Loading...
15-062.00 Inland Asphalt: Mansfield Ave Connection Contract THIS AGREEMENT, made and entered into this 1 day of \\I 2015, between the City of Spokane Valley under and by virtue of Title 35 RCV', 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: Mansfield Ave Connection Project SVPW Contract 15-062 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. V. The project was awarded for the bid amount of$516,455.00. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor ,T,tnP 99 , 2015. Date Al Hughbanks • Printed Name Chie A. 1i A A,& Title Fig NI) 1 Signature — ' i City of Spokane Valley ar K CA iimutA Printed ame _pi.)vay r N NAttl Title V4k //tAA — Signature Revised 6.19.13 iT1,, .0. Valley BOND NO: 9188388 ,j CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Inland Asphalt Company, (Contractor), as Principal, a contract for the construction of the project designated as Mansfield Ave Connection Project, Project No. 0156 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND (Surety), a corporation, organized under the laws of MARYLAND and licensed to do business in the State of Washington as surety and named in the current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee, in the sum of$ 516,455.00 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 - - u' ',,on • 4. • t': surety. INLAND -PH •[ FIDELITY AND DEPOSIT COMPANY OF MARYLAND PRINCI'AL( `! ,err' "• SURETY ��' \ Orx► 6/29/ 6/29/2015 Principe ignat :� Date --� ri - • - Date ' Al Hughban' TINA DAVIS Printed Name Printed Name Chief Estimator ATTORNEY-IN-FACT Title Title Name, address, and telephone of local office/agent of Surety Company is: MARSH USA,INC. TINA DAVIS 15 W.SOUTH TEMPLE,STE.700,SALT LAKE CITY,UT 84101 801-533-3624 on oikae 410... MLlley BOND NO: 9188388 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 Mansfield Ave Connection Project, Project No. 0156 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$ 516,455.00 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 - ec tin! on b-'- • the surety. INLAND A'Pi, H, Clll - FIDELITY AND DEPOSIT COMPANY OF MARYLAND PRINCI'AL r0 N 1%'ill,e• SURETY 44 A Princip. •nateip Date tre-' Date i Al Hughba l TINA DAVIS Printed Name Printed Name Chief Estimator ATTORNEY-IN-FACT Title Title Name, address, and telephone of local office/agent of Surety Company is: MARSH USA,INC. TINA DAVIS 15 W.SOUTH TEMPLE,STE.700,SALT LAKE CITY,UT 84101 801-533-3624 SURETY ACKNOWLEDGMENT STATE OF UTAH COUNTY OF SALT LAKE } SS On this 29TH day of JUNE, 2015, before me personally came TINA DAVIS 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 Resolutions thereof. AAPqic / Notary Publi LISA HALL I rte' Notary Public State of Utah Comm.No.681511 I My Comm.Expires Mar 13,2019 r • 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, Lindsey PLATTNER and Linda NIPPER, 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 27th day of April,A.D.2015. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND Q Otro )tG Ins Ln u •ED 4 .: woo .ftp un,..• 4 O Secretary Vice President Michael McKibben Thomas O.McClellan State of Maryland County of Baltimore On this 27th day of April,A.D.2015,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,THOMAS O. MCCLELLAN,Vice President,and MICHAEL MCKIBBEN,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. 99211}f..;-- '4Wriiaa Maria D.Adamski,Notary Public My Commission Expires:July 8,2019 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 Attorney...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 2 9Tlilay of JUNE 20 15 . slritTsiN eaP"e'N., o. trf ereftrANZa, rig114.4. 1** x 1LW Www .... *10°' AMI Gerald F.Haley,Vice President 110"\11111%, Spokane 40000 Valley BOND NO: 9188389 CONTRACTOR'S RETAINAGE 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 Mansfield Ave Connection Project, Project No. 0156 (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 FIDELITY AND DEPOSIT COMPANY OF MARYLAND organized and existing under the laws of the State of MARYLAND 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 TWENTY FIVE THOUSAND EIGHT HUNDRED TWENTY TWO AND 75/100 dollars ($ 25,822.75 ), 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 day of , 2015, 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 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. INLAN% •S-HALT CO PANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND PRP 4 ` J t1 OR) SUR TY �.� 6/29/15 _�. : • 2015 Principal 'p ature Date 'r'y Si.n. - == Al Hugh.a -s TINA DAVIS " Printed Name Printed Name Chief Estimator ATTORNEY-IN-FACT Title Title Name, address, and telephone of local office/agent of Surety Company is: MARSH USA,INC. TINA DAVIS 15 W.SOUTH TEMPLE,STE.700,SALT LAKE CITY,UT 84101 801-533-3624 Reviser 14 SURETY ACKNOWLEDGMENT STATE OF UTAH } COUNTY OF SALT LAKE } SS On this 29TH day of JUNE, 2015, before me personally came TINA DAVIS 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 Resolutions thereof. Notary 'Irblic LI'TALL Notary Public y t State of Utah g ' Comm.No.681511 My Comm.Expires Mar 13,2019 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, Lindsey PLATTNER and Linda NIPPER, 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 27th day of April,A.D.2015. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND c,,,ant% wV otPpsis. (SAL , • GPti�PIS(/b'q S r 2 O6\T «r. ttu =u toe 46y` "4...10.0" (J 111 t Secretary Vice President Michael McKibben Thomas O.McClellan State of Maryland County of Baltimore On this 27th day of April,A.D.2015,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,THOMAS O. MCCLELLAN,Vice President,and MICHAEL MCKIBBEN,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. 9k6.2„,- 0-27, Maria D.Adamski,Notary Public My Commission Expires:July 8,2019 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, this29THday of JUNE ,2015 . N wa odes,. ' � -A> 4 ;3 SA c�: 4ir so•. use i'AZ k O ZEAL Gerald F.Haley,Vice President 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 dew Inland Asphalt Company 7 NAME AND 8` ALi e CPM Development Corporation dba ADDRESS •lam- be PO Box 3366 OF INSURED ` Spokane,WA 99220-3366 I 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 not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued. EXP DATE 0 CONTINUOUS TYPE OF POLICY 0 EXTENDED POLICY NUMBER LIMIT OF LIABILITY 121 POLICY TERM WA7-C8D-004095-024 COVERAGE AFFORDED UNDER WORKERS 9/1/2015 WC LAW OF THE FOLLOWING EMPLOYERS LIABILITY COMPENSATION W C7-C81-004095-014 STATES: Bodily Injury by Accident ALL STATES EXCLUDING rr MONPOLISTICS STATES AND $1,000,000 Each Accident NY Bodily Injury by Disease V OR,WI $1,000,000 Policy Limit Bodily Injury by Disease V $1,000,000 Each Person General Aggregate-Other than Products/Completed Operations GENERAL LIABILITY 9/1/2015 TB2-C81-004095-114 $2,000,000 V -Per project aggregate included Products/Completed Operations Aggregate Q OCCURRENCE $2,000,000 ✓ 0 CLAIMS MADE Bodily Injury and Property Damage Liability $2,000,000 V Per Occurrence RETRO DATE Personal Injury Included* Per Person/Organization Other Other Included in BI/PD Liability FIRE DAMAGE$100,000;PER PROJECT AGGREGATE AUTOMOBILE 9/1/2015 AS2-C81-004095-124 $2,000,000 i Accident-Single c Limit s t lrB And bin LIABILITY Comp Ded$10,000 Each Person IBJ OWNED IBJ NON-OWNED Coll Ded$10,000 Each Accident or Occurrence 17J 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: Mansfield Ave.Connection Project,Contract No.15-062 City of Spokane Valley,its officers,employees and elected officials are named as additional insured with respect to the above referenced project. Coverage is primary and non-contributory. Waiver of subrogation applies. 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 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 7 ��� "_ "_Y .). �q ,Q-,... 11707 E. Sprague Ave.,Suite 106b Stanley S.Esposito Jr. Spokane Valley,WA 99206 Pittsburgh/0387 AUTHORIZED REPRESENTATIVE I I 12 Federal Street,Ste.310 Pittsburgh PA 15212-5706 412-231-1331 7/6/15 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-C81-004095-114 CON vERCIAL GENERAL LIABILITY CG 20 10 04 13 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 arts or include as an additional insured the person(s) or equipment 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 intended use by any person or organization in the performance of your ongoing operations for additional insured(s) at the location(s) other than another contractor or subcontractor the the g above.Haed engaged in performing operations for a deprincipal 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, thefollowing 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 agreedin 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-C81-004095-114 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. POLICY NUMBER:TB2-C81-004095-114 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against ,the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of your ongoing operations or "your work"done under a contract with that person or organization and included in the "products- completed operations hazard".This waiver applies only to the person or organization shown in the . Schedule below. SCHEDULE Name Of Person Or Organization: As required by written contract or agreement entered into prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 24 04 05 09 @ Insurance Services Office, Inc.,2008 Page 1 of 1 _4„ f 1, a��e.iisrar8 e�9> = >> a rg BUSINESS LICENSE 1889 i ;'; STATE OF WASHINGTON A.� t.. '4' Unified Business ID *: 601 006 854 p it*: Domestic Profit Corporation Business ID *: 1 . 4 tLocation: 3 , r; Expires: 07-31-2015 ^(1CPM DEVELOPMENT CORPORATION I;_ 0 INLAND ASPHALT COMPANY 1- 5111 E BROADWAY AVE SPOKANE VALLEY WA 99212 0928 (I: If441 '('', TAX REGISTRATION (600 664 174) 1 1 CITV LICENSES/REGISTRATIONS: SPOKANE GENERAL BUSINESS #T12004257BUS SPOKANE VALLEY GENERAL BUSINESS I :,.I � S,1 0 A I F.\ 11r IfiI G 1t) 7I t 4i i \:1 I'' k. is #I i,a Ii I ' '2 This document lists the registrations,endorsements,and licenses authorized for the business r, f:I named above.Byaccepting this document,thelicenseecertifiesthe informationonthe application c; was complete,true,and accurate to the best of his or her knowledge,and that business will be `r) 'f: conducted in compliance with all applicable Washington state,county,and city regulations. Director,Department of Revenue 11 41 W CO X X X CI .a N X X X X XXX X n N CO 0 Ln O Z to U a0 M Co CON N 00 L r- O 0 N N O L() 00 c O (q O N '- cOQ QQCO0 O 0_ U) ti 0 0 , O p ?) O .— , ?j 00 cz 13 CA cm O cn Q CA a> 0) O C Q Q - a) N 6 a - 4.6 O rn Cr CD Q Q> � a ai � � o >. > >a > o f ai L-• c > � � � 0 ai N > a) a Q c ai ai c 'O0 c N c c c0 (a ` co Y c (o ca coas co c c "' c c Q U Y c Y 0 0 0 >' aY 0 0 Q� J as O COE oao Q3caca� a a °_ a/) a) > c a) -c N 0 a) 0 < - z .. z t QJ � � N - c -c NZ .P-' V N. d' co N. 0) co U- N- Y 0 O 0) 0 O- c E O co ' Ln co .— �- - as O - � ,— - O > co co E O (�) N , „ J (C) O N v- v- -QEl= x x x x x x x 0- x X x < • Z x O U 0000000 Z O O OZ Z 0 O co C m m CO CO CO m CO CO m m CO Lo O m CO CD2 000000 (ti° 0N000E � d4o 0. 0_ CL 0. 0_ a Ln 0_ .- 0_ CL CL 0) ti NCL U E C L- 0 CU 4- (6 O > C U • X CO C o W J a 6 - oes E c ui o cU LL VyO O U a) c ac E B c E - z c E oac a) 07oo - o - .. _N Ute . V (n ,,, CV ci c ,--6 N W } W = c ,- a) m o o ca m 0 ` J o ' > c O § m a) > m` c a-i vw 1 c`a oas f oo - E oo5oota UUUW WJJZO_ 0_ WcnOc) F- � f; i ' Urban Corridor Program (UCP) TIBPr*tNumber Bid Authorization Form 9-E-208(003)-1 INSTRUCTIONS: Enter or update all information on the form.Mail the signed Bid Authorization Form and ALL required documentation to the TIB Office at: 505 Union Avenue SE, Suite 350 • Post Office Box 40901 • Olympia, WA 98504-0901 For assistance with your project, contact Gloria Bennett, T18 Project Engineer at(360)586-1143 GENERAL INFORMATION Lead SPOKANE VALLEY Agency Mansfield Avenue Length in Mlles Project Name 0.21 miles Pines Rd (SR 27) to 200' e/o Houk Rd Agency Ken Knutson Phone 509-720-5010 Contact Email kknutson@spokanevalley.org REQUIRED DOCUMENTATION Include the following items with your signed Bid Authorization Form ►Completed Plans and Specifications ►Final Engineer's Estimate Include verification of WSDOT review&approval of construction documents for projects on or ►adjacent to state highways PROJECT DESCRIPTION Describe the project as defined in the bid documents The project consists of improvement of Mansfield Avenue between Pines Rd and Mirabeau Parkway by the construction of a new roadway section, bike lanes, sidewalks, intersection realignment, signing, pavement marking, traffic control, stormwater and other related work. CHANGES IN PROJECT SINCE APPLICATION Describe any changes that have been made to the proposed project since application To facilitate acquisition of right of way one parcel and eliminate a contentious acquisition on another, the curb-to-curb roadway width was held at 40 ft on approximately 600 ft of the project rather than 46 ft as indicated in the grant application. TIB Bid Authorization Form Revised 9 April 2012-Generated by TIB Project Tracking System- 66956GIoriaBennett03172015081239 Page 1 of 3 4. i Project SPOKANE VALLEY 118 Project Number Name Mansfield Avenue - Pines Rd (SR 27) to 200` e/o Houk Rd 9-E-208(003)-1 PROJECT SCHEDULE Indicate only changes In project target dates(Month/Year)in the spaces below: Previous Schedule Current Schedule Bid Opening March 2015 June 2015 Contract Completion December 2015 December 2015 PROJECT COST ESTIMATE Update the costs to indicate the current estimated totals DESIGN PHASE CONSTRUCTION PHASE Design Engineering Right of WayConstruction Engineering Construction Other Contract Amount 104,867 4,000 808,781 Phase Total Phase Total 917,648 - . _--- Total Project Cost j 917,648 Include a cost breakdown of construction other items: - New electrical service for swale irrigation: $1,500; - New water service for swale irrigation: $2,500 DETERMINATION OF ELIGIBLE COST Enter the current estimated totals for Landscaping and Other Noneligible Cost Noneligible Total Landscaping Other Noneligible Cost f Allowable Landscaping Noneligible Total Noneligible Cost Engineering —— Cost Landscaping — ___._._ __-- 0 0 3,0001 40,639 0 0 Total Eligible Project Cost 917,648 Include a cost breakdown of noneligible items PROJECT COST CHANGE SINCE SELECTION $33,252 Include explanation of Cost Change 3.5%Decrease Reducing the roadway width to limit contentious right of way acquisitions resulted in the some existing curb and sidewalk being retained rather than demolished and replaced. This also resulted in lower quantities of crushed surfacing and hot mix asphalt for the street. Also, a developer on the north side of Mansfield near Pines Rd constructed approximately 125 SY of sidewalk and driveway that had been originally planned for this project. • TIB Bid Authorization Form Page 2 of 3 Revised 9 April 2012-Generated by TIB Project Tracking System- 66956GIoriaBennett03172015081239 9 4- project SPOKANE VALLEY Tia Project Number Name Mansfield Avenue - Pines Rd (SR 27) to 200' e/o Houk Rd 9-E-208(003)-1 FUNDING PARTNERS U•date fundin s amounts to indicate current funding based on the en*sneer's estimate Funding Partner Previous Funding Anticipated Funding SPOKANE VALLEY 0 TIB Funds 792,700 764,980 Developer 158,200 152,668 0 TOTAL $950,900 $917,648 Funding Partner Total is Correct AGENCY CERTIFICATION ►Certification is hereby given that all Local Funds and Other Funds associated with the Construction Phase of the project are secured. ►This project has been reviewed by the Legislative Body of the Administering Agency or agencies or its designee and is consistent with the agency's comprehensive plan for community development. ►Design work is complete for this project and is ready to be advertised. All applicable state laws and requirements have been met and incorporated into the contract documents. ►If the project is within a non-attainment area, the Lead Agency certifies compliance with all requirements of the State and Federal Clean Air Act. All right of way for this project has been acquired, or if right of way remains to be acquired a Possession and Use Agreement has been obtained for the parcels in question. All right of way required for this project has been acquired in accordance with state laws. ►For projects on or adjacent to state highways, WSDOT has reviewed and approved construction documents. r/(00 tf- '/-4.3//c- / ignature of Agency Designe Date Signed Steve M Worley, P.E. Senior Capital Projects f gineer Typed or Printed Name/Title TIB Bid Authorization Form Revised 9 April 2012-Generated by TIB Project Tracking System- 66956GIoriaBennett03172015081239 Page 3 of 3 . r J we v- 09 'rt , pa 4 1 eu V IV C Ei 8 z 0 88 QQ8 88 OQ8 8 8 88 Q8 888 888 QQ8 8 88 QQ8 8Q8 S8 QQ8 QQ8 QQQ8 a 8 8 8 8 8 8 8 8 88 8.8 888 �Q8 QQ8 QQ8 QQ8 C 00 O V o o N \C lQ 8 8 V tD N t(1 V V h p 4 0 UON} 10-1 N NN V?Y?VF OCO QO V G 00 Q W V Q N N O ...t N AA' to U O 06' ni N N r h Q .-t h h 7 M N cF 00 tII a-i M N cF O N e.i Mh rt K V V!V! I N ri N V! V V} V1N VVtVF rt V!VV) h V!N Vt VIn.4.4 411. I.A. w e-I VY N en h 143 i% N 4/1. 4/1/ 41 0 F 888888888888888888OQ8888S888888888888 01 iOvSp mtrO00hQ00eaO0 Ir+ h .ti ri .'4 Q0tri0ON90 N 00 O O S 0 V7VS 'i O4" N N N 4A ri N N N C 1r1 00 N VF 4o V1 o O h N Cr N to U .-1 irn 0 0 41 4Vf *n in th 4" < Ln V}VL h to +n in vs V1 Vr 43 h H .I-1 0 4 V} N t T O Vr4 sA V! UT /1 .-1 CIA, V4 44 i.e 4A 4?V!111. V! 44 C O 4.4 .-1 .-1 4.4 4-4 LA r-1 0 .-i M ri 8 0 to .-1 0 0 Cr 0 0 0 to 00 c t 0 N ri et e-[ Q' e-1 tn. a § O Vf�V N N Q a h N Ln 0 00 to LA C. ut h 00 aw Off' t`i N a M � tC r1 M .-1 rt h a hV4- H 0 ri 0) IA m ' co C x S z S O O S S a Muvi N vi N Li Q u: vi Q' N ti } 0- vi > Li Q Li Y } } Q Q 41 >-... H Q Q Q Q Y Li T -J Y Q J J W J J J w J -i W J J U0 -1 N J W -.i to LA vi W W vi N w Li 4 w w v1 J vi ...i v1 W I 4 Q O Q a z o. Q Q 1 3 Q � > 1- F- F Q -1 ISA0 al 0 W W WLLI 0[ Q 0 0 O 0 Q Z ¢ Z u 0 w j z Z Z Z j Z w a EF) Q m I- 2 0 < 0— ._. o � i- ay_ }n. cc � Z W F m a LL W W W ut Z W cl- t- D F F a U m Q N �_ j N C w g O w 0 a ° Q Cr w U v1UxC7 � 7 > > wU. 2Q22Q JU E a` C4 W w ¢ O w ~ ~ m Y 0 0 U JQ y m I- a oac z tm- Q U Z Q C7 LY S a a a a > 0 rt w m m t1'L w 3 LTuj . H▪ 0 1-- m _! Z V Q Q Z Z 2 0 0 0 Q Q N N i- Q W 0 0 0 a vl 1_ Z U c ›.- cc 0 > O Z 2 w 04 0U W a Z z _z ?� g 4 O p V z {LU rw- I- I-F F F s w C v) < Z m O Z F- 0 p i- h LA W O D U LD h Q y. ¢ Mt W W W W W Y V uo ,-4 Z Z 0 CI' O U Q W 11.0-1 a U F- 0 W W 11w LL LQi Lt. Z Z C� a Z Q' a U U U U U U Q Q co- Q▪ 7 [YI07 12 cz, C Lr1 i 0 Q F W- F O d W W U1 W W m W W Z Q N N N N N \\ x TN eq eir_ 0 0 0 0 0 0 0 0 .c —y —coo o a N lj g z IL a O z im- 2 6- a Z 4 > > > > w w w F N .4. U v~i Q x Z Z Z Z Z Z O U Q H t0 N Y Q' V m M 0 w U LL F- a Q C7 W U - Q 0 0 0 0 In V1 Ln n O Q Q a W W W W W W ? LU LU m 2OtT x .`A-1-1 0 2002aenTii ? vugF- Hcc1�) CCCCCCzzu0vaa = xQu � aaeWiau ccaLU 46 l 0 Z p yz t m E .-1 N m Cr v1 40 h CO G1 0 ri N m Cr LA t0 h 00 01 0 e-1 N M Cr LA t0 h CO 01 O .ti N m sr LA to h '� 0 0 0 0 0 0 0 0 0 ri ri a-44-1 N d r4 4-4N N N N N N N M m m mm M rt i e-1 ri N N N In y N r a-1 e-1 ri 1 r4 4.4 ri ai r1 aH e-1 r4 ri s-1 e-1 e-I r-1 4-1 e-1 a-1 e-1 ri N .-i r•1 r4 e-1 rl .y v.! e-1 N N 3-1.-1 ea-1 61 t a o d > a a a a p m d La a U 1- a 0 f et m V Ca .14 E E 41 »' os ° t C m c o o rT a °vy 0 0 c c L ac C co OO =(IP >O OO 0< CC c a O R O O C u t TS Is co d L = ` 2 e = N N J0cN O 0 u O C O o c v p0 p 0 U 2! 888, 8888888888888888882;888888 CI LI1 p ppp pp S pQ ppQp p pp pp p, ,I N N N O p O O pv. pS SO QS O c.1 tori a too N N O too O O lN N 00 Q 03 U1 a0 O tO N 00 tit O 00 itt tf1 ct O t0f1 V Oto QO f� 1e 00 O 00 O �/1 tf1 �0 N n th n a0 .•1 n t0 . t/1 (', M •7 e-i .-i tR t0 M u* .- h N M O . .i ...l 00 VI. 1/T VT N VT UT UT VT VT UT VT UA VT th in. in.An. I t!T N tR ih i!T n n N a W .NI a m N rt r 4, CO 00 N al N til IA UT VT VT VT to N N S S p� S o o o o a o Q 0 0 0 o O O p o p o p a a p a p o a. 0. o p o q c 0 Cl m u u N S O VMf N S in Q Q .1 8 S 1..4 N Q0' Qp S $ $ $ S S S O 000 1011 S toll c m v N a1 V N aJ e-1 V/ en N VT th I. O M IA t/T N 0 on M N to 0 tri N V1 vs. V1 U, en to; C Z t-1 Z V = . in U IA ^tet IA V1 t!T .y N e-1 N i!? ey n .-i M th Nth C 'O as N <on th VT th th to UT UA C til O/ to A a0 �. y o H ... C m u 0 E ego !O- A 3 d u o a` .O u '^ II R W =Ts eto a1 c 3 a V' .i N O O V1 O O a t11 r-i t0 to 1n on N <-4 to N <-1 e-1 N N s-1 ih N en .Cr C 03 yJ tn 3 0 111 Cr W N OVI' -1 .C eN-1 N N CIN IN •Ct -CC-1 N N t,-1O 0 0 U no V co on as :C, C CO 'C @ S x z Z z x z z c a1 O. U UU U 0- 0 0 0 0 0 0 0 0 0 0 0 O u c Q vi cc u: u: Q ti >; u: u: ui Q >- >- Q vi cc 5 Q Q Q Q < Q u: Q Q Q U c W J W J J W .i U N .J J W vi tri W .1 W W W W W W W J W W W OO To w I O C O co 1o W C O C 00 U U V ZCr W Z 13.1 C. W ? - Q Z Q = 23 5Wz W t= su z 5 -1 >> z w UU W w 2 ¢ 0 ei 'u2 in _ ° I-W LU C W F- 0 J Q Y d. z e-i 3 z H - K J y O L. UUU LU 41 I.0 Zz 0 ( t2a0 It CC W Q3 41 O Z CD us us cal cc — H a UJI 0 N Z W a0 _T..~ 0 Q cc tu J .-1 }M cc OZ 'F5- Q Q Q O Y > W W 2 2z z p W Z W W W N d}Lai O F Q z cc tu it, W Y >- } LL a O W } } W O t(- > U th -1 U dy F- N W W 5 Q "' g g +i ¢>¢ u, a, on vs a .D cj Q z z x z Z F- z Z u, 1-- aa. O W W. W W F- Z x H O _O _O ,,,, ,, /11 aO iW- z z 1.1.1 , 001... 7,,, 0 < < G O Q CQ' S F Q Z .-1 .! J U J W UJ 1- F- F -r to In = > a O d ... to z m J W a Z 2 CO CO CO N F- -I U 0 0 0 1... Z O U z J Z tj 0 c=J <C F z m _.1 a a a a z Q z 0- 0 W 2 z Q W a F- W W 3 W W 7 » D ¢ 'S O O O -a a W O m n. O a O Q D Om 0 n. 0 a 0 0. 0- W U 25 °a-S 25 . to 0- 1.- Cl U Q N-0 0- U U 0 2 U m Cl Q 00 01 0 .'1 N en co- 1h W N co 01 0 ei N M ct to W h. co 0, O .-1 N en cr V1 y en en v a sf v v mr vs. mI. a st N u1 tri an to an 0 an UI tri W W W W W W L ei e-1 .-t ei .i ei .-1 .-i ei ei .-k e-1 ei .i e I vi .-i .i c-I ci ei ei .-1 1-1 .i .-1 ei ei u N CO O F :x 1dJ`iii�i� ::1;12...."04°C) STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES PO Box 44274 Olympia, Washington 98504-4274 August 24, 2017 SPOKANE VALLEY, CITY OF 11707 EAST SPRAGUE AVE STE 106 SPOKANE VALLEY WA 99206 N 0 CERTIFICATE TO RELEASE L&I'S HOLD ON RETAINAGE 0 0 The Washington State Department of Labor& Industries is granting approval to,release our hold on the retained amount for MANSFIELD AVE. CONNETION PROJECT, Contract 15-062,to the following contractor: 0 N O 0 INLAND ASPHALT CO 700,174-00 601 006 854 0 O 0 0 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, Wendy Bowe Contract Release Specialist (360)902-5772 MCWE235@LNI.WA.GOV cc: INLAND ASPHALT CO PO BOX 3366 SPOKANE WA 99220-3366 Page 2 State of Washington 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 – — - _.. _ O O W O O O O W co co O O O O O O O O O Page 1