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16-066.00 Inland Asphalt: McDonald Rd Diet 16th to Mission Contract This agreement is entered into this day of J SIV , 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: McDonald Road Diet, Project#0221 Contract 16-066 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$1,728,000.00. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the date below, and the City has caused this instrument to be executed on the date stated above. CITY OF SPOKANE VALLEY CONTRACT MCDONALD ROAD DIET 27 BID NO:16-066 Executed by Contractor June 29 ,2016. Date Al Hughbanks Printed Name Chief Est.11 A i Ali AAAA Title Signature City of Spokane Valley /VctrK Cii1 Printed Name City Manager Title YU71}(4"---' wL� Signature F-,;sa-'I '.6. CITY OF SPOKANE VALLEY CONTRACT MCDONALD ROAD DIET 28 BID NO:16-066 soo..kalovoc\... VJ ` 9223194 BOND NO: CONTRACTOR'S PAYMENT BOND(FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Inland Asphalt Company(Contractor), as Principal, a contract for the construction of the project designated as McDonald Road Diet, Project No. 0221 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW)and chapter 60.28 RCW. The Principal, and Fidelity and Deposit Company of Maryland (Surety), a corporation organized under the laws of Maryland and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S.Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee, in the sum of$ 1,728,000.00 total Contract amount, subject to the provisions herein. This payment bond shall 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 bo.• ' only be accepted it is accompanied by a fully executed and original power of attorney for the officer exec .rig ' 'eh-If• h- � PRI CIP COpt d Asphalt Company SURETY Fidelity and Deposit Company of Maryland IV Principal Signa = Date 411111PRIPIIM":".."1111ES - - Al Hu:hb: . . 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 risen ? 14 13 CITY OF SPOKANE VALLEY CONTRACT MCDONALD ROAD DIET 29 BID NO:16-066 r . Spokane ValleyF. BOND NO: 9223194 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 MdcDonald Road Diet, Project No. 0221 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$ 1.728,000.00 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified; shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract;and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change, extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers. This bond will , y •- - .-pte• ' ' -ccompanied by a fully executed and original power of attorney for the officer executing on •• if• ! ; PRINCIPA "iy' ! Asphalt Company SURETY Fidelity and Deposit Company of Ma land i, ry �if1► Y�• • C 016 Principal S ignaturely Date `� :•:. ` —.Nemo- e Al Hu hban A •• N, 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 i7?ii,e!3 , 14 13 CITY OF SPOKANE VALLEY CONTRACT MCDONALD ROAD DIET 30 BID NO:16-066 SURETY ACKNOWLEDGMENT STATE OF UTAH } COUNTY OF SALT LAKE } SS On this 29TH day of JUNE, 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 Publ' ll LISA HAL Notary Pus State of U •r Comm. No.681511 ' My Comm.Expires Mr 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 MICHAEL BOND,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 May,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND (ZEAL -- •; fry ap Itf► 1 V i ,0447- $i _ t968 T Pe �y1WINM AL° Secretary Vice President Michael McKibben Michael Bond State of Maryland County of Baltimore On this 24th day of May,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,MICHAEL BOND,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. otnurno t ` ^ **.... 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 29THday of JUNE ,2016 . Duey., 43 �:, -oM°�4r-�cLYc+'- �4•0 ?�4{` t11 1. :_, o SEAL S. MO .� V: meaha Z 445 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 dba NAME AND ,-- Liberty Mutual. PO Box 3366 ADDRESS +� M � Spokane, WA 99220-3366 OF INSURED r1 I NSU RANCE 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 TYPE OF POLICY ❑CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY ❑EXTENEXTENDED ❑POLICY TERM COVERAGE AFFORDED UNDER WC WORKERS 9/1/2016 WA7-C8D-004095-025 LAW OF THE FOLLOWING STATES: EMPLOYERS LIABILITY COMPENSATION WC7-C81-004095-015 WA '1 States except OH,ND, b Bodily In'1,uty y Accident 1000,000 Each Accident -015:WI Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1,000,000 Each Person. COMMERCIAL 9/1/2016 TB2-C81-004095-115 General Aggregate GENERAL LIABILITY $2,000,000 El OCCURRENCE -Per Project Aggregate included. Products/Completed Operations Aggregate $2,000,000 0 CLAIMS MADE Each Occurrence $2,000,000 RETRO DATE Personal&Advertising Injury $2,000,000 Per Person/Organization Other Other Dama a to Premises Rented to Medical Exp:$5,000 You: 50.000 AUTOMOBILE Each Accident—Single Limit LIABILITY 9/1/2016 AS2-C81-004095-125 $2,000,000 B.I.And P.D.Combined Each Person EI OWNED ElNON-OWNED Each Accident or Occurrence ❑HIRED Each Accident or Occurrence OTHER 9/1/2015-9/1/2016 AS2-C81-054502-525 Physical Damage only Automobile policy -$'0,000 Comp -$10,000 Coll ADDITIONAL COMMENTS RE: McDonald Road Diet,Contract No.16-066 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 tern,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.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE Liberty Mutual INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE Insurance Group OF SUCH CANCELLATION HAS BEEN MAILED TO: tizynke I City of Spokane Valley �� l• � ' Stan Esposito 11707 E.Sprague, Suite 106 AUTHORIZED REPRESENTATIVE Pittsburgh/0387 v Spokane Valley,WA 99206 12 Federal Street,Ste.310 Pittsburgh PA 15212-5706 412-231-1331 7/1/2016 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 26010614 I 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 I rn rnl 9RRROR 09 11 POLICY NUMBER:TB2-C81-004095-115 COIV ERCtAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED-PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts 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 other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. 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 contractor 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 addkional 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 2010 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 G2013 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 CONIVERCIAL GENERAL LIABILITY CG 24040509 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 aimsg `4 t 4:-, { ' BUSINESS LICENSENi- 11 STATE OF t; rAR WASHINGTON r., #t grLI Unified Business ID #: 601 006 854th '.i Domestic Profit Corporation Business ID *: 1 -ii Location: 3 r;� Expires: 07-31-2016 al 0j CPM DEVELOPMENT CORPORATION : INLAND ASPHALT COMPANY )3 i 5111 E BROADWAY AVE SPOKANE VALLEY WA 99212 0928 i'ff ;3 eta y tr4 4 4,, TAX REGISTRATION (600 664 174) '•i iRf 1r CITY LICENSES/REGISTRATIONS: '' SPOKANE GENERAL BUSINESS #T12004257BUS ' Ii -ryry 't SPOKANE VALLEY GENERAL BUSINESS !"� Nz y x 3 4 ,., .=. !` yi, ,, E t 1 f qf.. I „rt P, 1-01 E(tt`' -t 1 �= rt 3p L \,ij }'sk�C�.'. Ki ti Tei {l,i eit7 t'-i' 1.. 0 This document lists the registrations,endorsements,and licenses authorized for the business pl named above.Byacceptingthisrdocument,thelicenseecertifiestheinformation ontheapplication �. • was complete,true,and accurate to the best of his or her knowledge,and that business will be -�{'�' 'i.P conducted in compliance with all applicable Washington state,county,and city regulations. Director,Department of Revenue rg f r, '0 - 1.:.$ O M o N m o ..y N o 1 Nr E P, ..e0 a Z w• O Z N r^I F M / F .?.. } 4, m ‘-% ,,k .-5. oZ Q N N `c >sKZ c.W J c O co dQ O• OMC LL Q CO.W O •D VWM 74 OZ OE F- o 4.4 t- Y O J ^ 4.1 la H W.-1 2 W t-C W < In Z Q O J Q W J i y co D.QQJ CZJ u ` O'OQ FWa . � r I_ •p•gTATg �t,t•••Lt DiA 4,.ti• ti O.Ilf �•IL illi 1 tl�l jx .. YO O STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES PO Box 44274 Olympia, Washington 98504-4274 January 26, 2018 SPOKANE VALLEY, CITY OF 10210 EAST SPRAGUE AVE SPOKANE VALLEY WA 99206 N - - -- - --- -- -^ _._ _... g CERTIFICATE TO RELEASE L&I'S HOLD ON RETAINAGE 0 The Washington State Department of Labor&Industries is granting approval to release our hold on the retained amount for MCDONALD ROAD DIET,Contract 16-066, to the following contractor: 0 0 •INLAND ASPHALT CO 700,174-00 601 006 854 0 0 0 0 0 We have determined that all workers' compensation premiums, increases, and penalties for this contractor have been paid in full or are readily collectible without recourse to the retained funds,per chapter 60.28 RCW. The contractor may still be liable for payment if we later determine they owe additional premiums related to this contract or other activities. Before final payment can be made to the contractor,you will also need to receive releases from the Departments of Revenue and Employment Security Department in addition to ensuring: • All liens against retainage have been satisfied • , All Affidavit of WagesPaid forms have been filed Thank you, _ , _ - Elsa McDonnell Contract Release Specialist (360)902-6558 MCDP235@LNI.WA.GOV cc: INLAND ASPHALT CO PO BOX 3366 SPOKANE WA 99220-3366 Page 2