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14-140.00 L & L Cargile: Appleway Trail Ph 2A Earthwork Contract THIS AGREEMENT, made and entered into this /014 day of 2014, between the City of Spokane Valley under and by virtue of Title 35 ' W, as amended and L & L Cargile, 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 Trail Phase 2A Earthwork Project SVPW Contract 14-045 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City of Spokane Valley by reasonof entering onto this contract, except as provided herein. City of Spokane Valley 11 Contract Documents Appleway Trail Phase 2A Earthwork Bid No: 14-045 V. The project was awarded for the bid amount of$186,301.00. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor / /9 , 2014.lle340 Date Larry Cargile Printed Name President Title _� •. a re City of Spokan Valley Printed Name Titl ,, / , Signature / Revised 6.19.13 City of Spokane Valley 12 Contract Documents Appleway Trail Phase 2A Earthwork Bid No: 14-045 s1 okane ,,,jValley� BOND NO: 2181933 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County,has awarded to L&L Cargile.Inc.(Contractor),as Principal, a contract for the construction of the project designated as Appfewav Trail Phase 2A Earthwork, Contract No, 14.045 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and North American Specialty Insurance Company (Surety), a corporation, organized under the laws of NH 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$186,301.00 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void,if and when the Principal,its heirs,executors,administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications,additions,and changes to said Contract that may hereafter be made, at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract; and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change,extension of time, alteration or addition to the terms of the Contract,the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety Is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL(CONTRACTOR) SUR-Ty North American Specialty Insurance L&L Ca !le, Inc. ? Company 8/28/14 orof 8/28/2014 -rincipa =gnature Date -ure y ign=tu Date Tarry Cargile Kathy Gurley Printed Name Printed Name President Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W. Main,#1400,Spokane,WA 99201 - 509-358-3800 Revised 1.14.13 City of Spokane Valley 14 Contract Documents Appleway Trail Phase 2A Earthwork Bid No: 14-045 cm Spo° ane „,•••OValley" BOND NO: 2181933 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 L&L Camila,Inc.(Contractor),as Principal, a contract for the construction of the project designated as Annlewav Trail Phase 2A Earthwork, Contract No. 14-045 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 North American Specialty Insurance Company (Surety), a corporation organized under the laws NH 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$ 186,301.00 total Contract amount(Including Washington State sales tax),subject to the provisions herein. This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay ail persons in accordancewith 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 and shall indemnify and hold nl'i 9 work; fy 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. PRINCIPAL(CONTRACT R) SUR North American Specialty Insurance L&L Car � Company i 8/28/14 8/28/2014 cipI Si ature Date rety Sig at Date Larry Cargile Kathy Gurley Printed Name Printed Name President Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W. Main,#1400, Spokane,WA 99201 -509-358-3800 Revised 1.14,13 City of Spokane Valley 13 Contract Documents Appteway Trail Phase 2A Earthwork Bid No: 14.045 . NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg,Illinois,each does hereby make,constitute and appoint: GEORGE C.SCHROEDER,KATHY GURLEY,CHRIS LARSON,ERIN L.REPP,H.KEITH McNALLY, DIANA R.WILLIAMS and HEATHER ANDERSON JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9th of May,2012: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." otuountro oxury,Hd+4f�ii aUpZ11NA ;r4 ��o�rG 0.64PP By F•. SEAL :O S Steven P.Anderson,Senior Vice President of Washington International Insurance Company ,S'(�(, �a W?� 1873 moo,;n &Senior Vice President of North American Specialty Insurance Company OZJ I m SAg 0 ZS tit y ..MPS.: `\\ yy�..'ry mp 141 xna iapunno0' By * David M.Layman,Vice President of Washington International Insurance Company ranataa &Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 13th day of January 2014 North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: On this 13th day of January ,2014 before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M.Layman, Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. p, "OFFICIAL SEAL" DONNA D.SKLENS Notary Public,State of Illinois Donna D.Sklens,Notary Public My Commission Expires 10/0612015 I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 28th day of August ,20 14 Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company&North American Specialty Insurance Company Spol�ane 4.000ValleyK BOND NO: 2181934 CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County, has awarded to L & L Carstile, Inc. ("Contractor"), as Principal, a contract for the construction of theproj ect designated as Applewav Trail Phase 2A Earthwork, Contract No. 14-045 (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 North American Specialty Insurance Company organized and existing under the laws of the State of NH 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 Nine Thousand Three Hundred and 00/100--- dollars ($9,300.00 ), 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 August , 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. 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 City of Spokane Valley 15 Contract Documents Appleway Trail Phase 2A Earthwork Bid No: 14-045 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. PRINCIPAL(CONTRACTOR) SU' TY North American Specialty Insurance L&L Care' c. r Com.any —400° /`" if ,4 /L h, , . 8/28/2014 ip-I S• -ture D to Sure y Sig at ii= Date Larry Cargile Kathy Gurley Printed Name Printed Name President Attorney-in-Fact Title Title Name, address, and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W.Main,#1400,Spokane,WA 99201 - 509-358-3800 Revised 1.14.13 I r. City of Spokane Valley 16 Contract Documents Appieway Trail Phase 2A Earthwork Bid No: 14-045 NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg,Illinois,each does hereby make,constitute and appoint: GEORGE C.SCHROEDER,KATHY GURLEY,CHRIS LARSON,ERIN L.REPP,H.KEITH McNALLY, DIANA R.WILLIAMS and HEATHER ANDERSON JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9th of May,2012: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." ` _ SEAL :l7= Steven P.Anderson,Senior Vice President of Washington International Insurance Company SEAL r W iT� 1973 o,n 1 &Senior Vice President of North American Specialty Insurance Company F rn 51. 00N 134.dL`�O � tiy`rb�� ��annbnnmaa�` 5, oe By �.y� r+tmrm�nnn.. David M.Layman,Vice President of Washington International Insurance Company &Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 13th day of January ,2014 North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: On this 13thday of January ,2014 ,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M.Layman, Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. "OFFICIAL SEAL" t kooti714 AV/AZ DONNAD.SKLENS ONotary Public,State of Illinois Donna D.Sklens,Notary Public My Commission Expires 10/06/2015 I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 28th day of August ,20 14 . Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company&North American Specialty Insurance Company 193725 , ® DATE(MMDD/YYYY) A��o CERTIFICATE OF LIABILITY INSURANCE 8/14/2014 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 Stacia Simpson NAME: Commercial Lines-(509)358-3800 PHONE 509-358-3844 FAX 509-358-3812 (AIC.No.Extl: (AIC,Nol: Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 E-MAIL o.comimi t saca.sson wellsfar ADDRESS: p @ g 601 West Main Street,Suite 1400 INSURER(S)AFFORDING COVERAGE NAIC# Spokane,WA 99201-0635INSURER A, Continental Western Insurance Company 10804 INSURED INSURER B: L&L Cargile, Inc. INSURER C: P.O.Box 11784 INSURER D: Spokane Valley,WA 99211 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 8057381 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AVSD TYPE OF INSURANCE INSD SUER POLICY EFF POUCY EXP LTR NSD POLICY NUMBER (MM DDIIYYYY) (MMDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X CWP2496379 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREM SESO(EaENTEoccu DAMAGE ence) $ 100,000 X WA STOP GAP-$1,000,000 MED EXP(Any one person) $ 10,000 X $1,000 PD DED PERSONAL 8 ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY X X CWP2496379 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS — X HIRED AUTOS x NON-OWNED AUTOS (Perraccident)ROPERTY DAMAGE $ $ A X UMBRELLA UAB X OCCUR X X CU2496382 12/31/2013 12/31/2014 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- i AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORlPARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SPOKANE VALLEY CAPITAL IMPROVEMENT PROJECT NO.0176;APPLEWAY TRAIL PHASE 2A-EARTHWORK SVPW BID NO.:14045 PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED STATUS IS GIVEN TO CITY OF SPOKANE VALLEY,THEIR DIRECTORS,OFFICERS, EMPLOYEES OR ANY OTHER ENTITY REQUIRED BY THE MAIN CONTRACT AS GRANTED BY THE FORM ATTACHED. WAIVER OF SUBROGATION AND PER PROJECT AGGREGATE DO APPLY PER THE FORM(S)ATTACHED. CERTIFICATE HOLDER CANCELLATION CITY OF SPOKANE VALLEY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PUBLIC WORKS DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E SPRAGUE AVENUE SUITE 106 AUTHORIZED REPRESENTATIVE SPOKANE VALLEY,WA 99206 9(�u�,.„j,._ I J The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) • THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS OR OTHERS - COMPLETED OPERATIONS -AUTOMATIC, INCLUDING PRIMARY NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: • i COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II-WHO IS AN INSURED is amended to include as an additional insured any person(s)or organization(s)when you are obligated by virtue of a written contract or agreement that such person be added as an additional Insured to your policy, but only with respect to "bodily injury","proparty damage"or"personal and advertising injury"caused, in whole or in part, by: 1. Your acts or omissions;or 2. The acts or omissions of those acting on your behalf; for that additional insured and included in the"products-completed operations hazard". B. LIMITS OF INSURANCE • Limits of insurance for such additional insured are the limits in this coverage form or the limits you and such additional insured agreed to by virtue of a contract or agreement,whichever is less. These limits are inclusive of and are not in addition to the Limits Of Insurance shown in the Declarations. C. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply to"bodily injury","property damage"or"personal and advertising injury"arising out of: 1. The rendering of or failure to render any professional services by you or on your behalf, but only with respect to either or both of the following operations: a. Providing engineering, architectural or surveying services to others in your capacity as an engineer,architect or surveyor;and b. Providing, or hiring independent professionals to provide, engineering, architectural or surveying services in connection with construction work you perform. 2. Subject to paragraph 3.below, professional services include: a. Preparing, approving, or failing to prepare or approve maps, •shop drawings, opinions, reports,surveys,field orders,change orders,or drawings and specifications;and b. Supervisory or inspection activities performed as part of any related architectural or engineering activities. 3. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you or performed by or for the construction manager, its employees or its subcontractors in connection with your products-completed operations. D. PRIMARY NON-CONTRIBUTORY When required by virtue of a written contract or agreement, coverage provided to any additional insured by ADDITIONAL INSURED — OWNERS,LESSEES, CONTRACTORS OR OTHERS — COMPLETED OPERATIONS—AUTOMATIC, INCLUDING PRIMARY NON-CONTRIBUTORYwill be on a primary basis and will not seek contribution from the additional insured's policy. • CL CG 20 48 01 12 Includes Copyrighted material of Insurance Services Page 1 of 1 Office,Incwith its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY PLATINUM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS If SECTION I—COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit provided by this policy, subject to the terms of SECTION III -LIMITS OF INSURANCE, shall be the greater of: b. The Medical Expense Limit shown in the Declarations of this Coverage Part. B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT If damage to premises rented to you under Coverage A. is not otherwise excluded from this policy, the following applies: 1. The last paragraph of SECTION I—COVERAGE A.2. Exclusions is deleted and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to your or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III — LIMITS OF INSURANCE. 2. Paragraph 6.of SECTION III—LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to Paragraph 5.above,the greater of: a. $300,000;or b. the Damage To Premises Rented To You Limit shown in the Declarations; is the most we will pay under COVERAGE A for damages because of"property damage" to any one premises, while rented to you or temporarily occupied by you with the permission of the owner. 3. Paragraph 4.b.(1)(a)(ii) Other Insurance of SECTION IV — COMMERCIAL GENERAL. LIABILITY CONDITIONS is deleted and replaced by the following: (ii) That is Fire, Lightning, Explosion, Smoke or Sprinkler Leakage insurance for premises rented to you or temporarily occupied by you with the permission of the owner; 4. Paragraph 9.a.of SECTION V—DEFINITIONS is deleted and replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an"insured contract"; C. LIMITED NON-OWNED WATERCRAFT 1. Paragraph g.(2) of SECTION I — COVERAGE A.2. Exclusions is deleted and replaced by the following: A watercraft you do not own that is: a. Less than 51 feet long;and b. Not used to carry persons or property for a charge. CL CG 00 13 01 12 Includes copyrighted material of Insurance Services Page 1 of 5 Office,Inc with its permission D. SUPPLEMENTARY PAYMENTS SECTION I—SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows: 1. The limit of insurance in paragraph 1.b. is increased from$250 to$2,500; and 2. The limit of insurance in paragraph 1.d.is increased from$250 to$500. E. AUTOMATIC ADDITIONAL INSURED — SPECIFIED RELATIONSHIPS — PRIMARY NON-CONTRIBUTORY The following is added to Paragraph 2.of SECTION II-WHO IS AN INSURED: e. Any person or organization described below, when you are obligated by virtue of a written contract or agreement that such person be added as an additional insured on your policy. When required by virtue of a written contract or agreement, coverage provided to any additional insured will be on a primary basis and will not seek contribution from the additional insured's policy. Only-the-following-p nal insureds-under-this-endorsement: (1) Managers Or Lessors Of Premises.The manager or lessor of a premise leased to you, but only with respect to liability arising from the ownership, maintenance or use of that part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (a) Any"occurrence"which takes place after you cease to be a tenant of that premises. (b) Structural alterations, new construction or demolition operations performed by or on • behalf of the manager or lessor. (2) Lessor Of Leased Equipment. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s)or organization(s). However, this insurance does not apply to any "occurrence"which takes place after the equipment lease expires. (3) Vendors. Any person or organization referred to below as vendor, but only with respect to"bodily injury"or"property damage"arising out of"your products"which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: (a) The insurance afforded the vendor does not apply to: (i) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (ii) Any express warranty unauthorized by you; (iii) Any physical or chemical change in the product made intentionally by the vendor; (iv) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (v) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business,in connection with the distribution or sale of the products; (vi) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; CL CG 00 13 01 12 Includes copyrighted material of Insurance Services Page 2 of 5 Office,Inc with its permission (vii) 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;or (viii) "Bodily injury" or "property damage".arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: i. The exceptions contained in Sub-paragraphs(iv)or(vi);or ii. Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (b) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. (4) State Or Political Subdivision — Permits Or Authorizations Relating To Premises. Any-state-orpoliticalsubdivision,,-subject lu the following additional provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures;or (b) The construction,erection, or removal of elevators;or (c) The ownership, maintenance,or use of any elevators covered by this insurance. F. BROADENED NAMED INSURED—NEWLY ACQUIRED 180 DAYS • Paragraph 3.of SECTION H-WHO IS AN INSURED is deleted and replaced by the following: Any organization you newly acquire or form, other than a joint venture, and over which you maintain ownership or majority interest of more than 50%will be a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period,whichever is earlier. b. COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. c. COVERAGE B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. G. AGGREGATE LIMITS OF INSURANCE The General Aggregate Limit under SECTION III — LIMITS OF INSURANCE applies separately to each of your: 1. Projects away from premises owned by or rented to you. 2. "Locations"owned by or rented to you. "Location"means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway,waterway or right-of-way of a railroad. H. KNOWLEDGE OF OCCURRENCE The following is added to paragraph 2.Duties In The Event Of Occurrence,Offense,Claim Or Suit of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS: e. A report of an"occurrence",offense,claim or"suit"to: (1) You, if you are an individual, (2) A partner, if you are a partnership, CL CG 00 13 01 12 Includes copyrighted material of Insurance Services Page 3 of 5 Office,Inc with its permission • (3) An executive officer, if you are a corporation, or (4) A manager, if you are a limited liability company; is considered knowledge and requires you to notify us of the"occurrence", offense, claim, or "suit"as soon as practicable. f. We are considered on notice of an "occurrence", offense, claim or "suit" that is reported to your Workers' Compensation insurer for an event which later develops into an "occurrence", offense,claim or"suit"for which there is coverage under this policy. However,we will only be considered on notice if you notify us as soon as you know the claim should be addressed by this policy rather than your Workers'Compensation policy. I. UNINTENTIONAL OMISSIONS The following is added to paragraph 6. Representations of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: d. If you unintentionally fail to disclose any exposures existing at the inception date of your policy,we--wlil-net-deny-coverage-under his--Coverers-part-solely-because-of-suck failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This provision does not apply to any known injury or damage which is excluded under any other provision of this policy. J. MENTAL ANGUISH Paragraph 3.of SECTION V—DEFINITIONS is deleted and replaced by the following: 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from any of these at any time. K. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended by the addition of the following: We waive any right of recovery we may have because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work" done under a 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"occurrence"giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring"suit"or transfer those rights to us and help us enforce those rights. L. OTHER INSURANCE When Coverage applies in this General Liability Enhancement Endorsement, no other coverage or limit of insurance in the policy applies to loss or damage insured by this coverage. M. NON-EMPLOYMENT DISCRIMINATION LIABILITY(DEFENSE WITHIN LIMITS) The following is added to paragraph 14. "Personal and advertising injury" SECTION V — DEFINITIONS of COMMERCIAL GENERAL LIABILITY COVERAGE FORM: h. Non-employment discrimination. Non-employment discrimination means violation of a person's civil rights with respect to such person's race, color, national origin, religion, gender, marital status, age, sexual orientation or preference, physical or mental condition, or any other protected class or characteristic established by any federal, state or local statutes, rules or regulations. Non-employment discrimination does not include violation of civil rights arising out of past, present or prospective employment. Our obligation under the Personal and Advertising Injury Liability Coverage to pay non- employment discrimination liability damages on your behalf applies only to the amount of damages in excess of$5,000 deductible as the result of any one offense regardless of the number of persons or organizations who sustain damages because of the offense. CL CG 00 13 01 12 Includes copyrighted material of Insurance Services Page 4 of 5 Office,Inc with its permission The most we will pay for all damages for non-employment discrimination is $15,000 annual aggregate. No other liability to pay sums or perform acts or services is covered. Supplemental Payments — Coverages A and B do not apply to non-employment discrimination coverage. N. ADDITIONAL INSURED—OWNERS, LESSEES OR CONTRACTORS OR OTHERS—AUTOMATIC, INCLUDING PRIMARY NON-CONTRIBUTORY 1. SECTION II—WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you are obligated by virtue of a written contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to "bodily injury", "property damage" or "personal and advertising injury"is caused, in whole or in part, by: a. Your acts or omissions;or . b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. This insurance does not apply to "bodily injury", "property damage", "personal and advertising injury"included within the"products-completed operations hazard". 2. Limits-of Insurance Limits of insurance for such additional insured are the limits in this coverage form or the limits you and such additional insured agreed to by virtue of a contract or agreement, whichever is less. These.limits are inclusive of and are not in addition to the Limits Of Insurance shown in the Declarations. 3. Exclusions With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services,including, but not limited to any of the following: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions,reports,surveys,field orders,change orders or drawings and specifications;or i (2) Supervisory, inspection,architectural or engineering activities. b. "Bodily injury"or"property damage"occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed;or (2) That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 4. Primary Non-Contributory When required by virtue of a written contract or agreement, coverage provided to any additional insured by ADDITIONAL INSURED — OWNERS, LESSEES, CONTRACTORS OR OTHERS — ONGOING OPERATIONS —AUTOMATIC, INCLUDING PRIMARY NON CONTRIBUTORY will be on a primary basis and will not seek contribution from the additional insured's policy. CL CG 00 13 01 12 Includes copyrighted material of Insurance Services Page 5 of 5 Office,Inc with its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR GENERAL LIABILITY PLATINUM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. PROPERTY DAMAGE TO BORROWED EQUIPMENT 1. Paragraph 2.j. of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perform operations at the time of loss. 2. SECTION III—LIMITS OF INSURANCE is deleted and replaced by the following: The most we will pay in any one "occurrence" for "property damage" to borrowed equipment is $15,000. This limit of insurance is the most we will pay regardless of the number of: a. Insureds; b. Claims made or"suits"brought;or c. Persons or organizations making claims or bringing"suits". 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as applicable to "property damage" as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any "suits" seeking those damages; and your duties in the event of an "occurrence",claim,or"suit"apply irrespective of the application of the deductible 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 we have paid. B. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT 1. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C(SECTION I),which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: a. A Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. b. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of"bodily injury"or"property damage" included in the "products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought;or (3) Persons or organizations making claims or bringing"suits". c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 1 of 4 Office,Inc with its permission • d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which cannot be attributed only to ongoing operations at a single designated construction project away from premises owned by or rented to the insured: a. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable;and b. Such payments shall not reduce any Single Construction Project General Aggregate Limit. 3. When coverage for liability arising out of the"products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the " oduets-eom eretio��;azard"--Will reduce—the—Products Completed—Operationc pr Pleted—op Aggregate Limit, and not reduce the General Aggregate Limit or the Single Construction Project General Aggregate Limit. 4. If the applicable construction project away from premises owned by or rented to the insured has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. C. LIMITED JOB SITE POLLUTION 1. Exclusion f.under Section I—Coverage A is replaced by the following: 2. Exclusions This insurance does not apply to: f. Pollution (1) ,Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge,dispersal,seepage, migration,release or escape of"pollutants": (a) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of,"pollutants";or (b) At or from a storage tank or other container, ducts or piping which is below or partially below the surface of the ground or water or which, at any time, has been buried under the surface of the ground or water and then subsequently exposed by erosion, excavation or any other means if the actual, alleged or threatened discharge,dispersal,seepage, migration, release or escape of"pollutants"arises at or from any premises, site or location which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the"pollutants"are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. Subparagraph (b) does not apply to "bodily injury" or "property damage" arising out of heat,smoke or fumes from a"hostile fire". (2) Any loss,cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement issued or made pursuant to any environmental protection or environmental liability statutes or regulations that any insured test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants";or CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 2 of 4 Office,Inc with its permission (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, or neutralizing or in any way responding to or assessing the effects of,"pollutants". However, this paragraph does not apply to liability for those sums the insured becomes legally obligated to pay as damages because of"property damage"that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. 2. With respect to "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants": a. The"Each Occurrence Limit"shown in the Declarations does not apply. b. Paragraph 7.of Limits Of Insurance(Section Ill)does not apply. c. Paragraph 1.of Section III—Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought; or (3) Persons or organizations making claims or bringing"suits". • d. The following are added to Section III—Limits Of Insurance: 8. 'Subject to 2.or 3.above,whichever applies,the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants" is $100,000 aggregate. 9. Subject to 8.above,the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of"bodily injury" sustained by any one person arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration,release or escape of"pollutants". D. VOLUNTARY PROPERTY DAMAGE 1. The following is added to Section 1—COVERAGES: We will pay, at your request for"property damage"to that part of any property: 1 a. Which you or any subcontractors working directly or indirectly on your behalf are performing operations;or b. That must be restored,repaired or replaced because "your work" was incorrectly performed on it. This insurance applies only to "property damage" to property of others while in your care, custody, or control, and arising out of operations away from your insured premises and incidental to your business. Exclusions J.(3),(4),(5)and(6)do not apply to this coverage. This insurance does not apply to "property damage" included within the "explosion hazard", the"collapse hazard"or the"underground property damage hazard". 2. For the .purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION III—LIMITS OF INSURANCE is replaced by the following: A. Limits of Insurance 1. Unless a higher limit is shown in the Declarations, the most we will pay in any one "occurrence"for"property damage"under this endorsement is$15,000. 2. Unless a higher limit is shown in the Declarations, the most we will pay for all covered "occurrences"during any one policy period is$15,000 Aggregate Limit of Insurance. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 3 of 4 Office,Inc with its permission The Limits of Insurance of this endorsement apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any"suits"seeking those damages;and your duties in the event of an "occurrence", claim, or "suit" apply irrespective of the application of the deductible 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-we-have-paid. 4. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: In the event of loss covered by this endorsement,the insured-shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs at actual cost to the insured, excluding prospective profit or overhead charges of any nature. Any property so paid for or replaced shall, at our option, become our property. Any payment made by us shall not constitute an admission of liability by an insured,or by us. b. Paragraph 4.Other Insurance is amended as follows: (1) Paragraph 4.a.Primary Insurance is deleted. (2) Subparagraphs (1) and (2) of paragraph 4.b. Excess Insurance are deleted and replaced with the following: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis. All other provisions that apply to paragraph 4.Other Insurance contained in the Commercial General Liability Coverage Form are applicable. 5. For the purposes of the coverage provided by D.VOLUNTARY PROPERTY DAMAGE, the following definitions are added to SECTION V—DEFINITIONS: a. "Collapse hazard" includes "structural property damage" and any resulting "property damage"to any other property at any time. b. "Explosion hazard" includes "property damage" arising out of blasting or explosion. The "explosion hazard"does not include"property damage" arising out of the explosion of air or steam vessels, piping under pressure, prime movers, machinery or power transmitting equipment. c. "Structural property damage" means the collapse of or structural injury to any building or structure due to: (1) Grading of land, excavating, borrowing, filling, back-filling, tunneling, pile driving, cofferdam work or caisson work;or (2) Moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support of that building or structure. d. "Underground property damage hazard" includes "underground property damage" and any resulting"property damage"to any other property at any time. e. "Underground property damage" means "property damage" to wires, conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any apparatus used with them beneath the surface of the ground or water, caused by and occurring during the use of mechanical equipment for the purpose of grading land, paving, excavating, drilling, borrowing,filling, back-filling or pile driving. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 4 of 4 j Office,Inc with its permission L&L CARGILE INC https://secure.lni.wa.gov/verify/Details/IiabilityCertificate.aspx?UB... A STATE OE WASHINGTON N Department of Labor & Industries Certificate of Workers' Compensation Coverage August 19, 2014 j WA UBI No. 602 283 127 L&I Account ID 5028900 Legal Business Name L& L CARGILE INC Doing Business As L& L CARGILE INC !Workers'Comp Premium Status: Account is current. Estimated Workers Reported Quarter 2 of Year 2014"11 to 20 (See Description Below) Workers" Account Representative TO/CAROLYN CRAWFORD } (360)902-4715-Email: CRAI235@Ini.wa.gov I Licensed Contractor? Yes License No. LLCARI*9720K Licen se Expiration 09/12/2015 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.1 6.1 90). 1 of 1 8/19/2014 4:06 PM