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10-188.03 Otis Elevator: CenterPlace Elevator Service CUSTOMER NO. DATE INVOICE NO. 394128 02/20/17 SR04008317 INVOICE AMOUNT DUE OCONTRACT: 13142 One Farm Springs INVOICE G Enclose This Coupon With Your Payment. Farmington,CT 06032 Make Check Payable To: OTIS ELEVATOR COMPANY Mall payment to: MB 01 018363 79462 B 67 A CENTERPLACE AT MIRABEAU PARK I"IIIIIII'i'I'II'IIIIII'1111'II'1'I'II111"11'1111"1111111"" C/O CITY OF SPOKANE VALLEY OTIS ELEVATOR COMPANY 11707 E. SPRAGUE AVE. , STE 106 P.O. BOX 73579 SPOKANE VALLEY WA 99206-6124 CHICAGO IL IIII'1111111'111111'IIIIIII""II'I"IIII1I11IIIIIIIIII"II111"1 60673-7579 PLEASE SEND CORRESPONDENCE TO YOUR LOCAL OFFICE AS SHOWN BELOW 00SR04008317 0000193142 2 RECEIVED E C 3 V D DETACH RETURN DOCUMENT ALONG PERFORATION p _� G+ ID -- t$$, 03 INVOIC : FEB 2 11 2017 OTIS ELEVATOR RECEIVED FEB 21 1017 'SERVICE CONTRACT CHARGES ** PARKS & RECREATION DEPT. CUSTOMER NO, DATE • INVOICE NO. 394128 02/20/17 SR04008317 BUILDING SR 445435 CENTERPLACE AT MIRABEAU P CONTRACT SR 04008 SERVICE FROM 03/01/17 TO 02/28/18 1,776.84 SALES TAX 154.58 ,_ TOTAL CURRENT CHARGES DUE 1,931.42 - - - PRICE ADJUSTMENT - - - IN ACCORDANCE WITH THE PROVISION FOR THE ADJUSTMENT OF PRICE AS SET FORTH IN THE CONTRACT ENTERED INTO BETWEEN US FOR THE SERVICE OF ELEVATOR EQUIPMENT: THE FORMER PRICE OF 143.13 HAS BEEN ADJUSTED AS INDICATED BELOW BASED UPON THE CHANGES THAT HAVE OCCURED IN THE ELEVATOR EXAMINERS' COST IN MAR 01,2017. THE ADJUSTED PRICE BECOMES EFFECTIVE MAR. 01,2017 AND SHALL REMAIN IN EFFECT UNTIL THE NEXT CHANGE IN ELEVATOR EXAMINERS' COST. BASED ON CHANGES IN ELEVATOR EXAMINERS' STRAIGHT TIME HOURLY COST: (A) (B) (C)=B/A (D) (E)=C*D FORMER CURRENT RATIO OF FORMER CURRENT ADJUSTED EXAMINERS' COST EXAMINERS' COST CHANGE CONTRACT PRICE CONTRACT PRICE 86.6866 89.6791 103.45209 143.13 148.07 APPROVED FOR PAYMENT NEW INVOICE AMOUNT INCLUDING TAXES 1,931.42 TOTAL A/IL lb°.1iSli /77/.7 SIGNATip RE DATE poi.0'7 . - .5,575. go.4 (. Ds . BARS FOR ANY QUESTIONS CONCERNING THIS INVOICE, CONTACT OTIS AT: 1-509-483-7328 • n• • • ATOR E.510 N. FOOTHILLS DRIVE SPOKANE WA 99207 PAYMENT DUE UPON RECEIPT-PLEASE PAY PROMPTLY WE CERTIFY THAT THE GOODS WERE PRODUCED IN COMPLIANCE WITH ALL APPLICABLE REQUIREMENTS OF SECTIONS 6. 7 AND 12 OF THE FAIR LABOR STANDARDS ACT,AS AMENDED,AND OF REGULATIONS AND ORDERS OF THE UNITED STATES DEPARTMENT OF LABOR ISSUED UNDER SECTION 14 HEREOF. RATE OF ONE AND ONE HALF PERCENT(1.5%)PER MONTHCHARGE TTHE MAXIMUM RATE ATE AALOLOWECALCULATED BY APPL CABLLE LAW,WFROM'THE HICHEVER IS LESS OF THE INVOICE AT THE * 018363 1/1 6 Page 1 of 1 • .1110—( 88. 03 DATE(MMIODIYYYY) AcO CERTIFICATE OF LIABILITY INSURANCE o3(MM/DDY7 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 have ADDITIONAL INSURED provisions or 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 suchcoeTACorsement(s). PRODUCER NAME: FAX MARSH USA INC. PHONE (AFAX ,No): 20 CHURCH STREET (A1C.No.Extl: HARTFORD,CT 06103 E-MAIL RECEIVEDINSURER(S)AFFORDING COVERAGE NAIC# (�1 INSURER A:Hartford Fire Insurance Company 19682 • /� INSURED APR 03 2U 17 INSURER B:National Union Fire Insurance Company of Pittsburgh,PA 19445 OTIS ELEVATOR COMPANY INSURER c American Home Assurance Company 19380 ONE FARM SPRINGS ROAD FARMINGTON,CT 06032 PARKS & RECREATION DEPT. INSURER D:New Hampshire Insurance Company 23841 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:F8JFZ9VX 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. INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LTR 02CSET10004 04/01/2017 04/01/2018EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300,000 CLAIMS-MADE X OCCUR $2,000,000 general aggregate per PREMISES(Ea occurrence) $ location/project MED EXP(Any one person) $ 10,000 $10,000,000 policy general aggregate — 1,000,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: 2,000,000 PRO- PRODUCTS-COMP/OP AGG $ POLICY n JECT I I LOC $ OTHER: 02CSET10000 AVO) 04/01/2017 04/01/2018 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY 02CSET10019(HI) (Ea accident) $ X ANY AUTO Hartford Underwriters Ins BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $. HIRED ONLY -- NON-OWNED PROPERTY DAMAGE $ HIRED (Per accident) AUTOS ONLY _ AUTOS ONLY $ - 02HUT10021 04/01/2017 04/01/2018 EACH OCCURRENCE $ 10,000,000 A X UMBRELLA LIAR X OCCUR AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS-MADE $ DED I I RETENTION$ CT WC(SIR 2.5MM)EX COV-6583040 04/01/2017 04/01/2018 X I STATUTE I I ER B WORKERSMCOMPENSATION CA-015 19205 D ANDY PROPRIETOR/PARTNER/EXECUTIVE FL-015519206,MA-015519212 E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER CERR/PARTNE EDCEcurivE YNN N/A MN-015519208,MULTI-015519204 1,000,000 (Mandatory InNH)EXCLUDED? MULTI-015519207,MULTI-015519211 E.L.DISEASE-EA EMPLOYEE $ (Mandatory If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 e DESRIPTION OF OPERATIONS below $ 1,000,000 A Owners'and Contractors'Protective 02CSET31000 04/01/2017 04101/2018 Aggregate $ 2,000,000 $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This certificate only applies to SR 04008 Centerplace at Mirabeau Park,2426 N Discovery Pl.,Spokane,WA Center Place at Mirabeau Park OTIS 0/0 City of Spokane Valley is named insured on the OCP and the insurance policies include a waiver of subrogation,both to the extent required by contract with ELEVATOR COMPANY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE-POLICY PROVISIONS. Center Place at Mirabeau Park MCity of Spokane Valley Mike Stone AUTHORIZED REPRESENTATIVE ' J /46/7) � � 11707 E.Sprague Ave Suite 106 (V� Spokane Valley,WA 99206 Page 1 of 2 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD OWNERS AND CONTRACTORS PROTECTIVE LIABILITY 0,r CERTIFICATE CERTIFICATE OF COVERAGE OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE is provided by the insurance company of the Hartford shown below;is provided on behalf of the Designated Contractor scheduled hereon;and consists of: A. This Certificate of Coverage. B. Owners and Contractors Protective Liability Coverage Form;and C. Any Endorsements issued to be a part of the Owners and Contractors Protective Liability Coverage Form and listed below: Insurer: Hartford Fire Insurance Company Policy Number:02CSET31000 HARTFORD, CT 06115 Previous Policy Number:RENEWAL Issued to Named Insured and Mailing Address: Center Place at Mirabeau Park C/O City of Spokane Valley Mike Stone • 11707 E . Sprague Ave Suite 106 Spokane Valley, WA 99206 Designated Additional Insureds: Coverage Period: 04/01/2017 to 04/01/2018 12:01 a.m.,standard time at your mailing address shown above. (Coverage Period means the period beginning with the inception date coverage is provided for the project specified herein and ending with the earlier of cancellation of coverage,expiration of coverage or completion of the project) Designated Contractor and Mailing Address: OTIS ELEVATOR COMPANY ONE FARM SPRINGS ROAD FARMINGTON, CT 06032 • Location of Covered Operations: Centerplace at Mirabeau Park 2426 N Discovery P1 . Spokane, WA Contract Number: SR 04008 LIMIITS OF INSURANCE The Limits of Insurance,subject to all the terms of this Owners and Contractors Protective Liability Coverage Form that apply,are: Each Occurrence Limit 2, 000, 000 Aggregate Limit 2, 000, 000 Premium: Included as part of the total Coverage Part premium,which is the responsibility of the Designated Contractor. Form Numbers of Coverage Forms, Endorsements and Schedules that are part of this Owners and Contractors • Protective Liability Coverage Form: Issue Date: 03/27/2017 Form HS 78 71 01 00 (c)2001,The Hartford F8JFZ9VX Page 2 of 2