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14-111.00 Clearwater Summit Group: Discovery Playground RenovationsCONSTRUCTION AGREEMENT Clearwater Summit Group, Inc. THIS CONSTRUCTIONAGREEMENT (the "Agreement") is made by and between the City of Spokane Valley, a code City of the State of Washington ("City") and Clearwater Summit Group, Inc., ("Contractor") jointly referred to as the "Parties". IN CONSIDERATION of the terms and conditions contained herein the Parties agree as follows: 1. Work to Be Performed. Contractor shall do all work and furnish all labor, supervision, tools, materials, supplies and equipment and other items necessary for the construction and completion of the Discovery Playground Renovations Project (the "Work") in accordance with the bid package and response thereto, and in accordance with this Agreement (which are by this reference incorporated herein and made part hereof (the "Contract Documents")), and shall perform any changes in the work in accordance with the Contract Documents. The terms and provisions in this Agreement shall control over any inconsistent or incompatible terms in any other Contract Document. Contractor shall, for the amount set forth in paragraph 4, below, assume and be responsible for the cost and expense of all work required for constructing and completing the Work and related activities provided for in the Contract Documents to City's satisfaction, within the time limits prescribed in the Contract Documents. The City Manager, or designee, shall administer and be the primary contact for Contractor. Upon notice from City, Contractor shall promptly commence work, complete the same in a timely manner, and cure any failure in performance under this Agreement. Unless otherwise directed by City, all work shall be performed in conformance with the Contract Documents, and all City, State and federal standards, codes, ordinances, regulations and laws as now existing or as may be adopted or amended. 2. Time for Performance. Contractor shall commence the Work within 10 days of receipt of a notice to proceed [or execution of this Agreement] and shall complete the Work within the times specified in the Contract Documents, as may be extended in accordance with this Agreement and the Contract Documents. 3. Compensation. In consideration of Contractor performing the Work, City agrees to pay Contractor in accordance with the Contract Documents the sum of $40,400.00, plus Washington State Sales Tax of $3,514.80, for a total of $43,914.80, based on the bid submitted by Contractor, and as may be adjusted in accordance with the Contract Documents. This total includes Project #1 Base Bid, Project #2 Base Bid and Project #2 Alternate Bid Item #1 plus Washington State Sales Tax. 4. Payment. Contractor may elect to be paid in monthly installments, upon presentation of an application for payment in a form satisfactory to City. Applications for payment shall be sent to the City Finance Department at the below stated address. Pursuant to Chapter 60.28 RCW, five percent of the compensation due Contractor shall be retained by City. City reserves the right to withhold payment under this Agreement which is determined in the reasonable judgment of the City Manager or designee to be noncompliant with the Contract Documents, City standards, City Code, and federal or state standards. Construction Agreement Page 1 of 6 5. Notice. Notice other than applications for payment shall be given in writing as follows: TO THE CITY: Name: Christine Bainbridge, City Clerk Phone: (509) 921-1000 Address: 11707 East Sprague Ave, Suite 106 Spokane Valley, WA 99206 TO THE CONTRACTOR: Name: Clearwater Summit Group, Inc. Phone: 509-482-2722 Address: P.O. Box 6470 Spokane, WA 99217 6. Applicable Laws and Standards. The Parties, in the performance of this Agreement, agree to comply with all applicable federal, state, and local laws, codes and regulations. 7. Certification Regarding Debarment, Suspension, and Other Responsibility Matters — Primary Covered Transactions. A. By executing this Agreement, the Consultant certifies to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; 2. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission or fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (A)(2) of this certification; and 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (federal, state, or local) terminated for cause or default. B. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this Agreement. 8. Prevailing Wages on Public Works. Contractor, any subcontractor, or other person doing work under this Agreement, shall comply with the requirements of RCW 39.12, and shall pay each employee an amount not less than the Prevailing Rate of Wage, as specified by the Industrial Statistician of the Washington State Department of Labor and Industries ("L&I"). If employing labor in a class not shown, Contractor shall request a determination of the correct wage rate for the class and locality from the Industrial Statistician. Contractor shall provide a copy of any such determinations to City. Before commencing, during, and upon completion of the work, Contractor shall file all forms and pay all fees required by L&I and shall indemnify and hold City harmless from any claims related to its failure to comply with RCW 39.12. The following information is provided pursuant to RCW 39.12.030: Construction Agreement Page 2 of 6 A. State of Washington prevailing wage rates applicable to this public works project, published by L&I are located at the L&I website address: https://fortress.wa.gov/lni/wagelookup/prvWagelookup. aspx B. This Project is located in Spokane County. C. The effective prevailing wage date is the same date as the bid due date as referenced in the original request for bids and as may be revised by addenda. A copy of the applicable prevailing wage rates is also available for viewing at the offices of City located at 11707 East Sprague, Suite 106, Spokane Valley, WA 99206. Upon request, City will mail a hard copy of the applicable prevailing wages for this project. 9. Relationship of the Parties. It is understood, agreed and declared that Contractor shall be an independent contractor, and not the agent or employee of City, that City is interested in only the results to be achieved, and that the right to control the particular manner, method and means in which the services are performed is solely within the discretion of Contractor. Any and all employees who provide services to City under this Agreement shall be deemed employees solely of Contractor. Contractor shall be solely responsible for the conduct and actions of all its employees under this Agreement and any liability that may attach thereto. 10. Ownership of Documents. All drawings, plans, specifications, and other related documents prepared by Contractor under this Agreement are and shall be the property of City, and may be subject to disclosure pursuant to RCW 42.56 or other applicable public record laws. 11. Records. The City or State Auditor or any of their representatives shall have full access to and the right to examine during normal business hours all of Contractor's records with respect to all matters covered in this Agreement. Such representatives shall be permitted to audit, examine and make excerpts or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and record of matters covered by this contract for a period of three years from the date final payment is made hereunder. 12. Warranty. Unless provided otherwise in the Contract Documents, Contractor warrants that all Work and materials performed or installed under this Agreement are free from defect or failure for a period of one year following fmal acceptance by City, unless a supplier or manufacturer has a warranty for a greater period, which warranty shall be assigned or transferred to City. In the event a defect or failure occurs in work or materials, Contractor shall, within the warranty period, remedy the same at no cost or expense to City. This warranty provision shall not be construed to establish a period of limitation with respect to Contractor's other obligations under this Agreement. 13. Contractor to Be Licensed And Bonded. Contractor shall be duly licensed, registered and bonded by the State of Washington at all times this Agreement is in effect. 14. Insurance. Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by Contractor, its agents, representatives, or employees. A. Minimum Scope of Insurance. Contractor shall obtain insurance of the types described below: 1. Automobile liability insurance covering all owned, non -owned, hired, and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute Construction Agreement Page 3 of 6 form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial general liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products - completed operations, stop gap liability, personal injury and advertising injury, and liability assumed under an insured contract. The commercial general liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of the commercial general liability insurance for liability arising from explosion, collapse or underground property damage. City shall be named as an insured under Contractor's commercial general liability insurance policy with respect to the work performed for City using ISO Additional Insured endorsement CG 20 10 10 01 and Additional Insured -Completed Operations endorsement CG 20 37 10 01 or substitute endorsements providing equivalent coverage. 3. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. B. Minimum Amounts of Insurance. Contractor shall maintain the following insurance limits: 1. Automobile liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial general liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate, and a $2,000,000 products -completed operations aggregate limit. C. Other Insurance Provisions. The insurance policies are to contain, or be endorsed to contain, the following provisions for automobile liability, professional liability and commercial general liability insurance: 1. Contractor's insurance coverage shall be primary insurance with respect to City. Any insurance, self-insurance, or insurance pool coverage maintained by City shall be excess of Contractor's insurance and shall not contribute with it. 2. Contractor shall fax or send electronically in .pdf format a copy of insurer's cancellation notice within two business days of receipt by Contractor. D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, Contractor shall furnish acceptable insurance certificates to City at the time Contractor returns the signed Agreement. The certificate shall specify all of the parties who are additional insureds, and will include applicable policy endorsements, and the deduction or retention level. Insuring companies or entities are subject to City acceptance. If requested, complete copies of insurance policies shall be provided to City. Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions, and/or self-insurance. Construction Agreement Page 4 of 6 15. Indemnification and Hold Harmless. Contractor shall, at its sole expense, defend, indemnify and hold harmless City and its officers, agents, and employees, from any and all claims, actions, suits, liability, loss, costs, attorney's fees and costs of litigation, expenses, injuries, and damages of any nature whatsoever relating to or arising out of the wrongful or negligent acts, errors or omissions in the services provided by Contractor, Contractor's agents, subcontractors, subconsultants and employees to the fullest extent permitted by law, subject only to the limitations provided below. Contractor's duty to defend, indemnify and hold harmless City shall not apply to liability for damages arising out of such services caused by or resulting from the sole negligence of City or City's agents or employees. Contractor's duty to defend, indemnify and hold harmless City against liability for damages arising out of such services caused by the concurrent negligence of (a) City or City's agents or employees, and (b) Contractor, Contractor's agents, subcontractors, subconsultants and employees, shall apply only to the extent of the negligence of Contractor, Contractor's agents, subcontractors, subconsultants and employees. Contractor's duty to defend, indemnify and hold City harmless shall include, as to all claims, demands, losses and liability to which it applies, City's personnel -related costs, reasonable attorneys' fees, and the reasonable value of any services rendered by the office of the City Attorney, outside consultant costs, court costs, fees for collection, and all other claim -related expenses. Contractor specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. These indemnification obligations shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under workers' compensation acts, disability benefit acts, or other employee benefits acts. Provided, that Contractor's waiver of immunity by the provisions of this paragraph extends only to claims against Contractor by City, and does not include, or extend to, any claims by Contractor's employees directly against Contractor. Contractor hereby certifies that this indemnification provision was mutually negotiated. 16. Waiver. No officer, employee, agent or other individual acting on behalf of either party has the power, right or authority to waive any of the conditions or provisions of this Agreement. No waiver in one instance shall be held to be waiver of any other subsequent breach or nonperformance. All remedies afforded in this Agreement or by law, shall be taken and construed as cumulative, and in addition to every other remedy provided herein or by law. Failure of either party to enforce at any time any of the provisions of this Agreement or to require at any time performance by the other party of any provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the validity of this Agreement or any part thereof. 17. Assignment and Delegation. Neither party shall assign, transfer, or delegate any or all of the responsibilities of this Agreement or the benefits received hereunder without first obtaining the written consent of the other party. 18. Confidentiality. Contractor may, from time to time, receive information which is deemed by City to be confidential. Contractor shall not disclose such information without the prior express written consent of City or upon order of a Court of competent jurisdiction. 19. Disputes. All disputes arising under or related to this Agreement that cannot be resolved through informal discussion and negotiations shall be resolved by litigation filed in the Superior Court for Spokane County, unless otherwise required by applicable federal or state law. 20. Subcontractor Responsibility. As required by RCW 39.06.020, Contractor shall verify responsibility Construction Agreement Page 5 of 6 criteria for each first tier subcontractor and its subcontractors of any tier that hires other subcontractors shall verify responsibility criteria for each of its subcontractors. Verification shall include that each subcontractor, at the time of subcontract execution, meets the responsibility criteria listed in RCW 39.04.350(1) and possesses an electrical contractor license, if required by chapter 19.28 RCW, or an elevator contractor license if required by chapter 70.87 RCW. This verification requirement must be included in every subcontract of every tier. 21. Jurisdiction and Venue. This Agreement is entered into in Spokane County, Washington. Venue shall be in Spokane County, State of Washington. 22. Entire Agreement. This Agreement constitutes the entire and complete agreement between the parties and supercedes any prior oral or written agreements. This Agreement may not be changed, modified or altered except in writing signed by the Parties. 23. Anti -kickback. No officer or employee of City, having the power or duty to perform an official act or action related to this Agreement shall have or acquire any interest in this Agreement, or have solicited, accepted or granted a present or future gift, favor, service or other thing of value from any person with an interest in this Agreement. 24. Business Registration. Prior to commencement of Work under this Agreement, Contractor shall register with the City as a business. 25. Severability. If any section, sentence, clause or phrase of this Agreement should be held to be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the validity of any other section, sentence, clause or phrase of this Agreement. 26. Exhibits. Exhibits attached and incorporated into this Agreement are: /� 1. 71 i p ILESPr�. 0,ee v it+s3v7 s. - %Ft.� nuictt./ j / M e csb 4,-.3,.....,,,rk- , G Ab 79 y 2. Insurance Endorsements The Parties have executed this Agreement this G ' ' day of July, 2014. CITY OF SPOKANE VALLEY: M a Jackson, Manager ATTEST. 11 Christine Bainbridge, City Clerk Construction Agreement Contractor: v Owner PN APPROVED AS TO FORM: (11.- `J "'attild Office 4the City ey Page 6 of 6 CLEAR -4 OP ID: SD ACORO' `...--- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/03/2014 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 Wheat & Associates Insurance P.O. Box 3548 Spokane, WA 99220-3548 Derek M Collett CONTACT PHOON:N (AHExt): FAX No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Co 10677 INSURED Clearwater Summit Group Inc Ruby Nee PO Box 6470 Spokane, WA 99217 INSURER B :AM Best Rating - A+ XV EPP0054856 INSURER C : 12/22/2014 INSURERD: $ 1,000,000 INSURER E : $ 500,000 INSURER F : $ 10,000 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 ADM MVD POLICY NUMBER EFF (MM/ DY/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X EPP0054856 12/22/2013 12/22/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. 7 POLICY X jE'r LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS EPP0054856 12/22/2013 12/22/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ $ A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE EPP0054856 12/22/2013 12/22/2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 $ DED X RETENTION $ 0 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTORY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFIC(Mandatory in NERH) EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A EPP0054856 WA STOP GAP 12/22/2013 12/22/2014 WC STATU- X OTH- LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Discovery Playground Renovations City of Spokane Vallye is Additional Insured pertaining to the General Liability per form GA233. Coverage is primary & non-contributory, and includes completed operations. Waiver of Subrogation applies. FAX TO: 509-688-0188 / Email to: mstone@spokane Valley.org CERTIFICATE HOLDER CANCELLATION City of Spokane Valley Parks & Recreation Dept 2426 N Discovery Place Spokane Valley, WA 99216 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage..................................................................... 2 2. Unintentional Failure to Disclose Hazards................................................................................ 7 3. Damage to Premises Rented to You 8 4. Supplementary Paymentsments........... ...... ......;......... ..... ......... ........ ...... ............ .....................� ............. 9 5. Medical Payments...................................................................................... 9 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.).. ... 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations .............................................. ......10 8. Waiver of Subrogation 10 9. Automatic Additional Insured - Specified Relationships* ............................... ... ............... 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions - Permits Relating to Premises; . • State or Political Subdivisions - Permits; and • Contractors' Operations 10. Broadened Contractual Liability - Work Within 50' of Railroad Property 14 11. Property Damage to Borrowed Equipment ................................ ................... .......... ...... .14 12. Employees as Insureds - Specified Health Care Services: .. .......... .... . ....... . ... ................... ... .. 14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence „•,,.••••• 14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance Services Office, Inc., with its permission„ Page 1 of 15 GA 233 02 07 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: 1. Employee Benefit Liability Coverage a. The following is added to SECTION 1 - COVERAGES: Employee Benefit Liability Coverage. (1) GA 233 02 07 Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as dam- ages caused by any act, er- ror or omission of the in- sured, or of any other per- son for whose acts the in- sured is legally liable, to which this insurance ap- plies. We will have the right and duty to defend the in- sured against any "suit" seeking those damages. However, we will have no duty to defend against any "suit" seeking damages to which this insurance does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or "suit" that may re- sult. But: 1) The amount we will pay for damages is limited as described in SEC- TION III - LIMITS OF INSURANCE; and 2) Our right and duty to defend ends when we have used up the ap- plicable limit of insur- ance in the payment of judgments or settle- ments. No other obligation or liabil- ity to pay sums or perform acts or services Is covered unless explicitly provided for under Supplementary Pay- ments. (b) This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the "administration" of your "employee benefit pro• gram"; and 1) Occurs during the pol- icy period; or 2) Occurred prior to the effective date of this endorsement provided: a) You did not have knowledge of a claim or "suit" on or before the ef- fective date of this endorsement. You will be deemed to have knowledge of a claim or "suit" when any "authorized repre- sentative"; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 15 COVERAGE PREMIUM BASIS (a) Area (b) Payroll (c) Gross Sales (d) Units (e) Other RATE (For Limits in Excess of $5,000) ADVANCE PREMIUM (For Limits in Excess of $5,000) b. Care, Custody or Control $ TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: 1. Employee Benefit Liability Coverage a. The following is added to SECTION 1 - COVERAGES: Employee Benefit Liability Coverage. (1) GA 233 02 07 Insuring Agreement (a) We will pay those sums that the insured becomes legally obligated to pay as dam- ages caused by any act, er- ror or omission of the in- sured, or of any other per- son for whose acts the in- sured is legally liable, to which this insurance ap- plies. We will have the right and duty to defend the in- sured against any "suit" seeking those damages. However, we will have no duty to defend against any "suit" seeking damages to which this insurance does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or "suit" that may re- sult. But: 1) The amount we will pay for damages is limited as described in SEC- TION III - LIMITS OF INSURANCE; and 2) Our right and duty to defend ends when we have used up the ap- plicable limit of insur- ance in the payment of judgments or settle- ments. No other obligation or liabil- ity to pay sums or perform acts or services Is covered unless explicitly provided for under Supplementary Pay- ments. (b) This insurance applies to damages only if the act, er- ror or omission, is negli- gently committed in the "administration" of your "employee benefit pro• gram"; and 1) Occurs during the pol- icy period; or 2) Occurred prior to the effective date of this endorsement provided: a) You did not have knowledge of a claim or "suit" on or before the ef- fective date of this endorsement. You will be deemed to have knowledge of a claim or "suit" when any "authorized repre- sentative"; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 15 i) Reports all, or any part, of the act, " error or omission to us or any other insurer; ii) Receives a written or ver- bal demand or claim for dam- ages because of the act, er- ror or omis- sion; and b) There is no other applicable insur- ance. (2) Exclusions This insurance does not apply to: (a) Bodily Injury, Property Damage or Personal and Advertising Injury "Bodily injury", "property damage" or "personal and advertising injury". (b) Dishonest, Fraudulent, Criminal or Malicious Act Damages arising out of any intentional, dishonest, fraudulent, criminal or mali- cious act, error or omission, committed by any insured, including the willful or reck- less violation of any statute. (c) Failure to Perform a Con- tract Damages arising out of fail- ure of performance of con- tract by any insurer. (d) Insufficiency of Funds Damages arising out of an insufficiency of funds to meet any obligations., under any plan included in the "employee benefit pro- gram". (e) Inadequacy of Perform- ance of investment / Ad- vice Given With Respect to Participation Any claim based upon: 1) Failure of airy invest- ment to perform; 2) Errors In providing in- formation on past per - Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission.. (f) formance of investment vehicles; or 3) Advice given to any person with respect to that person's decision to participate or not to participate in any plan included in the "em- ployee benefit pro- gram".. Workers' Compensation and Similar Laws Any claim arising out of your failure to comply with the mandatory provisions of any workers' compensation, unemployment compensa- tion insurance, social secu- rity or disability benefits law or any similar law. (g) ERISA Damages for which any in- sured is liable because of liability imposed on a fiduci- ary by the Employee Re- tirement Income Security Act of 1974, as now or hereafter amended, or by any similar federal, state or local laws (h) Available Benefits Any claim for benefits to the extent that such benefits are available, with reason- able effort and cooperation of the insured, from the ap- plicable funds accrued or other collectible insurance. Taxes, Fines or Penalties Taxes, fines or penalties, including those imposed under the Internal Revenue Code or any similar state or local law. (1) (j) Employment -Related Practices Any liability arising out of any: (1) Refusal to employ; (2) Termination of em- ployment; (3) Coercion, demotion, evaluation, reassign- ment, discipline, defa- mation, harassment, humiliation, discrimina- tion or other employ - Page 3 of 15 ment-related practices, acts or omissions; or (4) Consequential liability as a result of (1), (2) or (3) above. This exclusion applies whether the insured may be held liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. (3) Supplementary Payments SECTION I - COVERAGES, SUPPLEMENTARY PAY- MENTS - COVERAGES A AND B also apply to this Coverage. b. Who is an Insured As respects Employee Benefit Liabil- ity Coverage, SECTION II - WHO IS AN INSURED is deleted in its en- tirety and replaced by the following: (1) If you are designated in the Declarations as: (a) An individual, you and your spouse are Insureds, but only with respect to the conduct of a business of which you are the sole owner, (b) A partnership or joint ven- ture, you are an insured. Your members, your part- ners, and their spouses are also insureds but only with respect to the conduct of your business. (c) A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are in- sureds, but only with re- spect to their duties as your managers. (d) An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and di- rectors are Insureds, but only with respect to their duties as your officers or di- rectors. Your stockholders are also insureds, but only with respect to their IlabiHty as stockholders. (e) A trust, you are an insured, Your trustees are also in- sureds, but only with re- spect to their duties as trustees. (2) Each of the following is also an insured: (a) Each of your "employees" who is or was authorized to administer your "employee benefit program". (b) Any persons, organizations or "employees" having proper temporary authori- zation to administer your "employee benefit program" if you die, but only until your legal representative is ap- pointed. (c) Your legal representative if you die, but only with re- spect to duties as such. That representative will have all your rights and du- ties under this Coverage Part, Any organization you newly ac- quire or form, other than a part- nership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization, However, cover- age under this provision: (3) (a) Is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and (b) Does not apply to any act, error or omission that was committed before you ac- quired or formed the or- ganization. c. Limits of Insurance As respects Employee Benefit Liabil- ity Coverage, SECTION III - LIMITS OF INSURANCE is deleted in its en- tirety and replaced by the following: (1) The Limits of Insurance shown in Section B. Limits of Insur- ance, 1. Employee Benefit Li- ability Coverage and the rules below fix the most we will pay regardless of the number of: (a) Insureds; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc„ with its permission. Page 4of15 GA 233 02 07 (b) Claims made or "suits" brought; (c) Persons or organizations making claims or bringing "suits"; (d) Acts, errors or omissions; or (e) Benefits included in your "employee benefit pro- gram (2) The Aggregate Limit shown in Section B. Limits of Insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages because of acts, er- rors or omissions negligently committed in the "administra- tion" of your "employee benefit program". Subject to the limit described in (2) above, the Each Employee Limit shown in Section B. Limits of Insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages sus- tained by any one "employee", including damages sustained by such "employee's". dependents and beneficiaries, as a result of: (a) An act, error or omission; or (b) A series of related acts, er- rors or omissions,regard- less of the amount of time that lapses between such acts, errors or omissions, negligently committed in the "administration" of your "em- ployee benefit program". However, the amount paid un- der this endorsement shall not exceed, and will be subject to the limits and restrictions that apply to the payment of benefits in any plan included in the "em- ployee benefit program".. (4) Deductible Amount (a) Our obligation to pay dam- ages on behalf of the in- sured applies only to the amount of damages in ex- cess of .the deductible amount stated in the Decla- rations as applicable to Each Employee. The limits of insurance. shall not be reduced by the amount of this deductible. (3) (b) The deductible amount stated in the Declarations applies to all damages sustained by any one "em- ployee", including such "employee's" dependents and beneficiaries, because of all acts, errors or omis- sions to which this insur- ance applies. (c) The terms of this insurance, including those with respect to: 1) Our right and duty to defend the insured against any "suits" seeking those dam- ages; and 2) Your duties, and the duties of any other in- volved insured, in the event of an act, error or omission, or claim, apply irrespective of the application of the deductible amount (d) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as we have paid. d. Additional Conditions As respects Employee Benefit Li- ability Coverage, SECTION IV - COMMERCIAL GENERAL LIABIL- ITY CONDITIONS is amended as follows: (1) Item 2. Duties in the Event of Occurrence, Offense, Claim or Suit is deleted in its entirety and replaced by the following: 2. Duties in the Event of an Act, Error or Omission, or Claim or Suit a. You must see to it that we are noti- fied as soon as practicable of an act, error or omission which may result in a claim. To the extent possible, no- tice should include: (1) What the act, error or omission was and when it occurred; and (2) The names and addresses of anyone who may suffer dam- ages as a result of the act, error or omission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 15 b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit' and the date received; and (2) Notify us as soon as practicable.. You must see to it that we receive written notice of the claim or "suit' as soon as practicable. c. You and any other involved insured must (1) Immediately send us copies of any demands, notices, sum- monses or legal papers re- ceived in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; Cooperate with us in the investi- gation or settlement of the claim or defense against the "suit' and (3) (4) Assist us, upon our request, in the enforcement of any right against any person or organiza- tion which may be liable to the insured because of an act, error or omission to which this insur- ance may also apply. d. No insured will, except at that in- sureds own cost, voluntarily make a payment, assume any obligation; or incur any expense without our con- sent. (2) Item 5. Other Insurance is de- leted in its entirety and replaced by the following: 5. Other Insurance If other valid and collectible Insurance is available to the insured for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is ,pri- mary except when c. below applies. If 'this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in b. below.. b. Method of Sharing If all of the other insur- ance permits contribu- tion by equal shares, we will follow this method also. Under this approach each in- surer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other in- surance does not per- mit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of in- surance to the total ap- plicable limits of insur- ance of all insurers. c. No Coverage This insurance shall not cover any loss for which the insured is entitled to recovery un- der any other insur- ance in force previous to the effective date of this Coverage Part. e. Additional Definitions As respects Employee Benefit Li- ability Coverage, SECTION V - DEFINITIONS is amended as fol- lows: (1) The following definitions are added: 1. "Administration" means: a. Providing information to "employees", including their dependents and beneficiaries, with re- spect to eligibility for or scope of "employee benefit programs"; b. Interpreting the "em- ployee benefit pro- grams"; c. Handling records in connection with the "employee benefit pro- grams": or d. Effecting, continuing or terminating any "em- ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with Its permission. Page 6 of 15 in any benefit included in the "employee bene- fit program". However, "administration" does not include: a. Handling payroll de- ductions; or b. The failure to effect or maintain any insurance or adequate limits of coverage of insurance, including but not limited to unemployment in- surance, social security benefits, workers' com- pensation and disability benefits., 2. "Cafeteria plans" means plan authorized by applica- ble law to allow "employ- ees" to elect to pay for cer- tain benefits with pre-tax dollars. 3. "Employee benefit pro- grams" means a' program providing some or all of the following benefits to "em- ployees", whether provided through a "cafeteria plan" or otherwise: a. Group life insurance; group accident or health insurance; den- tal, vision and hearing plans; and flexible spending accounts; provided that no one other than an "em- ployee" may subscribe to such benefits and such benefits are made generally available to those "employees" who satisfy the plan's eligi- bility requirernents; b. Profit sharing plans, employee savings plans, employee stock ownership plans, pen- sion plans and stock subscription plans, provided that no one other than an "em- ployee" may subscribe to such benefits and such benefits are made generally available to all "employees" who are eligible under the plan for such benefits; c. Unemployment insur- ance, social security benefits, workers' com- pensation and disability benefits; and d. Vacation plans, includ- ing buy and sell pro- grams; leave of ab- sence programs, in- cluding military, mater- nity, family, and civil leave; tuition assis- tance plans; transpor-• teflon and health club subsidies. (2) The following definitions are deleted in their entirety and re- placed by the following: 21. "Suit" means a civil pro- ceeding in which money damages because of an act, error or omission to which this insurance applies are alleged. "Suit" includes: a. An arbitration pro- ceeding in which such damages are claimed and to which the in- sured must submit or does submit with our consent; b. Any other alternative dispute resolution pro- ceeding in which such damages are claimed and to which the in- sured submits with our consent; or c. An appeal of a civil proceeding. 8. "Employee" means a per- son actively employed, for- merly employed, on leave of absence or disabled, or refired_ "Employee" in- cludes a "leased worker". "Employee" does not in- clude a "temporary worker". 2. unintentional Failure to Disclose Haz- ards SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 7. Represen- tations is hereby amended by the addi- tion of the following: Based on our dependence upon your representations as to existing hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not reject coverage under this Coverage Part based solely on such failure. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with Its permission. Page 7 of 15 3. Damage to Premises Rented to You a. The last Subparagraph of Paragraph 2. SECTION I - COVERAGES, COVERAGE A. - BODILY INJURY AND PROPERTY DAMAGE, 2. LI- ABILITY Exclusions is hereby de- leted and replaced by the following: Exclusions c. through q. do not apply to damage by fire, explosion, light- ning, smoke or soot to premises while rented to you or temporarily occupied by you with permission of the owner. b. The insurance provided under SEC- TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY applies to "property damage" arising out of water damage to premises that are both rented to and occupied by you. (1) As respects Water Damage Le- gal Liability, as provided in Paragraph 3.b. above: The exclusions under SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions, other than i. War and the Nuclear Energy Liability Exclusion, are deleted and the following are added: This insurance does not apply to: (a) "Property damage": 1) Assumed in any con- tract; or 2) Loss caused by or re- sulting from any of the following: a) Wear and tear; b) Rust, corrosion, fungus, decay, deterioration, hid- den or latent: de- fect or any quality in property that causes it to dam- age or destroy it- self; c) Smog; d) Mechanical breakdown in- cluding rupture or bursting caused by centrifugal force; GA 233 02 07 e) Settling, cracking, shrinking or ex- pansion; or f) Nesting or infesta- tion, or discharge or release of waste products or secretions, by in- sects, birds, ro- dents or other animals. (b) Loss caused directly or indi- rectly by any of the follow- ing: 1) Earthquake, volcanic eruption, landslide or any other earth move- ment; 2) Water that backs up or overflows from a sewer, drain or sump; 3) Water under the ground surface press- ing on, or flowing or seeping through: a) Foundations, walls, floors or paved surfaces; b) Basements, whether paved or not; or c) Doors, windows or other openings. (c) Loss caused by or resulting from water that leaks or flows from plumbing, heat- ing, air conditioning, or fire protection systems caused by or resulting from freez- ing, unless: 1) You did your best to maintain heat in the building or structure; or 2) You drained the equipment and shut off the water supply if the heat was not main- tained_ (d) Loss to or damage to: 1) Plumbing, heating, air conditioning, fire pro- tection systems, or other equipment or ap- pliances; or 2) The interior of any building or structure, or to personal property in the building or structure Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 15 caused by or resulting from rain, snow, sleet or ice, whether driven by wind or not. c. Limit of insurance The Damage to Premises Rented to You Limit as shown in the Declara- tions is amended as follows: (2) Paragraph 6. of SECTION III - LIMITS OF INSURANCE is hereby deleted and replaced by the following: 6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, for damages because of "property damage" to premises while rented to you or temporarily occupied by you with permission of the owner, arising out of any one "occurrence" to which this insurance ap- plies. The amount we will pay is lim- ited as described in Section B. Limits of Insurance, 3. Dam- age to Premises Rented to You of this endorsement. (3) 4. Supplementary Payments Under SECTION I - COVERAGE, SUP- PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. Paragraph 2. is replaced by the fol- lowing: Up to the limit shown in Section B, Limits of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to the limit shown in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- dorsement per day because of time off from work. GA 233 02 07 5. Medical Payments The Medical Expense Limit of Any One Person as stated in the Declarations is amended to the limit shown in Section B. Limits of Insurance, 5. Medical Pay- ments of this endorsement. 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage a. Voluntary Property Damage Cov- erage We will pay for "property damage" to property of others arising out of op- erations incidental to the insured's business when: (1) Damage is caused by the in- sured; or (2) Damage occurs while in the in- sured's possession. With your consent, we will make these payments regardless of fault b. Care, Custody or Control Liability Coverage SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, j, Damage to Property, Subparagraphs (3), (4) and (5) do not appiy to "property damage" to the property of others described therein. With respect to the insurance provided by this section of the endorsement, the fol- lowing additional provisions apply: a. The Limits of Insurance shown in the Declarations are replaced by the lim- its designated in Section B. Limits of insurance, 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage of this endorsement with respect to cover- age provided by this endorsement. These limits are inclusive of and not in addition to the limits being re- placed. The Limits of Insurance shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam- age and Care, Custody or Control Liability Coverage of this endorse- ment fix the most we will pay In any one "occurrence" regardless of the number of: (1) insureds; (2) Claims made or "suits" brought; or (3) Persons or organizations mak- ing claims or bringing "suits". includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 15 b. Deductible Clause (9. ') Automatic Additional Insured - Speci- fied Relationships a. The following is hereby added to SECTION 11- WHO IS AN INSURED: (1) Our obligation to pay damages on your behalf applies only to the amount of damages for each "occurrence" which are in ex- cess of the deductible amount stated in Section B. Limits of Insurance, 6. Voluntary Prop- erty Damage and Care, Cus- tody or Control Liability Cov- erage of this endorsement. The limits of insurance will not be re- duced by the application of such deductible amount. (2) Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit, applies to each claim or "suit" irrespective of the amount. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the ac- tion taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 7. 180 Day Coverage for Newly Formed or. Acquired Organizations (3) SECTION 11 - WHO IS AN INSURED is amended as follows: Subparagraph a. of Paragraph 4. is hereby deleted and replaced by the fol- lowing: a. Insurance under this provision is af- forded onl until the 180th day after cquire or on -n ' - • •anization or the end of the policy • -riod, whichever is earlier; Waiver of Subrogation SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 9. Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following: We waive any right of recovery we may have because of payments we make:for injury or damage arising out of your on- going operations or "your work" done un- der a written contract requiring such waiver with that person or organization and Included in the "products -completed operations hazard". However, our rights may only be waived prior to the "occur- rence" giving rise to the injury or damage for which we make payment under thi Coverage Part. The insuredmus t nothing after a loss to impair ou At our request, the insured will bri or transfer those rights to us force those rights GA 233 02 07 o our r* ts. . "suit" help us (1) Any person or organization de- scribed in Paragraph 9.a.(2) below (hereinafter referred to as additional insured) whom you are required to add as an addi- tional insured under this Cover- age Part by reason of: (a) A written contract or agreement; or (b) An oral agreement or con- tract where a certificate of insurance showing that per- son or organization as an additional insured has been issued, is an insured, provided: (a) The written or oral contract or agreement is: 1) Currently in effect or becomes effective during the policy pe- riod; and 2) Executed prior to an "occurrence" or offense to which this insurance would apply; and (b) They are not specifically named as an additional in- sured under any other pro- vision of, or endorsement added to, this Coverage Part. (2) Only the following persons or organizations are additional in- sureds under this endorsement, and insurance coverage pro- vided to such additional in- sureds is limited as provided herein: (a) The manager or lessor of a premises leased to you with whom you have agreed per Paragraph 9.a.(1) above to provide insurance, but only with respect to liability aris- ing out of the ownership, maintenance or use of that part of a premises leased to you, subject to the following additional exclusions: This insurance does not apply to: 1) Any "occurrence" which takes place after Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 10 of 15 you cease to be a ten- ant in that premises. 2) Structural alterations, new construction or demolition operations performed by or on be- half of such additional insured, (b) Any person or organization from which you lease equipment with whom you have agreed per Paragraph 9.a.(1) above to provide in- surance, Such person(s) or organization(s) are insureds solely with respect to their liability arising out of the maintenance, operation or use by you of equipment leased to you by such per- son(s) or organizations(s). However, this insurance does not apply to any "oc- currence" which takes place after the equipment lease expires. (c) Any person or organization (referred to below as ven- dor) with whom you have agreed per Paragraph 9.a.(1) above to provide in- surance, but only, with re- spect to "bodily injury" or "property damage" arising out of "your products" which are distribufed or sold In the regular course of the ven- dor's business, subject to the following additional ex- clusions: 1) The insurance afforded the vendor does not apply to: a) "Bodily; injury" or "property:damage" for which the ven- dor is obligated to pay damages by reason of the as- sumption of liabil- ity in a contract or agreement. This exclusion does not apply to liability for damages that the vendor " would have in the ab- sence of the con- tract or agree- ment; b) Any express war- ranty unauthorized by you; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc„ with its permission. c) Any physical or chemical change in the product made intentionally by the vendor; d) Repackaging, un- less unpacked solely for the pur- pose of inspection. demonstration, testing, or the substitution of parts under in- structions from the manufacturer, and then repackaged in the original container; e) Any failure to make such in- spections, adjust- ments, tests or servicing as the vendor has agreed to make or normally under- takes to make in the usual course of business, in connection with the distribution or sale of the prod- ucts; f) Demonstration, in- stallation, servic- ing or repair op- erations, except such operations performed at the vendor's premises in connection with the sale of the product; Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor 2) This insurance does not apply to any in- sured person or or- ganization: a) From whom you have acquired such products, or any ingredient, part or container, entering into, ac- g) Page 11 of 15 GA 233 02 07 companying or containing such products; or b) When liability in- cluded within the "products - completed opera- tions hazard" has been excluded under this Cover- age Part with re- spect to such products. (d) Any state or political subdi- vision with which you have agreed per Paragraph 9.a.(1) above to provide in- surance, subject to the fol- lowing additional provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connec- tion with premises you own, rent or control and to which this insurance applies: 1) The existence, mainte- nance, repair, con- struction, erection, or removal of advertising signs, awnings, cano- pies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decora- tions and similar expo- sures; or 2) The construction, erec- tion, or removal of ele- vators; or 3) The ownership, main- tenance, or use of any elevators covered by this Insurance: (e) Any state or political subdi- vision with which you have agreed per Paragraph 9.a.(1) above to provide.in- surance, subject to the fbl- lowing provisions: 1) This insurance applies only with respect to op- erations performed by you or on your behalf for which the state or political subdivision has issued a permit. (3) (f) 2) This insurance does not apply to "bodily in- jury", "property dam- age" or "personal and advertising injury" aris- ing out of operations performed for the state or political subdivision. Any person or organization with which you have agreed per Paragraph 9.a.(1) above to provide insurance, but only with respect to li- ability arising out of "your work" performed for that additional insured by you or on your behalf. A person or organization's status as an insured under this provision of this endorsement contin- ues for only the period of time required by the written contract or agreement, but in no event beyond the ex- piration date of this Cover- age Part. If there is no written contract or agree- ment, or if no period of time is required by the written contract or agreement, a person or organization's status as an insured under this endorsement ends when your operations for that insured are completed. Any insurance provided to an additional insured designated under Paragraph 9.a.(2): (a) Subparagraphs (e) and (f) does not apply to "bodily injury" or "property damage" included within the "prod- ucts -completed operations hazard"; (b) Subparagraphs (a), (b), (d), (e) and (f) does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence or willful misconduct of the additional insured or their agents, "employees" or any other representative of the additional Insured; or (c) Subparagraph (f) does not apply to "bodily injury", "property damage" or "per- sonal and advertising injury" arising out of: 1) Defects in design fur- nished by or on behalf Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 12 of 15 of the additional in- sured; or 2) The rendering of, or failure to render, any professional architec- tural, engineering or surveying services, in- cluding: a) The preparing, approving or fail- ing to prepare or approve maps, shop drawings, opinions, reports, surveys, field or- ders, change or- ders or drawings and specifications; and b) Supervisory, in- spection, archi- tectural or engi- neering activities: 3) "Your work" for which a consolidated (wrap-up) insurance program has been provided by the primecontractor-project manager or owner of the construction project in which you are in- volved. b. Only with regard to insurance pro- vided to an additional insured desig- nated under Paragraph 9.a,(2) Sub- paragraph (f) above, SECTION III - LIMITS OF INSURANCE is amended to include: The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Coverage Part, whichever are Tess. If no limits are specified in the written contract or agreement, or if there is no written contract or agreement; the limits ap- plicable to the additional insured are those specified in the -Declarations of this Coverage Part. The limits of in- surance are inclusive of and not in addition to the limits of insurance shown in the Declarations. SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS is hereby amended as follows: (1) Condition 5. Other Insurance is amended to include: (a) Where required by a written contract or agreement, this insurance is primary and / or noncontributory as re - GA 233 02 07 spects any other insurance policy issued to the addi- tional insured, and such other insurance policy shall be excess and / or noncon- tributing, whichever applies, with this insurance. (b) Any insurance provided by this endorsement shall be primary to other insurance available to the additional insured except: 1) As otherwise provided in SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 5. Other Insurance, b. Excess Insurance; or 2) For any other valid and collectible insurance available to the addi- tional insured as an additional insured by attachment of an en- dorsement to another insurance policy that is written on an excess basis, In such case, the coverage provided u • - endorse- ex- ment shall a cess. s (2) ondition 11. Conformance to Specific Written Contract or Agreement is hereby added: 11. Conformance to Specific Written Contract or Agreement With respect to additional insureds described in Para- graph 9.a.(2)(f) above only: If a written contract or agreement between you and the additional insured specifies that coverage for the additional insured: a. Be provided by the In- surance Services Of- fice additional insured form number CG 20 10 or CG 20 37 (where edition specified); or b. Include coverage for completed operations; or Includes copyrighted material of Insurance Services Office, Inc., with its permission.. Pa • - 3 of 15 c. Include coverage for "your work"; and where the limits or cov erage provided to the ad tional insured is more re- strictive than was specifi- cally required in that written contract or agreement, the terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. above, or any combination thereof, shall be interpreted as providing the limits or coverage required by the terms of the written contract or agreement, but only to the extent that such limits or coverage is included within the terms of the Coverage Part to which this endorse- ment is attached. If, how- ever, the written contract or agreement specifies the In- surance Services Office additional insured form number CG 20 10 but does not specify which edition, or specifies an edition that does not exist, Paragraphs 9.a.(3)(a) and 9.a.(3)(b) of this endorsement shall not apply and Paragraph 9.b. of this endorsement shall ap- ply. 10. Broadened Contractual Liability - Work Within 50' of Railroad Property It is hereby agreed that Paragraph f.(1) of Definition 12. "Insured contract" (SEC- TION V - DEFINITIONS) is deleted. 11. Property Damage to Borrowed Equip= ment a. The following is hereby added to Ex- clusion j. Damage to Property of Paragraph 2., Exclusions of SEC- TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: Paragraphs (3) and (4) of this exclu= sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform opera- tions at the time of loss. b. With respect to the insurance pro- vided by this section of the en- dorsement, the following additional provisions apply: (1) The Limits of insurance shown in the Declarations are replaced by the limits designated in Sec- tion B. Limits of Insurance,' 11. of this endorsement with respect to coverage provided by this endorsement. These limits are inclusive of and not in addition to the limits being replaced. The Limits of Insurance shown in Section B. Limits of Insurance, Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 14 of 15 GA 233 02 07 11. of this endorsement fix the most we will pay in any one "oc- currence" regardless of the number of: (a) Insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bring "suits". (2) Deductible Clause (a) Our obligation to pay dam- ages on your behalf applies only to the amount of dam- ages for each "occurrence" which are in excess of the Deductible amount stated in Section B. Limits of Insur- ance, 11. of this endorse- ment. The limits of insur- ance will not be reduced by the application of such De- ductible amount. (b) Condition 2. Duties in the Event of Occurrence, Of- fense, Claim or Suit, ap- plies to each claim or "suit" irrespective of the amount. (c) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us.. 12. Employees as Insureds - Specified Health Care Services It is hereby agreed that Paragraph 2.a.(1)(d) of SECTION 11 - WHO IS AN INSURED, does not apply to your "em- ployees" who provide professional health care services on your behalf as duly li- censed: a. b. c. Nurses; Emergency Medical Technicians; or Paramedics, in the jurisdiction where an "occurrence" or offense to which this insurance applies takes place. 13. Broadened Notice of Occurrence Paragraph a. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- TIONS) is hereby deleted and replaced by the following: a. You must see to it that we are noti- fied as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "oc- currence" or offense took place; GA 233 02 07 (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. This requirement applies only when the "occurrence" or offense is known to an "authorized representative". Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 15 of 15 CLEARWATER SUMMIT GROUP INC Washington State Department of Labor & Industries Page 1 of 2 CLEARWATER SUMMIT GROUP INC Owner or tradesperson SWEET, TIM P Principals SWEET, TIM P, PRESIDENT ULLMAN, TY ROBERT, VICE PRESIDENT ULLMAN, LAURA LOUISE, SECRETARY SWEET, ELAINE, TREASURER Doing business as CLEARWATER SUMMIT GROUP INC WA UBI No. 601 450 995 PO BOX 6470 SPOKANE, WA 99217-0908 509-482-2722 SPOKANE County Business type Corporation License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. CLEARSG000KN Effective — expiration 05/15/2000— 07/11/2016 Bond TRAVELERS CAS & SURETY CO Bond account no. 055S103627339BCM Received by L&I 05/28/2002 Insurance Cincinnati Ins Co Policy no. EPP0054856 Received by L&I 12/03/2013 $12,000.00 Effective date 07/01/2002 Expiration date Until Canceled $1,000,000.00 Effective date 12/22/2010 Expiration date https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601450995&LIC=CLEARSG000KN&SAW=False 7/8/2014 CLEARWATER SUMMIT GROUP INC 12/22/2014 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Page 2 of 2 Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. This company has multiple workers' comp accounts. Active accounts L&I Account ID 472,384-01 Account is current. Doing business as CLEARWATER SUMMIT GROUP INC Estimated workers reported Quarter 1 of Year 2014 "21 to 30 Workers" L&I account representative T5 / MICHAEL MURPHY (360)902-4822 - Email: MURY235@Ini.wa.gov Track this contractor 9 Workplace safety and health No inspections during the previous 6 year period. © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington. a I)ingttir'' n-<czt' �',f=-xr:,rit•r�r Ytt �, �., tc https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601450995&LIC=CLEARSG000KN&SAW=False 7/8/2014 00"tts, Spaiane jvaliey RECEIVED JUN 27 i 1U14 PARKS & RECREATION DEPT. 11%53 Am BID RESPONSE DOCUMENTS Discovery Playground Renovations { M T ■ L A Michael Terrell ■ Landscape Architecture, PLLC 1421 North Meadowwood Lane, Suite 150 Liberty Lake, WA 99019 (509) 922-7449 DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT Person/Entity Name: CU 0�;.l Signature Of Bidder: Page 1 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT SECTION 00410 - BID RESPONSE DOCUMENTS BID PROPOSAL PROJECT TITLE: Discovery Playground Renovations NAME OF FIRM SUBMITTING BID: a L1/4.10 -..344 Z \ rvA.A tT" l�tZ t� cM Each bid shall constitute an offer to the City of Spokane Valley as outlined herein and no bidder may withdraw his bid after the hour set for the bid closing except under the conditions explained in the Information to Bidders Section. RECEIPT OF ADDENDA: Bidder acknowledges receipt of the following addenda: Addendum No. Date Addendum No. Date Addendum No. Date REJECTION: The City reserves the right to reject any or all proposals, portions or parts thereof and to waive all minor irregularities in bidding. Special attention will be directed to the qualifications of the bidders when considering awarding a contract. TIME TO COMPLETE: The work related to the Discovery Playground will be substantially completed within fifteen working days (weekdays), beginning on the day of commencement stipulated in a Notice to Proceed with the understanding that time is of the essence in the performance of this contract. If Alternate #1 is picked up the contract will extend to twenty working days. The Notice to Proceed is generally issued within 15 days after award. BID IS NOT ELIGIBLE FOR CONTRACTOR'S BOND ELECTION to withhold 50% retainage in lieu of furnishing a Contractor's Bond (Performance and Payment Bond). SUBCONTRACTORS LIST: See Special Conditions SUBMITTAL: The "Bid Response Documents" Section constitutes the Bid Proposal when completed and submitted. Please do not submit the entire Invitation to Bid manual. FREIGHT: Bid price(s) to include all freight costs to the job site. Person/Entity Name: (."t,e67, 12h4 SCIM .>!. Signature Of Bidder: Page 2 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT Project #1 - BASE BID - Discovery Playground Renovations As identified in the Construction Documents plans and details. PROJECT #1 BASE BID = $ 8.7% SALES TAX = 160 PROJECT #1 TOTAL BASE BID= $ 7 s� AtD Project #1 - ADDITIVE ALTERNATE BID ITEM #2 - Discovery Playground Renovations As identified in the Construction Documents plans and details. 1. Purchase, assembly, mounting and installation of Loll chairs. PROJECT #1 - ADDITIVE ALTERNATE BID ITEM#2 = $ (oOD O -D 8.7% SALES TAX = $ PROJECT #1 - TOTAL ADDITIVE ALTERNATE BID ITEM #2= -1-740.10 7(2ZCElo Person/Entity Name: Cel of m l Signature Of Bidder: 541,44141 IIS r Page 3 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT Project #2 - BASE BID - Discovery Playground Renovations As identified in the Construction Documents plans and details. PROJECT #2 BASE BID = $ ',Ifcl0o 00 8.7% SALES TAX = 11-C,3-0 PROJECT #2 TOTAL BASE BID= $ Project #2 - ADDITIVE ALTERNATE BID ITEM #1 - Discovery Playground Renovations As identified in the Construction Documents plans and details. 1. Installation of Owner Provided Play Equipment as identified in the Construction Documents plans and details. 2. Provide and install safety surfacing as specified. PROJECTE #2 ADDITIVE ALTERNATE BID ITEM#1 = 8.7% SALES TAX = 3oo . o PROJECT #2 - TOTAL ADDITIVE ALTERNATE BID ITEM #1= $ �t u I BID SUMMARY PROJECT #1 TOTAL BASE BID = $ 1 4O r PROJECT #1 - TOTAL ADDITIVE ALTERNATE BID ITEM #2 = -yt S7 - o, --v PROJECT #2 TOTAL BASE BID = $ yi 30 PROJECT#2 - TOTAL ADDITIVE ALTERNATE BID ITEM #1 = $ `G}� 574.10 (` 1 0 GRAND TOTAL = $ g,0, 1 , 00 Person/Entity Name: ea tlGlirinid Signature Of Bidder: Page 4 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT REPRESENTATIONS AND CERTIFICATIONS ANTI -KICKBACK No officer or employee of the City of Spokane Valley, having the power or duty to perform an official act or action related to this submittal, shall have or acquire any interest in this submittal, or have solicited, accepted or granted a present or future gift, favor, service, or other thing of value from or to any person involved in this submittal. REPRESENTATION: In submitting this bid we represent that the bid documents have been read and understood, that the site has been visited and or that we have familiarized ourselves with the local conditions under which the work is to be performed, that by signature of this proposal we acknowledge all requirements and that we have signed all certificates contained herein. REPRESENTATION: In submitting this bid we acknowledge the requirements and conditions applicable to bid deposits in the form of a cash bid deposit or surety bond bid deposit. I CERTIFY that no final determination of violation of RCW 50.12.070(1)(b), 50.16.070(1)(b), or 82.32.070(1)(b) has been made by the Washington State Departments of Employment Security, Labor And Industries or Revenue respectively dated within two years of the date of the opening of this bid. I understand further that no bid may be submitted, considered or contract awarded for a public work to any person or entity that has a determination of violation of the above referenced statutes within two years from the date that a violation is finally determined and the date of this bid opening. I CERTIFY that to the best of my knowledge the information contained in this proposal is accurate and complete and that I have the legal authority to commit this Firm to a contractual agreement. I realize the final funding for any service is based upon budget levels and the approval of the City of Spokane Valley. Name: [ j_ear-/AcedLi Person/Enter submitting bid (print) Signature: Title: (.C� Date: if/s�7C6//L/ Page 5 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT BIDDER'S ADMINISTRATIVE INFORMATION 1 PERSON/ENTITY a. Name as registered with the State Of Washington: C,Ls►t`— b. Physical Address: a22 -b Pu -'` its ` a"�-ii c. Mailing Address including zip code: po °X f�4 5e5v-40cr vs T121+ d. Remit To Address including zip code: Skl`ti� �`' ?O gL);G M5ov� e. Telephone number including area code: (io' 4� -� Z --4-2Z f. Fax number including area code: C5040 `E`t34 — 72,41.27 g. E-mail address for business correspondence:e-'''4rySk,,,km-iT0'v4 h. Washington State Contractors License Number: CLOA(Z--5"0c- - i. Federal Tax Identification Number: REDACTED - j. Washington State UBI Number: i,61gS-bi95 _ k. State Industrial Account Identification Number: qL/0/$ 2. INSURANCE COMPANY: a. Name of company: Ci 11 Ci nr)a f b. Mailing Address including zip code: Pc9e2go c. Insurance Agent Name: DerCK 10Jel d. Insurance Agent Telephone number including area code: CS09) •937 e. Insurance Agent Fax number including area code: (SO�� q a,2. • e/e3 3. BONDING COMPANY: a. Surety Name: V&f{, sA. 35-21Y- rJ b. Surety Mailing Address including zip code: Pato 21 Y - siop c. Bonding Agent Name: Nee Co I fa- d. Q_ 'IA d. Bonding Agent Mailing Address including zip code: P. 0 .80x 8s -i7 - Eeo - 1 1'Ifa` e. Bonding Agent Telephone number including area code: (sO9) e% 1}•d931 f. Bonding Agent Fax number including area code: (5-0c0 9go2 information and confidential ta32 330• current contains 82. ane This document pursuant to RON pertaining to has been redacted P review of our findings to Spokane Valley p or a ursua judicial review You arae Petition held documents pursuant and obtain or with 2.75.080 redacted l Code �SVMC� Page 6 pursuant CW 42.56.550• Pursuant to R 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT Bidder to provide the following information for ALL of the following trades/sub- contractors: 1. Concrete Contractor Chwvezc - (-e1w`t �/�� 2. Landscape Contractor (Irrigation and Planting? CL ,Zw, -rL- SiAKA A 3. Fence Contractor and Fabricator CL_Etc12-1/4P-1 Sa,AAvw�T (-..tz-s 2 4. Certified Playground Installer (� c��►, j �c%s5 BIDDER QUALIFICATION STATEMENT The following statements of experience, personnel, equipment, and general qualifications of the Bidder are submitted with the assurance that the owner can rely on its accuracy and truthfulness. If more space is required for your answers please attach a continuation sheet(s) to the corresponding bid response page referencing the item number. 1. The company has been in business continuously from (month and year) 2. The contractor shall employ or contract with a National Recreation and Parks Association (N.R.P.A.) Certified Playground Installer with a minimum of 5 years experience or three (3) installations of play equipment similar to the proposed contract. Contractor shall have a minimum of 5 years experience and three installations of a park with playgrounds of similar scope and complexity to that required under the proposed contract. 3. Provide the following information on three similar projects the company has completed that was on an order of magnitude equal to or greater in scope and complexity to that required under the proposed contract. Project Name Owner Phone No. Location #1 1N M is, Ala60,0,q V ktti- 12. Co T & o. # 2 : %Pntuwa,a frnAti.9 t‘..kskvi& 1A c7 li � G,ze. c #3 : Sin, �, �jQ, �s�k erg CTi SQawtsa -V1ty s Vt t WPrLik U t1.1 k v t4 x 6 PGwn+ Provide responses to the following items regarding each project listed above: A. Short description of project, for example "new playground", or "addition to playground", or "renovation of playground". t�GW 7‘,K -t612-00(--1› i-TcV'' svacs crw. B. Idi ify elements of project focused particularly on accessibility and/or activities for individuals of all abilities. *n ft2 s * ' 3S icy .1 vivt i_CcA,ma. etcax,s,6�,--- 00410 Bid Response Documents Page 7 DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT C. Name of Designer. Soc D. Construction contract value, both at the time of award and upon completion. E. Identify if you were the general contractor or a subcontractor on the project. F. The date each project was started and completed. V 7_01'Z- Z-0 0IZz-o t 20oci 4. List supervisory personnel currently employed by the Bidder and available for work on the project (Construction Manager, principal foreman, superintendents and engineers) is as follows: Years of Name Gkri-c-ta 171 (Aw Title Experience fti ,t+ ; M _ 6 Ntiv tog- ; ov.A Rte-AT 1-C tz-s 5. Attach a resume with the qualifications, previous employers, and experience of the project manager who is proposed to be assigned to this project. If a resume is not included in the bid documents the bidder agrees to furnish a resume within 24 hours of notice by the City. 00410 Bid Response Documents Page 8 DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT BIDDER COMPLIANCE CERTIFICATION PROJECT COMPLIANCE In compliance with the request for quotation, bidder hereby proposes to perform all work for this project in strict accordance with the contract documents, within the time set forth therein, and at the prices bid. SPECIFICATION COMPLIANCE The bidder certifies below that his/her bid complies in all respects with the attached specification documents, including the minimum specifications. YES NO Page 9 00410 Bid Response Documents DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT SUBCONTRACTOR LIST Project: Discovery Playground Renovations Subcontract List. It is strongly recommended that the subcontractor list be enclosed with the bid documents.. Please refer to "SUBCONTRACTORS" in the Information For Bidders Section for specific information regarding the listing requirements. Attach additional sheets if required. Use copies of these pages as masters for attachment. If a subcontractor list is not submitted with the bid, it must be delivered to the City of Spokane Valley Parks and Recreation Department, 2426 N. Discovery Place Spokane Valley, WA 99216 no later than 1:00 P.M. the same day of the published bid submittal date and time (one hour after the closing time of 12:00 P.M.). Type of work - Certified Playground Equipment Installer. If this work is required and the bidder will be doing the work the bidder must list its name as the contractor below. ti5J11--- CERTIFIED PLAYGROUND EQUIPMENT CONTRACTOR NAME (please print) Type of work - CONCRETE INSTALLATION. If this work is required and the bidder will be doing the work the bidder must list its name as the contractor below. l! E21� - 1 u 1 -'C CONCRETE CONTRACTOR NAME (please print) Type of work -LANDSCAPE CONTRACTOR. If this work is required and the bidder will be doing the work the bidder must list its name as the contractor below. CL-e-ve,skrso-- SLIW% vt -TiZ AIS LANDSCAPE CONTRACTOR NAME (please print) 00410 Bid Response Documents Page 10 DISCOVERY PLAYGROUND RENOVATIONS CITY OFSPOKANE VALLEY PARKS AND RECREATION DEPARTMENT BID DEPOSIT FORM OF BID DEPOSIT - CHECK ONE: Please submit this sheet with the bid deposit. A/ CASH. Attach the deposit behind this sheet. SURETY BOND - Attach bid bond behind this sheet. IT IS STRONGLY RECOMMENDED THAT YOU USE THE ATTACHED FORM. 00410 Bid Response Documents Page 11