14-180.00 Inland Asphalt: 2014 Stormwater Utility Small Works Projects Contract
THIS AGREEMENT,made and entered into this 22-44 day of Saipt , 2014, between the City
of Spokane Valley under and by virtue of Title 35 RCW, as amended and
Inland Asphalt Company
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:
Stormwater Utility 2014 Small Works Projects,Package 2
SVPW Contract #14-051
in accordance with and as described in the project plans and specification, and the
standard specification of the Washington State of Department of Transportation
which are by this reference incorporated herein and made part hereof and, shall
perform any changes in the work in accord with the Contract Documents.
The Contractor shall provide and bear the expense of all equipment, work and labor,
of any sort whatsoever that may be required for the transfer of materials and for
constructing and completing the work provided for in these Contract Documents
except those items mentioned therein to be furnished by the City of Spokane Valley.
II. The City of Spokane Valley hereby promises and agrees with the Contractor to
employ, and does employ the Contractor to provide the materials and to do and cause
to be done the above described work and to complete and finish the same in accord
with the project plans and specification and the terms and conditions herein
contained and hereby contracts to pay for the same according to the referenced
specifications and the schedule of unit or itemized prices at the time and in the
manner and upon the conditions provided for in this contract.
III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators,
successors, and assigns, does hereby agree to full performance of all covenants
required of the Contractor in the contract.
IV. It is further provided that no liability shall attach to the City of Spokane Valley by
reason of entering onto this contract, except as provided herein.
(p ILA-18�
V. The project was awarded for the bid amount of$152,077.00_.
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 September 2 2 ,2014.
Date
Al Hughbanks
Printed Name
Chief Esti' .tor
Title
/ i t
Signa
City of Spok e Valley
fib( 7.;1.2.("7
P ted ame
Ce i4' A
Titl-
AZIA f
ignature Revised 6.19.13
Siiole
�rValley
BOND NO: 9170316
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 INLAND ASPHALT COMPANY
(Contractor), as Principal, a contract for the construction of the project designated as Stormwater Small Works 2014,Package 2,
Project No. (Project #14-051) 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 FIDELITY AND DEPOSIT COMPANY OF MARYLAND (Surety),a corporation organized
under the laws MARYLAND 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$152,077.00
total Contract amount(including Washington State sales tax),subject to the provisions herein.
This payment bond shall become null and void, if and when the Principal,its heirs,executors,administrators,successors,or assigns
shall pay all persons in accordance with chapters 39.08 and 39.12 RCW,including all workers,laborers,mechanics,subcontractors,
and materialmen,and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of
such work;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee may suffer by reason of
the failure of Principal to make such required payments; and if such payment obligations have not been fulfilled, this bond shall
remain in full force and effect.
The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the
specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on
this bond,except as provided herein, and waives notice of any change,extension of time, alteration or addition to the terms of the
Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that
increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to
Surety is not required for such increased obligation.
This bond may be executed in two original counterparts,and shall be signed by the parties' duly authorized officers. This bond will
only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the
surety.
INLAND • 'H;LT au FIDELITY AND DEPOSIT COMPANY OF MARYLAND
PRIN' i' .11 i�I r .' i ) SUR TY/ /
�, 1/���1 a 1 d / 09/22/2014
Principal Sig Date urety Signature / Date
Al Hugh an'4. LISA HALL
Printed Name Printed Name
Chief Estimator ATTORNEY-IN-FACT
Title Title
Name,address,and telephone of local office/agent of Surety Company is: .
TINA DAVIS
15 W.SOUTH TEMPLE, STE. 700
SALT LAKE CITY, UT 84101
Spokane
.s0Valley
BOND NO: 9170316
CONTRACTOR'S PERFORMANCE BOND
to City of Spokane Valley,Washington
The City of Spokane Valley, Washington, in Spokane County, has awarded to INLAND ASPHALT COMPANY
(Contractor), as Principal, a contract for the construction of the project designated as Stormwater Small Works 2014,Package 2,
Project No. 14-051 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 FIDELITY AND DEPOSIT COMPANY OF MARYLAND (Surety),a corporation,organized
under the laws of MARYLAND 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$152,077.00
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.
INLAND ' ,,T T '' FIDELITY AND DEPOSIT COMPANY OF MAR AND
P' i , o litii,
S • � / /,L���I1t\- . Q Z Z 14- 40_ 04m,,� _. .. 2/2014
Principal Sifir ate Surety Signature Date
Al HughLISA HALL
Printed Name Printed Name
Chief Estimator ATTORNEY-IN-FACT
Title Title
Name,address,and telephone of local office/agent of Surety Company is:
TINA DAVIS
15 W.SOUTH TEMPLE, STE. 700
SALT LAKE CITY, UT 84101
SURETY ACKNOWLEDGMENT
STATE OF UTAH }
COUNTY OF SALT LAKE } SS
On this 22ND day of SEPTEMBER, 2014, before me personally came LISA HALL
to me known, who, being by me duly sworn, did depose and say that she is an
Attorney-In-Fact of FIDELITY AND DEPOSIT COMPANY OF MARYLAND the
corporation described in and which executed the within instrument; that she knows
the corporate seal of said corporation, that the seal affixed to the within instrument
is such corporate seal, and that she signed the said instrument and affixed the said
seal as Attorney-In-Fact of the Board of Directors of said corporation and by
authority of this office under the Standing Resolut' ns thereof.
.)•
T�'' Notary'�blic'
I 4,
OmeC,'3C .�-O-----{y(i----------.
1 9 6�: '! NOtary Public
t 41 � +c� CommissianNumbar6-9659 1
i Y l Y Commiusion Exp:0:59
�v'r'. +h`1:=.�,.�d � phos
1 Nr. 'lao.! ' Novanibor 30,2096 1
a ,
Ns State St 6 of Utah 1
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New
York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland,and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
THOMAS O. MCCLELLAN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said
Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby
nominate,constitute,and appoint Tina DAVIS,Lisa HALL and Lindsey PLATTNER,all of Salt Lake City,Utah, EACH its true and
lawful agent and Attorney-in-Fact,to make,execute, seal and deliver,for, and on its behalf as surety, and as its act and deed: any and all
bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said
Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of
the By-Laws of said Companies,and is now in force.
IN WITNESS WHEREOF,the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 24th day of July,A.D.2014. I
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
c atut4 as ttuos,% s�r��Ns e
p �S
8BAL _t of
' teM u ma
BY: *Citar2---„ ,..._g
el. ff./1K4-0(
Assistant Secretary Vice President
Michael McKibben Thomas O.McClellan
State of Maryland
City of Baltimore
On this 24th day of July,A.D.2014,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,THOMAS O.
MCCLELLAN,Vice President,and MICHAEL MCKIBBEN,Assistant Secretary,of the Companies,to me personally known to be the individuals and
officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,
that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and
that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said
Corporations.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written.
tt01.1:..1:,....s.' G
92titAt;_D. 00,,,,,-(2 .,:„v.:.0t,,c...44-
Maria D.Adamski,Notary Public
My Commission Expires:July 8,2015
1 POA-F 020-8022W
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies,
recognizances, stipulations,undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of
the By-Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attomey...Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice-President,Secretary, or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a
certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 22NDday of SEPTEMBER ,2014
ft" to". = UALltN 199171
9� Nr
Gerald F.Haley,Vice President
_ Certificate of Insurance CERTIFICATE
INSURANCE POLICISSUED AS A MATTER OF Y AND DOES NOT AMEND,INFORMATION.
XTEND,OR ALTER THE COVERAGE AFFORDED BYN YOU Y THE POLICIES LISTED BELOW.
THIS CERTIFICATE IS NOT AN
This is to Certify that NWelikk
Inland Asphalt Company 7 lik e
NAME
CPM Development Corporation dba ADDRESS V\%t Li ePO Box 3366 OF INSURED I Spokane, WA 99220-3366 I rfrMutual®
is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below.The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and
Conditions and is not altered by any rec,uirement,term or condition of any contract or other document with respect to which this certificate may be issued.
1 EXP DATE
0 CONTINUOUS
TYPE OF POLICY ❑EXTENDED POLICY NUMBER LIMIT OF LIABILITY
El POLICY TERM
WA7-C8D-004095-024 COVERAGE AFFORDED UNDER
WORKERS 9/1/2015 WC LAW OF THE FOLLOWING EMPLOYERS LIABILITY
COMPENSATION WC7-C81-004095-014 STATES:
ALL STATES EXCLUDING Bodily Injury by Accident
MONPOLISTICS STATES AND $1,000,000 Each Accident
NY Bodily Injury by Disease
$1,000,000 Policy Limit
OR,WI
Bodily Injury by Disease
$1,000,000 Each Person
General Aggregate-Other than Products/Completed Operations
GENERAL LIABILITY 9/1/2015 TB2-C81-004095-114' $2,000,000
-Per project aggregate included Products/Completed Operations Aggregate
21 OCCURRENCE $2,000,000
0 CLAIMS MADE Bodily Injury and Property Damage Liability
$2,000,000 Per Occurrence
RETRO DATE Personal Injury
• Included* Per Person/Organization
Other Other
Included in BI/PD Liability FIRE DAMAGE$100,000;PER
PROJECT AGGREGATE
Each Accident-Single Limit
AUTOMOBILE 9/1/2015 AS2-C81-004095-124 $2,000,000 B.I.And P.D.Combined
LIABILITY
Comp Ded$10,000 Each Person
10 OWNED
El NON-OWNED
Coll Ded$10,000 Each Accident or Occurrence
El HIRED Each Accident or Occurrence
ETHER
Excess Workers' 9/1/2015 EW7-68N-004095-344 SIR 250,000;EXCESS WC 250,000,000(INCLUDES WA STOP Compensation&Employers' GAP)EL$750,000
Liability
ADDITIONAL COMMENTS
RE: Stormwater Utility 2014 Small Works Projects,Package 2
City of Spokane Valley is named as additional insured with respect to the above referenced project. Coverage is primary and non-contributory.
lithe certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE-OHIO:ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS:IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT
THIS CERTIFICATE FOR ANY REASON,PLEASE CONTACT YOUR LOCAL SALES PRODUCER WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER
RIGHT HAND CORNER OF THIS CERTIFICATE.THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. Liberty Mutual
Insurance Group
NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.)
BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE
INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE
OF SUCH CANCELLATION HAS BEEN MAILED TO:
City of Spokane Valley 7Aaf. A,,Qt.,,r . -E.112.0.04';t6)4,_"11707 E. Sprague, Suite 106 Stanley S.Esposito Jr.
3 Spokane Valley,WA 99206 Pittsburgh/0387 AUTHORIZED REPRESENTATIVE
Bx
12 Federal Street,Ste.310
Pittsburgh PA 15212-5706 412-231-1331 9/29/14
OFFICE PHONE DATE ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772
Liberty
�► Mutual.
INSURANCE
Liberty Mutual Group
157 Berkeley Street
• Boston,MA 02116
Tel: (617)654-4096
Fax: (857)224-
August 21 2014
Re: Oldcastle Inc.,Oldcastle Materials,Inc.,CPM Development Corporation,Eugene Sand Construction,
Inc.,Interstate Concrete and Asphalt Co.
Policy#TB2-C81-004095-114,AS2-C81-004095-124,WA7-C8D-004095-024,WC7-C81-004095-024,
EW7-68N-004095-344
To Whom It May Concern:
Please accept this letter as confirmation that these customers have renewed with Liberty Mutual Insurance and
coverage continues under the attached expiring endorsements. We will release the renewal endorsements for the
current policy period of 9/1/14—9/1/15 within 30 days at which time,we will provide you copies of the
endorsements for your file.
Endorsements:
WC 00 03 13- Waiver of Our Right to Recover from Others Endorsement
CG 20 10 04 13—Additional Insured—Owners.Lessees or Contractors
CO 20 37 04 13—Additional Insured—Owners,Lessees or Contractors—Completed Operations
CO 24 04 05 09-Waiver of our Right to Recover From Others Endorsement
LD 24 10 07 13 -Primary and Non Contributory-Scheduled Additional Insured
AC 84 23 08 11 —Designated Insured—Noncontributing
CA 04 44 10 13—Waiver of Transfer of Rights of Recovery against Other to US(Waiver of Subrogation)
CA 20 48 10 13—Designated Insured
I hope this will suffice for verification purposes. If you have any questions,please contact me at
617-654-4096.
Regards,
.Natalie O'Brien
Natalie O'Brien
Underwriting Technical Specialist
Helping people live safe,more secure lives.
Certificate of Insurance
THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION.ONLY AND CONFERS NO RIGHT UPON YOU THE CERTIFICATE HOLDER.THIS CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND.EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
This is to Certify that OW
e't
Inland Asphalt Company —1 111, AL.NAME AND Libe
CPM Development Corporation dba •��
PO Box 3366 ADDRESS
I OF INSURED
Spokane, WA 99220-3366
P, �
Mutual®
is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below.The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and
Conditions and is nol altered by any rec,uirement,tenn or condition of any contract or other document with respect to which this certificate may be issued.
1 EXP DATE
0 CONTINUOUS
TYPE OF POLICY ❑EXTENDED POLICY NUMBER LIMIT OF LIABILITY
0 POLICY TERM
WA7-C8D-004095-025 COVERAGE AFFORDED UNDER
WORKERS 9/1/2016 WC7-C81-004095-015 WC LAW OF THE FOLLOWING EMPLOYERS LIABILITY
COMPENSATION STATES:
ALL STATES EXCLUDING Bodily Injury by Accident
MONPOLISTICS STATES AND $1,000,000 Each Accident
NY Bodily Injury by Disease 1
OR,WI $1,000,000 Policy Limit
Bodily Injury by Disease
$1,000,000 Each Person
General Aggregate-Other than Products/Completed Operations
GENERAL LIABILITY 9/1/2016 TB2-C81-004095-115 $2,000,000
-Per project aggregate included Products/Completed Operations Aggregate
El OCCURRENCE $2,000,000
❑CLAIMS MADE Bodily Injury and Property Damage Liability
$2,000,000 Per Occurrence
RETRO DATE Personal Injury
Included* Per Person/Organization
Other Other
Included in SI/PD Liability FIRE DAMAGE$100,000;PER
PROJECT AGGREGATE
AUTOMOBILE 9/1/2016 AS2-C81-004095-125 $2,000,000 InLimit Ad PD.Combined
LIABILITY
Comp Ded$10,000 Each Person
Q OWNED
0 NON-OWNED Coll Ded$10,000 Each Accident or Occurrence
0 HIRED Each Accident or Occurrence
OTHER
Excess Workers' 9/1/2016 EW7-68N-004095-345 SIR 250,000;EXCESS WC 250,000,000(INCLUDES WA STOP
Compensation&Employers' GAP)EL$750,000
Liability
ADDITIONAL COMMENTS
RE: Stormewater Utility 2014 Small Works Projects,Package 2
City of Spokane Valley is named as additional insured with respect to the above referenced project. Coverage is primary and non-contributory.
•If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date.
SPECIAL NOTICE-OHIO:ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER.SUBMITS
AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS:IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT
THIS CERTIFICATE FOR ANY REASON.PLEASE CONTACT YOUR LOCAL SALES PRODUCER WHOSE.NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER
RIGHT HAND CORNER OF THIS CERTIFICATE.THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. Liberty Mutual
Insurance Group
NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.)
BEFORE THE STATED EXPIRATION DATE THE COMI'ANY WILL NOT CANCEL OR REDUCE THE
INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE
OF SUCH CANCELLATION HAS BEEN MAILED TO:
City of Spokane Valley
11707 E. Sprague Ave.,Suite 106
s 0� � Stanley S.Esposito Jr.
!E—' Spokane Valley,WA 99206 Pittsburgh/0387 AUTHORIZED REPRESENTATIVE
cE,_ I I 12 Federal Street,Ste.310
Pittsburgh PA 15212-5706 412-231-1331 10/6/15
OFFICE PHONE DATE ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772
POLICY NUMBER:TB2-C81-004095-1 15 COMVERCIAL GENERAL LIABILITY
CG 2010 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or
include as an additional insured the person(s) or equipment ment furnished in connection with such
organization(s) shown in the Schedule, but only with work, on the project (other than service,
respect to liability for 'bodily injury", "property maintenance or repairs)to be performed by or
damage" or "personal and advertising injury" on behalf of the additional insured(s) at the
caused,in whole or in part.by: location of the covered operations has been
1. Your acts or omissions;or completed;or
2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the
behalf; injury or damage arises has been put to its
in the performance of your ongoing operations for intended use by any person or organization
the additional insured(s) at the location(s) ether than another contractor or subcontractorengaged in performing operationsa
designated above. for a
principal as a part of the same project.
However. C. With respect to the insurance afforded to these
1. The insurance afforded to such additional additional insureds, the following is added to
insured only applies to the extent permitted by Section III—Limits Of Insurance:
law;and If coverage provided to the additional insured is
2. If coverage provided to the additional insured is required by a contract or agreement, the most we
required by a contract or agreement, the will pay on behalf of the additional insured is the
insurance afforded to such additional insured will amount of insurance:
not be broader than that which you are required 1. Required by the contract or agreement;or
by the contract or agreement to provide for such
additional insured. 2. Available under the applicable Limits of
B. With respect to the insurance afforded to these Insurance shown in the Declarations;
additional insureds, the following additional whichever is less.
exclusions apply: This endorsement shall not increase the
This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the
"property damage" occurring after. Declarations.
SCHEDULE
Name Of Additional Insured Person(s) Location(s)Of Covered Operations
Or Organization(s):
Any owner,lessee,or contractor for whom you have Any location listed in such agreement
agreed in writing prior to a loss to provide liability
insurance
Information required to complete this Schedule,if not shown above, will be shown in the Declarations.
CG 2010 0413 ®Insurance Services Office,Inc.,2012 Page 1 of 1
Policy Number TB2-C81-004095-115
issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NON-CONTRIBUTORY—SCHEDULED ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
Schedule
Person or Organization:
Where required by written contract prior to a loss
If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or
any other basis for any person or organization shown in the Schedule that is an additional insured on this policy,
this policy will apply solely on the basis required by such written agreement If the applicable written agreement
does not specify on what basis the liability Insurance will apply,this Insurance shall be excess over any other valid
and collectible insurance available to the additional insured,whether such Insurance is on an excess,contingent or
primary basis.Condition 4 Other Insurance of Section IV is revised accordingly.
LD 2410 0713 ®2013 Liberty Mutual Insurance.All rights reserved. Page 1 of 1
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.