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16-092.00 Cameron-Reilly: Pines/Mirabeau Pkwy Intersection 11F -09 2 Contract THIS AGREEMENT, made and entered into this ZZ � day of , 2016, between the City of Spokane Valley under and by virtue of Title 35 RCW, as ame ded and Cameron-Reilly, LLC Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: The Contractor shall do all work and furnish all tools, materials, and equipment for: Pines Rd (SR27)/ Mirabeau Parkway Intersection Project SVPW Contract 16-092 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City of Spokane Valley by reason of entering onto this contract, except as provided herein. City of Spokane Valley Contract Pines Rd(SR27)/Mirabeau Parkway Intersection Project 1 Bid No: 16-092 V. The project was awarded for the bid amount of$204,158.17. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor July 14 , 2016. Date Jim Cameron Printed Name Manager Title Signatur City of Spokane all y (/ JM e K �1VkOlfh Printed Name A t.t 7 e11 Ma`� Title V Cd6-491. Signature Revised 1.14. City of Spokane Valley Contract Pines Rd (SR27)/Mirabeau Parkway Intersection Project 2 Bid No: 16-092 0238-Pines RD Mirabeau Parkway Intersection All Activity as of Jul 20 2016 . Project Prior Life Original Adjusted Years 2015 2016 To Date Available REVENUES Budget Budget Actual Actual Actual Actual Encumbered Funds 0334.0380 TIB 357,069.00 357,069.00 0.00 0.00 20,162.84 20,162.84 0.00 336,906.16 0397.3020 302 89,269.00 89,269.00 0.00 - 0.00 1,344.00 1,344.00 0.00 87,925.00 Total Revenue 446,338.00 I 446,338.00 0.00 0.00 21,506.84 21,506.840.00 424,831.16 Original I Adjusted Prior 2015 2016 Life Available EXPENDITURES Bud:et Budget _ Years Actual Actual To Date Encumbered Funds Preliminary Engineering 303.000.238.595.10.10.00 Sala ries&Wages 5,000.00 5,000.00 0.00 0.00 10,534.63 10,534.63 0.00 -5,534.63 303.000.238.595.10.10.99 Overtime 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.000.238.595.10.20.00 Employee Benefits 1,750.00 1,750.00 0.00 0.00 3,850.96 3,850.96 0.00 -2,100.96 303.000.238.595.10.20.99 Employee Benefits 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.000.238.595.10.41.02 Engineering&Architectural 35,337.00 35,337.00 0.00 0.00 13,586.90 13,586.90 19,478.10 2,272.00 303.000.238.595.10.41.06 Prof.Svcs-Survey 0.00 0.00 0.00 0.00 4,298.75 4,298.75 1.25 -4,300.00 303.000.238.595.10.41.07 Prof.Svcs.-Geotech 0.00 0.00 0.00 0.00 2,512.72 2,512.72 487.28 -3,000.00 303.000.238.595.10.41.17 Advertising 1,000.00 1,000.00 0.00 0.00 0.00 0.00 0.00 1,000.00 303.000.238.595.10.49.03 Printing&Binding 500.00 500.00 0.00 0.00 0.00 0.00 0.00 500.00 303.000.238.595.10.49.06 Miscellaneous Services 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.000.238.595.10.99.99 PE Contingency 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Prelim.Engineering 43,587.00, 43,587.00 0.00 0.00 34,783.96 34,783.96 19,966.63 -11,163.59 Right of Way No Transactions Recorded this Phase 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Right of Way 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Construction 303.000.238.595.64.10.00 Salaries&Wages 3,000.00 3,000.00 0.00 0.00 237.90 237.90 0.00 2,762.10 303.000.238.595.64.10.99 Overtime 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.000.238.595.64.20.00 Employee Benefits 1,050.00 1,050.00 0.00 0.00 80.52 80.52 0.00 969.48 303.000.238.595.64.20.99 Employee Benefits 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.000.238.595.64.41.08 Prof.Svcs.Mat.Testing 2,000.00 2,000.00 0.00 0.00 0.00 0.00 0.00 2,000.00 303.000.238.595.64.41.10 Prof.Svcs.-Consulting 37,537.00 37,537.00 0.00 0.00 0.00 0.00 0.00 37,537.00 303.000.238.595.64.41.17 Advertising 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.00a 238.595.64.49.03 Printing&Binding 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 303.000.238.595.64.63.00 Construction 359,164.00 359,164.00 0.00 0.00 0.00 0.00 29,867.50 329,296.50 303.000.238.595.64.99.99 Contingency 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Construction 402,751.00 402,751.00 0.00 0.00 318.42 318.42 29,867.50 372,565.08 Total Expenditures 446,338.00 446,338.00 0.00 0.00 35,102.38 35,102.38 49,834.13 361,401.49 • e Spokane ......W\tlley. BOND NO: 023010356 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington, in Spokane County,has awarded to Cameron—Reilly.LLC("Contractor"), as Principal, a contract for the construction of the project designated as Pines Rd (SR27) / Mirabeau Parkway Intersection Project, Project No. 16-092 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and The Ohio Casualty Insurance Company (Surety), a corporation, organized under the laws of New Hampshire 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$204,158.17 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified; shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract;and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change, extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties'duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINC •AL(C fa NTRACTOR) Cameron-Reilly,LLC SU The Ohio Casualty` Insurance Company 7-14-16 IrlIwAti �J�Y 311-.7-14-16 • ipal Signature Date Surety Signature Date Jim Cameron Shawn M.Wilson Tinted Name Printed Name Manager Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: moloney+o'neill/Alliant Insurance Services,Inc. 818 W.Riverside Avenue,Suite 800,Spokane,WA 99201 / 509-343-9238 Revised 1.14.13 CITY OF SPOKANE VALLEY CONTRACT PINES RD(sr27)/MIRABEAU PKWY INTERSECTION BID NO:16-092 np ffffffaJJ��nnnnn � Sp 11�11��WRnlll keys BOND NO: 023010326 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 Cameron—Reilly, LLC(Contractor), as Principal, a contract for the construction of the project designated Pines Rd (SR27) / Mirabeau Parkway Intersection Project, Project No. 16-092 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 The Ohio Casualty Insurance Company (Surety), a corporation organized under the laws New Hampshire 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 $204,158.17 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. PRINCIPAL(CONTRACTOR) Cameron-Reilly,LLCSURETY The Ohio Ca ualty Insurance Company /al 7-14-16 7-14-16 Prins ature Date Surety Signature Date Shawn M.Wilson Print.d Name Printed Name Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: moloney+o'neill/Alliant Insurance Services,Inc. 818 W.Riverside Avenue,Suite 800,Spokane,WA 99201 / 509-343-9238 Revised 1.14.13 CITY OF SPOKANE VALLEY CONTRACT PINES RD(sr27)/MIRABEAU PKWY INTERSECTION BID NO:16-092 : THIS'POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No.6980940 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company _ ,POWER OF`ATTORNEY-- . KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Cathie Hamlin;Cherie M.Boadle;Dan Romain;Jeff O'Neill;Jennifer K.Mendenhall;Mark L.Roff;Melodie L.Pike;Nicholas W.Paget; Patricia M.Wachter;Shawn M.Wilson all of the city of Spokane ,state of WA each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 8th day of May , 2015 , A• P�1D Cqs� �SY INSjJ �,SNSU/{ N 1NSURq American Fire and Casualty Company p �e�,\covoR%9eT ,�o�cpo«t%'7,/, `JP POS e ne, - pec. ,�oR,, rF The Ohio Casualty Insurance Company 0. z uQ n� n F a Liberty Mutual Insurance Company m Fc 1906 a l o 1919 n �> ° u 3 s d 1912 , - 19x1 a West merican Insurance Company W M b�-pi,HArn_,,„4,)*. ,',c HAWS aa� yam-.:40.1k,i- a ^•.��Nt4. O +' David M.Care , ssistant Secretary C STATE OF PENNSYLVANIA ss Rt di • 1- COUNTY OF MONTGOMERY _ C ti0 On this 8th day of May , 2015, before me personally appeared David M. Carey,who acknowledged himself to be the Assistant Secretary of American Fire and v 1-, c) 0 Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do, >,W p- execute the foregoing instrument for.the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. L a>> IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. 0 C. 03 sp. pq T COMMONWEALTH OF PENNSYLVANIA Z.°M .a if o onw F� Notarial Seal ,L /I /� p =—a) ti o =9 Teresa Pastella,Notary Public gIn L. �. O e, OF Plymouth Twp.,Montgomery County Teresa Pastella,Notary Public y =, '�� v My Commission Expires March 28,2017 W O 0 .j,„- iIP Member,Pennsylvania Association of Notaries 0E; cd f0 co This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty Insurance re p ai; Company,Liberty Mutual Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: .... 9 CL ARTICLE IV-OFFICERS-Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O C T`4; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, Z,a 0 O.E acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective 1 E ai powers of attorney,shall have full power to bind the Corporation by their signature and.execution of any such instruments and to attach thereto the seal of the Corporation. When so WI d p R executed,such instruments shall be as binding as if signed by the President and'attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under >c ▪ `' the provisions of this article may be revoked at any time by the Board,the Chairman,rthe President or by-the officer or officers granting such power or authority. tet .3 C ARTICLE XIII-Execution of Contracts SECTION 5.Surety Bonds and Undertakings.Anyoffrcer of the Company authorized for that purpose in writing by the chairman or the president, E o? > :12 and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys:in-fact,as may be necessary to act in behalf of the Company to make,execute, L�, O '3 seal,acknowledge and deliver as surety any and all undertakings;bonds,recognizances and other surety obligations jSuch attomeys-in-fact subject to the limitations set forth in their O o Z v respective powers of attorney,shall have full power to bind the Company by their signature and execution`of any such instruments and to attach thereto the seal of the Company. When so c� executed such instruments shall be as bindingas if Signed thepresident and attested bythe secret -„,,T-'•••---1,---by secretary. - y ,:=.!---„ 0 a. Certificate of Designation-The President of the Coin an ,acting to the B aws of the Co any authorizes David M.Cane Assistant Secretaryto appoint such attorneys-in-n-.~�i 9 P Y pursuantYI mP Y Y Y� fact as may be necessary to act on behalf of the Company to make;execute'seal;acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. .-x-;-- :� . Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with 1 the same force and effect as though manually affixed. - I,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked. ji. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this`L4 day of ,20 i( . a 1906 no 0 1919 n F o 1912 g Q 1991 By: u g x 0 y ? y a Gregory W.Davenport,Assistant Secretary ""it„),• �1.mmes','' .. - 4,S,,NAM `N4 -.'>IsSACHeo t'' 3 /NLyphn T2 66 of 100 LMS 12873 122013 - 5/17/2016 CAMERON REILLY LLC 4 STATE OF WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage May 17, 2016 WA UBI No. 602 633 401 L&I Account ID .119,442-00 Legal Business Name CAMERON REILLY LLC Doing Business As ,CAMERON REILLY LLC + Workers' Comp Premium Status: Account is current. Estimated Workers Reported Quarter 1 of Year 2016 "21 to 30 (See Description Below) Workers" :Account Representative TO/ KARLA BOWMAN (360)902-5535 - t Email: BOWK235@Ini.wa.gov I Licensed Contractor? Yes License No. CAMERRL942NU 'License Expiration 08/31/2016 1 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 51.1 2.050 and 51.16.190). haps://secure.lni.wa.gov/verify/Details/liabi IityCertificate.aspx?U BI=602633401&LIC=CAM ERR L942N U&SAW=&ACCT=11944200 1/1 CAMEREI-01 PWACHTER ACORO° DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME:ACT Debbie Johnston,CPCU,ARM,CIWCS Moloney O'Neill/Alliant Insurance Services Inc. PHONE FAX 818 W.Riverside,Ste 800 (a/c,No,Ext):(509)325-3024 (A/C,No): Spokane,WA 99201 ADDRESS:djohnston@mo-ins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Western Insurance Company 10804 INSURED INSURER B: Cameron-Reilly,LLC INSURER C: 309 N Park Rd INSURER D: Spokane,WA 99212 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP WLIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CPA6023167-20 12/31/2015 12/31/2016 DAMAGE l O Ea REN i EDoccurrence) $ 500,000 PREMISES( _MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jECOr X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO X CPA6023167-20 12/31/2015 12/31/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CPA6023167-20 12/31/2015 12/31/2016 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A CPA6023167-20 12/31/2015 12/31/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) RE: Contract 16-092 Pines Road(SR27)&Mirabeau Parkway Intersection City of Spokane Valley,the contracting agent and its officers,elected officials,employees,agents and volunteers,Spokane County and its officers,elected officials,employees,agents and volunteers are additional insureds as respects general liability for the ongoing and completed operations of the named insured. Coverage is primary non-contributory. Per project applies. Additional insured status applies to automobile liability. Umbrella follows form. See attached forms CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave,Ste 106 Spokane,WA 99206 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CLCA01.490215 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE EXPANSION ENDORSEMENT - PLATINUM This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to the coverages provided by this endorsement,the provisions of the Business Auto Coverage Form apply unless modified by this endorsement. A. NEWLY ACQUIRED OR FORMED ORGANIZA- "property damage": because of the conduct TIONS of an "insured" under Paragraphs a. or b. The following is added to Paragraph A.1.Who Is under Paragraph A.1. Who Is An Insured of Section II - Covered Autos Liability Cover- An Insured of Section II -Covered Autos Liability Coverage: age, caused by an "accident" and resulting from the ownership, maintenance or use of a Any organization you newly acquire or form, oth- covered"auto"; er than a partnership,joint venture or limited lia- bility company or any organization excluded ei- 2. The written contract or agreement described ther by this Coverage Part or by endorsement, above must have been executed prior to the and over which you maintain ownership or ma- "propertyaccidentthat caused the "bodily injury" or jority interest of more than 50 percent will qualify damage" and be in effect at the time of such as a Named Insured. However: "accident"; This insurance does not apply to any newly 3. The insurance afforded to any such addition- 1. al "insured" does not apply to any"accident" acquired or formed organization that is an "insured" under any other automobile policy beyond the period of time required by the or would be an "insured" under such policy written contract or agreement described but for its termination or the exhaustion of its above; Limit of Insurance. 4. The most we will pay on behalf of such addi- 2. Coverage does not apply to "bodily injury"or ti©nal"insured(s)"is the lesser of: "property damage" that occurred before you a. The Limits of Insurance specified in the acquired or formed the organization. written contract or agreement described 3. Coverage under this provision is afforded on- above;or ly until the 180th day after you acquire or b. The Limits of Insurance shown in the form the organization or the end of the policy Declarations. period,whichever is earlier. This provision shall not increase the Limit of B. ADDITIONAL INSURED BY CONTRACT OR Insurance shown in the Declarations in this AGREEMENT policy or coverage part;and The following is added to Paragraph A.1.,Who Is 5. The following changes are made to Para- An Insured of Section II -Covered Autos Liability graph 5.Other Insurance of B.General Con- Coverage: ditions under Section IV - Business Auto When you have agreed in a written contract or Conditions: agreement to include a person or organization as a. The following is added to Paragraph 5.a.: an additional "insured", such person or organiza- If required by the written contract or tion is included as an "insured"subject to the fol- agreement described above, the insur- lowing: ance afforded to the additional insured 1. Such person or organization is an additional under this provision will be primary to, "insured" only to the extent such person or and will not seek contribution from, the organization is liable for "bodily injury" or additional insured's own insurance. CL CA 01 49 0215 Includes copyrighted material of Insurance Services Page 1 of 5 Office, Inc.,with its permission b. Paragraph 5.c.is deleted in its entirety. 1. The Limits of Insurance are increased to$75 6. Paragraph A.1.c. under Section 0 - Covered per day to a maximum of$2,500. Autos Liability Coverage is deleted in its en- 2. We will also pay reasonable and necessar« tirety, expenses to facilitate the return of the stole 7. The definition of "insured contract" under "auto"to you. Section V- Definitions is amended to add the 3. It is agreed and understood and it is our sta following: ed intent that expenses incurred by you ui An Insured contract" does not include that der the Transportation Expenses Coverag part of any contract or agreement: Extens'^" will not also be covered or pa under the Rental Reimbursement Coverage That pertains to the ownership, maintenance provided by this endorsement or any rental or use of an "auto" and which indemnifies a reimbursement coverage added by separate person or organization for other than the vi- endorsement to this policy. carious liability of such person or organize- H. EXTENDED COVERAGE-AIRBAGS tion for "bodily injury" or "property damage" caused by your operation or use of a covered The following is added to Exclusion B.3.a. of "auto". Section IIi-Physical Damage Coverage: However, a person or organization is an ad- However,this exclusion does not apply to the un- ditional "insured" under this provision only to intended discharge of an airbag. the extent such person or organization is not This coverage is excess over any other collecti- named as an "insured" by separate en- ble insurance or warranty providing such airbag dorsement to this policy. coverage. C. EMPLOYEES AS INSUREDS I. AUTO LOAN/LEASE GAP COVERAGE The following is added to Paragraph A.1.Who Is AnThe following is added to Section III - Physical Insured Section II - Covered Autos Liability Coverage: Damage Coverage, Paragraph C. Limits of Insur- ance. Any "employee" of yours is an "insured" while 4, In the event of a total"loss"to a covered"au- using a covered"auto"you don't own, hire or bar- row in your business or your personal affairs. to", we will pay any unpaid amount due on the lease or loan for a covered"auto", less: D. INCREASED COVERAGE-BAiL BONDS a. The amount under the Physical Damage The Supplementary Payments Coverage Exten- Coverage section of the policy;and sion of Section II - Covered Autos Liability Cov- b. Any: erage is amended as follows: (1) Overdue lease/loan payments at the The Limit of Insurance in paragraph A.2.a.(2) is time of the"loss"; increased to$5,000. • E. INCREASED COVERAGE - LOSS OF EARN- (2) Financial penalties imposed under a INGS lease for excessive use, abnormal wear and tear or high mileage; The Supplementary Payments Coverage Exten- (3) Security deposits not returned by the sion of Section II - Covered Autos Liability Coy- lessor; erage is amended as follows: The Limit of Insurance in paragraph A.2.a.(4) is (4) Costs for extended warranties,Credit increased to$1,000. Life Insurance, Health, Accident or Disability Insurance purchased with F. FELLOW EMPLOYEE COVERAGE the loan or lease;and The Fellow Employee Exclusion contained in (5) Carry-over balances from previous Section II - Covered Autos Liability Coverage loans or leases. does not apply. This coverage is excess J. GLASS REPAIR-NO DEDUCTIBLE any other collectable insurance. G. COVERAGE EXTENSION - TRANSPORTA- The following is added to Paragraph D. Deducti- TiON EXPENSES ble of Section III-Physical Damage Coverage: Paragraph A.4.8. Transportation Expenses of Any Comprehensive Coverage deductible shown Section III-Physical Damage Cover age is in the Declarations does not apply to "toss" to amended as follows: glass when you elect to patch or repair rather than replace the glass. Page 2 of 5 includes copyrighted material of Insurance Services CL CA 01 49 0215 Office, Inc.,with its permission K. INCREASED COVERAGE - ELECTRONIC O. HIRED AUTO PHYSICAL DAMAGE COVER- EQUIPMENT AGE The $1,000 limit indicated in Paragraph C.1.b. The following is added to Paragraph A.4. Cover- under Section III - Physical Damage Coverage is age Extensions of Section III - Physical Damage increased to$2,500. Coverage: L. EXTENDED COVERAGE - PERSONAL PROP- If hired "autos" are covered "autos" for Covered ERTY Autos Liability Coverage and if Physical Damage The following is added to Paragraph A.4. Cover- Coverage is provided for any "auto" you own, age Extensions of Section UI - Physical Damage then the Physical Damage coverages provided are extended to "autos" you lease, rent, hire or Coverage: borrow from someone other than your "employ- Physical Damage Coverage on a covered "auto" ees", partners or members of their households may be extended to"loss"to your personal prop- subject to the following: arty or, if you are an individual, the personal 1. The most we will pay in any one "loss" is the property of a family member, that is in the coy- lesser of: ered"auto"at the time of"loss"and caused by an "accident" and resulting from the ownership, a. The actual cash value of the"auto"; maintenance or use of a covered"auto". b. The cost to repair or replace the "auto"; The insurance provided by this coverage exten- or sion is excess over any other collectible insur- ance. The most we will pay for any one loss" c• $100,000. under this coverage extension is$500. However, 2. Paragraph 1. above is subject to a deducti- our payment for "loss" to personal property will ble. The deductible shall be equal to the only be for the account of the owner of the prop- amount of the highest deductible shown for erty. any owned "auto" of the same classification Under this provision, personal property does not for that coverage. In the event there is no include and we will not pay for"loss"of currency, owned "auto" of the same classification the coins,securities or contraband. highest deductible for any owned auto will apply for that coverage. No deductible applies to this coverage extension. No deductible will apply to "loss" caused by M. TOWING fire or lightning. Paragraph A.2. Towing of Section III - Physical 3. Hired Auto Physical Damage Coverage is Damage Coverage, is replaced by the following: subject to the following: If a private passenger type "auto" or light truck a. If symbol 8 is shown in the Covered Auto "auto" (0-10,000 Lbs. GVW) is provided both section of the Declarations page for any Comprehensive and Collision Coverage, we will of the Physical Damage coverages, then pay up to $150 for towing and labor costs in- the Hired Auto Physical Damage cover- curred each time such "auto" is disabled, If a age described in this endorsement does medium, heavy or extra-heavy truck or extra- not apply. heavy Truck-tractor "auto" (greater than 10,000 b, Other than indicated in Paragraphs a.di- Lbs. GVW) is provided both Comprehensive and Collision Coverage, we will pay up to $250 for redly above, coverage provided under towing and labor costs incurred each time such this provision will be excess over any "auto" is disabled. However, the labor must be other collectible insurance or coverage. performed at the place of disablement. 4. In addition to the limit set forth in Paragraph N. FIRE EXTINGUISHER RECHARGE 1.above we will pay up to$500 per day, to a maximum of$3,500 per"loss"for: The following is added to Paragraph A.4. Cover- a. Any costs or fees associated with the age Extensions of Section IV- Physical Damage "loss"to a hired"auto";and Coverage: When fire extinguishers are kept in your covered b. Loss of use of the hired "auto", provided "auto" and any are discharged in an attempt to it is the consequence of an acc nd as a for extinguish a fire, we will pay the lesser of the ac- which you are legally liable, and as a re- sult of which a monetary loss is sus- tual cost of recharging or replacing such fire ex- twined by the leasing or rental concern. tinguisher(s). No deductible applies to this coverage However, Paragraph A.4.b. Loss of Use Expens- es under Section III -Physical Damage Coverage CL CA 01 49 0215 Includes copyrighted material of Insurance Services Page 3 of 5 Office, Inc.,with its permission of the Business Auto Coverage Form does not (2) Your partners or members, if you are apply. designated in the Declarations as a P. RENTAL REIMBURSEMENT COVERAGE partnership or joint venture; We will pay for rental reimbursement expenses (3) Your members or managers, if you incurred by you for the rental of an "auto" be- are designated in the Declarations as cause of"loss"to a covered"auto". a limited liability company; 1. Payment applies in addition to the otherwise (4) Your executive officers if you are applicable amount of each coverage you designated in the Declarations as an have on the covered"auto". organization other than an individual, partnership, joint venture or limited 2. No deductible applies to this coverage. liability company;and 3. We will pay only for those expenses incurred (5) The spouse of any person named in during the policy period beginning 24 hours Paragraphs 1.a.(1). through 1.a.(4) after the loss"and ending, regardless of the while a resident of the same house- expiration date of the policy, with the lesser hold; of the following number of days: Except: a. The number of days when the covered (a) Any "auto" owned by that indi- "auto"has been repaired or replaced,or vidual or by any member of b. 45 days. his or her household. 4. Our payment is limited to the lesser of the fol- (b) Any"auto" used by that individu- lowing amounts: al or his or her spouse while a. Necessary and actual expenses incurred; working in a business of selling, servicing, repairing or parking or "autos". b. Not more than$75 for any one day; 2. Changes In Auto Medical Payments And 5. We will pay up to an additional $300 for the Uninsured And Underinsured Motorists reasonable and necessary expenses you in- Coverages cur to remove your materials and equipment The following is added to Who is An In- from the covered "auto" and replace such cured: materials and equipment on the rental"auto". 6. This coverage does not apply while there are Any individual named in 1.a above and his or her "family members" are "insured" while spare or reserve "autos" available to you for "occupying"or while a pedestrian when being your operations. struck by any"auto"you don't own except: 7. If "loss" results from the total theft of a cov- Any"auto"owned by that individual or by any ered "auto" of the "private passenger type", "family member". we will pay under this coverage only that amount of your rental reimbursement ex- 3. Changes in Physical Damage Coverage penses which is not already provided for un- Any private passenger type "auto" you don't der the Physical Damage Coverage Exten- own, hire or borrow is a covered"auto"while sion of the Business Auto Coverage Form or in the care, custody or control of any individ- any endorsements thereto ual named in Q.1.a. above or his or her However,this provision does not apply to the spouse while a resident of the same house- extent that rental reimbursement is provided hold except: by separate endorsement to this policy, a. Any"auto"owned by that individual or by Q. DRIVE OTHER CAR COVERAGE any member of his or her household;or 1. The following is added to Section iI - Cov- b. Any "auto" used by that individual or his ered Autos Liability Coverage: or her spouse while working in a busi- a. Any"auto" you don't own, hire or borrow ness of selling, servicing, repairing or parking"autos". is a covered"auto"for Liability Coverage while being used by: 4. The most we will pay for the total of all dam- (1} You, if you are designated in the dam- ages under Covered Autos Liability Unin- sured Motorists Coverage and Underinsured Declarations as an individual; Motorists Coverage is the Limit Of Insurance Page 4 of 5 Includes copyrighted material of Insurance Services CL CA 01 49 0215 Office,Inc.,with its permission shown in the Declarations as applicable to 3. At our request you must provide us with a copy of owned"autos". the aforementioned written contract or agree- 5. Our obligation to pay for, repair, return or re- ment. place damaged or stolen property under T. UNINTENTIONAL OMISSIONS Physical Damage Coverage, will be reduced The following is added Paragraph B.2.of Section by a deductible equal to the amount of the highest deductible shown for any owned pri- vate passenger type "auto"applicable to that If you fail to disclose any hazards existing at the coverage. If there are no owned private pas- inception date of this policy, such failure will not senger type "autos", the deductible shall be prejudice the coverage provided to you. Howev- $250 for Comprehensive Coverage and$500 er, this provision does not affect our right to col- for Collision Coverage. No deductible will lect additional premium or exercise our right of apply to"loss"caused by fire or lightning. cancellation or nonrenewal. 6. Additional Definition U. LIBERALIZATION As used in this DRIVE OTHER CAR Provi- If we revise this endorsement to provide greater sion: coverage without additional premium charge, we "Family member" means a person related to will automatically provide the additional coverage the individual named in 1.a. by blood, mar- to all endorsement holders as of the day the revi- riage or adoption who is a resident of the in- sion is effective in your state. dividual's household, including a ward or fos- ter child. R. KNOWLEDGE OF AN ACCIDENT, CLAIM, SUIT OR LOSS The following is added to Paragraph A.2.of Sec- tion IV-Business Auto Conditions: Your obligation to provide prompt notice of "accident", claim, "suit"or"loss" is satisfied if you or a person designated by you to be responsible for insurance matters is notified of, or in any manner made aware of an "accident", claim, "suit" or "loss" and provides us such notice as soon as practicable S. WAIVER OF SUBROGATION BY CONTRACT OR AGREEMENT The following is added to Paragraph A.5 of Sec- tion IV-Business Auto Conditions: We waive any right of recovery we may have against a person or organization because of payments we make for"bodily injury"or"property damage"when you and such person or organiza- tion have agreed in writing in a contract or agreement to waive such right of recovery, pro- vided: 1. Such written contract or agreement was: a. Made prior to the "accident" or"loss" resulting in the covered "bodily injury"or "property damage"; and b. Was in effect at the time of the covered "bodily injury"or"property damage". 2. The covered "bodily injury" or"property damage" must arise out of the operations specified in such written contract or agreement. CL CA 01 49 0215 Includes copyrighted material of Insurance Services Page 5 of 5 Office, Inc.,with its permission COMMERCIAL GENERAL LIABILITY CL CG 0013 0813 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY PLATINUM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS If SECTION I-COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part 1. The Medical Expense Limit provided by this policy, subject to the terms of SECTION III - LIMITS OF INSURANCE,shall be the greater of: a. $10,000;or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT If damage to premises rented to you under Coverage A. is not otherwise excluded from this policy, the following applies: 1. The last paragraph of SECTION I-COVERAGE A.2.Exclusions is deleted and replaced by the following: Exclusions c.through n.do not apply to damage by fire,lightning,explosion,smoke or sprinkler leakage to premises while rented to your or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III-LIMITS OF INSURANCE. 2. Paragraph 6.of SECTION III-LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to Paragraph 5.above,the greater of: a. $300,000;or b. the Damage To Premises Rented To You Limit shown in the Declarations; is the most we will pay under COVERAGE A for damages because of"property damage"to any one premises,while rented to you or temporarily occupied by you with the permission of the owner. 3. Paragraph 4.b.(1)(a)(ii) Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and replaced by the following: (ii) That is Fire, Lightning, Explosion, Smoke or Sprinkler Leakage insurance for premises rented to you or temporarily occupied by you with the permission of the owner; 4. Paragraph 9.a.of SECTION V-DEFINITIONS is deleted and replaced by the following: a. A contract for a lease of premises. However,that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an"insured contract"; CL CG 0013 0813 Includes copyrighted material of Insurance Services Page 1 of 6 Office, Inc.,with its permission C. LIMITED NON-OWNED WATERCRAFT 1. Paragraph g.(2)of SECTION I-COVERAGE A.2.Exclusions is deleted and replaced by the following: A watercraft you do not own that is: a. Less than 51 feet long;and b. Not used to carry persons or property for a charge. D. SUPPLEMENTARY PAYMENTS SECTION I-SUPPLEMENTARY PAYMENTS-COVERAGES A AND B is amended as follows: 1. The limit of insurance in paragraph 1.b.is increased from$250 to$2,500;and 2. The limit of insurance in paragraph 1.d.is increased from$250 to$500. E. AUTOMATIC ADDITIONAL INSURED-SPECIFIED RELATIONSHIPS-PRIMARY NONCONTRIBUTORY The following is added to Paragraph 2.of SECTION II-WHO IS AN INSURED: e. Any person or organization described below,when you are obligated by virtue of a written contractor agreement that such person be added as an additional insured on your policy. When required by virtue of a written contract or agreement, coverage provided to any additional insured will be on a primary basis and will not seek contribution from the additional insureds policy. Only the following persons or organizations are additional insureds under this endorsement (1) Managers Or Lessors Of Premises.The manager or lessor of a premise leased to you, but only with respect to liability arising from the ownership, maintenance or use of that part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (a) Any"occurrence"which takes place after you cease to be a tenant of that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. (2) Lessor Of Leased Equipment Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s)or organization(s). However,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. (3) Vendors. Any person or organization,but only with respect to"bodily injury"or"property damage" arising out of"your products"shown in the Schedule which are distributed or sold in the regular course of the vendor's business,subject to the following additional exclusions: a. The insurance afforded the vendor does not apply to: 1. "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; 2. Any express warranty unauthorized by you; 3. Any physical or chemical change in the product made intentionally by the vendor; Page 2 of 6 Includes copyrighted material of Insurance Services CL CG 0013 0813 Office, Inc.,with its permission 4. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; 5. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; 6. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; 7. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container,part or ingredient of any other thing or substance by or for the vendor. b. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. (4) State Or Political Subdivision -Permits Or Authorizations Relating To Premises. Any state or political subdivision,subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own,rent,or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings,sidewalk vaults,street banners,or decorations and similar exposures;or (b) The construction,erection,or removal of elevators;or (c) The ownership,maintenance,or use of any elevators covered by this insurance. Limits of insurance for such additional insured are the limits in this coverage form or the limits you and such additional insured agreed to by virtue of a contract or agreement,whichever is less. These limits are inclusive of and are not in addition to the Limits Of Insurance shown in the Declarations. When required by virtue of a written contract or agreement, coverage provided to any additional insured AUTOMATIC ADDITIONAL INSURED - SPECIFIED RELATIONSHIPS - PRIMARY NONCONTRIBUTORY will be on a primary basis and will not seek contribution from the additional insureds policy. F. BROADENED NAMED INSURED-NEWLY ACQUIRED 180 DAYS Paragraph 3.of SECTION II-WHO IS AN INSURED is deleted and replaced by the following: Any organization you newly acquire or form,other than a joint venture,and over which you maintain ownership or majority interest of more than 50%will be a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period,whichever is earlier. b. COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. c. COVERAGE B does not apply to"personal and advertising injury"arising out of an offense committed before you acquired or formed the organization. G. AGGREGATE LIMITS OF INSURANCE The General Aggregate Limit under SECTION III - LIMITS OF INSURANCE applies separately to each of your: CL CG 0013 0813 Includes copyrighted material of Insurance Services Page 3 of 6 Office,Inc.,with its permission 1. Projects away from premises owned by or rented to you. 2. "Locations"owned by or rented to you. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street,roadway,waterway or right-of-way of a railroad. When paragraph B. Construction Project General Aggregate Limit on form CL CG 00 20 is a part of this policy,then paragraph G.Aggregate Limits of Insurance of this endorsement does not apply. H. KNOWLEDGE OF OCCURRENCE The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS: e. A report of an"occurrence",offense,claim or"suit"to: (1) You,if you are an individual, (2) A partner,if you are a partnership, (3) An executive officer,if you are a corporation,or (4) A manager,if you are a limited liability company; is considered knowledge and requires you to notify us of the"occurrence",offense,claim,or"suit" as soon as practicable. f. We are considered on notice of an "occurrence", offense, claim or "suit" that is reported to your Workers Compensation insurer for an event which later develops into an "occurrence", offense,claim or"suit"for which there is coverage under this policy. However,we will only be considered on notice if you notify us as soon as you know the claim should be addressed by this policy rather than your Workers Compensation policy. I. UNINTENTIONAL OMISSIONS The following is added to paragraph 6. Representations of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: d. If you unintentionally fail to disclose any exposures existing at the inception date of your policy,we will not deny coverage under this Coverage Part solely because of such failure to disclose. However,this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This provision does not apply to any known injury or damage which is excluded under any other provision of this policy. J. MENTAL ANGUISH Paragraph 3.of SECTION V-DEFINITIONS is deleted and replaced by the following: 3. "Bodily injury"means bodily injury,sickness or disease sustained by a person,including mental anguish or death resulting from any of these at any time. K. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended by the addition of the following: We waive any right of recovery we may have because of payments we make for"bodily injury" or"property damage" arising out of your ongoing operations or"your work" done under a contract requiring such waiver with that person or organization and included in the"products-completed operations hazard". However,our tights may only be waived prior to the"occurrence"giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request,the insured will bring"suit"or transfer those rights to us and help us enforce those rights. Page 4 of 6 Includes copyrighted material of Insurance Services CL CG 0013 0813 Office, Inc.,with its permission Paragraph K.WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS does not apply if another waiver of transfer of rights of recovery against others is endorsed separately to this policy. L. OTHER INSURANCE When Coverage applies in this General Liability Enhancement Endorsement, no other coverage or limit of insurance in the policy applies to loss or damage insured by this coverage. M. NON-EMPLOYMENT DISCRIMINATION LIABILITY(DEFENSE WITHIN LIMITS) The following is added to paragraph 14."Personal and advertising Injury" SECTION V-DEFINITIONS of COMMERCIAL GENERAL LIABILITY COVERAGE FORM: h. Non-employment discrimination. Non-employment discrimination means violation of a persons civil rights with respect to such persons race, color, national origin, religion,gender,marital status, age,sexual orientation or preference, physical or mental condition,or any other protected class or characteristic established by any federal,state or local statutes, rules or regulations. Non-employment discrimination does not include violation of civil rights arising out of past, present or prospective employment. Our obligation under the Personal and Advertising injury Liability Coverage to pay non-employment discrimination liability damages on your behalf applies only to the amount of damages in excess of$5,000 deductible as the result of any one offense regardless of the number of persons or organizations who sustain damages because of the offense. The most we will pay for all damages for non-employment discrimination is$15,000 annual aggregate. No other liability to pay sums or perform acts or services is covered. Supplemental Payments-Coverages A and B do not apply to non-employment discrimination coverage. N. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS OR OTHERS- AUTOMATIC, INCLUDING PRIMARY NON-CONTRIBUTORY 1. SECTION iI - WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you are obligated by virtue of a written contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused by your ongoing operations for the additional insured and only to the extent that such "bodily injury", "property damage"or"personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf. This insurance does not apply to "bodily injury", "property damage", "personal and advertising injury" included within the"products-completed operations hazard". This insurance does not apply to any additional insured scheduled on your policy by separate endorsement 2. Limits of Insurance Limits of insurance for such additional insured are the limits in this coverage form or the limits you and such additional insured agreed to by virtue of a contract or agreement,whichever is less. These limits are inclusive of and are not in addition to the Limits Of Insurance shown in the Declarations. 3. Exclusions A. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply to"bodily injury","property damage"or"personal and advertising injury"arising out of: 1. The rendering of or failure to render any professional services by you or on your behalf, but only with respect to either or both of the following operations: CL CG 00 93 0813 includes copyrighted material of Insurance Services Page 5 of 6 Office, Inc.,with its permission a. Providing engineering, architectural or surveying services to others in your capacity as an engineer,architect or surveyor,and b. Providing, or hiring independent professionals to provide, engineering, architectural or surveying services in connection with construction work you perform. 2. Subject to Paragraph 3.below,professional services include: a. Preparing,approving,or failing to prepare or approve, maps,shop drawings,opinions,reports, surveys,field orders,change orders,or drawings and specifications;and b. Supervisory or inspection activities performed as part of any related architectural or engineering activities. 3. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you or performed by or for the construction manager, its employees or its subcontractors in connection with your ongoing operations. B."Bodily injury"or"property damage"occurring after. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed;or 2. That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 4. Primary Non-Contributory When required by virtue of a written contract or agreement,coverage provided to any additional insured by ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS OR OTHERS - ONGOING OPERATIONS-AUTOMATIC,INCLUDING PRIMARY NON CONTRIBUTORY will be on a primary basis and will not seek contribution from the additional insured's policy. Page 6 of 6 Includes copyrighted material of Insurance Services CL CG 0013 0813 Office,Inc.,with its permission POLICY NO: CPA 6023167-20 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Al #1 .0 GENERAL LIABILITY PLATINUM AMENDMENT - ADDITIONAL INSURED - Provision N. (Revised) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY PLATINUM ENDORSEMENT A. Provision N.ADDITIONAL INSURED- b. If the written contract specifically OWNERS, LESSEES OR CONTRACTORS- requires you to provide additional AUTOMATIC INCLUDING PRIMARY NON- insured coverage via the 10/01 CONTRIBUTORY is deleted in its entirety and edition of CG2010 (aka CG 20 10 10 replaced with the following: 01)or via the 11/85 edition of N. ADDITIONAL INSURED-OWNERS, CG2010 (aka CG 20 10 11 85), then LESSEES OR CONTRACTORS - in paragraph 2.a.above, the words AUTOMATIC INCLUDING PRIMARY NON- "caused in whole or in part by"are CONTRIBUTORY replaced by the words"arising out of'. 1. Section II -Who Is An Insured is c. The insurance afforded to such amended to include as an additional additional insured only applies to the insured any person(s)or organization(s) extent permitted by law; and for whom you are required by virtue of a written contract or agreement that such d. If coverage provided to the additional person(s)or organization(s)be added as insured is required by a contract or an additional insured on your policy. agreement, the insurance afforded to 2. The insurance provided to the additional such additional insured will not be insured is limited as follows: broader than that which you are required by the contract or a. Such person or organization is an agreement to provide for such additional insured only with respect additional insured. to liability for"bodily injury", "property e. This insurance ends at the earliest of damage"or personal and advertising injury"caused in whole or the following times: in part by: (1) When the Named Insureds work (1) Acts or omissions of the Named called for in the written contract Insured;or has been completed (2) The acts or omissions of those acting (2) When all of the Named Insureds work done at a job site has been on behalf of the Named Insured; completed if the written contract in the performance of the Named calls for work at more than one Insureds work for the additional job site insured(s)specified in the written (3) When that part of the Named contract provided the contract or Insureds work done at a job site agreement requires you to provide the has been put to its intended use additional insured such coverage and is: by any person or organization i. Currently in effect or becomes other than the Named Insured or effective during the term of this those acting on the Named policy; and Insured's behalf. ii. Was executed prior to the"bodily Work that may need service, injury", "property damage"or maintenance, correction, repair or "personal and advertising injury". replacement, but is otherwise Includes copyrighted material of Insurance Services Page 1 of 3 Office, Inc., with its permission complete,will be treated as If coverage provided to the additional completed. insured is required by a contract or f. This insurance does not apply to any agreement,the most we will pay on additional insured scheduled on your behalf of the additional insured is the amount of insurance: policy by separate endorsement. a. Required by the contract or agreement; or 2. Exclusions b. Available under the applicable Limits With respect to the insurance afforded to of Insurance shown in the these additional insureds, the following Declarations; additional exclusions apply to"bodily injury", "property damage"or"personal whichever is less. and advertising injury"arising out of: This endorsement shall not increase the a. The rendering of or failure to render applicable Limits of Insurance shown any professional services by you or in the Declarations. on your behalf, but only with 4. Other Insurance respect to either or both of the For purposes of this endorsement, the following operations: following is added to the Section IV- (1) Providing engineering, Commercial General Liability architectural or surveying Conditions,4.Other Insurance services to others in your condition and supersedes any provision capacity as an engineer, to the contrary: architect or surveyor; and This insurance is excess of all other (2) Providing, or hiring independent insurance available to an additional professionals to provide, insured whether on a primary, engineering, architectural or excess, contingent or any other surveying services in connection basis. But, if required by a written with construction work you contract or written agreement to be perform. primary and noncontributory, this b. Subject to Paragraph c.below, insurance will be primary to and will professional services include: not seek contribution from any insurance on which the additional (1) Preparing, approving, or failing to insured is a Named Insured. prepare or approve, maps, shop No other coverage or limit in the drawings, opinions, reports, policy applies to loss or damage surveys, field orders, change insured by this coverage. orders, or drawings and specifications; and B. The following coverage is added: (2) Supervisory or inspection Contractual Liability-Railroads activities performed as part of 1. With respect to operations performed for a any related architectural or Railroad within 50 feet of railroad property, engineering activities. p y' the definition of"insured contract" in Section c. Professional services do not include V-Definitions is replaced by the following: services within construction means, 9. "Insured Contract"means: methods, techniques, sequences and procedures employed by you or a. A contract for a lease of premises. performed by or for the construction However, that portion of the contract manager, its employees or its for a lease of premises that subcontractors in connection with indemnifies any person or your ongoing operations. organization for damage by fire to 3. Limits of Insurance premises while rented to you or temporarily occupied by you with With respect to the insurance afforded to permission of the owner is not an these additional insureds,the following is "insured contract"; added to Section III-Limits Of b. A sidetrack agreement; Insurance: c. Any easement or license agreement; Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission d. An obligation, as required by This insurance is excess of all other ordinance, to indemnify a insurance that is Railroad Protective municipality, except in connection Liability or similar coverage for"your with work for a municipality; work" performed for a Railroad. But, if required by a written contract or e. An elevator maintenance agreement written agreement to be primary and f. That part of any other contract or noncontributory, this insurance will agreement pertaining to your be primary to and will not seek business (including an contribution from any insurance on indemnification of a municipality in which the Railroad is a Named connection with work performed for a Insured. municipality) under which you No other coverage or limit in the assume the tort liability of another party to pay for"bodily injury" or policy applies to loss or damage "property damage"to a third person insured by this coverage or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f.does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. 2. Other Insurance For purposes of this endorsement, the following is added to the Section IN- Commercial General Liability Conditions,4. Other Insurance condition and supersedes any provision to the contrary: Includes copyrighted material of Insurance Services Page 3 of 3 Office, Inc., with its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR GENERAL LIABILITY PLATINUM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. PROPERTY DAMAGE TO BORROWED EQUIPMENT 1. Paragraph 2.j. of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perform operations at the time of loss. 2. SECTION III—LIMITS OF INSURANCE is deleted and replaced by the following: The most we will pay in any one "occurrence" for "property damage" to borrowed equipment is $15,000. This limit of insurance is the most we will pay regardless of the number of: a. Insureds; b. Claims made or"suits" brought;or c. Persons or organizations making claims or bringing "suits". 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as applicable to "property damage" as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any "suits" seeking those damages; and your duties in the event of an "occurrence", claim, or"suit"apply irrespective of the application of the deductible amount. c. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken; you shall promptly reimburse us for such part of the deductible amount as we have paid. B. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT 1. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: a. A Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. b. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of"bodily injury" or"property damage" included in the "products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought;or (3) Persons or organizations making claims or bringing "suits". c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 1 of 4 Office,Inc with its permission d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which cannot be attributed only to ongoing operations at a single designated construction project away from premises owned by or rented to the insured: a. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and b. Such payments shall not reduce any Single Construction Project General Aggregate Limit. 3. When coverage for liability arising out of the`products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit or the Single Construction Project General Aggregate Limit. 4. If the applicable construction project away from premises owned by or rented to the insured has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. C. LIMITED JOB SITE POLLUTION 1. Exclusion f. under Section I—Coverage A is replaced by the following: 2. Exclusions This insurance does not apply to: f. Pollution (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants": (a) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) At or from a storage tank or other container, ducts or piping which is below or partially below the surface of the ground or water or which, at any time, has been buried under the surface of the ground or water and then subsequently exposed by erosion, excavation or any other means if the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants"arises at or from any premises, site or location which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the"pollutants"are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. Subparagraph (b) does not apply to "bodily injury" or "property damage" arising out of heat, smoke or fumes from a"hostile fire". (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement issued or made pursuant to any environmental protection or environmental liability statutes or regulations that any insured test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants";or CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 2 of 4 Office, Inc with its permission (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, or neutralizing or in any way responding to or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for those sums the insured becomes legally obligated to pay as damages because of"property damage"that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. 2. With respect to "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants": a. The"Each Occurrence Limit"shown in the Declarations does not apply. b. Paragraph 7.of Limits Of Insurance(Section III)does not apply. c. Paragraph 1.of Section III—Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought; or (3) Persons or organizations making claims or bringing "suits". d. The following are added to Section III—Limits Of Insurance: 8. Subject to 2.or 3.above, whichever applies, the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants" is $100,000 aggregate. 9. Subject to 8. above,the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants". D. VOLUNTARY PROPERTY DAMAGE 1. The following is added to Section 1—COVERAGES: We will pay, at your request for"property damage"to that part of any property: a. Which you or any subcontractors working directly or indirectly on your behalf are performing operations; or b. That must be restored, repaired or replaced because "your work" was incorrectly performed on it. This insurance applies only to "property damage" to property of others while in your care, custody, or control, and arising out of operations away from your insured premises and incidental to your business. Exclusions j.(3),(4),(5) and (6)do not apply to this coverage. This insurance does not apply to "property damage" included within the "explosion hazard", the"collapse hazard"or the"underground property damage hazard". 2. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION III—LIMITS OF INSURANCE is replaced by the following: A. Limits of Insurance 1. Unless a higher limit is shown in the Declarations, the most we will pay in any one "occurrence"for"property damage" under this endorsement is $15,000. 2. Unless a higher limit is shown in the Declarations, the most we will pay for all covered "occurrences"during any one policy period is$15,000 Aggregate Limit of Insurance. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 3 of 4 Office, Inc with its permission The Limits of Insurance of this endorsement apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that`occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any"suits"seeking those damages; and your duties in the event of an "occurrence", claim, or "suit" apply irrespective of the application of the deductible amount. c. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken; you shall promptly reimburse us for such part of the deductible amount as we have paid. 4. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: In the event of loss covered by this endorsement, the insured shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs at actual cost to the insured, excluding prospective profit or overhead charges of any nature. Any property so paid for or replaced shall, at our option, become our property. Any payment made by us shall not constitute an admission of liability by an insured, or by us. b. Paragraph 4. Other Insurance is amended as follows: (1) Paragraph 4.a. Primary Insurance is deleted. (2) Subparagraphs (1) and (2) of paragraph 4.b. Excess Insurance are deleted and replaced with the following: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis. All other provisions that apply to paragraph 4. Other Insurance contained in the Commercial General Liability Coverage Form are applicable. 5. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, the following definitions are added to SECTION V—DEFINITIONS: a. "Collapse hazard" includes "structural property damage" and any resulting "property damage"to any other property at any time. b. "Explosion hazard" includes "property damage" arising out of blasting or explosion. The "explosion hazard"does not include "property damage" arising out of the explosion of air or steam vessels, piping under pressure, prime movers, machinery or power transmitting equipment. c. "Structural property damage" means the collapse of or structural injury to any building or structure due to: (1) Grading of land, excavating, borrowing, filling, back-filling, tunneling, pile driving, cofferdam work or caisson work; or (2) Moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support of that building or structure. d. "Underground property damage hazard" includes "underground property damage" and any resulting"property damage"to any other property at any time. e. "Underground property damage" means "property damage" to wires, conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any apparatus used with them beneath the surface of the ground or water, caused by and occurring during the use of mechanical equipment for the purpose of grading land, paving, excavating, drilling, borrowing,filling, back-filling or pile driving. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 4 of 4 Office, Inc with its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS OR OTHERS - COMPLETED OPERATIONS - AUTOMATIC, INCLUDING PRIMARY NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO IS AN INSURED is amended to include as an additional insured any person(s)or organization(s) when you are obligated by virtue of a written contract or agreement that such person or organization(s) be added as an additional insured to your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused by "your work" for the additional insured and only to the extent that such "bodily injury", "property damage" or "personal and advertising injury" is caused by your negligence, or the negligence of those performing operations on your behalf, for that additional insured and included in the "products-completed operations hazard". This insurance does not apply to any additional insured scheduled on your policy by separate endorsement. B. LIMITS OF INSURANCE Limits of insurance for such additional insured are the limits in this coverage form or the limits you and such additional insured agreed to by virtue of a contract or agreement, whichever is less. These limits are inclusive of and are not in addition to the Limits Of Insurance shown in the Declarations. C. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply to"bodily injury", "property damage"or"personal and advertising injury"arising out of: 1. The rendering of or failure to render any professional services by you or on your behalf, but only with respect to either or both of the following operations: a. Providing engineering, architectural or surveying services to others in your capacity as an engineer, architect or surveyor; and b. Providing or hiring independent professionals to provide, engineering, architectural or surveying services in connection with construction work you perform. 2. Subject to paragraph 3. below, professional services include: a. Preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders,or drawings and specifications; and b. Supervisory or inspection activities performed as part of any related architectural or engineering activities. 3. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you or performed by or for the construction manager, its employees or its subcontractors in connection with your products-completed operations. D. PRIMARY NON-CONTRIBUTORY When required by virtue of a written contract or agreement, coverage provided to any additional insured by ADDITIONAL INSURED — OWNERS, LESSEES, CONTRACTORS OR OTHERS — COMPLETED OPERATIONS — AUTOMATIC, INCLUDING PRIMARY NON-CONTRIBUTORY will be on a primary basis and will not seek contribution from the additional insured's policy. CL CG 20 48 01 14 Includes Copyrighted material of Insurance Services Page 1 of 1 Office,Inc with its permission Policy No. CPA 6023167-20 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Ai #2.0 ADDITIONAL INSURED — OWNERS, LESSEES, CONTRACTORS OR OTHERS— Ongoing And Completed Operations — AUTOMATIC STATUS, INCLUDING PRIMARY NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II-WHO IS AN INSURED is amended to include as an additional insured any person(s) or organization(s)when you are obligated by virtue of a written contract or agreement that such person or organization(s)be added as an additional insured to your policy. Such person(s)or organization(s)is an additional insured only with respect to liability for"bodily injury" or"property damage" or"personal and advertising injury" caused, in whole or in part by, "your work" performed for that additional insured for "your" ongoing operations and included in the "products- completed operations hazard". This insurance applies only when you are required to add the additional insured by a written contract or agreement, provided the contract or agreement is: 1. Currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to the"bodily injury"or"property damage"or"personal and advertising injury". However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. For purposes of this endorsement, throughout the policy, the terms"you"and"your"refer to the Named Insured shown in the Declarations. B. Exclusions With respect to the insurance afforded to these additional insureds, the following additional exclusions apply to"bodily injury"and"property damage"arising out of: 1. The rendering of or failure to render any professional services by you or on your behalf, hutt only with respect to either or both of the following operations: a. Providing engineering, architectural or surveying services to others in your capacity as an engineer, architect or surveyor; and b. Providing, or hiring independent professionals to provide,engineering, architectural or surveying services in connection with construction work you perform. Includes copyrighted material of Insurance Services Office,Inc.,2012 with its permission Page 1 of 2 Policy No. CPA 6023167-20 COMMERCIAL GENERAL LIABILITY 2. Subject to Paragraph 3.below, professional services include: a. Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders, change orders, or drawings and specifications;and b. Supervisory or inspection activities performed as part of any related architectural or engineering activities. 3. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you or performed by or for the construction manager, its employees or its subcontractors in connection with your ongoing operations. C. Limits of Insurance With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. D. Other Insurance For purposes of this endorsement,the following is added to the Section IV—Commercial General Liability Conditions,4. Other Insurance condition and supersedes any provision to the contrary: This insurance is excess of all other insurance available to an additional insured whether on a primary, excess, contingent or any other basis. But, if required by a written contract or written agreement to be primary and noncontributory,this insurance will be primary to and will not seek contribution from any insurance on which the additional insured is a Named Insured. No other coverage or limit in the policy applies to loss or damage insured by this coverage. Includes copyrighted material of Insurance Services Office, Inc.,2012 with its permission Page 2 of 2 sTA7E IP'1`>.'I 1989 a STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES PO Box 44274 Olympia, Washington 98504-4274 June 15, 2017 SPOKANE VALLEY, CITY OF 11707 EAST SPRAGUE AVE STE 106 SPOKANE VALLEY WA 99206 coN 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 PINES ROAD(SR 27) & MIRABEAU PARKWAY INTERSECTION o PROJECT , Contract 16-092, to the following contractor: O 0 CAMERON-REILLY LLC 119,442-00 602 633 401 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 RC W. 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, Crystal Forsberg-Taylor Contract Release Specialist (360)902-5385 SMCR23 5@LNI.WA.GOV cc: CAMERON-REILLY LLC 309 N PARK ROAD SPOKANE VALLEY WA 99212 Page 2