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14-091.00 Spokane Rock Products: Appleway Street Preservation
Contract 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 amended and Spokane Rock Products,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: Appleway Blvd Street Preservation Project (Thierman Rd to Park Rd) SVPW Contract 14-028 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. City of Spokane Valley 11 Contract Forms Appleway Blvd St Preservation Project Bid No.: 14-028 p 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$ 2c141621145 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 C, S. 2.cL ,2014. Date C4v` Printed Name -ENS -Qs N`.A N -A-0' P Title - — 10• Signature City of Spokane Valley A L&/cron Printed Name ✓/i Arer /- City of Spokane Valley 12 Contract Fonns Appleway Blvd St Preservation Project Bid No.: 14-028 S`rrpo"kane�'r� 40000\Taller BOND NO: 106077369 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 Spokane Rock Products,Inc. (Contractor), as Principal, a contract for the construction of the project designated as the Annlewav Blvd Street Preservation Protect #0202, in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Travelers Casualty and Surety Company of America (Surety), a corporation organized under the laws connect icu r 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$ 294,624.45 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. Spf n c ONTRACTOR) SURETY Sp ane ck ducts, Inc-- Travelers asualty nd Surety Company of America (j.,.r� June 5, 2014 June 5, 2014 Principal Signature Date Surety Date 24:4"—,L kalrfrVP(tA"j Jar Haff _ Printed Name Printed Name '‘.\ N,A,(��D¢,(� Attorney-In-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Conover Insurance Services, LLC . , . 1804 W. Lewis Street Pasco, WA 99301 (509)545-3800 City of Spokane Valley 13 Contract Forms Appleway Blvd St Preservation Project Bid No.: 14-028 :-,a WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER 4 a POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company - Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 226761 Certificate No. 005715899 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company. St. Paul Guardian Insurance Company. St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa.and that Fidelity and Guaranty Insurance Underwriters,Inc..is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Pamela L.Thurman,Jacqueline F.Hernandez,JoHanna E.Zerb,Charles E.Hudon,Karen E.Alley,Jared Haff,Sarah Scott,and Ashley Stevens of the City of Pasco ,State of Washington ,their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above,to sign.execute,seal and acknowledge any and all bonds.recognizances.conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in theirrbusiness ofguaranteeing the fidelity of persons.guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or perniitiedfin anvactions or.proceedings allowed by law. �-" air ���v IN WITNESS WHEREOF,the Companies have caused this instmment to be sianed:and thea'wrporate seals to be hereto affixed.this 19th day of November , 2013 0,tk'(�j�; t�'� Farmington Casualty Com ny' 41/48,---� .{'f9�� St.Paul Mercury Insurance Company Fidelity and GuarantyrInsurance mpany.OS Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America • - St.Paul Fire and Marine Insurance Company United Slates Fidelity and Guaranty Company St.Paul Guardian Insurance Company pl.5 uxa` y}.•• i J 6; O�lM IMSV9 ,a.Ix5V9V q V pa��br‘ p�y�• VV- MMryryeervrv.�,,...�.. Q« RPOx1, 5 (, 8 --....,ray I ern Cp''""rF^1 _a +dt�+r_,ds ®b� `:.1951 �. seati.e 1. .3„0.4„„, s °�e- gf�� ,,r 1,o. a Sk 8+2?�:;, 9a. !� N' . Z �VS.ANNDI r�. �� r arJata -CrState of Connecticut By: /Pie '�if City of Hartford ss. Robert L.Raney. enior Vice President On this the 191h day of November 2013 ,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company. Fidelity and Guaranty Insurance Company.Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company.Travelers Casualty and Surety Company-Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company.and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. p,TET \ci a a J\ In Witness Whereof,I hereunto set my hand and official seal. ' `nft % w' • V� My Commission expires the 30th day of June,2016. * PIMA 2 Marie C.Tetreault,Notary Public CCP 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUTTHE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St. Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances.contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President.any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond.recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President.the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President.any Vice President. any Assistant Vice President,any Secretary.any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes.the undersigned,Assistant Secretary.of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc..St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company.Travelers Casualty and Surety Company of America,and United'States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Compari�es)wh*hich:is m fu➢force audleffec[and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and,affixed the-seals of said'Companies this 5th day of June .20 14. �S � �0�� 'Kevin E.Hughes,Assistant Sec tMiU4�TL 6 M ��TL pi Suq ��tu Ma fiWq. 'Mo 6 6�.ai ilk°Rroyinm �lcWr°Mifni Y, .'� E 1962 0 6�—.y§^" °" _ it i /Tilt � .fIU�`° 'a'ySEAL:+o! SBEL,'i ®� °'®� y rix I.w „°°s.,v 6'� Jal % : qa ,�! ate, p N' cc fsaw�. ie.._- as `Q , `°MI AMS` To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER .3. Spoka >.3/4' „0. walley° BOND NO: 1 oso771fi9 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County,has awarded to Spokane Rock Products, Inc. (Contractor),as Principal,a contact for the construction of the project designated as the Applewav Blvd Street Preservation Proiect#0202 in Spokane Valley, Washington, and said Principal is required under the tenns of the Contract to furnish a performance bond in accordance'with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Travelers Casualty and Surety Company of America (Surety), a corporation, organized under the laws of Connecticut 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$294,624.4 5 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 tens 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( NTRACTOR) SURETY Spokad cts, Inc. Travelers Casualty .end Surety Company of America June 5. 2014 " ,I s.-_ 014 Principa ature Date Surety ,..rt 'e Date , \ NeCI-- -rN dird Haff _ Printed Name Printed Name r 1)��' 1— NAAP— Attorney-In-Fact Title Title ,— Name,address,and telephone of local office/agent of Surety Company is: Conover Insurance Services, LLC 1804 W. Lewis Street Pasco WA 99301 (S091548-1800 City of Spokane Valley 14 Contract Fortes Appleway Blvd St Preservation Project Bid No.: 14-028 WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 226761 Certificate No. 005715903 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company.St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company.Travelers Casualty and Surety Company of America.and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut. that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa.and that Fidelity and Guaranty Insurance Underwriters.Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Pamela L.Thurman,Jacqueline F.Hernandez,JoHanna E.Zerb,Charles E.Hudon,Karen E.Alley,Jared Haff,Sarah Scott,and Ashley Stevens • of the City of Pasco ,State of Washington ,their true and lawful Attomey(s)-in-Fact. each in their separate capacity if more than one is named above,to sign,execute.seal and acknowledge any and all bonds.recognizances.conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or perniittediin anv:actions ouproceedings allowed by law. 41 } IN WITNESS WHEREOF.the Companies have caused this instmmen✓to e iggnned—randtheirrcorporate seals to be hereto affixed,this 19th day of November 2013 (c-V4 �{^1' Farmington Casualty Company' �_Q� Q9 St.Paul Mercury Insurance Company Fidelity and Guarantylastrrance Conhpauy,O Travelers Casualty and Surety Company • Fidelity and Guaranty Insuisance Underwriters,Inc. Travelers Casualty and Surety Company of America • St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company j cestmc d,eaa,�l Y „WI':Tni J 6 y ��lM YS49 jP\,N549�f JN\l Hp ��yglD,� 4 nlfY.(� Fob tin DIED"van�e.m ,pa 4i:,ni IFni Hwnmxf•. 4lFn10. s ` X9$1 Y - �� : EAL / " +yr ° �E ''4c.x,`• �isrx+aft t�:SBALp ca+ra/' 9y mwaa e- i State of Connecticut By: �0%) it / City of Hartford ss. Robert L.Raney. enior Vice President On this the 19th day of November 2013 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc..St.Paul Fire and Marine Insurance Company.St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company.Travelers Casualty and Surety Company.Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do.executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. i. In Witness Whereof,I hereunto set my hand and official seal. ' `TAR `• `5.w" v . � My Commission expires the 30th day of June.2036. * PulatF `Mane C.Tetreault.Notary Public s 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,deli• ty and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recoenizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President.the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary.of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company.St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelit}and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Compadie?,)hich:is in`-full forceiand effect and has not been revoked. OSS A 4.s IN TESTIMONY WHEREOF,I have hereunto set my hand and:affixed theseais ofsaid.Cbmp''anies this 5th day of June ,20 14. Kevin E.Hughes,Assistant Sec r y GPSU4 0,0„Nno° NV NS NS y /t�1rya 0 19•62 o ®% _ _ i/c°aco"ret r•:�pvvoaarEsni ` L 6 i Y — zt xaarre� f \ +• ia�"•icFt° ya ba �'-SEAL�oe %,.SBEL < taM \oma/j@p's rM ark •_,..tr•^ \�d \ % +a N < ANt To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER - crnOFk „� 40...Valley BOND NO: 106077370 CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County,has awarded to Spokane Rock Products, Inc. ("Contractor"), as Principal, a contract for the construction of the project designated as Apnlewav Blvd Street Preservation Project #0202 (the "Contract") in Spokane Valley,Washington. The Principal,existing under and by virtue of the laws of the State of Washington and authorized to do business in the State of Washington,and Travelers Casualty and Surety Company of America organized and existing under the laws of the State of Connecticut and authorized to transact business in the State of Washington as Surety, are jointly and severally held and bound unto the City of Spokane Valley, hereinafter called Obligee, and are similarly held and bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW, in the penal sum of 5% of the Contract, which is Fourteen Thousand Seven Hundred Thirty One and 22/100 dollars ($ 14,731.22 ),plus 5%of any increases in the Contract amount that have occurred or may occur, due to change orders, increases in the quantities, or the addition of any new item of work. WHEREAS, on the 28th day of May , 2014, the said Principal and Obligee herein executed and entered into the Contract. WHEREAS, said Contract and chapter 60.28 RCW require the Obligee to withhold from the Principal the sum of 5% from monies earned by the Principal on estimates during the progress of the construction,hereinafter referred to as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under chapter 60.28 RCW. NOW THEREFORE, the condition of the obligation is such that the Principal and Surety are held and bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW in the aforesaid sum. This bond,including any proceeds therefrom,is subject to all claims and liens and in the same manner and priority as set forth for retained percentages in chapter 60.28 RCW. The condition of this obligation is also such that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund purposes of chapter 60.28 RCW to the Obligee, and indemnify and hold the Obligee harmless from any and all loss,costs,and damages that the Obligee may sustain by release of the earned retained funds to the Principal, then upon notification of such satisfaction and release of the Surety by the Obligee,this obligation shall be null and void. City of Spokane Valley 15 Contract Forms Appleway Blvd St Preservation Project Bid No.: 14-028 ce PROVIDED HOWEVER,that: 1. The Surety shall be liable under this obligation as Principal. The Surety will not be discharged or released from liability for any act, omission or defenses of any kind or nature that would not also discharge Principal. 2, This obligation shall be binding upon and inure to the benefit of the Principal, the Surety, the Obligee, the beneficiaries of the trust fund created by chapter 60.28 RCW and their respective heirs,executors, administrators,successors and assigns. 3. Any suit under this bond must be instituted within the time provided by applicable law. 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. PRkNCIPAL NTRACTOR) SURETY Spbka ock .o ucts, Inc. Travelers Ca ualty aTi41 Surety Company of America June 5, 2014 /x/y}/ June 5, 2014 Principal Signature Date Surety 1 attire Date w7) Jared Haff Printed Name Printed Name '1- IL/kit Attorney-In-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Conover Insurance Services, LLC 1804 W. Lewis Street Pasco, WA 99301 (509)545-3800 City of Spokane Valley 16 Contract Forrns Appleway Blvd St Preservation Project Bid No.: 14-028 WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERS,, Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 226761 Certificate No. 005715900 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company. St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the'State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Pamela L.Thurman,Jacqueline F.Hernandez,JoHanna E.Zerb,Charles E.Hudon,Karen E.Alley,Jared Haff,Sarah Scott,and Ashley Stevens • of the City of Pasco ,State of Washington ,their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above,to sign.execute.seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their,business ofguaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or per iitted'-in anvract`ions or.pmceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrummen�to be signed3andtheiorporate seals to be hereto affixed,this 19th day of November . 2013 C � ' Farmington Casualty Comp tit ' O {2 yt St.Paul Mercury Insurance Company • Fidelity and Guaranty Insurance Companv'0 Travelers Casualty and Surety Company Fidelity and Guaranty Insur oce Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company ' St.Paul Guardian Insurance Company u„ /et'''. � 144 gg- {t•/ +4 0'Ni04rL9 y,mP�.,N54P 9i,.1 h0 ,1/41,1"210) 8q9�62� i Bra lid U ue en i 4gavvarr_n• HAFno66 at4lf01n.BV VIP 4s`'*xcr�Ya° �b X957 c1c �.SEAL:to ! SSALjE' \ """' o r �q��,°-yl State of Connecticut By: C' rte'f/ City of Hartford ss. Robert L.Raney. enior Vice President On this the 19th day of November 2013 ,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. p•TET In Witness Whereof,I hereunto set my hand and official seal. ' 'TAq W w" C • My Commission expires the 30th day of June,2016. * Abat10 * Marie C.Teneault,Notary Public 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company.fidelity_.. and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking.and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is h FURTHER RESOLVED.that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED.that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond.recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President.any Vice President. any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I.Kevin E.Hughes.the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and r Surety Company.Travelers Casualty and Surety Company of America,and Umi[ed�S[a[es Fidelitcand Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said CompaAies-Ahrch:is in full force and effect and has not been revoked. StiP*7120SPI 4•11,' CC IN TESTIMONY WHEREOF,I have hereunto set my hand and'affixed the-seals of"said'Comp'anies this 5 t,,h day of June .201±. <stict. VC "Kevin/E HugheAssistant Sec tary • 1' h eiaciA �Zr A g t1t _ !'iM•r>� :O.i.T.%rIo;nF e 1982 0 — hL a/ i`l°P°IP.�"X"S_Yr9en '��Jrsirµ Q.ee �W1dp. Y ssap \Te• - 1951 -�SExcie3 ,S8ELr con'. S u® %.I dY .eSs ' To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. • WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER _ - • ® A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYYI 6/5/2014 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). PRODUCER 22a°CT Jacqueline Hernandez, ACSR Conover Insurance PHONE0 Fre' (509)545-3800 FAX /AIX Nal:1509)547-7960 /AIC N 1804 West Lewis Street AIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL A Pasco WA 99301 INSURER A American Economy Insurance Co. 19690 INSURED INSURERBAmerlcan Guarantee & Liab Ins 26247 Spokane Rock Products Inc. INsuRERc:Houston Casualty Company 42374 P.O. Box 3808 INsuRERD:Great American Insurance Co 16691 INSuRERE:Zurich American Insurance Co 16535 Spokane WA 99220 INSURER F: COVERAGES CERTIFICATE NUMBER:2014-2015 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 TYPE OF INSURANCE ADDLSUBR POUCYEFF POLICY EXP UMITS LTR INSR MD POLICY NUMBER IMMIDD/YYYY) IMrNDD/YYYY1 GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 ✓ -DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES fEa ocwnencel $ 200,000 A CLAMS-MADE X OCCUR 01CI74054110 1/1/2014 1/1/2015 MED EXP(Any one person) S 10,000 X Contractual PERSONAL B ADV INJURY S 1,000,000 X Includes X, C, V GENERAL AGGREGATE $ 2,000,000 ."--- GEM_ GEN'L AGGRE�GATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG 5 2,000,000 (/ 7 POLICY I h I ff 6 f LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Eaac[Nenp 5 1,000,000 fr— X ANY AUTO BODILY INJURY(Per person) 5 B ALLOWNED SCHEDULED BAP378494000 1/1/2014 1/1/2015 BODILY INJURY(Per acodent) 5 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) 5 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAB CLAMS-MADE AGGREGATE $ 4,000,000 DED RETENTIONS R14XC5029500 1/1/2014 1/1/2015 S A WORKERS COMPENSATION X WC TOC STAT - OTH- FR AND EMPLOYERS'UABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN NIA E.L EACH ACCIDENT 5 1,000,000 V (MandatoryOFFICERIMEMBER in NH) 01C174054110 01CI74054110 1/1/2014 1/1/2015 EL DISEASE-EA EMPLOYEE 5 1,000,000 I' RINH) If yes,clescnbe under DESCRIPTION OF OPERATIONS below NA STOP GAP E.L.DISEASE-POLICY LIMIT S 1,000,000 ✓ A CONTRACTORS POLLUTION 01CI74054110 1/1/2014 1/1/2015 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD WI,Additional Remarks Schedule,if more space is required) Company D, Excess Liability, Policy #TUE066081300, 1/1/2014 to 1/1/2015, $5,000,000. Company E: Multi-State Workers Compensation/Employers Liability, Policy #WC932718001, 1/1/2014 to 1/1/2015, $1,000,000. RE: Appleway Blvd Street Preservation Project (Thierman Rd to Park Rd) , SVPW Contract 14-028. City of Spokane Valley and its officers, elected officials, employees, agents, and volunteers are additional insured."If required by written agreement: Business Auto additional insured applies per attached blanket Form #UCA424ECW (04-11) . Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09. CERTIFICATE HOLDER CANCELLATION (509)921-1008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave Suite 106 AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99206 �,,,,��,,�o J Hernandez, ACSR/JAC cAZQ i�7'—" ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninnclm The ACr1Rn name anal Innn are ranicterad marks of Amnon • COMMENTS/REMARKS Per-Project Agg per Form WE 25 03 05 09. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. 0 Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I.Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Liability Coverage: The following are also"insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an"auto" referenced in Paragraphs a.and b. above. d. Any person(s) or organization(s) where required by written contract or written agreement executed prior to any"accident" provided the"accident" arises out of operations contemplated by such contract or agreement. 2. The following is added to the Other Insurance Provision in the Conditions Section: Coverage for any person(s) or organization(s) where required by written contract or written agreement executed prior to any "accident" will apply on a primary basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the coverage form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4)of the Coverage Extensions Provision in Section II—Liability Coverage are replaced by the following: (2) Up to$5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the"insured"at our request, including actual loss of earnings up to$500 a day because of time off from work. C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II —Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. U-CA-424-E CW(04-11) Page 1 of 5 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total"loss"to a covered"auto",we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. Any amount paid under the Physical Damage Coverage Section of the coverage form; and b. Any: (1) Overdue lease or loan payments at the time of the"loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous leases or loans. F. Towing and Labor The following is added to Paragraph A.2. of the Physical Damage Coverage Section: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible will be $100 or the deductible shown in the Declarations, whichever is less. If glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Loss Of Use Expenses Provision of the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto" (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered"auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is$100 per day,to a maximum of$3000. I. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to $750 for"loss"to personal effects which are: (1) Personal property owned by an"insured"; and U-CA-424-E CW(04-11) Page 2 of 5 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. (2) In or on a covered"auto". b. Subject to Paragraph a. above, the amount to be paid for"loss"to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same"loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form do not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an"insured"; and (b) Are in a covered "auto"at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such"loss". K. Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV— Physical Damage Coverage in the Motor Carrier Coverage Form do not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or coverage form and by another policy or coverage form issued to you by us, the following applies for each covered "auto"on a per vehicle basis: 1. If the deductible on this policy or coverage form is the smaller(or smallest)deductible, it will be waived; or 2. If the deductible on this policy or coverage form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller(or smallest) deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered"autos"damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all"loss"from any one cause is$5,000. U-CA-424-E CW(04-11) Page 3 of 5 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. N. Temporary Substitute Autos—Physical Damage 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos—Physical Damage If Physical Damage Coverage is provided by this coverage form on your owned covered "autos", the following types of vehicles are also covered"autos"for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto"you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. "Loss"; or 5. Destruction. 2. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos—Physical Damage We will pay the owner for"loss"to the temporary substitute"auto" unless the"loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner,we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. O. Amended Duties In The Event Of Accident,Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of"accident", claim, "suit"or"loss", you must give us or our authorized representative prompt notice of the"accident", claim, "suit"or"loss". However, these duties only apply when the"accident", claim, "suit" or "loss"is known to you (if you are an individual), a partner(if you are a partnership), a member(if you are a limited liability company) or an executive officer or insurance manager(if you are a corporation). The failure of any agent, servant or employee of the"insured"to notify us of any"accident", claim, "suit"or"loss"shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the"accident"or'"loss"occurred and if a claim is made or"suit" is brought, written notice of the claim or"suit"including, but not limited to, the date and details of such claim or"suit"; (2) The"insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident",claim, "suit"or"loss"to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident"or"loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. O. Employee Hired Autos—Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: U-CA-424-E CW(04-11) Page 4 of 5 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. (1) Any covered"auto"you lease, hire, rent or borrow; and (2) Any covered"auto" hired or rented under a written contract or written agreement entered into by an"employee"or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official's duties as respect their obligations to you. However, any"auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this coverage form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this coverage form; or (2) Make an error, omission, improper description of"autos"or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph (5)(a)of the Policy Period, Coverage Territory Condition is replaced by the following: (a) A covered"auto" is leased, hired, rented or borrowed for a period of 60 days or less; and T. Bodily Injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. All other terms and conditions of this policy remain unchanged. U-CA-424-E CW(04-11) Page 5 of 5 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED - (SECTION 1) IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY", "PROPERTY DAMAGE" OR "PERSONAL INJURY"; AND B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS OR OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES NOT QUALIFY AS AN ADDITIONAL INSURED WITH RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS LIMITED AS FOLLOWS: A. IN THE EVENT THAT THE LIMITS OF INSURANCE OF THIS COVERAGE PART SHOWN IN THE DECLARATIONS EXCEED THE LIMITS OF LIABILITY REQUIRED BY THE "WRITTEN CONTRACT REQUIRING INSURANCE" , THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- = MENT SHALL NOT INCREASE THE LIMITS OF INSUR- ANCE DESCRIBED IN SECTION III - LIMITS OF - INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL - INSURED DOES NOT APPLY TO "BODILY INJURY", "PROPERTY DAMAGE" OR "PERSONAL INJURY" - ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, ENGINEERING OR SURVEYING SERVICES, INCLUDING: i . THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP C-AG31-PRIRTWl-1901-0091.Y Page 2 of 2 C AG31-PRIN9E131A90<a092-Y • Libcrt�, COMMERCIAL GENERAL LIABILITY Northwest. CO 7900 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL12011185 This endorsement modities insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS,SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii . SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN THE "PRODUCTS—COMPLETED OPERA— TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES YOU TO PROVIDE SUCH COVERAGE FOR THAT ADDITIONAL INSURED, AND THEN THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED APPLIES ONLY TO SUCH "BODILY INJURY" OR "PROPERTY DAMAGE" THAT OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS EXCESS OVER ANY VALID AND COLLECTIBLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, IF THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES THAT THIS INSURANCE APPLY ON A PRIMARY BASIS OR A PRIMARY AND NON—CONTRIBU— TORY BASIS, THIS INSURANCE IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA— - TION AS A NAMED INSURED FOR SUCH LOSS, AND - WE WILL NOT SHARE WITH THAT "OTHER INSURANCE" . BUT THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT STILL IS EXCESS OVER ANY VALID AND COLLECTI— - BLE "OTHER INSURANCE", WHETHER PRIMARY, — EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 CG 7900 07 87 Papa 1 oI2 EP C-AG 31.PR IXS901.19"11p91Y Page 2 of 2 C-AG-31-PRINT001.190-009A-Y • Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 7900 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES 11_ 12011185 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENT1STS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: i . HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii . THE NAMES AND ADDRESSES OF ANY INJURED PERSONS AND WITNESSES; AND iii . THE NATURE AND LOCATION OF ANY INJURY OR DAMAGE ARISING OUT OF THE "OCCURRENCE" OR OFFENSE. B. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADDITIONAL INSURED, THE ADDITIONAL INSURED MUST: i . IMMEDIATELY RECORD THE SPECIFICS OF THE CLAIM OR "SUIT" AND THE DATE RECEIVED; AND ii . NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE RECEIVE WRITTEN NOTICE OF THE CLAIM OR "SUIT" AS SOON AS PRACTICABLE. C. THE ADDITIONAL INSURED MUST IMMEDIATELY SEND US COPIES OF ALL LEGAL PAPERS RECEIVED IN CONNECTION WITH THE CLAIM OR "SUIT", COOPERATE WITH US IN THE INVESTIGATION OR SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST THE "SUIT" , AND OTHERWISE COMPLY WIH ALL = POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE DEFENSE AND INDEMNITY OF ANY CLAIM OR "SUIT" TO ANY PROVIDER OF "OTHER INSURANCE" WHICH = WOULD COVER THE ADDITIONAL INSURED FOR A LOSS = WE COVER UNDER THIS ENDORSEMENT. HOWEVER, Mrs THIS CONDITION DOES NOT AFFECT WHETHER THE • INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA— • TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc., 1983 CG 7e 0D 07 87 Page 1 of 2 EP C AG31-PRINTW I-1904-009 sY Page 2 of 2 GPG31 PRINT001-1904004'V tLiberty COMMERCIAL GENERAL LIABILITY i9 Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3. ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS AND THE "PERSONAL INJURY" IS CAUSED BY AN OFFENSE COMMITTED: A. AFTER THE SIGNING AND EXECUTION OF THE CONTRACT OR AGREEMENT BY YOU; • B. WHILE THAT PART OF THE CONTRACT OR AGREEMENT IS IN EFFECT; AND C. BEFORE THE END OF THE POLICY PERIOD. Copyright, Insurance Services Office, Inc., 1983 CG79000787 Pag31o12 EP 4A W 1-PRI tRmI.190a4109i.r • Page 2 of 2 C-AG31-PRINT001.1904004&Y tt Liberty COMMERCIAL GENERAL LIABILITY N„°rth, ' ;,,.,. CG 24 04 05 04 POLICY NUMBER: WARIER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. - Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of "your work' done under a contract with that person Section IV — Conditions: or organization and included in the We waive any right of recovery we may have against "products-completed operations hazard". This waiver the person or organization shown in the Schedule applies only to the person or organization shown in above because of payments we make for injury or the Schedule above. • e Insurance Services Office,Inc.,2008 Wean and ria Saleco logo are registered Irademada dl SeleeoCorpw.tkn o GG24040509 EP C-aS I•PRINTIC1-191440714 Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 25 03 05 09 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECTS) • GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED 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 Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section I — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I —Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for Genera; Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit 2. The Designated Construction Project Gen- shown in the Declarations, such limits will be •• eral Aggregate Limit is the most we will pay subject to the applicable Designated Con- for the sum of all damages under Coverage struction Project General Aggregate Limit. A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or "property damage" included in the obligated to pay as damages caused by 'products-completed operations hazard", "occurrences^ under Section I — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section I — Coverage C, which = a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing "suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and *Insurance Services Office,Inc., 2008 ._ select and the&alma logo ere registered twde,na,tr of saltte(o,awailon CG2503050e Pagel oft EP C'AG31-PRI Nuel-I15t COSY 2. Such payments shalt not reduce any Desig- Aggregate Limit nor the Designated Construction hated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned, delayed, or abandoned and 'products-completed operations hazard' is pro- then restarted, or if the authorized contracting vided, any payments for damages because of • parties deviate from plans, blueprints, designs, "bodily injury" or 'propery damage" included in specifications or timetables, the project will still the 'products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section ill — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. • • Page 2 of 2 • C-AG31-PRlN11Cl C64- Th-Y OM Of 0415MNGTCP4 Department of Labor& Industries Certificate of Workers' Compensation Coverage June 5, 2014 WA UBI No. 602 082 495 L&I Account ID 1133,446-07 Legal Business Name [SPOKANE ROCK PRODUCTS INC l Doing Business As I SPOKANE ROCK PRODUCTS INC Workers'Comp Premium Status: Account is current. m. I Estimated Workers Reported Quarter 1 of Year 2014"51 to 75 Workers" . I(See Description Below) Account Representative ITO/CAROLYN CRAWFORD (360)902-4715 - Email: CRAI235@Ini.wa.gov Licensed Contractor? Yes I License No. SPOKARP990BH License Expiration 02/01/2016 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 51.16.190). r ©2-0 2 c A� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/23/2014 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). � PRODUCER CONTACT Jacqueline Hernandez, ACSR NAME: Conover Insurance IAIC.PHONEo Extl (509)545-3800 FAX (AIC,No): (509)547-7960 N 1804 West Lewis Street EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# I Pasco WA 99301 INsuRERAAmerican Economy Insurance Co 19690 INSURED INSURER B:American Guarantee & Liab Ins. 26247 . Spokane Rock Products Inc. INSURER C:Houston Casualty Company 42374 P.O. Box 3808 INsuRERo:Great American Insurance Co 16691 INSURERE:Zurich American Insurance Co 16535 Spokane WA 99220 INSURERF: COVERAGES CERTIFICATE NUMBER:2015-2016 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 TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 200,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR X 01CI74054120 1/1/2015 1/1/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —I POLICY X MT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED SAP378494001 1/1/2015 1/1/2016 AUTOS _ AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ C UMBRELLA LIAB OCCUR H15XC50295-01 1/1/2015 1/1/2016 EACH OCCURRENCE $ 4,000,000 D x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ TUE066081301 1/1/2015 1/1/2016 2nd Layer Excess $ 5,000,000 E WORKERS COMPENSATION WC932718002 1/1/2015 1/1/2015 x WC ST TU- OFR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N MULTI STATE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER in NH) EMBER EXCLUDED? N/A A (Mandatory O1CI74054120 1/1/2015 1/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below WASHINGTON STOP GAP E.L.DISEASE-POLICY LIMIT $ 2,000,000 A CONTRACTORS POLLUTION O1CI74054120 1/1/2015 1/1/2016 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) RE: Appleway Blvd Street Preservation Project (Thierman Rd to Park Rd) , SVPW Contract.14-028. City of Spokane Valley and its officers, elected officials, employees, agents, and volunteers are additional insured. Business Auto additional insured applies per attached blanket Form #UCA424ECW (04-11) . Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09. Per-Project Agg per Form #CG 25 03 05 09. CERTIFICATE HOLDER CANCELLATION (509)921-1008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 11707 E Sprague Ave Suite 106 Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE ' J Hernandez, ACSR/NAT c e4a-e-&"-o_- , , ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 ron,nn *n, That Amon nnnno,a.,.+Inn*.nro ro..ie+nrcrt.r.erlrc..f Aman 19—o11 9 Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Liability Coverage: The following are also"insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs a. and b. above. d. Any person(s) or organization(s) where required by written contract or written agreement executed prior to any"accident" provided the"accident"arises out of operations contemplated by such contract or agreement. 2. The following is added to the Other Insurance Provision in the Conditions Section: Coverage for any person(s) or organization(s) where required by written contract or written agreement executed prior to any "accident" will apply on a primary basis and any insurance maintained by the additional "insured"will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the coverage form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II—Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds(including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurredby the"insured"at our request, including actual loss of earnings up to$500 a day because of time off from work. C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II —Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. U-CA-424-E CW(04-11) Page 1 of 5 Inch,rice rnn,,rinhterl material of Ineswenn.Cen,iree(Wino. Inn ,with Re nermice inn uuiaaiUJvu a}!44!" 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Lia};uM a Japun Jan!Jp a;noy;iM paJiy Jo pa;uaJ apiyan a;o asn jo ssol Jo; Aed o; alglsuodsaa Alle6al sawooaq „paansui„ ue yolynn Jo; sasuadxa Aed ll!M am `a6ewea leolsAyd o;ny paJ!H JOd sasuadx3 asn;p ssoi :6uiMollo;eq}Aq peoeldeJ si uoRoas a6eaanoa a6ewea IeolsAgd eq;;o uolslnad sasuadx3 asn 40 ssoi ayl sasuadx3 asn jo ssoi paseaaoui—a6ewea IeolsAyd opny paa!H 'H 'peoeldaJ uey}Jay;eJ paJiedaJ ssel6 ay; 6ulney;o uol}do ay; anal no 'penleM aq illM algl}onpap ay} 'peoeldaa uey} Jay;ea paJiedaJ Allen}oe sl pue paJiedaJ aq ueo ssel6 ;l •ssal sl JanayoigM.'suoi}eaepaa eq; ui uMoys algi;onpap ay;J0 001,$ aq !pm alggonpap ay; 'peoeldai aq isnw ssel641 :uoi;oag a6eaano0 a6ewea IeolsAyd ay;;o •e•E•y ydea6eJed o; pappe sl 6u!Mollo;all a6eaanoa ssela papualx3 •9 ;uawalgeslp;o aoeld an pawaojJed aq }snw Jogel ay; 'JanaMoH 'palgeslp Si ads(}Ja6uassed a}enud ay; „o;ne„ paJanoo a awl; yoea paJJnoul S;SOO Fogel pue 6u!Mo}Jo; GL$ o}dn Aed ll!M aM :uol;oas a6eaanoa a6ewea IeolsAyd ay;;o•z y ydeJ6eJed o; pappe si 6u!Mollo;all aoge-I pue 6ulnnol •A .sueol Jo saseal snolnaJd WOJ;seoueleq rano-kuea (s) pue 'aseal Jo ueol • ay} y}iM paseyomd aoueJnsui A;l!igesip JO wappoe `y;leay 'eouemsul a;ll;lpal° 'sal;ueJJeM papua;xa Jo;s;soa (i,) 'Jossal ay}Aq pawn;@ ;ou s;isodap Ajunoas (E) 'a6eallw ON Jo aea; pue Je@M lewiouge 'asn anlssaoxa ao;@seal a Jepun pasodwl sagleued Ieloueuld (z) '„ssol„et-14;o awl}ay;}e s}uawled ueol JO @seal anpJanp (I.) • :Auy •q pue 'WJo;a6eJanoo ay;40 uogoaS a6eaanoa a6ewea IeolsAyd ay;Japun pied ;unowe Auy •e :ssal '„o;ne„ paJanoo a Jo;ueoi JO @seal ay; uo anp;unowe pledun Aue Aed ll!M aM '„o}ne„ paaanoo a o;„ssol„ le;o;a;o}Liana ay} ul a6eaanoa deo ueoi JO @seal :uol;oas a6eaanoa a6ewea leolsAyd ay};o uolslnoJd a6eaanoa ay}o} pappe sl 6uiMo11o;aQL a6eaanoa dea ueoi JO asea1 •3 .suogeJ;suowap A;IIi6e>lonJ}Jo o}ne Jay}o pue soapoJ){onJ}ao o}ne 'o} pa;lwll ;ou ;nq Ise Lions ';uana weJ6oJd A;a;es Janup e ui 6u4edlolped „so;ne„ paJanoo o; Aidde ;ou saop uolsnpxa slyl :wood @6eJ@n09 JepJea JO;OIN ay;;o a6eaan09 a6ewea IeolsiCgd — Al uol;oag ;o suolsnlox3 ay; ul •q•z ydeJ6eJed pue WJod a6eaanoa o;ny ssaulsn8 ay} 40 a6eaanoa a6ewea Ieolsi(yd — III uogoes ;o suolsnlox3 ay; ul 7 ydeJ6eJed o; pappe sl 6uIM0110; all •Z (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for"loss"to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same"loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form do not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". K. Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV— Physical Damage Coverage in the Motor Carrier Coverage Form do not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or coverage form and by another policy or coverage form issued to you by us, the following applies for each covered "auto" on a per vehicle basis: 1. If the deductible on this policy or coverage form is the smaller(or smallest) deductible, it will be waived; or 2. If the deductible on this policy or coverage form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller(or smallest) deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered "autos"damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss"from any one cause is $5,000. U-CA-424-E CW(04-11) Page 3 of 5 Inrinrice rnn,,rinhforl mefariol of Incnrenre Qan,irc.c(-Winn Inn ,n,ifh ife nermiceinn N. Temporary Substitute Autos— Physical Damage 1. The following is added to Section 1—Covered Autos: Temporary Substitute Autos— Physical Damage If Physical Damage Coverage is provided by this coverage form on your owned covered "autos", the following types of vehicles are also covered "autos"for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. "Loss"; or 5. Destruction. 2. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos— Physical Damage We will pay the owner for"loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. 0. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of"accident", claim, "suit"or"loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or"loss". However, these duties only apply when the"accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member(if you are a limited liability company) or an executive officer or insurance manager(if you are a corporation). The failure of any agent, servant or employee of the"insured"to notify us of any"accident", claim, "suit" or"loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the"accident" or"loss" occurred and if a claim is made or"suit" is brought, written notice of the claim or"suit" including,_but not limited to, the date and details of such claim or"suit"; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit" or"loss"to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or"loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos—Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: U-CA-424-E Cw(04-11) Page 4 of 5 I nrliirloe rnn,,rin hfarl moforiol of Ines,ronro Con,iroc(lffira Inr ,niifh ife nnrmiccinn (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee"or elected or appointed official with your permission while being operated within the course and scope of that "employee's"employment by you or that elected or appointed official's duties as respect their obligations to you. However, any"auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this coverage form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this coverage form; or (2) Make an error, omission, improper description of"autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph (5)(a)of the Policy Period, Coverage Territory Condition is replaced by the following: (a) A covered"auto" is leased, hired, rented or borrowed for a period of 60 days or less; and T. Bodily Injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. All other terms and conditions of this policy remain unchanged. U-CA-424-E CW(04-11) Page 5 of 5 Innlnrlee rnns,rinhforl m,forini of Inenr,nre Can,inoc(Win= Inn ,*,ifh ifc normiccinn � - Liberty COMMERCIAL GENERAL LIABILITY ff Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 1201 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED - (SECTION 1) IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY" , "PROPERTY DAMAGE" OR "PERSONAL INJURY"; AND B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS OR OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES NOT QUALIFY AS AN ADDITIONAL INSURED WITH RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS LIMITED AS FOLLOWS: A. IN THE EVENT THAT THE LIMITS OF INSURANCE OF THIS COVERAGE PART SHOWN IN THE DECLARATIONS EXCEED THE LIMITS OF LIABILITY REQUIRED BY THE "WRITTEN CONTRACT REQUIRING INSURANCE" , THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- = MENT SHALL NOT INCREASE THE LIMITS OF INSUR- emm ANCE DESCRIBED IN SECTION III - LIMITS OF EWA INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL EEE INSURED DOES NOT APPLY TO "BODILY INJURY" , ams "PROPERTY DAMAGE" OR "PERSONAL INJURY" ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, ENGINEERING OR SURVEYING SERVICES, INCLUDING: i . THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 oft EP GAG-3t-PRINT001.1904 091-Y 17. Page 2 of 2 C-AG-31-PRINT001.1994.0092-Y Liberty COMMERCIAL GENERAL LIABILITY r ' Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii . SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERA- TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES YOU TO PROVIDE SUCH COVERAGE FOR THAT ADDITIONAL INSURED, AND THEN THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED APPLIES ONLY TO SUCH "BODILY INJURY" OR "PROPERTY DAMAGE" THAT OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS EXCESS OVER ANY VALID AND COLLECTIBLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, IF THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES THAT THIS INSURANCE APPLY ON A ▪ PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBU- ..,:. TORY BASIS, THIS INSURANCE IS PRIMARY TO 552 "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL .r.' INSURED WHICH COVERS THAT PERSON OR ORGANIZA- • TION AS A NAMED INSURED FOR SUCH LOSS, AND WE WILL NOT SHARE WITH THAT "OTHER EE• S INSURANCE" . BUT THE INSURANCE PROVIDED TO 12;— THE ADDITIONAL INSURED BY THIS ENDORSEMENT STILL IS EXCESS OVER ANY VALID AND COLLECTI- BLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, MEE THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 CG79000787 Page lof2 EP C-AG31•PRINTe31.1904-0093•Y x • Page 2 of 2 C-AG-31-PRINTOW-1904- 94-Y • Liberty COMMERCIAL GENERAL LIABILITY As Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: i. HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii. THE NAMES AND ADDRESSES OF ANY INJURED PERSONS AND WITNESSES; AND iii . THE NATURE AND LOCATION OF ANY INJURY OR DAMAGE ARISING OUT OF THE "OCCURRENCE" OR OFFENSE. B. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADDITIONAL INSURED, THE ADDITIONAL INSURED MUST: i . IMMEDIATELY RECORD THE SPECIFICS OF THE CLAIM OR "SUIT" AND THE DATE RECEIVED; AND ii. NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE RECEIVE WRITTEN NOTICE OF THE CLAIM OR "SUIT" AS SOON AS PRACTICABLE. C. THE ADDITIONAL INSURED MUST IMMEDIATELY SEND US COPIES OF ALL LEGAL PAPERS RECEIVED IN CONNECTION WITH THE CLAIM OR "SUIT" , COOPERATE WITH US IN THE INVESTIGATION OR SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST THE "SUIT" , AND OTHERWISE COMPLY. WIH ALL POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE pp DEFENSE AND INDEMNITY OF ANY CLAIM OR "SUIT" TO ANY PROVIDER OF "OTHER INSURANCE" WHICH EEE WOULD COVER THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, Mai THIS CONDITION DOES NOT AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER " INSURANCE" AVAILABLE TO THE ADDITIONAL EEE INSURED WHICH COVERS THAT PERSON OR ORGANIZA- = TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Paget of 2 EP C-AG31-PRIMTo 1.190a•0095.Y X Page 2 of 2 C-AG•31-PR INT001-1904 0096-Y liberty COMMERCIAL GENERAL LIABILITY G ` Northwest. CG 79 00 07 87 .'dn dtTrt4Ratlp THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3. ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS AND THE "PERSONAL INJURY" IS CAUSED BY AN OFFENSE COMMITTED: A. AFTER THE SIGNING AND EXECUTION OF THE CONTRACT OR AGREEMENT BY YOU; B. WHILE THAT PART OF THE CONTRACT OR AGREEMENT IS IN EFFECT; AND C. BEFORE THE END OF THE POLICY PERIOD. m▪om imm- m Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 B7 Page 1 of 2 EP C-AG-31-PR5T *.19pa.W97-Y • x • Page 2 of 2 C-AG-31-PAINTOD1-19x4-00911-Y • tp-Liberty COMMERCIAL GENERAL LIABILITY Nord ierst. CO 24 04 05 09 POLICY NUMBER: WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. Information required to complete this Schedule, it not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of "your work" done under a contract with that person Section IV — Conditions: or organization and included in the "products-completed operations hazard". This waiver We waive any right of recovery we may have against applies only to the person or organization shown in the person or organization shown in the Schedule the Schedule above. above because of payments we make for injury or insurance Services Office, Inc., 2008 Safeco and the Salem logo ere reg lered fradernarls of Soleco Corpotatlon .- CG24040509 EP FAG31 PRINi1701-19040071-Y r WA,Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 25 03 05 09 ..,,m.N",..:.:,..m POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) -GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED 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 Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section 1 — Coverage A, Such payments shall not reduce the General • and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I —Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit 2. The Designated Construction Project Gen- subject to the applicable Designated shown in the Declarations, such limits will be eral Aggregate Limit is the most we will pay Con- struction Project General Aggregate Limit. for the sum of all damages under Coverage A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or `property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section i -- Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section I — Coverage C, which a. Insureds; cannot be attributed only to ongoing operations seas.* at a single designated construction project shown .... b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing "suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and Insurance Services Office, inc., 2008 Sateen and the Safeco logo are registered trademarks of Seleno Corporation CG 25 93 05 09 Page 1 of 2 EP C-AC-3tARINTiX11-19174 T5.Y • 2. Such payments shall not reduce any Desig- Aggregate Limit nor the Designated Construction nated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned, delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, "bodily injury" or `propery damage" included in specifications or timetables, the project will still the "products-completed operations hazard" will be deemed to be the same construction project. • reduce the Product s-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section iti -- Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. • Page 2of2 C•AG•31•PRiHTD71-1904.OQ7t-Y