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16-031.00 Inland Asphalt: 32nd Ave Preservation Contract This agreement is entered into this 2� ' day of marl,,, , 2016, between the City of Spokane Valley ("City") and Inland Asphalt Company ("Contractor"), pursuant to Title 35 RCW, as adopted or amended. In consideration of the terms and conditions contained herein and attached and made a part of this agreement,the parties agree as follows: I. The Contractor shall do all work and furnish all tools,materials, and equipment for: 32"d Avenue Preservation Project#0229 Contract 16-031 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. II. The City 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 by reason of entering onto this contract, except as provided herein. V. The project was awarded for the bid amount of$1,249,249.49. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the date below, and the City has caused this instrument to be executed on the date stated above. Executed by Contractor March 15 , 2016. Al Hughbanks Printed Name CiUiiMi E. ti -to Title Signature City of Spokane Valley C&iJUv A4crK Printed Name y,befklr Title V 64- CidilDtt Signature Revised I-8-I 6 SC1 fl OF pokane 9200750 BOND NO: 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 32"d Avenue Preservation Project No. 0229 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$1,249,249.49 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 'e surety. Inland As p - mpFidelity and Deposit Company of Maryland PRINC 4g / / SURETY WIle 3/15/16 ��41.1.......__3114/201 Principal Signa e r Date xc,:un �r Date Al Hughba• 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. 15 W.South Temple,Ste.700 Salt Lake City,UT 84101 801-533-3624 SpoKaane „�l►'�Valley 9200750 BOND NO: 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 32°d Avenue Preservation Project No. 0229 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$1,249,249.49 total Contract amount(including Washington State sales tax),subject to the provisions herein. This payment bond shall become null and void,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW,including all workers,laborers,mechanics,subcontractors, and materialmen,and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments;and if such payment obligations have not been fulfilled,this bond shall. remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,except as provided herein,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. Inland Asph• pan Fidelity and Deposit Company of Maryland PRINCIP foil!TN, SURE Y Arelli �� 3 15 1• 3/14/2016 Principa ignatur= Date S !- - Al Hu hban. 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. 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 14TH day of MARCH 2016, 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. AO < / ..... ,.._ _,„,,„,,,,..„„„,..., _..,._.__ Notary P 1 c *�, LISA HALL y � M>.��:o Notary Public kI, ; State of Utah " '1 r 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 24th day of November,A.D.2015. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND SEAL cIioa00, 0 :% ;`o a A�tt O t.m • 7 ...____74 BY Secretary Vice President Michael McKibben Thomas O.McClellan State of Maryland County of Baltimore On this 24th day of November,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 swom,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. I:CitF,/-1.‹. ct 7'0 92t6tiA,- ',,,,iii i it �.,. 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 14THIay of MARCH ,20 16 . p i 4!..-;;;;;;:71.0%o3` � %%1,1 ow. szt SEAL L 19ee ifi «. , �.... • A Gerald F.Haley,Vice President Spokane .00Walley. BOND NO: 9214151 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 32'Avenue Preservation Project No.0229(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 Sixty Two Thousand Four Hundred Sixty Two and 47/100 dollars($.6F,462.47 ),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 2-444-1 .,4 day of ic.l CJS , 2016, 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. Inland As t mi-ny , Fidelity and Deposit Company of Maryland PRINC A O " 4 1�;` SURETY �1 �-� I • 14/2016 Principal Signa. Da . Pate Al Hughb: . :- 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. 15 W.South Temple,Ste.700 Salt Lake City,UT 84101 801-533-3624 I rxtIced 1 I a: SURETY ACKNOWLEDGMENT STATE OF UTAH } COUNTY OF SALT LAKE } SS On this 14TH day of MARCH 2016, 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 P 'c LISA HA Sr Notary Pub is —�` `, State of Utah � �fir' 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 24th day of November,A.D.2015. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND spar. ' _ --- ;.: By. _ Secretary Vice President Michael McKibben Thomas O.McClellan State of Maryland County of Baltimore On this 24th day of November,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. '411'1 tiO 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 14THday of MARCH ,20 16 . T1 %ZEAL Me fi G � / Gerald F.Haley,Vice President Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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.POLICY LIMITS ARE NO LESS THAN THOSE LISTED,ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that I Inland Asphalt Company CPM Development Corporation oration dba NAME AND ' \t i PO Box 3366 ADDRESS „lir LirtyMI/Wale Spokane, WA 99220-3366 OF INSURED INSURANCE 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 CONTINUOS TYPE OF POLICY CIPOLICY NUMBER LIMIT OF LIABILITY EXTEN 0 EXTENDED ❑POLICY TERM WORKERS 9/1/2016 WA7-C8D-004095-025 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING STATES: COMPENSATION WC7-C81-004095-015 WA :All States except OH,ND, Bodily Iury by Accid 4)n' ent 1,000,000 Each Accident -015:WI Bodily Injury By Disease $1,000,000 Policy I imit Bodily Injury By Disease $1,000,000 Each Pelson COMMERCIALGeneral Aggregate GENERAL LIABILITY 9/1/2016 TB2-C81-004095-115 $2,000,000 m OCCURRENCE -Per Project Aggregate included. Products/Completed Operations Aggregate $2,000,000 ❑CLAIMS MADE Each Occurrence $2,000,000 RETRO DATE Personal&Advertising Injury $2,000,000 Per Person/Organization Other Other Damagge to Premises Rented to Medical Exp:$5,000 You:$250.000 AUTOMOBILEEach Accident—Single Limit LIABILITY 9/1/2016 AS2-C81-004095-125 $2,000,000 B.I.And P.D.Combined Each Person M OWNED mNON-OWNED Each Accident or Occurrence ElHIRED Each Accident or Occurrence OTHER 9/1/2015-9/1/2016 AS2-C81-054502-525 Physical Damage only Automobile policy -$T0,000 Comp -$10,000 Coll ADDITIONAL COMMENTS RE: 32nd Ave.Street Preservation,Contract No.16-031 City of Spokane Valley is included 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. NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) Liberty Mutual 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 Insurance Group OF SUCH CANCELLATION HAS BEEN MAILED TO: Cit of Spokane Valley Stan Esposito 11707 E. Sprague Ave., Suite 106 Pittsburgh/0387 AUTHORIZED REPRESENTATIVE ti x Spokane Valley,WA 99206 12 Federal Street,Ste.310 3/15/2016 u Pittsburgh PA 15212-5706 412-231-1331 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as rJespects such insurance as is afforded by those Companies NM 772 07-10 26010614 1 LM_44 1 9/15-9/16 - Standard Limits 2/2 1 Nicholas Misoni 1 8/18/2015 11:47,10 AM (CDT) 1 Page 1 of 1 LDI COI 268896 02 11 POLICY NUMBER:TB2-CB1.004095-115 COMVERCIAL 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 Il — Who Is An Insured is amended to 1. AI! work, including materials, parts 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 in the performance of your ongoing operations for intended use by any person or organization addo ofy insured(s) at the latiofor other than another contractor or subcontractor the designatedddabove. engaged in performing operations for a principal as a part of the same project. However. C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III—Limits Of Insurance: law;and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contract or agreement;or by the contract or agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to 'bodily injury" or applicable Limits of Insurance shown in the "property damage" occurring after. Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): Any owner,lessee,or contractor for whom you have Any location listed in such agreement agreed in writing prior to a loss to provide liability insurance Information required to complete this Schedule,if not shown above, will be shown in the Declarations. CG 20 10 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 1 Policy Number TB2-C81-004095-115 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY—SCHEDULED ADDITIONAL INSURED This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: Where required by written contract prior to a loss If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule that is an additional insured on this policy, this policy will apply solely on the basis required by such written agreement If the applicable written agreement does not specify on what basis the liability insurance will apply,this insurance shall be excess over any other valid and collectible insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis.Condition 4 Other Insurance of Section IV is revised accordingly. LD 2410 0713 @ 2013 Liberty Mutual Insurance.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. POLICY NUMBER:TB2-C81-004095-115 COIVNERCIAL 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 INLAND ASPHALT CO haps://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?U a STATE Or WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage March 24, 2016 WA UBI No. '328 003 915 L&I Account ID 700,174-00 Legal Business Name INLAND ASPHALT CO Doing Business As OLDCASTLE INC Workers'Comp Premium Status: Self Insured. This business is certified to cover its own workers' comp costs. No premiums due. Estimated Workers Reported i N/A (See Description Below) Account Representative 1(360)902-4817 Licensed Contractor? No What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). 1ofl 3/24/2016 8:54 AM n �•� '-1 r� .41.-;;Lt BUSINESSLICENSE ill f lI STATE OF 7F ski, •WASHINGTON s g ..1;11, Unified Business ID #: 601 006 854 ';,T,' p,.9i Domestic Profit Corporation Business ID #: 1 II14/ ! 10 Location: 3 I�� Expires: 07-31-2016 I+ CPM DEVELOPMENT CORPORATION ;'`[ INLAND ASPHALT COMPANY Voj 5111 E BROADWAY AVE 04Ff .'tl SPOKANE VALLEY WA 99212 0928i.1 s;fl iii- ,.; F;fa TAX REGISTRATION (600 664 174) -(41 r'.: 3 „1 CITY LICENSES/REGISTRATIONS: trA iN SPOKANE GENERAL BUSINESS #T12004257BUS r`" i' SPOKANE VALLEY GENERAL BUSINESS c` Ir:f gl 124t. 5 1 14 1111 V4.' 4 t] I 1.14 1,1 -V-;l , .,'I' d t l ,�j ll.,�, I-y,t1 olY r(4 01 ,41 , - . NAT il ;IA r This document lists the registrations,endorsements,and licenses authorized for the business • t` 4,1 named above.Byacceptingthis.document,the licenseecert Hies the informationonthe application a.., 1.1,1, was complete,true,and accurate to the best of his or.her knowledge;and that business will be ti ,�. conducted in compliance with all applicable Washington state,county,and city regulations. Director,Department of Revenue i .P! 'T-' ,.. - '� - Ste' ' J' G7 "+' •_'- _G..A^«r . _.,�%r',•--z = _ .--,,,c^+= _r' _ "v ..4_"'r-To__ r�u`-_.u...�. �:-.+�a,,,,,- �ac5 '�J _-"Z� - . 214,4 • IL . 1 oN N z t '' O ,-4 tit F M N c I o y IL n0N I I °F _, w CO n,NiZ a Z Z N rl t-M I- M O CO s cc (9 1- 'D N m O y = ce OZ N OZ<c O CV O 'OND: E LL zcc u- r-i V 0Q$ Z�CDw 0 O 0 w W 6- I- 7- i i N F z..=W Hw_J N Q in Q_ _J Q W J to CI PA' H W< I , ,, a =