INSURED (CONTRACTORS) - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Who Is An Insured (Section II) is amended to ii. supervisory, inspection, or engineering include as an insured any person or organization services. (herein referred to as an additional insured), but only if you are required to add that person or c. The insurance provided to the additional organization as an insured to this policy by a insured, referred to in paragraph 1. of this written contract that is in effect prior to the "bodily endorsement, does not cover"bodily injury" or injury', "property damage", or "personal and "property damage" caused by your negligent advertising injury". acts and omissions in the performance of "your work" that occurs within the "products- 2. The insurance provided to the additional insured completed operations hazard," unless the is limited as follows: written contract, referred to in paragraph 1. of this endorsement, contains a specific a. That person or organization is only an requirement that you procure completed additional insured if, and only to the extent operations coverage or coverage within the that, the injury or damage is caused by "products-completed operations hazard" for negligent acts or omissions of you or your the additional insured. However, even if subcontractor in the performance of "your coverage within the "products-completed work" to which the written contract applies. operations hazard" is required by the written The person or organization does not qualify contract, such coverage is available to the as an additional insured with respect to injury additional insured only if the "bodily injury" or or damage caused in whole or in part by "property damage" occurs prior to the end of independent negligent acts or omissions of the time period during which you are required such person or organization. by the written contract to provide such coverage or the expiration date of the policy, b. The insurance provided to the additional whichever comes first. insured does not apply to "bodily injury", "property damage", or "personal and 3. If other valid and collectible insurance, whether on advertising injury" arising out of an architect's, a primary, excess, contingent or any other basis, engineer's, or surveyor's rendering of or is available to the additional insured for a loss we failure to render any professional services cover under this endorsement, then the insurance including: provided by this endorsement is excess over that other insurance. However, the insurance provided i. the preparing, approving, or failing to by this endorsement will be primary to other prepare or approve maps, drawings, insurance on which the additional insured is a opinions, reports, surveys,change orders, named insured for the covered loss, if the written design or specifications; and contract, referred to in paragraph 1. of this ANIC GL 1061 03 08 Page 1 of 2 005333 (IIIIIII III Illi II IIll II l 1110 1111111 II II1111 111 III ILII IIIII III IIII 'CYB01A25/002122/05/06/0/0/0/0' ro " Alaska National „` INSURANCE COMPANY endorsement, contains a specific requirement that this insurance be primary or primary and non- contributory. In that case we will not share with that other insurance on a pro-rata or other basis. If the other insurance available to the additional insured, whether on a primary, excess, contingent or any other basis, is coverage for which it has been named as an additional insured, then the coverage provided by this endorsement is excess over that other insurance. • This endorsement changes the policy olic to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective 6/30/2014 Policy No. 14FPS09101 Insured N.A. Degerstrom, Inc. Endorsement No. Countersigned By • ANIC GL 1061 03 08 Page2of2 • 005334 01 0110 ILII 1111 I III 11010111 IIIA III 101011011 I cvsu,azs nuz,zzrosrosro,u,oro