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09-060.00 Colvico: Sprague Thierman Signal Pole Replacement
AGREEMENT FOR CONSTRUCTION OR SERVICES Colvico Inc. Contract Number 09 -027 THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and Colvico Inc. hereinafter "Contractor," jointly referred to as "parties." IN CONSIDERATION of the terms and conditions contained herem the parties agree as follows 1 Work to Be Performed The Contractor shall do all work and furnish all labor, tools, materials, supplies and equipment for the Sprague/Thierman signal pole replacement (hereinafter "work ") in accordance with, and as described in the Scope of Services, Special Provisions, the Standard Specifications for Road, Bndge, and Municipal Construction 2008 and Amendments to of the Washington State Department of Transportation, which are by this reference incorporated herem and made part hereof ( "Contract Documents'), and shall perform any changes in the work in accord with the Contract Documents The CONTRACTOR shall, for the amount set forth in the Contractor's bid proposal attached hereto, assume and be responsible for the cost and expense of all work required for constructing and completing the work and related activities provided for in the Contract Plans and Contract Documents, except those items mentioned therein to be furnished by the City of Spokane Valley The City Manager, or designee, shall administer and be the primary contact for Contractor Prior to commencement of work, Contractor shall exercise best efforts to contact the City Manager or designee to review the scope of work, schedule, and tune of completion Upon notice from the City, Contractor shall promptly commence work, complete the same in a timely manner, and cure any failure in performance under this agreement Unless otherwise directed by the City, all work shall be performed in conformance with the Contract Plans, Contract Documents, City and State standards Contractor acknowledges review of the Contract Plans and Contract Documents and accepts the same Contractor shall exercise best efforts, including the selection of the highest quality materials, so that all work performed shall be in compliance with current related industry standards 2 Term of Contract This agreement shall be in full force and effect upon execution and shall remain in effect until December 31 ", 2009 The City may terminate this agreement by ten days' written notice to the other party In the event of such termination, the City shall pay the Contractor for all work previously authorized and satisfactorily performed prior to the termination date 3 Compensation The City agrees to pay the Contractor [ *] a fee of $641330 for the work, as full compensation for everything funushed and done under this agreement C09 -060 4 Payment The Contractor may elect to be paid in monthly installments, upon presentation of an invoice to the City, or in a lump sum, upon completion of the work Applications for payment shall be sent to the City Clerk at the below - stated address The City reserves the right to withhold payment under this agreement which is determined, in the reasonable ,judgment of the City Manager, to be noncompliant with the Contract Plans, Contract Documents, or City or State standards 5 Notice Notice shall be given in writing as follows TO THE CITY TO THE CONTRACTOR Name Chnstme Bainbridge, City Clerk Name Phil Amsden Phone Number (509) 921 -1000 Phone Number (509) 536 -1875 Address 11707 East Sprague Ave, Suite 106 Mobile Spokane Valley, WA 99206 Address P O Box 2682 Spokane, WA 99220 6 AggHcable Laws and Standards The parties, in the performance of this agreement, agree to comply with all applicable Federal, State and local laws, and City ordinances and regulations 7 Prevailing Wages on Public Works Unless otherwise required by law, if this contract is for a "public work" which is defined as "work, construction, alteration, repair or improvement other than ordinary maintenance executed at the cost of the City," the following provision applies This agreement provides for the construction of a public work and a payment of prevailing wages according to Washington law All workers, laborers or mechanics shall be paid a prevailing rate of wage that is set forth in an Exhibit to this agreement Before any payment may be made to Contractor a "Statement of Intent to Pay Prevailing Wages" must be submitted to the City Following final acceptance of the public works project, the Contractor and each subcontractor shall submit an "Affidavit of Wages Paid" before retained funds will be released to the Contractor The affidavit must be certified by the industrial statistician of the Department of Labor and Industries 8 Relationship of the Parties It is hereby understood, agreed and declared that the Contractor shall be an independent Contractor and not the agent or employee of the City, that the City is interested in only the results to be achieved, and that the right to control the particular manner, method and means of the work is solely within the discretion of the Contractor Any and all employees who provide services to the City under this agreement shall be deemed employees of the Contractor The Contractor shall be solely responsible for the conduct and actions of all its employees under this agreement and any liability that may attach thereto 9 Ownership of Documents All drawings, plans, specifications, and other related documents prepared by the Contractor under this agreement are and shall be the property of the City, and may be subject to disclosure pursuant to RCW 42 56 or other applicable public record laws 10 Records The City or State Auditor or any of their representatives shall have full access to and the right to examine during normal business hours all of the Contractor's records with respect to all matters covered in this contract Such representatives shall be permitted to audit, examine and make excerpts or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and record of matters covered by this contract for a period of three years from the date final payment is made hereunder 11 Warranty Unless provided otherwise in the Contract Plans or Contract Documents, Contractor warrants all work and materials performed or installed under this contract are free from defect or failure for a period of one year following final acceptance by the City, unless a supplier or manufacturer has a warranty for a greater period, which warranty shall be assigned to the City In the event a defect or failure occurs in work or materials, the Contractor shall within the warranty period remedy the same at no cost or expense to the City 12 Contractor to Be Licensed And Bonded The Contractor shall be duly licensed and bonded by the State of Washington at all tunes this agreement is in effect 13 Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for mjunes to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, their agents, representatives, employees or subcontractors No Limitation. Contractor's maintenance of insurance as required by the agreement shall not be construed to limit the liability of the Contractor to the coverage provided by such insurance, or otherwise limit the City's recourse to any remedy available at law or in equity A Minimum Scope of Insurance Contractor shall obtain insurance of the types described below 1 Automobile Liability insurance covering all owned, non - owned, hued and leased vehicles Coverage shall be written on Insurance Services Office (ISO) from CA 00 01 or a substitute form providing equivalent liability coverage If necessary, the policy shall be endorsed to provide contractual liability coverage 2 Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products- completed operations, stop gap liability, personal mjury and advertising mjury, and liability assumed under an insured contract The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85 There shall be no endorsement or modification of the Commercial General Liability insurance for liability arising from explosion, collapse or underground property damage The City shall be named as an insured under the Contractor's Commercial General Liability insurance policy with respect to the work performed for the City using ISO Additional Insured endorsement CG 20 10 10 01 and Additional Insured- Completed Operations endorsement CG 20 37 10 01 or substitute endorsements providing equivalent coverage 3 Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington B Minimum Amounts of Insurance Contractor shall maintain the following insurance limits 1 Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident 2 Commercial General Liability insurance shall be written with limits no less that $1,000,000 each occurrence, $2,000,000 general aggregate and a $2,000,000 products - completed operations aggregate limit C Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance 1 The Contractor's insurance coverage shall be primary insurance as respect the City Any Insurance, self - insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it 2 Cancellation of Consultant's insurance shall be governed by either a the policy shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty days prior written notice by certified mail, return receipt requested, has been given to the City, or b the Consultant shall provide at least 30 days prior written notice by certified mail, return receipt requested of a cancellation D Acceptability of Insurers Insurance is to be placed with insurers with a current A M Best rating of not less than A VII E Evidence of Coverage As evidence of the insurance coverages required by this contract, the Contractor shall furnish acceptable insurance certificates to the City at the time the Contractor returns the signed contract The certificate shall specify all of the parties who are additional insureds, and will include applicable policy endorsements, and the deduction or retention level Insuring companies or entities are subject to City acceptance If requested, complete copies of insurance policies shall be provided to the City The Contractor shall be financially responsible for all pertinent deductibles, self- insured retentions, and/or self - insurance 14 Indemnification and Hold Harmless The Contractor shall defend, indemnify and hold the City, its officers, officials, employees and volunteers harmless from any and all claims, mjunes, damages, losses or suits including attorney fees, arising out of or in connection with the performance of this agreement, except for mjunes and damages caused by the sole negligence of the City Should a court of competent ,jurisdiction determine that this Agreement is subject to RCW 4 24 115, then, in the event of liability for damages ansmg out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Contractor and the City, its officers, officials, employees, and volunteers, the Contractoes liability hereunder shall be only to the extent of the Contractor's negligence It is further specifically and expressly understood that the indemnification provided herein constitutes the Contractor's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification This waiver has been mutually negotiated by the parties The provisions of this section shall survive the expiration or termination of the agreement 15 Waiver No officer, employee, agent, or other individual acting on behalf of either party, has the power, right, or authority to waive any of the conditions or provisions of this agreement No waiver in one instance shall be held to be waiver of any other subsequent breach or nonperformance All remedies afforded in this agreement, or by law, shall be taken and construed as cumulative, and in addition to every other remedy provided herein or by law Failure of either party to enforce, at any time, any of the provisions of this agreement, or to require, at any time, performance by the other party of any provision hereof, shall in no way be construed to be a waiver of such provisions, nor shall it affect the validity of this agreement, or any part thereof 16 Assignment and Dele action Neither party shall assign, transfer, or delegate any or all of the responsibilities of this agreement, or the benefits received hereunder, without first obtaining the written consent of the other party 17. Jurisdiction and Venue This agreement is entered into in Spokane County, Washington. Venue shall be in Spokane County, State of Washington. 18. Arbitration All disputes arising under this agreement shall be resolved through arbitration pursuant to State law. Rules for arbitration shall be those prescribed by the American Association of Arbitration. 19. Entire Agreement This written agreement constitutes the entire and complete agreement between the parties, and supercedes any prior oral or written agreements. This agreement may not be changed, modified, or altered, except in writing and signed by the parties hereto. 20. Anti - kickback No officer or employee of the City, having the power or duty to perform an official act or action related to this agreement, shall have, or acquire, any interest in this agreement, or have solicited, accepted, or granted, a present or future gift, favor, service, or other thing of value from any person with an interest in this agreement. 21. Business Registration Prior to commencement of work, Contractor shall register with the City as a business. 22. Severability If any section, sentence, clause or phrase of this agreement should be held to be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the validity of any other section, sentence, clause or phrase of this agreement. 23. Exhibits Exhibits attached and incorporated into this agreement are: 1. Scope of Work 2. Insurance Certificates. 3. Performance and Payment Bond b A - IN WITNESS WHEREOF, the parties have executed this agreement this day of _ 2009. TY SP VALLEY: CONTRA OR: A le- City Manager Owner RED ACTED Tax I.D. No.: Z AT S APPROVED AS TO FORMi Clerk Office Vthe City A rney This document contains confidential tax information and has been redacted pursuant to RCW 82.32.330. You may petition for a review of our findings pertaining to any redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. my or S 1P n � ao�No. CONTRACTOR'S PERFORMANCE AND PAYMENT BOND TO DUAL OBLIGEES KNOW ALL MEN BY THESE PRESENTS, that (Contractor), as Principal, and a corporation of (Bonding Company), as Surety, whose principal office is located at are firmly bound unto the State of Washington and the City of Spokane Valley, a political subdivision the State of Washington, as Obligees, to fulfill the obligations of the Principal and the Surety under the Contract to which reference is hereafter made, in the amount of $ (including Washington State sales tax) for payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents. WHEREAS, Principal has by written Proposal dated offered to enter into a Contract with the City of Spokane Valley for Contract No. pursuant to the terms and conditions set forth in the Contract Documents dated NOW, THEREFORE, the condition of this obligation is such that if the Principal shall faithfa ly perform all the provisions of the Contract on its part, and pay all laborers, mechanics, subcontractors and material suppliers, and all persons who supply such person or persons or subcontractors with provisions and supplies for the carrying on of such work, and indemnify and hold harmless the Obligees from all loss, cost or damage which it may suffer by reason of the failure to do any of the foregoing, then this obligation shall be null and void; otherwise it shall remain in full force and effect. All persons who have furnished labor, materials or supplies for use in and about the work provided for in the Contract shall have a direct right of action under this bond, to the extent and in the manner set forth in RCW 39.08. The said Surety for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract or to the WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the WORK or to the SPECIFICATIONS. No final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. SIGNED AND SEALED THIS DAY OF YEAR 20 SURETY PRINCIPAL Signature Signature Typed Name Typed Name Title Title (SEAL) RETAINAGE - Release of retainage will not be paid before 45 days has passed from the date of the City of Spokane Valley accepting the work of the project as complete provided the following conditions are met: 1. Releases have been received from the State Department of Labor and Industries, the State Employment Security Department, and all other departments and agencies having jurisdiction over the activities of the Contractor. 2. On contracts totaling more than $20,000.00, a release has been obtained from the State Department of Revenue. 3. No claims, as provided by law, have been filed against the retained percentage as evidenced by a check with the County Auditor - Recording, City Clerk and the Public Works Department. 4. Affidavits of Prevailing Wages Paid approved by the Washington State Department of Labor and Industries on the Contractor and each and every Subcontractor. MY OF ,; 0 00valley . SCOPE OF SERVICES SPRAGUE/THIERMAN SIGNAL POLE REPLACEMENT 1. This project is located at the southwest corner of the intersection of Sprague Avenue and Thierman Road. 2. The scope of work includes complete removal and disposal of the existing traffic signal pole, two mastarms, and luminaire pole and installation of a new signal pole, two mastarms and luminaire arm. The existing foundation, anchor bolts, anchor bolt nuts, and all signal appurtenances including mastarm signage, signal heads, pedestrian heads, terminal cabinet, opticom system, and all wiring are to be re -used and installed on the new pole and mastarms. Spokane County to provide a new luminaire head and two pushbutton assemblies for installation by the contractor. The contractor shall replace any items damaged during removal or construction. 3. Removal of the existing pole and installation of the new pole, two mastarms, luminaire arm, and all appurtenances are to be completed on the same day. The signal shall be back in operation the same day. 4. The existing signal pole, two mastarms, and luminiare arm are to become the property of the contractor, the contractor shall be responsible for the removal from the site and disposal. 5. Contractor is responsible for retrieving and transporting the replacement pole and mastarms from Spokane County's Flora Pit at 2715 N Flora Rd, Spokane Valley, WA to the site. Two working days notice is required to the Spokane County Signal Shop at 477 -7702. 6. The contractor is to be responsible for all traffic control needed to complete the project. Sprague Avenue must be left open for 2 lanes of travel. Thierman Road must be left open for one lane of travel in each direction between Sprague and Appleway. The intersection may operate with stop control on the Thierman Road approaches. Flagger control will be needed during most of the day. A traffic control plan must be submitted to the Senior Traffic Engineer in the Public Works Department for approval two working days prior to commencing work. 7. A City right -of -way permit is not required for this project. Approval for any use of private property for staging or construction must be obtained by the contractor. 8. All work to be done in accordance with the Standard Specifications for Road, Bridge, and Municipal Construction 2008 and Amendments to as published by the Washington State Department of Transportation 9. Contract time shall begin with the issuance of the Notice to Proceed. A total of thirty (30) working days will be allowed for this project. See the Special Provisions "Coordination" clause for additional information. The bid will be lump sum. APR -21 -2009 02:35PM FV '"OLVICO +1 509 534 3.551 T -5gn P.009/009 F -134 spokan e jUalley BOND NO: 2095812 CON R-kCTOR'S PERFORNLANCE AND PAYMENT BOND TO DUAL OBLIGEES KNOW ALL MEN. BY THESE PRESENTS, that Colvico, Inc. (Contractor), as Principal, and Norht American Specialty Insurance C ompany (Bonuing Company), as Surety, a corporation of New Hampshire , , whose principal ofnce is located at Manchester, New Hampshire firmly bound unto the State of Washington and the City of Spokane 'Valley, a political subdivision the State of Washington, as Obligees, to fulfill the obligations of the Principal and the Surety under the Contract to which reference i9 liereafter made, in the amnunt of $ 6413.30 (including Washington State sales tax) for payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns jointly and severailly, firmly by these presents. WHEREAS, Principal has by written Proposal dated 4/2/09 offered to euter into a Contract with the City of Spokane valley for Contract No. 09-027 pursuant to the terms and conditions set forth in the Contract Documents dated 4/17/09 NOW, THEREFORE, the condition of this obligation is such that ,Fthe Principal shall faithfully perform all the provisions of the Contract on its part, and pay all laborers, mechanics, subcontractors and:tat -rW suppliers, and all persons who supply such person or persons or subcontractors with provisions and supplies for the carrying on of such work, and indemnify and hold harmless the Obligees from all loss, cost or damage which it may suffer by reason of tho eilize to do any of the foregoing then t1L obligation shall be null and void, otherwise it shall remain in full force and effect. All persons who have furnished labor, materials or supplies for use in and about the work provided for in the Contract shall have a direct right of action under this bond, to the extent and in the manner set forth in RCW 39.08. The said Surety for value received hereby stipulates and agrees that no change, es.'ten atom of time, alteration or addition to the terms of the Contract or to the WORK to be performed ihereunder or the SPECIFICATIONS accompanying the same shall in anyway affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the WORK or to the SPECIFICATIONS. No fanal settlement between the OWNER and the CONTRACTOR shall abridge the right of any bene5ciary hereunder, whose cl may be uns?+isfied_ SIGNED A2\TD SE, t.E•D THIS 22 nd DAY OF April North American - Specialty Insurance Company � � 9 .;ianat.Jre I lle Ande Typed Name Attorney -in -Fact Title YEAR 20 09 . Colvico, Inc. P SAL Si�ature CoR S. Colvin, Typed Name ��es�d�nf Title (SEAT.) NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Itasca, Illinois, each does hereby make, constitute and appoint: W.W. WELLER, GEORGE C. SCHROEDER, KATHY GURLEY, CHRIS LARSON, ERIN L. REPP, H. KEITH McNALLY, JO ANN MIKKELSEN and HEATHER ANDERSON JOINTLY OR SEVERALLY Its true and lawful Attorneys) -in -Fact, to make, execute, sea] and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contacts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: TWENTY-FIVE MILLION ($25,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 24' of March, 2000: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTIER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." �uuuuu1 4 17 N s'G';Z10N� y 2, g �' SEAL i n w Strvea P. Anderson, President & Chief Eaecufive Officer of �Yashington International Insurance Company S C F E �¢: :m. € 2: _AL s W :Z 1973 P 4,,. 1 & Senior ice President of North American Specialty Insurance Company Q r0 Em E �........... By David 111. hymen, Stnior Iv ice President of Washington International Insurance Company & \ ice President or North American Specialty Insurance Compsny IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this day of September , 2009 . North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Du Page SS: On this 3 0th day of September 20 before me, a Notary Public personally appeared Steven P. Anderson , President and CEO of Washington Intemational Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman , Senior Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their resnective companies. �oFFICL4L sEAL7 DONNA D. S1sI.ENS Notary Public, State of Illinois My Conmmission B#= /101 i , 1""'o /J Donna D. Sklens, Notary Public I, James A. Carpenter , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Powcl• of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 22n day of A Dril , 20 OS James A. Carpenter, Vice President & Assistant Sezmatin• orWashingter. Internat c uil Compam• d North American Specialty lnso:!mee Company Vr <,CK 1 I n oA I C V r LIAMIL1 I T IIVJVPCHIVVC 04/24/2009 PRODUCER (509)325 - 3024 =3 FAX 509)325 - 1803 "` .< Moloney, O'Neill , Corer >'y & Jones, Inc. 818 W Riverside, #800 Spokane, WA 99201 THIS CERTIFICATE IS ISSUED A4 .t4TTER OF INFORMATION ONLY AND CONFERS NO RIGHTE1 THE CERTIFICATE HOLDER. THIS CERTIFICATE DO AbT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Col vi co Inc PO Box 2682 Spokane Valley, WA 99212 INSURER !A American Fire & Casualty POLICY NUMBER INSURER B: POLICY EXPIRATION INSURER C INSURER D GENERAL LIABILITY INSURER E, 11/01/2008 P`r% % /Cn Ar`CC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L NSRr TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 53 754142 11/01/2008 11/01/2009 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISE'; (Ea armi er)rn $ 100, X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $ 1,000,000 A X Blanket Additional X Insd CG85831005 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X JE LOC AUTOMOBILE LIABILITY 53754142 11/01/2008 11/01/2009 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 X BODILY INJURY $ ALL OWNED AUTOS (Per person) A SCHEDULED AUTOS X BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) X PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY. AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR F� CLAIMS MADE $ $ DEDUCTIBLE $ RETENTION $ 53754142 11/01/2008 11/01/2009 OR LIMIT O R E.L. EACH ACCIDENT $ 1,000,000 EMPLOYERS' LIABILITY WASHINGTON STOP GAP A ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDEDI E.L. DISEASE - EA EMPLOYE $ 1,000,000 E L DISEASE - POLICY LIMIT $ 1 ,000,000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS E: SPRAGUE /THIERMAN SIGNAL POLE REPLACEMENT PROJECT ITY OF SPOKANE VALLEY ARE NAMED AS ADDITIONAL INSUREDS FOR GENERAL IABILITY AS SHOWN ABOVE AND ATTACHED. PRIMARY PER FORM CG84161203 TTACHED. CERTIFICATE HOLDER UAry (_tLLA I IUry CITY OF SPOKANE VALLEY 11707 E SPRAGUE #106 SPOKANE VALLEY, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILLENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR12ED REPRESENTATIVE Tim Warner /CLH ACORD 25 (2001108) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) Faae 'I ot 'I I Intents & Affidavits "0 Off Return to Main Menu —i L Help Please print this receipt for your records. Your payment has been processed and your form has been submitted. Transaction Id 2405964120003337590823 Form Filed Form Id: 11233725 lIntent Billin Information: Colvico Electric PO Box 2682 S pokane, WA 99220 F — Card and Number IVISA 1 1 f i f i l l 1 1 -4 1F - 0 4 10! F u r 1E-- Amount Billed: 1$40.00 https://secureaccess-wa-gov/Ini/pwia/Payment/ProcessCharge.asp 4/24/2009