Loading...
15-063.00 T. LaRiviere: Houk Sinto Maxwell Preservation 1 -0(4,3 Contract Contract THIS AGREEMENT,made and entered into this day of . , 2015, between the City of Spokane Valley under and by virtue of Title 35 C ,as amended and T. LaRiviere Equipment& Excavation,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: Houk—Sinto -Maxwell Street Preservation Project SVPW Contract 15-063 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. City of Spokane Valley 1 Contract Forms Houk-Sinto-Maxwell St Preservation Project Bid No.:15-063 V. The project was awarded for the bid amount of$339,647.83. 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 , ,2015. Date Printed Name A Title • Signature City of Spokane Valley C (tlDuvMrK Printtedd Name -e � C4' fv V Title �� l I l I Signature Reised 13 City of Spokane Valley 2 Contract Forms Houk-Sinto-Maxwell St Preservation Project Bid No.:15-063 EJcopy Spokane Valley. BOND NO: BD 742231 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County,has awarded to T.LaRiviere Equipment& Excavation, Inc. (Contractor), as Principal, a contract for the construction of the project designated as the Houk-Sinto-Maxwell Street Preservation Project 40220 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 Nationwide Mutual Insurance Company (Surety), a corporation, organized under the laws of Ohio 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$93 9;647.8 3total 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. T.LaRiviere Equipment & Excavation, Inc. Nati wide Mutual Insurance Company PRINCIPAL(CONTRACTOR) SURE 4 I0 /), Principal Signature yr 8 2NO r Date Sure ignature \ Date 1\\ (.1c) John L. Green t Ailed Name Printed Name e`r� a Attorney—in—Fact _ ., Title Title 1 ' ? Name,address,and telephone of local office/agent of Surety Company is: Inland Insurance, Inc. 9016 E. Indiana, Suite A, Spokane Valley, WA 99212 509-456-2648 City of Spokane Valley 1 Contract Forms Houk-Sinto-Maxwell St Preservation Project Bid No.:15-063 Power of Attorney KNOW ALL MEN BY THESE PRESENTS THAT: Nationwide Mutual Insurance Company,an Ohio corporation AMCO Insurance Company,an Iowa corporation Farmland Mutual Insurance Company,an Iowa corporation Allied Property and Casualty Insurance Company,an Iowa corporation Nationwide Agribusiness Insurance Company,an Iowa corporation Depositors Insurance Company,an Iowa corporation hereinafter referred to severally as the"Company"and collectively as the"Companies,'each does hereby make,constitute and appoint: JAMES P.DINNEEN JOHN L.GREEN SPOKANE VALLEY WA each in their individual capacity,its true and lawful attorney-in-fact,with full power and authority to sign,seal,and execute on its behalf any and all bonds and undertakings, and other obligatory instruments of similar nature,in penalties not exceeding the sum of ONE MILLION AND NO/100 DOLLARS S 1,000,000.00 and to bind the Company thereby,as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company;and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed. This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company: "RESOLVED,that the president,or any vice president be,and each hereby is,authorized and empowered to appoint attorneys-in-fact of the Company,and to authorize them to execute and deliver on behalf of the Company any and all bonds,forms,applications,memorandums,undertakings,recognizances,transfers,contracts of indemnity,policies,contracts guaranteeing the fidelity of persons holding positions of public or private trust,and other writings obligatory in nature that the business of the Company may require;and to modify or revoke,with or without cause,any such appointment or authority;provided,however,that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company." "RESOLVED FURTHER,that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them,and to affix the seal of the Company thereto;provided,however,that said seal shall not be necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company. Execution of Instruments. Any vice president,any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents,instruments,contracts,or other papers in connection with the operation of the business of the company in addition to the chairman of the board,the chief executive officer,president,treasurer or secretary;provided,however,the signature of any of them maybe printed,engraved,or stamped on any approved document, contract,instrument,or other papers of the Company. IN WITNESS WHEREOF,the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 13"' day of February,2014. '�� 1w\ �a� f 0,:t g peso!."...,. /i�?— :c' A-. `�`..•,� Terrance Williams,President and Chief Operating Officer of Nationwide Agribusiness Insurance Company / �� / $� and Farmland Mutual Insurance Company;and Vice President of Nationwide Mutual Insurance Company, :SEA_ /*' /,;SEAL_.• AMCO Insurance Company,Allied Property and Casualty Insurance Company,and Depositors Insurance �. I '• ' Company a\��r ',sal. ACKNOWLEDGMENT 40M� , ,u?! ` ' STATE OF IOWA,COUNTY OF POLK: ss /a: �••.' / c� .i.,,..- 114 m ,g. On this 13th day of February,2014.before me came the above-named officer for the Companies aforesaid,to Os.: ..:.• / SEAL a0 me personally known to be the officer described in and who executed the preceding instrument, and he •••• . / ` + :;J acknowledged the execution of the same,and being by me duly sworn,deposes and says,that he is the officer -. I ,�` * of the Companies aforesaid,that the seals affixed hereto are the corporate seals of said Companies,and the said corporate seals and his signature were duly affixed and subscribed to said instrument by the authority and .���b. .♦ , direction of said Companies. &e--C-3-- ire:' / �? Sandy Alia t�! ' i �: snay. + ��T / I , Notarial Seal—Iowa � SEA_L- (r :SEAL; Commission Number 152705 *1 Notary Public / '• +/ My Commission Expires March,24,2017 ♦ y? . ♦44i •lise My Commission Expires \m►. ��� CERTIFICATE March 24,2017 I, Robert W Homer III,Secretary of the Companies,do hereby certify that the foregoing is a full,true and correct copy of the original power of attorney issued by the Company;that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner;that said Terrance Williams was on the date of the execution of the foregoing power of attorney the duly elected officer of the Companies,and the corporate seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors;anddhe foregoing power of attorney is still in full force and effect. - IN WITNESS WHEREOF,I have hereunto subscribed my name as Secretary,and affixed the corporate seals of said Companies,this.110th, day of June ,20 15 al ri---,,, .- ` .) v Secretary , - This Power of Attorney Expires 09/18/15 --, . BDJ 1(03-14)00 ' 26535 [DC CP Y Spokane _..Va11ey° BOND NO: BD 742231 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 T.LaRiviere Equipment&Excavation, Inc. (Contractor),as Principal,a contract for the construction of the project designated as the Houk-Sinto-Maxwell Street Preservation Project#0220,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 Nationwide Mutual Insurance Company (Surety), a corporation organized under the laws Ohio 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$339,647.R Mal 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 materiahnen,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. T.LaRiviere Equipment & Excavation, Inc. Nationw'- - Mutual Insu ance Company PRINCIPAL CONTRACTOR) SURETY 0 I ` -//0 (-04Z-le''" Principal Signature Date Surety Si• a' e Date r` / ‘NTh ' Vak\KCIC. John i . Green L Printed Name Printed Name ,` ' — tk'Afil\- Attorney—in—Fact ' , 1._t_ Title Title t ' Name,address,and telephone of local office/agent of Surety Company is: Inland Insurance, Inc. (, ? 9016 E. Indiana, Suite A, Spokane Valley, WA 99212 509-456-2648 City of Spokane Valley 1 Contract Forms Houk-Sinto-Maxwell St Preservation Project Bid No.:15-063 Power of Attorney KNOW ALL MEN BY THESE PRESENTS THAT: Nationwide Mutual Insurance Company,an Ohio corporation AMCO Insurance Company,an Iowa corporation Farmland Mutual Insurance Company,an Iowa corporation Allied Property and Casualty Insurance Company,an Iowa corporation Nationwide Agribusiness Insurance Company,an Iowa corporation Depositors Insurance Company,an Iowa corporation hereinafter referred to severally as the"Company"and collectively as the"Companies,"each does hereby make,constitute and appoint: JAMES P.DINNEEN JOHN L.GREEN SPOKANE VALLEY WA each in their individual capacity,its true and lawful attorney-in-fact,with full power and authority to sign,seal,and execute on its behalf any and all bonds and undertakings, and other obligatory instruments of similar nature,in penalties not exceeding the sum of ONE MILLION AND NO/100 DOLLARS S 1,000,000.00 and to bind the Company thereby,as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company;and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed. This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company: "RESOLVED,that the president,or any vice president be,and each hereby is,authorized and empowered to appoint attorneys-in-fact of the Company,and to authorize them to execute and deliver on behalf of the Company any and all bonds,forms,applications,memorandums,undertakings,recognizances,transfers,contracts of indemnity,policies,contracts guaranteeing the fidelity of persons holding positions of public or private trust,and other writings obligatory in nature that the business of the Company may require;and to modify or revoke,with or without cause,any such appointment or authority;provided,however,that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company." "RESOLVED FURTHER,that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them,and to affix the seal of the Company thereto;provided,however,that said seal shall not be 1 necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company. Execution of Instruments. Any vice president,any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents,instruments,contracts,or other papers in connection with the operation of the business of the company in addition to the chairman of the board,the chief executive officer,president,treasurer or secretary;provided,however,the signature of any of them may be printed,engraved,or stamped on any approved document, contract,instrument,or other papers of the Company. IN WITNESS WHEREOF,the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 13°' day of February,2014. �� �' ftp*°• -4 Terrance Williams,President and Chief Operating Officer of Nationwide Agribusiness Insurance Company 41 - / and Farmland Mutual Insurance Company;and Vice President of Nationwide Mutual Insurance Company, /,SEAL4 /,.SEAL,/ AMCO Insurance Company,Allied Property and Casualty Insurance Company,and Depositors Insurance .. it • • `/ Company ACKNOWLEDGMENT ♦ \ 'f '7••14, STATE OF IOWA,COUNTY OF POLK: ss /l: /,:• .x� On this 13 day of February,2014,before me came the above-named officer for the Companies aforesaid,to /,:SEAL:+� • SBAL 0 me personally known to be the officer described in and who executed the preceding instrument, and he '•.. :°,� acknowledged the execution of the same,and being by me duly sworn,deposes and says,that he is the officer t, ` tlam gel' ``= �• of the Companies aforesaid,that the seals affixed hereto are the corporate seals of said Companies,and the said corporate seals and his signature were duly affixed and subscribed to said instrument byte authorityand direction of said Companies. �/ � +mss\�+ �406:1111" � _I'" 7 G� 4 Ia�s�`�v,,,u� �, SandyAiitz arc /a;' "44 / > ' ! , Notarial Seal—Iowa ,;€SEAL;; / iSEAL/ Commission Number 152785 / + . Notary Public = • My Commission Expires March,24,2017 q7 pi.., i`4i, ............. My Commission Expires \�� til 6' CERTIFICATE March 24,2017 I,Robert W Homer III,Secretary of the Companies,do hereby certify that the foregoing is a full,true and correct copy of the original power of attorney issued by the Company;that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner;that said Terrance Williams was on the date of the execution of the foregoing power of attorney the duly elected officer of the Companies,and the corporate seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors;and the foregoing power of attorney is still in full force and effect. , IN WITNESS WHEREOF,I have hereunto subscribed my name as Secretary,and affixed the corporate seals of said Companies this 1.0 tt .day-, ..••' , , of June 20 15 ‘. Secretary -, This Power of Attorney Expires 09/18/15 - • BDJ 1(03-14)00 26535 ��1 TLARI-1 OP ID:MH ACORO" DATE(MM/DDIYYYY) `,,,_---- CERTIFICATE OF LIABILITY INSURANCE 06/09/2015 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 Inland Insurance Inc. NAME:PHONE 9016 E Indiana Ave.,Suite A INC. Ext): (A/C,No): Spokane Valley,WA 99212 E-MAIL James P Dinneen ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alaska National Ins Co 38733 INSURED T.Lariviere Equipment INSURERS:Idaho State Insurance Fund &Excavation,Inc. PO Box 100 INSURER C: Athol,ID 83801-0897 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE IINSD 4WD POLICY NUMBER (MM/DDYIYYYY) (EFF MM/DD�) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE X OCCUR X X 15D PS 08913 04/10/2015 04/10/2016 PAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) 5 X Contractual MED EXP(Any one person) S 5,000 X XCU Separ of Insd PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,000 POLICY X jECT LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) A X ANY AUTO X X 15D AS 08913 04/10/2015 04/10/2016 BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS _ AUTOS NRTNED PROPERTY DAMAGE S X HIRED AUTOS X AUTOS (Per accident) _ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE 15D LU 08913 04/10/2015 04/10/2016 AGGREGATE 5 3,000,000 DED X RETENTIONS 10000 5 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ERH B ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N/A 614860 04/10/2015 04/10/2016 E.L.EACH ACCIDENT 5 1,000,000 A MFandatory in NH)EMBER EXCLUDED? I I 15D PS 08913-STOP GAP 04/10/2015 04/10/2016 E.L.DISEASE-EA EMPLOYEES 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 A Leased&Rented Eq 15D PS 08913 04/10/2015 04/10/2016 Limit 100,000 A Scheduled Equipmen 15D PS 08913 04/10/2015 04/10/2016 Limit 2,041,672 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:Houk-Sinto-Maxwell Sts Preservation Project No 0220/SVPW Bid#15-063 The City of Spokane Valley is primary non-contributory additional insured as respects the above project only per insuring forms ANIC GL1061 0308;ANIC 1162 0115;CG2503 0509;and ANIC CA1150 1013 attached. CERTIFICATE HOLDER CANCELLATION CITYOI2 • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Spokane Valley ACCORDANCE WITH EATE THEREOF, NOTICE WILL BE DELIVERED IN HE POLICY PROVISIONS. Public Works Department 11707 E Sprague Ave#106 AUTHORIZED REPRESENTATIVE Spokane Valley,WA 99206 -1 JIm Dinneen/President I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD "1 Alaska National INSURANCE COMPANY ADDITIONAL INSURED (CONTRACTORS) - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Who Is An Insured (Section II) is amended to ii. supervisory, inspection, or engineering include as an insured any person or organization services. (herein referred to as an additional insured), but only if you are required to add that person or c. The insurance provided to the additional organization as an insured to this policy by a insured, referred to in paragraph 1. of this written contract that is in effect prior to the"bodily endorsement, does not cover"bodily injury"or injury", "property damage", or "personal and "property damage" caused by your negligent advertising injury". acts and omissions in the performance of "your work" that occurs within the "products- 2. The insurance provided to the additional insured completed operations hazard," unless the is limited as follows: written contract, referred to in paragraph 1. of this endorsement, contains a specific a. That person or organization is only an requirement that you procure completed additional insured if, and only to the extent operations coverage or coverage within the that, the injury or damage is caused by "products-completed operations hazard" for negligent acts or omissions of you or your the additional insured. However, even if subcontractor in the performance of "your coverage within the "products-completed work" to which the written contract applies. operations hazard" is required by the written The person or organization does not qualify contract, such coverage is available to the as an additional insured with respect to injury additional insured only if the "bodily injury" or or damage caused in whole or in part by "property damage" occurs prior to the end of independent negligent acts or omissions of the time period during which you are required such person or organization. by the written contract to provide such coverage or the expiration date of the policy, b. The insurance provided to the additional whichever comes first. insured does not apply to "bodily injury", "property damage", or "personal and 3. If other valid and collectible insurance, whether on advertising injury" arising out of an architect's, a primary, excess, contingent or any other basis, engineer's, or surveyor's rendering of or is available to the additional insured for a loss we failure to render any professional services cover under this endorsement, then the insurance including: provided by this endorsement is excess over that other insurance. However, the insurance provided i. the preparing, approving, or failing to by this endorsement will be primary to other prepare or approve maps, drawings, insurance on which the additional insured is a opinions, reports, surveys, change orders, named insured for the covered loss, if the written design or specifications; and contract, referred to in paragraph 1. of this ANIC GL 1061 03 08 Page 1 of 2 t/741 ?= Alaska National �-= w_-t ' INSURANCE COMPANY endorsement, contains a specific requirement that this insurance be primary or primary and non- contributory. In that case we will not share with that other insurance on a pro-rata or other basis. If the other insurance available to the additional insured, whether on a primary, excess, contingent or any other basis, is coverage for which it has been named as an additional insured, then the coverage provided by this endorsement is excess over that other insurance. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 13 Countersigned By ANIC GL 1061 03 08 Page 2 of 2 2/2 Alaska National INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this endorsement restrict SUPPLEMENTARY PAYMENTS—COVERAGES A coverage. Read the entire policy carefully to AND B, Paragraph 1.d. is replaced by the following: determine rights, duties, and what is and is not covered. d. All reasonable expenses incurred by the insured at our request to assist us in the Throughout this policy, the words "you" and "your" investigation or defense of the claim or suit, refer to the Named Insured shown in the including actual loss of earnings up to $500 a Declarations. The words "we", "us", and "our" refer to day because of time off from work. the company providing this insurance. SECTION II—WHO IS AN INSURED, paragraph 2. e. Other words and phrases that appear in quotation is added as follows: marks have special meaning. Refer to SECTION V— DEFINITIONS in the Commercial General Liability e. Any person(s) or organization(s) (referred to Coverage Form. throughout this coverage form as vendor) for whom you have agreed in writing to provide The coverages provided by this endorsement apply insurance such as is afforded by this per"occurrence" and, unless otherwise specified, are coverage form but only with respect to"bodily subject to all of the terms, conditions, exclusions and injury" or "property damage" arising out of deductible provisions of the policy, to which it is "your products" which are distributed or sold attached. in the regular course of the vendor's business. SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE However: LIABILITY, 2. Exclusions, g. Aircraft, Auto Or Watercraft section(2) is replaced by the following: (1) The insurance afforded to such vendor only applies to the extent permitted by (2) A watercraft that you do not own that is: law; and (a) Less than 50 feet long; and (2) If coverage provided to the vendor is required by a contract or agreement, the (b) Not being used to carry persons or insurance afforded to such vendor will not property for a charge. be broader than that which you are required by the contract or agreement to SUPPLEMENTARY PAYMENTS — COVERAGES A provide for such vendor. AND B, Paragraph 1.b. is replaced by the following: With respect to the insurance afforded to b. Up to $10,000 for cost of bail bonds required these vendors, the following additional because of accidents or traffic law violations exclusions apply: arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. ANIC GL 1162 01 15 Page 1 of 4 Alaska National INSURANCE COMPANY The insurance afforded the vendor does not apply (2) Such inspections, adjustments, tests or to: servicing as the vendor has agreed to make or normally undertakes to make in a. "Bodily injury"or"property damage"for which the usual course of business, in the vendor is obligated to pay damages by connection with the distribution or sale of reason of the assumption of liability in a the products. contract or agreement. This exclusion does not apply to liability for damages that the This insurance does not apply to any insured vendor would have in the absence of the person or organization, from whom you have contract or agreement; acquired such products, or any ingredient, part or container, entering into, accompanying or b. Any express warranty unauthorized by you; containing such products. c. Any physical or chemical change in the SECTION II—WHO IS AN INSURED, paragraph 2. f. product made intentionally by the vendor; is added as follows: d. Repackaging, except when unpacked solely f. Any person(s) or organization(s) for whom for the purpose of inspection, demonstration, you have agreed in writing to provide testing, or the substitution of parts under insurance as is afforded by this coverage instructions from the manufacturer, and then form but only with respect to liability arising repackaged in the original container; out of the ownership, maintenance or use of that part of the premises leased to you by e. Any failure to make such inspections, such person(s)or organization(s). adjustments, tests or servicing as the vendor has agreed to make or normally undertakes This insurance does not apply to: to make in the usual course of business, in connection with the distribution or sale of the (1) Any "occurrence" which takes place after products; you cease to be a tenant in that premises. f. Demonstration, installation, servicing or repair operations, except such operations (2) Structural alterations, new construction or performed at the vendor's premises in demolition operations performed by or on connection with the sale of the product; behalf of such person(s) or organization(s). g. Products which, after distribution or sale by you, have been labeled or relabeled or used However: as a container, part or ingredient of any other thing or substance by or for the vendor; or (1) The insurance afforded to such additional insured only applies to the extent h. "Bodily injury" or "property damage" arising permitted by law;and out of the sole negligence of the vendor for its own acts or omissions or those of its (2) The coverage to the additional insured employees or anyone else acting on its will not be broader than that which you behalf. However, this exclusion does not are required by the contract or agreement apply to: to provide for such additional insured. (1) The exceptions contained in Sub- paragraphs d.orf.; or ANIC GL 1162 01 15 Page2of4 Alaska National �� INSURANCE COMPANY SECTION III — LIMITS OF INSURANCE, Paragraph SECTION IV—COMMERCIAL GENERAL LIABILITY 6. Is replaced by the following: CONDITIONS — Paragraph 4. — Other Insurance is amended to add: 6. Subject to Paragraph 5. above, the Damage to Premises Rented to You Limit is the most we will d. Primary and Noncontributory Insurance pay under Coverage A for damages because of "property damage" to any one premises, while This insurance is primary to and will not seek rented to you, or in the case of damage by fire, contribution from any other insurance while rented to you or temporarily occupied by available to an additional insured under your you with permission of the owner. policy provided that: If a limit is shown for Damage to Premises (1) The additional insured is a Named Rented to You the most we will pay under Insured under such other insurance;and Coverage A for damages because or "property damage" to any one premises is the Limit shown (2) You have agreed in writing in a contract in the Declarations or $500,000, whichever is or agreement that this insurance would greater. be primary and would not seek contribution from any other insurance SECTION III — LIMITS OF INSURANCE, Paragraph available to the additional insured. 7. Is replaced by the following: This Paragraph d. supersedes any provision 7. Subject to Paragraph 5. above, the Medical to the contrary in Paragraphs a. through c. Expense Limit is the most we will pay under above. Coverage C for all medical expenses because of "bodily injury"sustained by any one person. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS — Paragraph 6. — Representations is If a limit is shown for Medical Expense in the replaced by the following: Declarations the most we will pay under Coverage C for all medical expenses because of 6. Representations "bodily injury" sustained by any one person is the Limit shown in the Declarations or $15,000, By accepting this policy, you agree: whichever is greater. a. The statements in the Declarations are SECTION III — LIMITS OF INSURANCE, the accurate and complete; following is added: b. Those statements are based upon With respect to the insurance afforded to the insureds representations you made to us;and described in Paragraphs 2.e. and 2.f. of Section II — Who Is An Insured, if coverage provided to such c. We have issued this policy in reliance upon insured is required by a contract or agreement, the your representations. most we will pay on behalf of such insured is the amount of insurance: The unintentional omission of, or unintentional error in, any information you provided to us (1) Required by the contract or agreement; which we relied upon in issuing this policy will or not prejudice your rights under this insurance. However, this provision does not affect our right (2) Available under the applicable Limits of to collect additional premium or to exercise our Insurance shown in the Declarations; rights of cancellation or nonrenewal in accordance with applicable laws and regulations. whichever is less. This provision shall not increase the applicable Limits of Insurance shown in the Declaration. ANIC GL 1162 01 15 Page 3 of 4 nip Alaska National 46, NCE COPANY SECTION IV—COMMERCIAL GENERAL LIABILITY SECTION V — DEFINITIONS — Paragraph 3. — CONDITIONS—is amended to add Paragraph 10. "Bodily Injury" is replaced by the following: 10. Blanket Waiver of Transfer of Rights of "Bodily injury" means bodily injury, sickness or Recovery Against Others disease sustained by a person including death or mental anguish resulting from any of these. Mental We waive any right of recovery we may have anguish means any type of mental or emotional against any person or organization because of illness or disease payments we make for injury or damage arising out of "your work" done under a written contract with that person or organization. The waiver applies only to the person or organization you contracted with and then only if the contract requires you to obtain this agreement from us. otic the This endorsement changes itis attached and unless otherwise stated, is effective on the date policy to which issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. Countersigned 9 By Includes copyrighted material of Insurance Services Office, Inc.,with its permission ANIC GL 1162 01 15 Page 4 of 4 aleg, Alaska Na oval INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. — Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words "you" and "your" Others to Us refer to the Named Insured shown in the Declarations. The words "we", "us", and"our"refer to This condition does not apply to any the company providing this insurance. person(s) or organization(s) to the extent that subrogation against that person or Other words and phrases that appear in quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V— or the"loss"under a contract with that person DEFINITIONS in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION II — COVERED AUTO LIABILITY per "accident" and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2)—Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law SECTION It — COVERED AUTO LIABILITY violations) required because of an COVERAGE, Paragraph A.1. Who Is An Insured is "accident"we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating SECTION II — COVERED AUTO LIABILITY an "auto" hired or rented under a COVERAGE, Paragraph A.2.a. (4)—Supplementary contract or agreement in an "employee's" Payments is replaced by the following: name, with your permission, while performing duties related to the conduct (4) All reasonable expenses incurred by of your business. the"insured" at our request, including actual loss of earnings up to $500 a e. Any person or organization for whom you day because of time off from work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of"autos"covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. ANIC CA 1150 10 13 Producer Copy Page 1 of 4 1,7, Alaska Na :anal INSURANCE COMPANY c. "Loss" caused by falling objects or SECTION II — COVERED AUTO LIABILITY missiles. . COVERAGE, Paragraph A.2.c.—Voluntary Property Damage is added as follows: However, you have the option of having glass breakage caused by a covered "auto's" c. Voluntary Property Damage collision or overturn considered a loss"under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage Glass Repair—Waiver of Deductible caused by an "insured", but without liability to a third party, up to$25;000.We No deductible applies to glass breakage, if will not make a Voluntary Property the glass is repaired rather than replaced. Damage payment to anyone who is an "insured"under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. — Transportation Expenses is SECTION III — PHYSICAL DAMAGE COVERAGE, replaced by the following: Paragraph A.2.-Towing is replaced by the following: a. Transportation Expenses Towing We will pay up to $200 per day to a We will pay up to $500 for towing and labor maximum of $1,500 for temporary costs incurred each time a covered "auto" transportation expense incurred by you that is a: because of the total theft of a covered "auto"that is a: a. Private passenger; (1) Private passenger; b. Truck; (2) Truck; c. Pick-up truck; (3) Pick-up truck; d. Panel; or (4) Panel;or e. Van (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the type vehicle under. 20,000 lbs. of Gross labor must be performed at place of disablement. Vehicle Weight. We will pay only for those covered"autos"for which you carry either Comprehensive or Specified SECTION III — PHYSICAL DAMAGE COVERAGE, Causes of Loss Coverage. We will pay Paragraph A.3. - Glass Breakage - Hitting a Bird for temporary transportation expenses or Animal -Falling Objects or Missiles is replaced incurred during the period beginning 48 by the following: hours after the theft and ending, regardless of the policy's expiration, Glass Breakage—Hitting a Bird or Animal when the covered "auto" is returned to Falling Objects or Missiles use or we pay for its"loss". If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss" caused by hitting a bird or animal; and ANIC CA 1150 10 13 Producer Copy Page 2 of 4 � ► Alaska Na.SURANCE anal ANY (2) Specified Causes of Loss only if the SECTION III — PHYSICAL DAMAGE COVERAGE, Declarations indicate that Specified Paragraph A.4.b. — Loss of Use Expenses is Causes of Loss Coverage is provided replaced by the following: for the"auto"withdrawn from service; or b. Loss of Use Expenses—Hired, Rented, (3) Collision only if the Declarations or Borrowed Automobiles indicate that Collision Coverage is provided for the "auto" withdrawn We will pay expenses for which an from service. "insured" becomes legally responsible to pay for loss of use of a vehicle hired, SECTION III — PHYSICAL DAMAGE COVERAGE, rented or borrowed without a driver under Paragraph A.4.d. — Airbag Coverage is added as a written rental contract or agreement. follows: We will pay for loss of use expenses, if caused by: d. Airbag Coverage (1) Other than Collision, only if the We will pay for the cost to repair, replace, Declarations indicate that or reset an airbag that inflates for any Comprehensive Coverage is provided reason other than as a result of a for the vehicle withdrawn from collision, if the Declarations indicate that service. the covered "auto" has Comprehensive Coverage or Specified Causes of Loss (2) Specified Causes of Loss only if the Coverage. Declarations indicate that Specified Causes of Loss Coverage is provided SECTION III — PHYSICAL DAMAGE COVERAGE, for the vehicle withdrawn from Paragraph A.4.e. — Rental Reimbursement service. Coverage is added as follows: (3) Collision only if the Declarations e. Rental Reimbursement Coverage indicate that Collision Coverage is provided for the vehicle withdrawn We will pay up to $75 per day for rental from service. reimbursement expenses incurred by you for the rental of an "auto" because of However, the most we will pay for any "loss"to a covered"auto"that is a: expenses for loss of use is$200 per day, to a maximum of$1,500. (1) Private Passenger; SECTION III — PHYSICAL DAMAGE COVERAGE, (2) Truck; Paragraph A.4.c.—Non-Transportation Loss of Use Expenses is added as follows: (3) Pick-up truck; c. Non-Transportation Loss of Use (4) Panel;or Expenses (5) Van We will pay up to $2,000 for non- transportation expense incurred by you, type vehicle under 20,000 lbs. of Gross because of "loss" to a covered "auto", if Vehicle Weight. Payment applies in caused by: addition to the otherwise applicable amount of each coverage you have on a (1) Other than Collision, only if the covered "auto". No deductibles apply to Declarations indicate that this coverage. Comprehensive Coverage is provided for the"auto"withdrawn from service; ANIC CA 1150 10 13 Producer Copy Page 3 of 4 itYM- INSAlURANCE aska Na onal (1) We will pay only for those expenses SECTION IV — BUSINESS AUTO CONDITIONS — incurred during the policy period Paragraph B.5.b. — Other Insurance is replaced by beginning 24 hours after the "loss" the following: and ending, regardless of the policy's expiration, with the lesser of the b. For Hired Auto Physical Damage following number of days: Coverage, the following are deemed to be covered"autos"you own: (a) The number of days reasonably required to repair or replace the (1) Any covered "auto" you lease, hire, covered"auto". rent,or borrow;and (b) 30 days. (2) Any covered "auto"" hired or rented by your "employee" under a contract (2) This coverage does not apply while in that individual "employee's" name, there are spare or reserve "autos" with your permission, while available to you for your operations. performing duties related to the conduct of your business. (3) The Rental Reimbursement Coverage described above does not However, any"auto"that is leased, hired, apply to a covered "auto" that is rented or borrowed with a driver is not a described or designated as a covered covered"auto". "auto" on Rental Reimbursement Coverage Form CA 99 23. SECTION V — DEFINITIONS - Paragraph C. — "Bodily injury"is replaced by the following: SECTION IV — BUSINESS AUTO CONDITIONS — Paragraph B.2. —Concealment, Misrepresentation Or C. "Bodily injury" means bodily injury, sickness or Fraud is amended by adding Unintentional Failure disease sustained by a person including death or to Disclose Hazards at the end of Paragraph B.2. as mental anguish resulting from any of these. follows: Mental anguish means any type of mental or emotional illness or disease Unintentional Failure to Disclose Hazards If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 3 Countersigned By ©Insurance Services Office, Inc., 2009 ANIC CA 1150 10 13 Producer Copy Page 4 of 4 1 Public Works Department Sjökane Capital Improvement Program Valley 11707 E Sprague Ave Suite 106 ♦ Spokane Valley WA 99206 509.92 1.1000 • Fax: 509.688-0261 • cityhall@spokanevalley.org Memorandum Date: May 22, 2015 To: Finance Through Steve Worley, Capital Projects Sr Engr. From: Craig Aldworth, Project Engineer Re: Budget Adjustment—Houk Sinto Maxwell St Preservation Project, CIP 0220 The Houk—Sinto—Maxwell Street Preservation Project bids were opened today. The attached Budget Adjustment incorporates the lowest bid prices and the design expenditures. See the attached Expenditure Spreadsheet and the Bid Tab. The budget has been adjusted to provide the funding for the lowest bid plus a 15 % contingency. The Budget Adjustment reduces the amount needed from Fund 311 from $316,965 to $309,640. The adjustment adds funding for the following non-street preservation work included in the bid under separate schedules: Schedule B—Stormwater work provides for updates to the existing storm water structures. These improvements are being funded by $99,234 from Fund 402. Schedule C—Other Work provides for construction of a pedestrian sidewalk at the SE corner of the Houk Rd/Maxwell Street intersection. The new sidewalk is located between the Valley Hospital and numerous medical clinics and will provide a safe route for the numerous handicapped pedestrians. This improvement is being funded by$18,473 from Fund 303 since it is not street preservation work. . . iia, cane4004°Noftwo, Houk-Sinto-Maxwell St Preservation - #0220 .00•OValley. May 22 2015 Expenditure Accounts I Budget PE Description Current I Change New 311.000.220.595.10.10.00 Salaries&Wages 9,000 4,000 13,000 311.000.220.595.10.10.99 Overtime - - 311.000.220.595.10.20.00 Employee Benefits 1,750 2,750 4,500 311.000.220.595.10.20.99 Employee Benefits - - 311.000.220.595.10.41.02 Engineering &Architectural - - 311.000.220.595.10.41.06 Prof. Svcs -Survey 1,000 (1,000) - 311.000.220.595.10.41.07 .Prof. Svcs. -Geotech - 311.000.220.595.10.41.17 Advertising 1,000 (1,000) - 311.000.220.595.10.43.01 Travel/Mileage - 311.000.220.595.10.49.03 Printing & Binding 1,000 (500) 500 1 311.000.220.595.10.49.06 Miscellaneous Services - . - 311.000.220.595.10.99.99 PE Contingency 1,250 (1,250) - 3 . . . I Sub Total: 15,000 3,000 18,000 RW Description Current Change New "ransactions Recorded this PIO - - ...„_-------5.----..-.---------. . .............................. . . . I Sub Total: * - - - CN Description Current I Change New 311.000.220.595.30.10.00 Salaries &Wages 5,000 3,000 8,000 311.000.220.595.30.10.99 Overtime - - 311.000.220.595.30.20.00 Employee Benefits 1,750 1,000 2,750 311.000.220.595.30.20.99 Employee Benefits - - 311.000.220.595.30.41.08 Prof. Svcs. Mat.Testing 4,000 4,000 8,000 311.000.220.595.30.41.10 Prof.Svcs. -Consulting - - 311.000.220.595.30.41.17 Advertising 1,690 (1,690) - 311.000.220.595.30.49.03 Printing & Binding - - 311.000.220.595.30.63.00 ST Pres Construction 280,500 (43,205) 237,295 311.000.220.595.30.99.99 ST Pres CN Contingency 9,025 ] 26,570 35,595 303.000.220.595.30.63.00 Other Construction 16,063 16,063 303.000.220.595.30.99.99 Other CN Contingency ] 2,410 2,410 402.000.220.595.30.63.00 SW Construction 86,290 86,290 402.000.220.595.30.99.99 SW CN Contingency 12,944 12,944 3 . . . I Sub Total: 301,965 107,382 409,347 Project Total: I 316,965 110,382 427,347 I Funding Accounts Budget PE Description Current Change New 0397.3110 311 316,965 (7,325) 309,640 7:77:77:77:Y7:7:7:7:.:77.77:77 303 18,473 18,473 -- ----�- ----------- ..,. -------- 402 99,234 99,234 I Project Total: 316,965 110,382 427,347 APPROVALS Project Manager Date Sr Capital Proj Eng Date Public Works Director Date Finance Director Date 3 Accounting will look up BARS code according to Description Notes 5-22-15 Adjusted budget to include non street preservation work and bid results. IS-o(5 Employment. Security Departm WASHINGTON STATE /� November 23,2016 ' L- AN 232017 d CITY OF SPOKANE VALLEY 11707 E SPRAGUE AVE., SPOKANE VALLEY, WA 99206 T..LaRixier Fqliipment&.Excavation uc. _ _ !TM#; 602-764-461 r - PO BOX 100 ESD#000-482103-00-5 ATHOL,ID 83801-0100 The Employment Security Department hereby certifies those contributions,penalties and interest due from the above named contractor under the Employment Security Act have been paid in full or provided for with respect to the following public works contract: Description: Houk Sinto Maxwell Street Preservation Project Contract number: 15-063 The Employment Security Department hereby certifies that it has no claim pursuant to RCW 50.24.130 against the public body named above for tax attributable to service performed for said public body by the above named contractor on the above described contract. The Employment Security Department releases its lien on the retained percentage which is provided by RCW 60.28.040 for contributions,penalties and interest due from said contractor. This certificate does not release said contractor from liability for additional contributions, penalties and interest which may be later determined to be due with respect to the above mentioned contract. If we may be of further assistance,please call(360)902-9450 or email-��- publicworks@esd.wa.gov EMPLOYMENT SECURITY DEPARTMENT Original—Disbursing Office Duplicate—Employer Triplicate—Central Office Files STATE 0.0 'li ; �iir^ iOjn2 ®1=1•••••• :1889 Lt0 STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES PO Box 44274 Olympia, Washington 98504-4274 I = September 05, 2017 SPOKANE VALLEY, CITY OF 11707 EAST SPRAGUE AVE STE 106 SPOKANE VALLEY WA 99206 N co _ CERTIFICATE TO RELEASE L&I'S HOLD ON RETAINAGE 0 g The Washington State Department of Labor& Industries is granting approval to release our hold on the retained amount for HOUK-SINTO-MAXWELL STREET PRESERVATION 0 PROJECT, Contract 15-063, to the following contractor: O 0 T LARIVIERE EQUIPMENT EXVN INC 262,678-00 602 764 461 0 0 0 O • We have determined that all workers' compensation premiums, increases, and penalties for this contractor have been paid in full or are readily collectible without recourse to the retained funds, per chapter 60.28 RCW. The contractor may still be liable for payment if we later determine they owe additional premiums related to this contract or other activities. Before final payment can be made to the contractor, you will also need to receive releases from the Departments of Revenue and Employment Security Department in addition to ensuring: • All liens against retainage have been satisfied • All Affidavit of WagesPaid forms have been filed Thank you,' ^` —__._ _ _ _ Elsa McDonnell Contract Release Specialist (360)902-6558 MCDP235@LNI.WA.GOV cc: T LARIVIERE EQUIPMENT EXVN INC PO BOX 100 ATHOL ID 83801 Page 2 HI ►�t State of Washington wj DEPARTMENT OF LABOR AND INDUSTRIES PO Box 44274 Olympia WA 98504-4274 SPOKANE VALLEY, CITY OF 11707 EAST SPRAGUE AVE STE 106 SPOKANE VALLEY WA 99206 N C.) O 0 W O O O O A O_ O O -- O O O O O O Page 1 III