Loading...
15-086.00 Bacon Concrete: Sprague/Long Sidewalks 15- o 8Sc, Contract THIS AGREEMENT, made and entered into this day of aci4041, 2015of under and irt� ue of Title 35 RCW amended and between the City SpokaneValley by Bacon Concrete, 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: !. The Contractor shall do all work and furnish all tools, materials, and equipment for: Sprague/Long Sidewalk Improvements SVPW Contract 15-086 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. 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 CONTRACT SPRAGUE/LONG SIDEWALK IMPROVEMENTS BID NO:15-083 V. The project was awarded for the bid amount of$237,647.00. 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 byContractor / / 2015. Date 6112- -C-- -e)prcoiNi Printed Name Tine Z---t-- Signature 6--------- City of Spoka Valley ke t7jaas i Punted Name//� C at.c„ talk -nature OP R_-,E ; CITY OF SPOKANE VALLEY CONTRACT SPRAGUE/LONG SIDEWALK IMPROVEMENTS BID NO:15-083 stiokano,:s.„ BOND NO: B0367157 CONTRACTOR'S PAYMENT BOND(FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Bacon Concrete, Inc. (Contractor), as Principal, a contract for the construction of the project designated as Sprague/Long Sidewalk Improvements Project No. 15-086 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)and chapter 60.28 RCW. The Principal, and The Cincinnati Ins. Co. (Surety), a corporation organized under the laws of OH 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$237,647tate! Contract amount, subject to the provisions herein. This payment bond shalt cover any and all taxes incurred pursuant to Titles 50 and 51 RCW,taxes imposed on the Principal pursuant to Title 82 RCW,and any additional sales taxes. 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, 39.12, and 60.28 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; shall pay all taxes due pursuant to Titles 50,51, and 82 RCW;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. PRiNCIPA (CONT TOR) SIZTYe /� ��' 000.02 ,04. 8/14/15 Principal Sig urn Date Surety Signature Date Greg Bacon Patrick McNamara Printed Name Printed Name President Attorney-in-fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Wheat & Associates— 1306 N. Post St. , 509-922- 2937 CITY OF SPOKANE VALLEY CONTRACT SPRAGUE/LONG SIDEWALK IMPROVEMENTS BID NO:15-083 THE CINCINNATI INSURANCE COMPANY Fairfield,Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That THE CINCINNATI INSURANCE COMPANY,a corporation organized under the laws of the State of Ohio, and having its principal office in the City of Fairfield,Ohio, does hereby constitute and appoint Zac Wheat; Tena M. Wheat; Derek M. Collett; Kathy M. Whipple; Stacy Breithaupt; Patrick McNamara; Shellie Duncan; Brendon Nepon and/or Alia Bakke of Spokane, Washington its true and lawful Attomey(s)-in-Fact to sign,execute, seal and deliver on its behalf as Surety,and as its act and deed,any and all bonds,policies,undertakings,or other like instruments,as follows: Any such obligations in the United States, up to Fifteen Million and No/100 Dollars ($15,000,000.00) This appointment is made under and by authority of the following resolution passed by the Board of Directors of said Company at a meeting held in theprincipal'office of the Company, a beingpresent and voting, on the o th dayof December, 1958, which quorum resolution is still in effect: "RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attorneys-in- Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attorney-in-Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority.Any such writings so executed by such Attorneys-in- Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected ------ officers of the Company." This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 7th day of December, 1973. "RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney. granted, and the signature of the Secretary otrAssistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company." IN WITNESS WHEREOF,THE CINCINNATI INSURANCE COMPANY has caused these presents to be sealed with its corporate seal, duly attested by its Vice President this 10th day of May,2012. THE CINCINNATI INSURANCE COMPANY v CORPORATE o SEAL - �'.. - A _• OH10 . Vice President STATE OF OHIO ) ss: COUNTY OF BUTLER ) On this 10th day of May,2012,before me came the above-named Vice President of THE CINCINNATI INSURANCE COMPANY, to me personally known to be the officer described herein,and acknowledged that the seal affixed to the preceding instrument is the corporate seal of said Company and the corporate seal and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporation. tttttuft,,,� �� Al. s .t```t A 2 j9<A� * s �V MARK J.HJLLER,Attorney at Law 11. w . r. ti 4O, NOTARY PUBLIC-STATE OF OHIO ts.' My commission has no expiration ",, TE.. OV „Ass date.Section 147.03 O.R.C. ,,,,,dans, I,the undersigned Secretary or Assistant Secretary of THE CINCINNATI INSURANCE COMPANY,hereby certify that the above is a true and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in full force and effect. GIVEN under my hand and seal of said Company at Fairfield, Ohio. this day of ,/ ,cru telyr�'C. C/{ 11- / / ! Ga CORPORATE �—Assistant Secretary a SEAL oHIO BN-1005 (5/12) art ofkailre BOND NO: B0367157 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Bacon Corer r P t P, T n r_ (Contractor),as Principal, a contract for the construction of the project designated as Sprague/Long Sidewalk Improvements), Project No. 15-086 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 The Cincinnati Ins. Co. (Surety), a corporation, organized under the laws of OH 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$237,647 total Contract amount (including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors,or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified; shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract; and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change, extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties'duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIP L(CONTRACTOR) SU TY x/14/15 Principal =l a 9-t re Date Surety Signature Date Greg Bacon Patrick McNamara Printed Name Printed Name President Attorney-in-fact Title Title Name,address,and telephone of local office/a ent of Sur Co n Wheat & Associates, 1306 N. Post St. , n9-9z2-2937 CITY OF SPOKANE VALLEY CONTRACT SPRAGUE/LONG SIDEWALK IMPROVEMENTS BID NO:15-083 TEE CINCINNATI INSURANCE COMPANY Fairfield,Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That THE CINCINNATI INSURANCE COMPANY,a corporation organized under the laws of the State of Ohio,and having its principal office in the City of Fairfield,Ohio,does hereby constitute and appoint Zac Wheat; Tena M. Wheat; Derek M. Collett; Kathy M. Whipple;' Stacy Breithaupt; Patrick McNamara; Shellie Duncan; Brendon Nepon and/or Alia Bakke of Spokane, Washington its true and lawful Attorney(s)-in-Fact to sign,execute, seal and deliver on its behalf as Surety,and as its act and deed,any and all bonds,policies,undertakings,or other like instruments,as follows: Any such obligations in the United States, up to Fifteen Million and No/100 Dollars ($15,000,000.00) . This appointment is made under and by authority of the following resolution passed by the Board of Directors of said Company at a meeting held in the principal office of the Company, a quorum being present and voting, on the 6" day of December, 1958, which resolution is still in effect: "RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attorneys-in- Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attorney-in-Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority.Any such writings so executed by such Attorneys-in- Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected -- officers of the Company." This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 7"day of December, 1973. "RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney, granted, and the signature of the Secretary of Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company." IN WITNESS WHEREOF,THE CINCINNATI INSURANCE COMPANY has caused these presents to be sealed with its corporate seal, duly attested by its Vice President this 10"day of May,2012. THE CINCINNATI INSURANCE COMPANY u CORPORATE o - e SEA LQe +` A - OHIO ��-''��� "��� Vice President STATE OF OHIO ) ss: COUNTY OF BUTLER ) On this 10"day of May,2012,before me came the above-named Vice President of THE CINCINNATI INSURANCE COMPANY, to me personally known to be the officer described herein,and acknowledged that the seal affixed to the preceding instrument is the corporate seal of said Company and the corporate seal and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporation. O let 4 � lrj < * � .t •_ >�,arE,_ - MARK J.HJLLER,Attorney at Law /. �. ti�� • r,:�vs �O'� NOTARY PUBLIC-STATE OF OHIO S , My commission has no expiration �� + Ottidate.Section 147.03 O.R.C. nsuinsio I,the undersigned Secretary or Assistant Secretary of THE CINCINNATI INSURANCE COMPANY,hereby certify that the above is a true and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in full force and effect. GIVEN under my hand and seal of said Company at Fairfield, Ohio. this day of ] 46,L truer. /8:74-, /J//�\/ CORPORATE 3 Assistant Secretary a SEAL 0H10 BN-1005 (5/12) ars crs /��, s of ane 4000 Malley BOND NO: B0367158 CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington, in Spokane County, has awarded to Bacon Concrete, Inc ("Contractor), as Principal, a contract for the construction of the project designated as SpraquelLonq Sidewalk Improvements Project No. 15-086(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 The Cincinnati Ins. Co. organized and existing under the laws of the State of OH 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 Eleven thousand eight hundred eighty two dollars ($11,882.35 ), 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 14th day of August , 20 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. CITY OF SPOKANE VALLEY CONTRACT SPRAGUE/LONG SIDEWALK IMPROVEMENTS BID NO:15-083 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. PRINCIPAL(CONTRACTOR) SU ���''� 8/14/15 Principal ature Date Surety Signature Date • Greg Bacon Patrick McNamara Printed Name Printed Name President Attorney—in—fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Wheat & Associates, 1306 N. Post St. , 509-922-2937 CITY OF SPOKANE VALLEY CONTRACT SPRAGUE/LONG SIDEWALK IMPROVEMENTS BID NO:15-083 THE CINCINNATI INSURANCE COMPANY Fairfield,Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That THE CINCINNATI INSURANCE COMPANY,a corporation organized under the laws of the State of Ohio, and having its principal office in the City of Fairfield, Ohio,does hereby constitute and appoint Zac Wheat; Tena M. Wheat; Derek M. Collett; Kathy M. Whipple; Stacy Breithaupt; Patrick McNamara; Shellie Duncan; Brendon Nepon and/or Alia Bakke of Spokane, Washington its true and lawful Attomey(s)-in-Fact to sign,execute, seal and deliver on its behalf as Surety, and as its act and deed,any and all bonds,policies,undertakings,or other like instruments, as follows: Any such obligations in the United States, up to Fifteen Million and No/100 Dollars ($15,000,000.00) . This appointment is made under and by authority of the following resolution passed by the Board of Directors of said Company at a meeting held in the principal office of the Company, a quorum being present and voting, on the 6th day of December, 1958, which resolution is still in effect: "RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attorneys-in- Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attorney-in-Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority.Any such writings so executed by such Attorneys-in- Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected - officers of the Company." This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 7th day of December, 1973. "RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company." IN WITNESS WHEREOF,THE CINCINNATI INSURANCE COMPANY has caused these presents to be sealed with its corporate seal, duly attested by its Vice President this 10th day of May,2012. THE CINCINNATI INSURANCE COMPANY CORPORATE o - SEAL - OHIO • Vice President STATE OF OHIO ) ss: COUNTY OF BUTLER ) On this 10t day of May,2012,before me came the above-named Vice President of THE CINCINNATI INSURANCE COMPANY, to me personally known to be the officer described herein,and acknowledged that the seal affixed to the preceding instrument is the corporate seal of said Company and the corporate seal and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporation. ..•% sl A E���'"I. s 3 5 MARK J. H(7.;t% R,Attorney at Law yalk +; 4�@ NOTARY PUBLIC-STATE OF OHIO My commission has no expiration 44 888111eisibt- E Of date.Section 147.03 O.R.G. I,the undersigned Secretary or Assistant Secretary of THE CINCINNATI INSURANCE COMPANY,hereby certify that the above is a true and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in full force and effect. GIVEN under my hand and seal of said Company at Fairfield, Ohio. this day of /Cat14-4-‘ �p�u lfl31,•C. / CORPORATE 3 Assistant Secretary a SEAL t OHIO BN-1005 (5/12) ISA(:UN-2 UI'IU:I'M AC-ORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/17/2015 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 Zac Wheat Wheat&Associates InsurancePHONE P.O.Box 3548 A/C,No,Ext):509-922-2937 FAX p C,No): 509-9224103 Spokane,WA 99220-3548 AIL ADDRESS:zac@wheatinsurance.com Zac Wheat INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Ins Co 24082 INSURED Bacon Concrete,Inc. INSURER B: Greg Bacon 16510 N Brannon Ln INSURER C Spokane,WA 99208 INSURER D: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000'/ CLAIMS-MADE X OCCUR X X BKS56383812 12/31/2014 12/31/2015 DAMAGE TO RENTED 000000, 1 " PREMISES(Ea occurrence) $ � MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000/ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000/ POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,0001 OTHER: $ AUTOMOBILE LIABILITY CEO MBI aeDtSINGLE LIMIT $ 1,000,000 Y A X ANY AUTO BKS56383812 12/31/2014 12/31/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY STATUTE X ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N BKS56383812 12/31/2014 12/31/2015 E.L.EACH ACCIDENT $ 1,000,0001 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WA STOP GAP E.L.DISEASE-EA EMPLOYEE $ 1,000,000✓ If yes,describe under / DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000+ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured,Waiver of Subrogation, Primary&Non contributory per endorsement CG8810. Products and-Completed operations per CG8583. Per Project aggregate limits CG8870 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave STE 106 Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE 91/10 idak ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r -,:i ,?. STATF pm _ - 1 BUSINESS LICENSE1:.) r,,4 1888 N EI STATE OF # __WASHINGTON '--- ---- - __. _ ._ ` li !k� Unified Business ID U: 601 398 658 ?� >), Domestic Profit Corporation Business ID U: 1 '' Location: 1 Expires: 06-30-2016 '-) E BACON CONCRETE, INC. ii. 16510 ;N BRANNON LN if;I SPOKANE WA 99208 8750 A , w1 ,.,i 1 TAX REGISTRATION ,i (4 INDUSTRIAL INSURANCE 4 UNEMPLOYMENT INSURANCE 1 fl CITY LICENSES/REGISTRATIONS: t `-, SPOKANE GENERAL BUSINESS 8T12011451BUS LIBERTY LAKE GENERAL BUSINESS 4,1 SPOKANE VALLEY GENERAL BUSINESS 0 LICENSING RESTRICTIONS: Not licensed to hire minors without a Minor Work Permit. C% rt ,1 J., t yi C r t 4 V3. - - 211 4.1 4I .4a:= i 1. 61 'I 9 it 1 11 t+ :W 1 11 }k This document lists the registrations,endorsements,and licenses authorized for the business )` e, named above.Byacceptingthisdocument,the licenseecertifiesthe informationontheapplication< . -.04-: t was complete,true,and accurate to the best of his or her knowledge,and that business will be" conducted in compliance with all applicable Washington state,county,and city regulations Director,Department of Revenue r; i 41 H --..'-i'-' '� � ,., . .w. -��-_-_..a�' .• '''.,_ > _7.; "".-: !-.;-"§P.-7:---1-7--2--. .,. _ "`Tc5, ..`�*.`-^'a'-i4 'Sa-.4 i_-' "�#; •-a.- +mom ;;` . 1 W ,IS W. S! Nto o c 0 In RM y IX r sp e N Z 0cr O iit2N ! 0 N~m i i O z 28 = e 1.)2f°et �� u. o Q • 41 WZM-10: ! E z LL rl M J W u2c J K2 1 !tu mu a F O ri W 5g2-11V4 N O Z 0 2 -! p co Z e a J W FW.. co WON 1-401-1.5C0). ! ' I'H m W Z C' Q i.4 i W W_ii ,. F- tA ,::1Ca UK6 LC F•JW WQQ 6 co vasNSr9J> - 1 ' E rr:17. VZZ Wh-JZi-Z ` / O 5-'4 o Q K d Q 1 Q 1 ! 7 W O W Y z0 ~ utno4CWa. XOW a.mO m 'D m.- ui F.1.4 D O-7 0 i t D I i 5-086 Pub moi-, BACON-2 OP ID: PM ACOREY DATE(MM/DD/YYYY) 4......-,-- CERTIFICATE OF LIABILITY INSURANCE 01/19/2016 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 Zac Wheat Wheat&Associates Insurance NAME: P.O.Box 3548 (A/CC,NN,Ext):509-922-2937 FAX No):509-922-4103 Spokane,WA 99220-3548 E-MAIL zac wheatinsurance.com Zac Wheat ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Ins Co 24082 , INSURED Bacon Concrete,Inc. INSURER B: Greg Bacon 16510 N Brannon Ln INSURER C: Spokane,WA 99208 INSURER D: INSURER E: 1 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. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTRINSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X BKS56383812 12/31/2015 12/31/2016 DAMAGE l O Ea RENTED occurrence) $ 1,000,000 PREMISES( MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOCPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ A X ANY AUTO BKS56383812 12/31/2015 12/31/2016 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PR OPERTY DAMAGE $ HIRED AUTOS AUTOS Perer accident) $ X UMBRELLA LIAB — OCCUR _EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE USO56383812 12/31/2015 12/31/2016 AGGREGATE $ DED X RETENTION$ 0 $ WORKERS COMPENSATION 11- AND EMPLOYERS'LIABILITY STATUTE X ER YIN A ANY PROPRIETOR/PARTNER/EXECUTIVE N/A BKS56383812 12/31/2015 12/31/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) WA STOP GAP E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate Holder is included as Additional Insured,Waiver of Subrogation, Primary&Non contributory per endorsement CG8810. Products and-Completed operations per CG8583. Per Project aggregate limits CG8870 Project:Sprague Long Sidewalk CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave STE 106 Spokane Valley,WA 99206 AUTHORIZED� l I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD