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17-027.00 Inland Asphalt: Indiana Ave Preservation - Mirabeau Pkwy to Evergreen Contract This agreement is entered into this t f day of , 2017, between :the City of Spokane Valley ("City") and Inland Asphalt Paving ("Co tractor"), pursuant to Title 35 RCW, as adopted or amended. In consideration of the terms and conditions contained herein and attached and made a part of this agreement,the parties agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Indiana Avenue Street Preservation Project#0255 Contract 17-027 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City. II. The City hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein conhained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City by reason of entering onto this contract,except as provided herein. V. The project was awarded for the bid amount of$445,868.00. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the date below, and the City has caused this instrument to be executed on the date stated above. Executed by Contractor 4i0,2iL. Zee , 2017. Date 4- 174‹H3 1'KS Printed Name 'LO 'VCT\0.,Nr 1 Title ,I T J LJi__ Signature lir City of Spokane "a ey i /�Gtrk ( au1wuti Printed Name City Manager Title Sign tur2 Rer ised 1-8-t A 0 olIane 40,001gM e" . BOND NO: 9249764 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington,in Spokane County,has awarded to Inland Asphalt Company(Contractor),as Principal, a contract for the construction of the project designated as Indiana Avenue Street Preservation Project, Project No. 0255, in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Fidelity and Deposit Company of Maryland (Surety), a corporation,organized under the laws of Maryland and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly wound to the City of Spokane Valley,as Obligee,in the sum of$ 445,868.00 total Contract amount (including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors,or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications,additions,and changes to said Contract that may hereafter be made,at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract; and if such performance obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change,extension of time,alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change,extension of time,alteration or addition to the terms,of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be'paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be a -'ted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf o s Inland Asphalt Com,. , Fidelity and Deposit Company of Maryland PRINCIPAL(CO • , C • ) (/ 4/ SURETY ti L ,1`- AC--1 �t 6/2017 Principal Si�fra liprst: �Dae .� R Date• .. -" - AL-44J< 1' ic.5 Tina Davis _ . _ • - • . - Printed Name Printed Name C' JC—t-ra.) lcvN( 46F•2 Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Marsh USA Inc. 15 W.South Temple,Ste.700 . Salt I akP City, UT R4101 ,+,1 ,:.i ' • l' City of Spokane Valley Contract Documents Indiana Avenue St Preservation 1 Bid#17-027 anoke BOND NO: 9249764 CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Inland Asphalt Company (Contractor), as Principal, a contract for the construction of the project designated as Indiana Avenue Street Preservation Project, Project No. 0255 in Spokane Valley, Washington, and said Principal is required under the terms ofrthe Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Fidelity and Deposit Company of Maryland (Surety), a corporation organized under the laws Maryland and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S.Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee, in the sum of$ 445 868 00 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 bell- of the surety. Inland Asphalt C• J Fidelity and Deposit Company of Maryland PRINCIPAL( • r� rhs SURETY - AOKI Principal Signatu - 0141p late Date _ COkis-r i-ttJ r`47V,o4 - Tina Davis Printed Name Printed Name /42 NVr \N1'-, Attorney-in-Fact - Title Title Name,address,and telephone of local office/agent of Surety Company is: Marsh USA Inc. 15 W.South Temple,Ste.700 Salt Lake City, UT 84101 Revised 1.14 i r • , State of UT County of Salt Lake ss: On April 26, 2017 ,before me,a Notary Public in and for said County and State,residing therein,duly commissioned and sworn,personally appeared Tina Davis known to me to be Attorney-in-Fact of Fidelity and Deposit Company of Maryland , the corporation described in and that executed the within and foregoing instrument,and known to me to be the person who executed the said instrument in behalf of the said corporation,and he duly acknowledged to me that such corporation executed the same. IN WITNESS WHEREOF,I have hereunto set my hand and affixed my official seal,the daa d year stated in this certificate above. AP / My Commission Expires 3/13/2019 v/ lat. i a Hall Notary Public �i•�, LISA tiOr 'w `��'''�": Notary Public State of Utah 0 Comm. No. 681511 k` .- My Comm.Expires Mar 13,2019 kt y a ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland,and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by GERALD F.HALEY,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Tina DAVIS, Lisa HALL, Lindsey PLATTNER and Linda NIPPER, all of Salt Lake City,Utah, EACH its true and lawful agent and Attorney-in-Fact,to make, execute,seal and deliver,for, and on its behalf as surety,and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 24th day of May,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND pqty4.‘1.,".3.4t. ,gyp 9LtOg�i 474"0":,S, ♦ q, n /0/..."'"'.V.fM`�YrR 1 /44e r--7 At tell t lhtr 4 �tt��yJjJ (fitiaN,-, Assistant Secretary Vice President Dawn E.Brown Gerald F.Haley Staie.of Maryland County of Baltimore On this 24th day of May,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,GERALD F. HALEY, Vice President, and DAWN E. BROWN,Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. ,0111 Tit,,, Itco S,G�i 92thAt;,- 1�2�i./ri 'v , ..� qC�r r ti i�...�1 I6 r�lC'ti�� I�filllll ll` Maria D.Adamski,Notary Public My Commission Expires:July 8,2019 POA-F 020-8022W r • ' 7 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter,wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this 26THday of APRIL ,2017 . Q OE�Ofri �Jgirti :a. z t —, o:am' SEAL IOWA VA 9 �tw i Ai 100 OM* Aeb °p'N.uin."� • 4U9f Michael Bond,Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT ALL REQUIRED INFORMATION TO: Zurich American Insurance Co. Attn: Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 °'Yolane Val a BOND NO 9249765 CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington, in Spokane County,has awarded to Inland Asphalt Company, ("Co'tr ,cto>")r a$ Principal, a contract for the construction of the project designated as Indiana Avenue Street Preservation Project,Project No. 0255, (the"Contract") in Spokane Valley,Washington. The Principal, existing under and by virtue of the laws of the State of Washington and authoriZed to do business in the State of Watshington, and Fidelity and Deposit Company of Maryland organized and existing under thelaws of the State of Maryland and authorized td transact business in the State of Washington as Surety, are jointly and severally held and bound unto th4 City of Spokane Valley, hereinafter called Obligee, and are similarly held and bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW, in the penal sum of 5% of the Contract, Which is Twenty Two Thousand Two Hundred Ninety Three and 40/100 dollars ($ 22,293.40 ), plus 5% of any increases in the Contract amount that have occurred or may occur, due to change orders, increases in the quantities,or the addition of any new item of work. WHEREAS, on the 26th day of April 2016 the said Principal and Obligee herein executed and entered into the Contract. WHEREAS, said Contract and chapter 60.28 RCW require the Obligee to withhold from the Principal the sum of 5% from monies earned by the Principal on estimates during the progress of the construction, hereinafter referred lo as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under chapter 60.2$RCW. NOW THEREFORE,the condition of the obligation is such that the Principal and Surety are held and,bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW in the aforesaid sum. TE'ris bond, including any proceeds therefrom, is.subject to all elaims and liens and in the same manner and priority as set forth for retained percentages in chapter 60.28•RCW. The condition of this obligation is also such that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund purposes of chapter 6028 RCW to the Obligee,and indemnify and hold the Obligee harrliless,from any and all loss, costs, and damages that the Obligee may sustain by release of the earned retained funds to the Principal,then upon notification of such satisfaction and release of the Surety by the obligee,this obligation shall be null and void. PROVIDED HOWEVER,that 1. The Surety shall be liable under this obligation as Principal. The Surety will not be discharged or released from liabilityfor any act,omission or defenses of any kind or nature that would not also discharge Principal. 2. This obligation shall be binding upon and inure to the benefit of the Principal,the Surety,the Obligee,the beneficiaries of the trust fund created by chapter 60.28 RCW and their respective heirs, 1 executors,administrators,successors and assigns. 3. Any suit under this bond must be instituted within the time provided by applicable law. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer e.ecu i ; . .ehalf of the surety. Inland Asphalt ' • fn� Fidelity and Deposit Company of Maryland PRINCIP lie ISURETY i. Ari, D Principal 'T':F. e� - _ ~—B�-_ 4L Al1p%)vtc--) Tina Davis _ ; Printed Name Printed Name - C10ii srcwc .t�rl �J,bhe..(L Attorney-in-Fact - • Title „ Title -' Name;address,and telephone of local office/agent of Surety Company is: Marsh USA Inc. ` ' - 15 W.South Temple, Ste.700 - Salt Lake City, UT 84101 k. i. ' t 2 A L State of UT County of Salt Lake ss: On April 26, 2017 ,before me,a Notary Public in and for said County and State,residing therein,duly commissioned and sworn,personally appeared Tina Davis known to me to be Attorney-in-Fact of Fidelity and Deposit Company of Maryland the corporation described in and that executed the within and foregoing instrument,and known to me to be the person who executed the said instrument in behalf of the said corporation,and he duly acknowledged to me that such corporation executed the same. IN'WITNESS WHEREOF,I have hereunto set my hand and affixed my official seal,the i.y and year stated in this certificate above. AP 1 My Commission Expires 3/13/2019 Ni.. A-dd ' 1 411 Lisa Hall l _,Notary Public WLISA HALL P 4r,oy.4` Notary Public = State of Utah a "� ,; = Comm. No.681511 "" My Comm.Expires Mar 13,2019 s, ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by GERALD F.HALEY,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Tina DAVIS, Lisa HALL, Lindsey PLATTNER and Linda NIPPER, all of Salt Lake City, Utah, EACH its true and lawful agent and Attorney-in-Fact,to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 24th day of May,A.D.2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND Sim ZIN �t "". I S , % ` i —.-- ln: 4,N6 % aN Fi :V 1 if g ..o . q•-,..., T''.2,7j�..,,,.' .@......,4(60,, .1,...ei ---7. At Assistant Secretary Vice President Dawn E.Brown Gerald F.Haley State of Maryland County of Baltimore On this 24th day of May,A.D.2016,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,GERALD F. HALEY,Vice President,and DAWN E. BROWN,Assistant Secretary, of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same,and being by me duly sworn, deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. r 9 `` facitrit `t�`.. '•, GC.iiit�'t gip` �4}a ttt��d Maria D.Adamski,Notary Public My Commission Expires:July 8,2019 POA-F 020-8022W EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V, Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. • RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this 26THIay of APRIL ,20 17 . vp " u+s'"w "oh 16i 211" z , 88AL I Vo Michael Bond,Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT ALL REQUIRED INFORMATION TO: Zurich American Insurance Co. Attn: Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 r • Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER.THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.POLICY LIMITS ARE NO LESS THAN THOSE LISTED,ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that Inland Asphalt Company 1, CPM Development Corporation dba NAME AND TT • r' - LibertyMutual.t __l .PO Box 3366 ADDRESS Spokane, WA 99220-3366 OF INSURED Ff INSURANCE is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and Conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued. EXP DATE TYPE OF POLICY El CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY ❑EXTENDED 21 POLICY TERM WORKERS 9/1/2017 WA7-C8D-004095-026 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING STATES: COMPENSATION -026:All States except OH,ND, Bodily In'uny by Accident ✓ WC7-C81-004095-016 WA,WY 1,000,000 Each Accident -016:WI Bodily Injury By Disease $1,000,000 Policy I(mit Bodily Injury By Disease $1,000.000 E,,ch Person COMMERCIAL 9/1/2017 TB2-C81-004095-116 • General Aggregate GENERAL LIABILITY $2,000,000 v -Per Project Aggregate included ®OCCURRENCE Products/Comleted Operations P P Aggregate $2,000,000 V 0 CLAIMS MADE Each Occurrence $2,000,000 v RETRO DATE Personal&Advertising Injury $2,000,000 Per Person/Organization l/ Other Other Dama a to Premises Rented to Medical Exp:$5,000 You:$250.000 AUTOMOBILE 9/1/2017 AS2-C81-004095-126 'Each Accident—Single Limit LIABILITY $2,000,000 B.I.And P.D.Combined OBD Each Person 121 NON-OWNED Each Accident or Occurrence IA HIRED Each Accident or Occurrence OTHER 9/1/2016-9/1/2017 -AS2-C81-054502-526 -Physical Damage only -Automobile policy -$10,000 Comp -$10,000 Coll -Excess Workers 9/1/2016-9/1/2017 -EW7-68N-004095-346 SIR$250 000 Compensation and Employer (WA) Excess WC-$250,000,000(includes WA stop gap)/EL-$750,000 V Liability Per OCC. ADDITIONAL COMMENTS RE: Indiana Avenue Street Preservation project,Contract No. 17-027 City of Spokane Valley,its officers,elected officials,employees,agents and volunteers are included as additional insured with respect to the above referenced project.I,- • r•If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE Liberty Mutual INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE Insurance Group OF SUCH CANCELLATION HAS BEEN MAILED TO: r City of Spokane Valley ) &. 1 7zi� 11707 E. Sprague Ave., Suite 106 Valerie Reece .` AUTHORIZED REPRESENTATIVE Spokane Valley,WA 99206 Fairfield/049C y 9450 Seward Road 4/26/17 Fairfield OH 45014 800-332-3226 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 34975155 1 LM_44 1 9/16-9/17 - WA 2/2 1 Donna Smitala 1 4/3/2017 3:11:55 PM (CDT) 1 Page 1 of 1 LDI COI 268896 02 11 POLICY NUMBER:Ti32-C81-004095-116 COMVERCOAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who is An Insured is amended to 1. All work„ including materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only with work, on the project (other than service, respect to Ilablty for "bodily injury", "property maintenance or repairs) to bat performed by or damage" or "personal and advertising injury" on behalf of the additional Insured(s) at the caused,in whole or in part,by: location of the covered operations has been 1. Your ads or omissions;,or completed;or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalL injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization other than another contractor or subcontractor the additional insured(s) at the location(s) designated above, engaged to performing operations for a principal as a part of the same project However: C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following Is added to iisured only applies to the extent permitted by SectiOn 10—LimIts Of Insurance law•,and II coverage provided to the additional 'insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contract or agreement;or y the contract or agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown the Declarations; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not Increase the This insurance does not apply to "bodily injury or applicable Limits of Insurance shown in the 'property damage' occurring after: Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): Any owner,lessee,or contractor for whom you have My location listed in such agreement agreed in writing prior to a loss to provide Iiabliiy insurance Information required to complete this Schedule,If not shown above, wiI be shown in the Declarations. CG 2010 0413 43 Insurance Services Office, Inc..2012 Page 1 of 1 PO BOX 3366 SPOKANE WA 99220-3366 CE'•. +?EEFc,PF" 'a"t'.• • �''(-- ��; �,'i ...— .�— a—�, a—. � ...— ..�—.. �- ..—.— _..—_ �. � _. �-. .� _ f L t 41;;`x" ;t BUSINESS LICENSE 1. :I 51A1F(If i *; WASHtV(..tON , i 'l Corporation Unified Business ID#: 601006854 t Business ID#: 001 tt tt Location: 0003 ;p i + CPM DEVELOPMENT CORPORATION Expires: Jul 31,2017 11, r, INLAND ASPHALT COMPANY i flI 5111 E BROADWAY AVE 1,i. SPOKANE VALLEY,WA 99212-0928 '4 TAX REGISTRATION#600664174 I t 1, '� CITY ENDORSEMENTS: { •.1 SPOKANE VALLEY GENERAL BUSINESS , I SPOKANE GENERAL BUSINESS#T12004257BUS t Y' REGISTERED TRADE NAMES: ;t k INLAND ASPHALT COMPANY ) 11 rti r' a I Ott 1: I 1 _ R'r I 4 I I. i - .I VI11( lots I.n t t',� this Jurkiment itch the registrations.,einlotsemoots, ,and G<rnees audio+iced fur the hicsineey named above B1 at r eptmg tins dot ument,the licensee c et Hiles the mtormattou on the appl ratrnu l'.1, . nits complete.title,anti attmate to the hest of his DI lief I.nowledge and that hostiles.wtli lie ft t ondu<ted ut compliance tsith all applicable Washington stale,count}.anti t its regulations. tial•+foot IA•i.ninwnt it Rrsenu. ' Craig Aldworth From: Tibbits,Jamie (Inland Asphalt) <jtibbits@oldcastlematerials.com> Sent: Monday, May 08, 2017 7:44 AM To: Craig Aldworth Subject: FW: [EXT] Indiana St Pres -Insurance questions Craig Please see below for clarification on Worker's Comp. Thanks, Jamie Tibbits Inland Asphalt Company 509-536-3141 From:Wells,Stacy(Oldcastle Materials) Sent: Monday, May 08, 2017 7:43 AM To:Tibbits,Jamie (Inland Asphalt) <Itibbits@oldcastlematerials.com> Subject: RE: [EXT] Indiana St Pres- Insurance questions Hi Jamie, We are self-insured in the state of Washington. The Excess Work Comp /Employers Liability policy is noted on the certificate. Let me know if you need further details. Stacy From:Tibbits,Jamie (Inland Asphalt) Sent: Monday, May 08, 2017 7:49 AM To:Wells,Stacy(Oldcastle Materials)<Stacy.Wells@oldcastlematerials.com> Subject: FW: [EXT] Indiana St Pres- Insurance questions Stacy I know our insurance hasn't changed,but the wording under the Worker's Comp section looks different. Can you clarify the question below, please? Thanks, Jamie Tibbits Inland Asphalt Company 509-536-3141 From: Craig Aldworth [mailto:caldworth@spokanevalley.org] Sent: Friday, May 05, 2017 4:42 PM To:Tibbits,Jamie (Inland Asphalt)<itibbits@oldcastlematerials.com> Subject: [EXT] Indiana St Pres- Insurance questions 1 Jamie The insurance Cert appears to state that the Workers comp provided does not apply in Washington State? Please have your insurance rep send me an email explaining the situation. Thanks, Craig CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you are expecting this email and know the contents are safe. ATTENTION: Ce courriel vient de l'exterieur de l'entreprise. Ne cliquez pas sur les liens, et n'ouvrez pas les pieces jointes, a moins que vous ne connaissiez l'expediteur du courriel et savez que le contenu est securitaire. 2 • *748498* 111111111111 11111 11111111111111(11111111 • REMS FileNet Cover Sheet AUDIT NUMBER 208499 FOLDER NUMBER 0166180 CITY SPOKANE VALLEY STATE WA PARTY NAME SPOKANE COUNTY, WASHINGTON PRIMARY PURPOSE Crossing - Public Roadway EFF. DATE 5/4/2017 MP START 9.62 MP END PRIMARY CIRC7 OS010 DESCRIPTION CROE - Inland Asphalt Company BOX NUMBER 0 BATCH 00 • UNION PACIFIC RAILROAD COMPANYu`W°" CONTRACTOR'S RIGHT OF ENTRY AGREEMENT LDING AMERIC/I' 'Am` Form Approved:AVP Law 03/01/2013 111 111 4 Folder No.: 1661-80 UPRR Audit No.: o g CONTRACTOR'S RIGHT OF ENTRY AGREEMENT THIS AGREEMENT is made and entered into as of the 14W\\day of 0Y14-1 2017, by and between UNION PACIFIC RAILROAD COMPANY, a Delaware corporation ("Railroad");and INLAND ASPHALT COMPANY,a ( u �vi-zie"% corporation ("Contractor"). D RECITALS: Contractor has been hired by the City of Spokane Valley ("City") to grind two inches of the existing pavement, install new traffic loops and conduit, inlay two inches of new asphalt, install pavement markings and reconstruct the sidewalks of the existing public at-grade road crossing at with all or a portion of such work to be performed on property of Railroad in the vicinity of the Railroad's Mile Post 9.62(DOT 176083D)on its Spokane Subdivision in or near Spokane Valley, Spokane County, Washington, as such location is in the general location shown on the ,Railroad ,Location Print marked Exhibit A,attached hereto and hereby made a part hereof,which work is the subject of a contract dated February 17,2017,between the Railroad and the City. The Railroad is willing to permit the Contractor to perform the work described above at the location described above subject to the terms and conditions contained in this Agreement AGREEMENT: NOW,THEREFORE, it is mutually agreed by and between Railroad and Contractor, as follows: ARTICLE 1 - DEFINITION OF CONTRACTOR. For purposes of this Agreement,all references in this agreement to Contractor shall include Contractor's contractors,subcontractors,officers,agents and employees,and others acting under its or their authority. ARTICLE 2- RIGHT GRANTED; PURPOSE. Railroad hereby grants to Contractor the right, during the term hereinafter stated and upon and subject to each and all of the terms,provisions and conditions herein contained,to enter upon and have ingress to and egress from the property described in the Recitals for the purpose of performing the work described in the Recitals above. The right herein granted to Contractor is limited to those portions of Railroad's property specifically described herein,or as designated by the Railroad Representative named in Article 4. ARTICLE 3- TERMS AND CONDITIONS CONTAINED IN EXHIBITS B.C&D. Articles of Agreement Page 1 of 4 UNION PACIFIC RAILROAD COMPANY NTRACTOR'S RIGHT OF ENTRY AGREEMENT BUUDING MSA' M"I" orm Approved:AVP Law 03/01/2013 IW The General Terms and Conditions contained in Exhibit B, the Insurance Requirements contained in Exhibit C, and the Minimum Safety Requirements contained in Exhibit D, each attached hereto,are hereby made a part of this Agreement. ARTICLE 4- ALL EXPENSES TO BE BORNE BY CONTRACTOR; RAILROAD REPRESENTATIVE. A. Contractor shall bear any and all costs and expenses associated with any work performed by Contractor,or any costs or expenses incurred by Railroad relating to this Agreement. B. Contractor shall coordinate all of its work with the following Railroad representative or his or her duly authorized representative(the"Railroad Representative"): Max Mccrosky Mgr Track Mntce 402-615-0428 mmmccros@up.com C. Contractor,at its own expense,shall adequately police and supervise all work to be performed by Contractor and shall ensure that such work is performed in a safe manner as set forth in Section 7 of Exhibit B. The responsibility of Contractor for safe conduct and adequate policing and supervision of Contractor's work shall not be lessened or otherwise affected by Railroad's approval of plans and specifications involving the work, or by Railroad's collaboration in performance of any work,or by the presence at the work site of a Railroad Representative,or by compliance by Contractor with any requests or recommendations made by Railroad Representative. ARTICLE 5- SCHEDULE OF WORK ON A MONTHLY BASIS. The Contractor,at its expense,shall provide on a monthly basis a detailed schedule of work to the Railroad Representative named in Article 4B above. The reports shall start at the execution of this Agreement and continue until this Agreement is terminated as provided in this Agreement or until the Contractor has completed all work on Railroad's property. ARTICLE 6- TERM;TERMINATION. A. The grant of right herein made to Contractor shall commence on the date of this Agreement, and continue until 5-(4-1 ,unless sooner terminated as herein (Expiration Date) provided,or at such time as Contractor has completed its work on Railroad's property,whichever is earlier. Contractor agrees to notify the Railroad Representative in writing when it has completed its work on Railroad's property. Articles of Agreement Page 2 of 4 NION PACIFIC RAILROAD COMPANY a. � ii) NTRACTOR'S RIGHT OF ENTRY AGREEMENT BUILDING Ammar ""`"` orm Approved:AVP Lew 03!01/2013 IIIIII B. This Agreement may be terminated by either party on ten(10)days written notice to the other party. ARTICLE 7- CERTIFICATE OF INSURANCE. A. Before commencing any work,Contractor will provide Railroad with the(i)insurance binders, policies, certificates and endorsements set forth in Exhibit C of this Agreement, and (ii) the insurance endorsements obtained by each subcontractor as required under Section 12 of Exhibit B of this Agreement. B. All insurance correspondence,binders,policies,certificates and endorsements shall be sent to: Union Pacific Railroad Company Real Estate Department 1400 Douglas Street, MS 1690 Omaha,NE 68179-1690 UPRR Folder No.:1661-80 ARTICLE 8- DISMISSAL OF CONTRACTOR'S EMPLOYEE. At the request of Railroad,Contractor shall remove from Railroad's property any employee of Contractor who fails to conform to the instructions of the Railroad Representative in connection with the work on Railroad's property,and any right of Contractor shall be suspended until such removal has occurred. Contractor shall indemnify Railroad against any claims arising from the removal of any such employee from Railroad's property. ARTICLE 9- CROSSINGS. No additional vehicular crossings(including temporary haul roads)or pedestrian crossings over Railroad's trackage shall be installed or used by Contractor without the prior written permission of Railroad. ARTICLE 10- CROSSINGS;COMPLIANCE WITFI MUTCD AND FRA GUIDELINES. A. No additional vehicular crossings(including temporary haul roads)or pedestrian crossings over Railroad's trackage shall be installed or used by Contractor without the prior written permission of Railroad. B. Any permanent or temporary changes, including temporary traffic control, to crossings must conform to the Manual of Uniform Traffic Control Devices (MUTCD) and any applicable Federal Railroad Administration rules,regulations and guidelines,and must be reviewed by the Railroad prior to any changes being implemented. In the event the Railroad is found to be out of compliance with federal safety regulations due to the Contractor's modifications,negligence,or any other reason arising from the Contractor's presence on the Railroad's property, the Contractor agrees to assume liability for any civil penalties imposed upon the Railroad for such noncompliance. Articles of Agreement Page 3 of 4 UNION PACIFIC RAILROAD COMPANY .i0 ONTRACTOR'S RIGHT OF ENTRY AGREEMENT MAWS I i •,, onn Approved:AVP Law 03/01/2013 111111 ARTICLE II- EXPLOSIVES. Explosives or other highly flammable substances shall not be stored or used on Railroad's property without the prior written approval of Railroad. IN WITNESS WHEREOF, the parties hereto have duly executed this agreement in duplicate as of the date first herein written. UNION PACIFIC RAILROAD COMPANY (Federal Tax ID#94-6001323) By: 1Lt Danielle Allen Senior Manager-Real Estate INLAN i ;Jr! i," BY A OM ,frdi it l sL.Printed Name: K� Millr ' Title: CPN/ orvoNi - Articlos of Agreement Page 4 of 4 • • ' EXHIBIT "A" idle 1 RAILROAD LOCATION PRINT FOR AN EXISTING AT GRADE PUBLIC ROAD CROSSING AGREEMENT I. • i• Q -I, 1 v "4 /, j/ I' it. r,, .` s- olio yx- l i ON r DOT No. 176083 D M.P.9.62 Spokane Subdivision -. Spokane Valley,Spokane County, WA At Grade Public Road Crossing. " .,1. elle . ..4 _, UNION PACIFIC RAILROAD COMPANY SPOKANE SIII3DIVISION RAILROAD MILE POST 9.62 SPOKANE VALLEY.SPOKANE COUNTY.WA To accompany an agreement with THE CITY OF SPOKANE VALLEY AND ITS CONTRACTOR co%ering an At Grade Public Road Crossing. Folder No. 166I-80 Date:February 17.2017 WARNING IN All OCCASIONS.U P('OMMI NI('A'IONS I*PARTMFNT MUST BF cow-rm.-aro IN ADVANCE OF ANY WORK TO of TFRMINE F%1STFNCF AND MC OF FIBER OPTIC CAat.1 PI ION( I.181M))336-Q193 Exhibit A Railroad Location Print • UNION PACIFIC RAILROAD COMPANY L.,oh NTRACTOR'S RIGHT OF ENTRY AGREEMENT BUILDING AMERICK Fot►a Approved:AVP Law 03101/2013 11111 EXHIBIT B TO CONTRACTOR'S RIGHT OF ENTRY AGREEMENT GENERAL TERMS&CONDITIONS Section 1. NOTICE OF COMMENCEMENT OF WORK-FLAGGING. A. Contractor agrees to notify the Railroad Representative at least thirty (30) working days in advance of Contractor commencing its work and at least ten(10)working days in advance of proposed performance of any work by Contractor in which any person or equipment will be within twenty-five(25)feet of any track,or will be near enough to any track that any equipment extension(such as,but not limited to,a crane boom)will reach to within twenty-five(25)feet of any track. No work of any kind shall be performed,and no person,equipment,machinery,tool(s),material(s),vehicle(s),or thing(s)shall be located,operated,placed,or stored within twenty-five(25)feet of any of Railroad's track(s)at any time,for any reason, unless and until a Railroad flagman is provided to watch for trains. Upon receipt of such ten(10)-day notice,the Railroad Representative will determine and inform Contractor whether a flagman need be present and whether Contractor needs to implement any special protective or safety measures. If flagging or other special protective or safety measures are performed by Railroad,Railroad will bill Contractor for such expenses incurred by Railroad,unless Railroad and a federal, state or local governmental entity have agreed that Railroad is to bill such expenses to the federal, state or local governmental entity. If Railroad will be sending the bills to Contractor,Contractor shall pay such bills within thirty(30)days of Contractor's receipt of billing. If Railroad performs any flagging, or other special protective or safety measures are performed by Railroad,Contractor agrees that Contractor is not relieved of any of Its responsibilities or liabilities set forth in this Agreement. B. The rate of pay per hour for each flagman will be the prevailing hourly rate in effect for an eight-hour day for the class of flagmen used during regularly assigned hours and overtime in accordance with Labor Agreements and Schedules in effect at the time the work is performed. in addition to the cost of such labor,a composite charge for vacation,holiday, health and welfare, supplemental sickness, Railroad Retirement and unemployment compensation, supplemental pension, Employees Liability and Property Damage and Administration will be included,computed on actual payroll. The composite charge will be the prevailing composite charge in effect at the time the work is performed. One and one-half times the current hourly rate is paid for overtime, Saturdays and Sundays, and two and one-half times current hourly rate for holidays. Wage rates are subject to change,at any time,by law or by agreement between Railroad and its employees,and may be retroactive as a result of negotiations or a ruling of an authorized governmental agency. Additional charges on labor are also subject to change. If the wage rate or additional charges are changed, Contractor(or the governmental entity,as applicable)shall pay on the basis of the new rates and charges. C. Reimbursement to Railroad will be required covering the full eight-hour day during which any flagman is furnished,unless the flagman can be assigned to other Railroad work during a portion of such day,in which event reimbursement will not be required for the portion of the day during which the flagman is engaged in other Railroad work. Reimbursement will also be required for any day not actually worked by the flagman following the flagman's assignment to work on the project for which Railroad is required to pay the flagman and which could not reasonably be avoided by Railroad by assignment of such flagman to other work ,even though Contractor may not be working during such time. When it becomes necessary for Railroad to bulletin and assign an employee to a flagging position in compliance with union collective bargaining agreements, Contractor must provide Railroad a minimum of five(5)days notice prior to the cessation of the need for a flagman. If five(5)days notice of cessation is not given,Contractor will still be required to pay flagging charges for the five (5)day notice period required by union agreement to be given to the employee,even though flagging is not required for that period. An additional ten(10)days notice must then be given to Railroad if flagging services are needed again after such five day cessation notice has been given to Railroad. Section 2. LIMITATION AND SUBORDINATION OF RiGHTS GRANTED A. The foregoing grant of right is subject and subordinate to the prior and continuing right and obligation of the Railroad to use and maintain its entire property including the right and power of Railroad to construct,maintain,repair,renew,use,operate, change,modify or relocate railroad tracks,roadways,signal,communication,fiber optics,or other wirelines,pipelines and other fealties upon,along or across any or all parts of its property,all or any of which may be freely done at any time or times by Railroad without liability to Contractor or to any other party for compensation or damages. CONTRACTOR'S RiGHT OF ENTRY Page 1 of 4 Exhibit B AGREEMENT General Terms&Conditions Form Approved:AVP Law 03/01/2013 UNION• IPACIFIC RAILROAD COMPANY , o�rmm Approved:T 'S Law0 RIGHT OF ENTRY AGREEMENT BUILDING AMERICA' i Ic 111 B. The foregoing grant is also subject to all outstanding superior rights(Including those in favor of licensees and lessees of Railroad's property,and others)and the right of Railroad to renew and extend the same,and is made without covenant of title or for quiet enjoyment. Section 3. NO INTERFERENCE WiTH OPERATIONS OF RAILROAD AND ITS TENANTS. A. Contractor shall conduct its operations so as not to interfere with the continuous and uninterrupted use and operation of the railroad tracks and property of Railroad, including without limitation, the operations of Railroad's lessees, licensees or others,unless specifically authorized in advance by the Railroad Representative. Nothing shall be done or permitted to be done by Contractor at any time that would in any manner impair the safety of such operations. When not in use, Contractor's machinery and materials shall be kept at least fifty(50)feet from the centerline of Railroad's nearest track,and there shall be no vehicular crossings of Railroads tracks except at existing open public crossings. B. Operations of Railroad and work performed by Railroad personnel and delays in the work to be performed by Contractor caused by such railroad operations and work are expected by Contractor,and Contractor agrees that Railroad shall have no liability to Contractor,or any other person or entity for any such delays. The Contractor shall coordinate its activities with those of Railroad and third parties so as to avoid interference with railroad operations. The safe operation of Railroad train movements and other activities by Railroad takes precedence over any work to be performed by Contractor. Section 4, LIENS. Contractor shall pay in full all persons who perform labor or provide materials for the work to be performed by Contractor. Contractor shall not create, permit or suffer any mechanic's or materialmen's liens of any kind or nature to be created or enforced against any property of Railroad for any such work performed. Contractor shall indemnify and hold harmless Railroad from and against any and all liens,claims,demands,costs or expenses of whatsoever nature in any way connected with or growing out of such work done, labor performed,or materials furnished. If Contractor fails to promptly cause any lien to be released of record,Railroad may,at its election,discharge the lien or claim of lien at Contractor's expense. Section 5. PROTECTION OF FIBER OPTIC CABLE SYSTEMS. A. Fiber optic cable systems may be buried on Railroad's property. Protection of the fiber optic cable systems is of extreme importance since any break could disrupt service to users resulting in business interruption and loss of revenue and profits. Contractor shall telephone Railroad during normal business hours(7:00 a.m.to 9:00 p.m.Central Time,Monday through Friday,except holidays)at 1-800-336-9193(also a 24-hour,7-day number for emergency calls)to determine if fiber optic cable is buried anywhere on Railroad's property to be used by Contractor. If it is, Contractor will telephone the telecommunications company(ies)involved, make arrangements for a cable locator and,if applicable,for relocation or other protection of the fiber optic cable. Contractor shall not commence any work until all such protection or relocation(if applicable) has been accomplished. B. in addition to other indemnity provisions in this Agreement,Contractor shall indemnify,defend and hold Railroad harmless from and against all costs,liability and expense whatsoever(including,without limitation,attorneys'fees,court costs and expenses)arising out of any act or omission of Contractor,its agents and/or employees,that causes or contributes to(1) any damage to or destruction of any telecommunications system on Railroad's property,and/or(2)any injury to or death of any person employed by or on behalf of any telecommunications company,and/or its contractor,agents and/or employees, on Ralroad's property. Contractor shall not have or seek recourse against Railroad for any claim or cause of action for alleged loss of profits or revenue or loss of service or other consequential damage to a telecommunication company using Railroad's property or a customer or user of services of the fiber optic cable on Railroad's property. Section 6. PERMITS-COMPLIANCE WITH LAWS. in the prosecution of the work covered by this Agreement,Contractor shall secure any and all necessary permits and shall comply with all applicable federal, state and local laws, regulations and enactments affecting the work including, without limitation,all applicable Federal Railroad Administration regulations. Section 7. SAFETY. A. Safety of personnel, property, rail operations and the public is of paramount importance in the prosecution of the work performed by Contractor. Contractor shall be responsible for initiating,maintaining and supervising all safety,operations and programs in connection with the work. Contractor shall at a minimum comply with Railroad's safety standards listed in CONTRACTOR'S RIGHT OF ENTRY Page 2 of 4 Exhibit B AGREEMENT General Terms&Conditions Form Approved:AVP Law 03/01/2013 • UNION PACIFIC RAILROAD COMPANY ",,,," diel.NFoTM TRACTOR'S AVP RIGHT HT ENTRYOFzAGREEMENT BUILDING A '!'111 'i Exhibit D,hereto attached,to ensure uniformity with the safety standards followed by Railroad's own forces. As a part of Contractor's safety responsibilities,Contractor shall notify Railroad if Contractor determines that any of Railroad's safety standards are contrary to good safety practices. Contractor shall furnish copies of Exhibit D to each of its employees before they enter the job site. B. Without limitation of the provisions of paragraph A above,Contractor shall keep the job site free from safety and health hazards and ensure that its employees are competent and adequately trained in all safety and health aspects of the job. C. Contractor shall have proper first aid supplies available on the job site so that prompt first aid services may be provided to any person injured on the job site. Contractor shall promptly notify Railroad of any U.S.Occupational Safety and Health Administration reportable injuries. Contractor shall have a nondelegable duty to control its employees while they are on the job site or any other property of Railroad, and to be certain they do not use, be under the influence of, or have in their possession any alcoholic beverage,drug or other substance that may inhibit the safe performance of any work. D. If and when requested by Railroad,Contractor shall deliver to Railroad a copy of Contractor's safety plan for conducting the work (the "Safety Plan"). Railroad shall have the right, but not the obligation, to require Contractor to correct any deficiencies in the Safety Plan. The terms of this Agreement shall control if there are any inconsistencies between this Agreement and the Safety Plan.' Section 8. INDEMNITY. A. To the extent not prohibited by applicable statute, Contractor shall indemnify, defend and hold harmless Railroad, its affiliates,and its and their officers,agents and employees(individually an"Indemnified Party"or collectively"Indemnified Parties")from and against any and all loss,damage, injury, liability, claim,demand, cost or expense(including,without limitation,attorney's,consultant's and expert's fees,and court costs),fine or penalty(collectively,"Loss")incurred by any person (including, without limitation, any Indemnified Party, Contractor, or any employee of Contractor or of any Indemnified Party)arising out of or in any manner connected with(i)any work performed by Contractor,or(ii)any act or omission of Contractor,its officers,agents or employees,or(iii)any breach of this Agreement by Contractor. B. The right to indemnity under this Section 8 shall accrue upon occurrence of the event giving rise to the Loss,and shall apply regardless of any negligence or strict liability of any Indemnified Party,except where the Loss is caused by the sole active negligence of an Indemnified Party as established by the final judgment of a court of competent jurisdiction.The sole active negligence of any Indemnified Party shall not bar the recovery of any other Indemnified Party. C. Contractor expressly and specifically assumes potential liability under this Section 8 for claims or actions brought by Contractor's own employees. Contractor waives any immunity it may have under worker's compensation or industrial insurance acts to indemnify the Indemnified Parties under this Section 8. Contractor acknowledges that this waiver was mutually negotiated by the parties hereto. D. No court or jury findings in any employee's suit pursuant to any worker's compensation act or the Federal Employers' Liability Act against a party to this Agreement may be relied upon or used by Contractor in any attempt to assert liability against any Indemnified Party. E. The provisions of this Section 8 shall survive the completion of any work performed by Contractor or the termination or- expiration of this Agreement. In no event shall this Section 8 or any other provision of this Agreement be deemed to limit any liability Contractor may have to any Indemnified Party by statute or under common law. Section 9. RESTORATION OF PROPERTY. In the event Railroad authorizes Contractor to take down any fence of Railroad or in any manner move or disturb any of the other property of Railroad in connection with,the work to be performed by Contractor,then in that event Contractor shall,as soon as possible and at Contractor's sole expense,restore such fence and other property to the same condition as the same were in before such fence was taken down or such other property was moved or disturbed. Contractor shall remove all of Contractor's tools,equipment,rubbish and other materials from Railroad's property promptly upon completion of the work, restoring Railroad's property to the same state and condition as when Contractor entered thereon. CONTRACTOR'S RIGHT OF ENTRY Page 3 of 4 Exhibit B AGREEMENT General Terms&Conditions Form Approved:AVP Law 03/01/2013 • UNION PACIFIC RAILROAD COMPANY 14 ON %NTRACTOR'S RIGHT OF ENTRY AGREEMENT BUILDING MERCK r.uria Folin Approved:AVP Lew 03!01!2013 111111 Section 10. WAIVER OF DEFAULT. Waiver by Railroad of any breach or default of any condition,covenant or agreement herein contained to be kept,observed and performed by Contractor shall in no way impair the right of Railroad to avail itself of any remedy for any subsequent breach or default. Section 11. MODIFICATION-ENTIRE AGREEMENT. No modification of this Agreement shall be effective unless made in writing and signed by Contractor and Railroad.This Agreement and the exhibits attached hereto and made a part hereof constitute the entire understanding between Contractor and Railroad and cancel and supersede any prior negotiations,understandings or agreements,whether written or oral,with respect to the work to be performed by Contractor. Section 12. ASSIGNMENT-SUBCONTRACTING. Contractor shall not assign or subcontract this Agreement, or any interest therein, without the written consent of the Railroad. Contractor shall be responsible for the acts and omissions of all subcontractors. Before Contractor commences any work, the Contractor shall, except to the extent prohibited by law; (1) require each of its subcontractors to include the Contractor as"Additional Insured"in the subcontractor's Commercial General Liability policy and Business Automobile policies with respect to all liabilities arising out of the subcontractor's performance of work on behalf of the Contractor by endorsing these policies with ISO Additional Insured Endorsements CG 20 26,and CA 20 48(or substitute forms providing equivalent coverage;(2)require each of its subcontractors to endorse their Commercial General Liability Policy with"Contractual Liability Railroads'ISO Form CG 24 17 10 01 (or a substitute form providing equivalent coverage)for the job site;and(3)require each of its subcontractors to endorse their Business Automobile Policy with"Coverage For Certain Operations In Connection With Railroads'ISO Form CA 20 70 10 01 (or a substitute form providing equivalent coverage)for the job site. CONTRACTOR'S RIGHT OF ENTRY Page 4 of 4 Exhibit B AGREEMENT General Terms&Conditions Form Approved:AVP Law 03/012013 • UNION PACIFIC RAILROAD COMPANY NNTRACTOR'S RIGHT OF ENTRY AGREEMENT BUILDING AMERICA* Forth Approved:AVP Law 03/01/2013 f l h I I± EXHIBIT C TO CONTRACTOR'S RIGHT OF ENTRY AGREEMENT INSURANCE REQUIREMENTS Contractor shall,at its sole cost and expense,procure and maintain during the course of the Project and until all Project work on Railroad's property has been completed and the Contractor has removed all equipment and materials from Railroad's property and has cleaned and restored Railroad's property to Railroad's satisfaction,the following insurance coverage: A. COMMERCIAL GENERAL LIABILITY INSURANCE. Commercial general liability(CGL)with a limit of not less than $5,000,000 each occurrence and an aggregate limit of not less than$10,000,000. CGL insurance must be written on ISO occurrence form CG 00 01 12 04(or a substitute form providing equivalent coverage). The policy must also contain the following endorsement,which must be stated on the certificate of insurance: • Contractual Liability Railroads ISO form CG 241710 01 (or a substitute form providing equivalent coverage)showing "Union Pacific Railroad Company Property"as the Designated Job Site. • Designated Construction Project(s)General Aggregate Limit ISO Form CG 25 03 03 97(or a substitute form providing equivalent coverage)showing the project on the form schedule. B. BUSINESS AUTOMOBILE COVERAGE INSURANCE. Business auto coverage written on ISO form CA 00 01 10 01(or a substitute form providing equivalent liability coverage)with a combined single limit of not less$5,000,000 for each accident and coverage must include liability arising out of any auto(including owned,hired and non-owned autos). The policy must contain the following endorsements,which must be stated on the certificate of insurance: • Coverage For Certain Operations In Connection With Railroads ISO form CA 20 70 10 01 (or a substitute form providing equivalent coverage)showing"Union Pacific Property"as the Designated Job Site. • Motor Carrier Act Endorsement-Hazardous materials clean up(MCS-90)if required by law. C. WORKERS'COMPENSATION AND EMPLOYERS'LIABILITY-INSURANCE. Coverage must include but not be limited to: • Contractor's statutory liability under the workers'compensation laws of the state where the work is being performed. • Employers'Liability(Part B)with limits of at least$500,000 each accident,$500,000 disease policy limit$500,000 each employee. If Contractor is self-insured, evidence of state approval and excess workers compensation coverage must be provided. Coverage must include liability arising out of the U.S.Longshoremen's and Harbor Workers'Act,the Jones Act, and the Outer Continental Shelf Land Act,if applicable. The policy must contain the following endorsement,which must be stated on the certificate of insurance: • Alternate Employer endorsement ISO form WC 00 03 01 A (or a substitute form providing equivalent coverage) showing Railroad in the schedule as the alternate employer(or a substitute form providing equivalent coverage). D. RAILROAD PROTECTIVE LIABILITY INSURANCE. Contractor must maintain Railroad Protective Liability insurance written on ISO occurrence form CG 00 35 12 04(or a substitute form providing equivalent coverage)on behalf of Railroad as named insured,with a limit of not less than $2,000,000 per occurrence and an aggregate of$6,000,000. A binder stating the policy is in place must be submitted to Railroad before the work may be commenced and until the original policy is forwarded to Railroad. E. UMBRELLA OR EXCESS INSURANCE. If Contractor utilizes umbrella or excess policies,these policies must"follow form"and afford no less coverage than the primary policy. F. POLLUTION LIABILITY INSURANCE. Pollution liability coverage must be written on ISO form Pollution Liability Coverage Form Designated Sites CG 00 3912 04(or a substitute form providing equivalent liability coverage),with limits of at least CONTRACTOR'S RIGHT OF ENTRY Page 1 of 2 Exhibit C AGREEMENT Insurance Requirements Form Approved:AVP Law 03/01/2013 UNION PACIFIC RAILROAD COMPANYuT+o, IIQNTRACTOR'S RIGHT OF ENTRY AGREEMENT BUILDING AMICA' � Forth Approved:AVP Law 03/01/2013 111111 $5,000,000 per occurrence and an aggregate limit of$10,000,000. If the scope of work as defined in this Agreement includes the disposal of any hazardous or non-hazardous materials from the job site,Contractor must furnish to Railroad evidence of pollution legal liability insurance maintained by the disposal site operator for losses arising from the insured facility accepting the materials, with coverage in minimum amounts of $1,000,000 per loss,and an annual aggregate of$2,000,000. OTHER REQUIREMENTS G. All policy(ies)required above(except worker's compensation and employers liability)must include Railroad as"Additional Insured"using ISO Additional Insured Endorsements CG 20 26,and CA 20 48(or substitute forms providing equivalent coverage). The coverage provided to Railroad as additional insured shall,to the extent provided under ISO Additional Insured Endorsement CG 20 26,and CA 20 48 provide coverage for Railroad's negligence whether sole or partial,active or passive,and shall not be limited by Contractor's liability under the indemnity provisions of this Agreement. H. Punitive damages exclusion,if any,must be deleted(and the deletion indicated on the certificate of insurance),unless the law governing this Agreement prohibits all punitive damages that might arise under this Agreement. I. Contractor waives all rights of recovery,and its insurers also waive all rights of subrogation of damages against Railroad and its agents,officers,directors and employees.This waiver must be stated on the certificate of insurance. J. Prior to commencing the work, Contractor shall furnish Railroad with a certificate(s)of insurance, executed by a duly authorized representative of each insurer,showing compliance with the insurance requirements in this Agreement. K. All insurance policies must be written by a reputable insurance company acceptable to Railroad or with a current Best's Insurance Guide Rating of A-and Class VII or better,and authorized to do business in the state where the work is being performed. L. The fact that insurance is obtained by Contractor or by Railroad on behalf of Contractor will not be deemed to release or diminish the liability of Contractor,including,without limitation,liability under the indemnity provisions of this Agreement. Damages recoverable by Railroad from Contractor or any third party will not be limited by the amount of the required insurance coverage. CONTRACTOR'S RIGHT OF ENTRY Page 2 of 2 Exhibit C AGREEMENT Insurance Requirements Form Approved:AVP Law 03/01/2013 UNION PACIFIC RAILROAD COMPANY u.o� 1112NTRACTOR'S RIGHT OF ENTRY AGREEMENT t3U1LD[NO manor "c"'' Farm Approved:AVP Law 03/01/2013 1 1 1 1 1 1 • EXHIBIT D TO CONTRACTOR'S RIGHT OF ENTRY AGREEMENT MINIMUM SAFETY REQUIREMENTS The term"employees"as used herein refer to all employees of Contractor as well as all employees of any subcontractor or agent of Contractor. I. CLOTHING A. All employees of Contractor will be suitably dressed to perform their duties safely and in a manner that will not interfere with their vision,hearing,or free use of their hands or feet. Specifically,Contractor's employees must wear: i. Waist-length shirts with sleeves. ii. Trousers that cover the entire leg. If flare-legged trousers are worn,the trouser bottoms must be tied to prevent catching. iii. Footwear that covers their ankles and has a defined heel. Employees working on bridges are required to wear safety-toed footwear that conforms to the American National Standards Institute (ANSI) and FRA footwear requirements. B. Employees shall not wear boots(other than work boots),sandals,canvas-type shoes,or other shoes that have thin soles or heels that are higher than normal. C. Employees must not wear loose or ragged clothing,neckties,finger rings,or other loose jewelry while operating or working on machinery. It. PERSONAL PROTECTIVE EQUIPMENT Contractor shall require its employees to wear personal protective equipment as specified by Railroad rules, regulations, or recommended or requested by the Railroad Representative. i. Hard hat that meets the American National Standard(ANSI)Z89.1—latest revision. Hard hats should be affixed with Contractor's company logo or name. ii. Eye protection that meets American National Standard (ANSI)for occupational and educational eye and face protection,Z87.1—latest revision. Additional eye protection must be provided to meet specific job situations such as welding,grinding,etc. iii. Hearing protection,which affords enough attenuation to give protection from noise levels that will be occurring on the job site. Hearing protection,in the form of plugs or muffs,must be worn when employees are within: • 100 feet of a locomotive or roadway/work equipment • 15 feet of power operated tools • 150 feet of jet blowers or pile drivers • 150 feet of retarders in use(when within 10 feet,employees must wear dual ear protection—plugs and muffs) iv. Other types of personal protective equipment,such as respirators,fall protection equipment,and face shields, must be worn as recommended or requested by the Railroad Representative. IU. ON TRACK SAFETY Contractor is responsible for compliance with the Federal Railroad Administration's Roadway Worker Protection regulations—49CFR214,Subpart C and Railroad's On-Track Safety rules. Under 49CFR214,Subpart C,railroad contractors are responsible for the training of their employees on such regulations. In addition to the instructions contained in Roadway Worker Protection regulations,all employees must: i. Maintain a distance of twenty-five(25)feet to any track unless the Railroad Representative is present to authorize movements. CONTRACTOR'S RIGHT OF ENTRY Page 1 of 2 Exhibit D AGREEMENT Minimum Safety Requirements Form Approved:AVP Law 03/01/2013 • • . UNION PACIFIC RAILROAD COMPANY 0 ONTRACTOR'S RIGHT OF ENTRY AGREEMENT BUILDING AMERICA' "'""` Fo Approved:AVP Lew 03/01/2013 111 111 ii. Wear an orange,reflectorized workwear approved by the Railroad Representative. iii. Participate in a job briefing that will specify the type of On-Track Safety for the type of work being performed. Contractor must take special note of limits of track authority,which tracks may or may not be fouled,and clearing the track. Contractor will also receive special instructions relating to the work zone around machines and minimum distances between machines while working or traveling. IV. EQUIPMENT A. It is the responsibility of Contractor to ensure that all equipment is in a safe condition to operate. If,in the opinion of the Railroad Representative,any of Contractor's equipment is unsafe for use,Contractor shall remove such equipment from Railroad's property. In addition,Contractor must ensure that the operators of all equipment are properly trained and competent in the safe operation of the equipment. In addition,operators must be: i. Familiar and comply with Railroad's rules on Iockout/tagout of equipment. ii. Trained in and comply with the applicable operating rules if operating any by-rail equipment on-track. iii. Trained in and comply with the applicable air brake rules if operating any equipment that moves rail cars or any other railbound equipment. B. All self-propelled equipment must be equipped with a first-aid kit,fire extinguisher,and audible back-up warning device. C. Unless otherwise authorized by the Railroad Representative,all equipment must be parked a minimum of twenty-five (25)feet from any track. Before leaving any equipment unattended,the operator must stop the engine and properly secure the equipment against movement. D. Cranes must be equipped with three orange cones that will be used to mark the working area of the crane and the minimum clearances to overhead powerlines. V. GENERAL SAFETY REQUIREMENTS A. Contractor shall ensure that all waste is properly disposed of in accordance with applicable federal and state regulations. B. Contractor shall ensure that all employees participate in and comply with a job briefing conducted by the Railroad Representative,if applicable. During this briefing,the Railroad Representative will specify safe work procedures, (including On-Track Safety)and the potential hazards of the job. If any employee has any questions or concerns about the work,the employee must voice them during the job briefing. Additional job briefings will be conducted during the work as conditions,work procedures,or personnel change. C. All track work performed by Contractor meets the minimum safety requirements established by the Federal Railroad Administration's Track Safety Standards 49CFR213. D. All employees comply with the following safety procedures when working around any railroad track: i. Always be on the alert for moving equipment. Employees must always expect movement on any track, at any time,in either direction. ii. Do not step or walk on the top of the rail,frog,switches,guard rails,or other track components. iii. In passing around the ends of standing cars,engines,roadway machines or work equipment,leave at least 20 feet between yourself and the end of the equipment. Do not go between pieces of equipment of the opening is less than one car length(50 feet). iv. Avoid walking or standing on a track unless so authorized by the employee in charge. v. Before stepping over or crossing tracks,look in both directions first. vi. Do not sit on,lie under,or cross between cars except as required in the performance of your duties and only when track and equipment have been protected against movement. E. All employees must comply with all federal and state regulations concerning workplace safety. CONTRACTOR'S RIGHT OF ENTRY Page 2 of 2 Exhibit D AGREEMENT Minimum Safety Requirements Form Approved:AVP Law 03/01/2013 r"\ Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER.THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.POLICY LIMITS ARE NO LESS THAN THOSE LISTED,ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that FC-PM Development Corporation DBA Inland Asphalt CompanyNAME AND ...111 ti f y P.O.Box 3366 ADDRESS 4 Lied Mutual. Spokane WA 99220-3366 OF INSUREDii INSURANCE L is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below.The insurance afforded by the listed policy(ics)is subject to all their terms,exclusions and Conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued EXP DATE TYPE OF POLICY 0 EXTENCONTIDED POLICY NUMBER LIMIT OF LIABILITY ❑EXTENDED m POLICY TERM WORKERS 9/1/2017 WA7-C8D-004095-026 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OP THE FOLLOWING STATES: COMPENSATION WC7-C81-004095-016 WA 'WYates except OH,ND, Bodily Ig'ury by Accident :61,000,000 Bach Accident -016:WI Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1.000,000 EkcaPersen COMMERCIAL 9/1/2017 TB2-C81-004095-116 General Aggregate GENERAL LIABILITY $10,000,000 ®OCCURRENCE -Per Project Aggregate included. Products/Completed Operations Aggregate El CLAIMS MADE - Each Occurrence $10,000,000 a p St 0 $2 ,000,00 RETRO DATE Personal&Advertising Injury $2,000,000 Per Person I Organization Other Other Damage to Premises Rented to Medical Exp:$5,000 You:5250.000 AUTOMOBILE 9/1/2017 AS2-C81-004095-126Each Accident—Single Limit (-� LIABILITY $2,000,000 B.1.And P.D.Combined l:1 OWNED Each Person LO NON-OWNED Each Accident or Occurrence 121 HIRED Each Accident or Occurrence OTHER 9/1/2016-9/1/2017 -AS2-C81-054502-526 $Phyyssical Damage only -Automobile policy -$10,000 Comp -Excess Workers 9/1/2016-9/1/2017 -EW7-68N-004095-346 SIR$250 000 Compensation and Employer (WA) Excess WC-$250,000,000(includes WA stop gap)/EL-$750,000 Liability Per OCC. ADDITIONAL COMMENTS RE: Folder No.1661-80 Union Pacific Railroad is named as additional Insured with respect to the above referenced project and folder number. Waiver of subrogation is included in favor of the additional insured,where required by written contract,and where applicable by law. •If the certificate expiration date is continuous or extended term,you wilt be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE Liberty Mutual INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE Insurance Group OF SUCH CANCELLATION HAS BEEN MAILED TO: Folder No.1661-80 Union Pacific Railroad t 11.- •«cam' .- Attn: Danielle Allen Valerie Reece B I Omaha Douglas 68179et Fairfield 1049C AUTHORIZED REPRESENTATIVE z 9450 Seward Road Fairfield OH 45014 800-332-3226 4/27/2017 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 353161e6 I LM_44 19/16-9/17 - tut 10/10 I Donna Soltala 14/27/2017 2)56153 0M (CDT) I Page 1 of 1 LDI COI 268896 02 11 POLICY NUMBER:TB2-C81-004095-116 COM4ERCIAL GENERAL L IA ILiTY CG 20100418 THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ R CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -• Who is An Insured is amended to 1. All work, including materials, parts or include as an additional Insured the person(s) or equipment furnished h connection with such organaation(s) shown in the Schedule,but only with work, on the project (other than service, respect to Ilabiki for 'bodily injury", 'property maintenance or repairs)to be performed by or damage' or 'personal and advertising injury' on behalf of the additional Insured(s) at the caused,In whole or in part,by: location of the covered operations has been 1. Your acts or omissions;or completed;or 2. The acts or omissions of those acting on your 2. That portion of "your work' out of which the behalf, injury or damage arises has been put to is In the performance of your ongoing operations for Intended use by any person or organization the additional insured(s)of at the thorn for other than another contractor or subcontractor designated above. engaged in performing operations for a principal as a part of the same project. However: C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional Mam,reds, the following Is added to insured only applies to the extent permitted by Section Limits Oflnsuranee: law;and If coverage provided to the additional insured b 2. ti coverage provided to the additional Insured is required by a contract or agreement the most we required by a contract or agreement, the wig pay on behalf of the additional insured is the insurance afforded to such additional Insured coil amoutrt of insurance: not be broader than that which you aro required 1. Required by the contract or agreement;or by the contract or agreement to provide for such additional Insured. 2. Available under the applicable Links of B. With respect to the Insurance afforded to these Insurance shown in the Declarations; additional Insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to `bodily injury" or applicable Linits of Insurance shown in the 'properly damage'occurring after. Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): My owner,lessee,or contractor for whom you have Any location listed in such agreement agreed in writing prior to a loss to provide!Milky insurance Information required to complete this Schedule,if not shown above. wit be shown it the Declarations. CG 2010 0413 0 insurance Services Office,Inc.,2012 Page 1 of 1 POLICY NUMBER T82-C81-004095-116 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US • This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETEDOPERATIONS LIABILITY COVERAGE PART The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of your ongoing operations or "your work`done under a contract with that person or organization and included in the 'products- completed operations hazard".This waiver applies only to the person or organization shown in the Schedule below. SCHEDULE Name Of Person Or Organization: As required by written contract or agreement entered into prior to Toss. Information required to complete this Schedule,If not shown above, WI be shown in the Declarations. CG 24 04 05 09 el)Insurance Services Office.Inc.,2008 Page 1 of 1 r` 1. AC a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMrYY) 41.....,i 4/27/2017 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(les)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 such endorsement(s). PRODUCERCONTACT Liberty Mutual Insurance Co. National Insurance East NAME; Donna Smitala 2000 Westwood Dr. PHONE EAX o.Exit 715-870-6376 IFAtc,No): 715-842-6865 Wausau,WI 54401 E.MANL ADDRESS: Donna.Smitala C)LibertyMutual.com INSURER(S)AFFORDING COVERAGE - NAIC# www.LibertyMutual.com INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B: CPM Development Corporation DBA Inland Asphalt Company INSURER C: P.O. Box 3366 INSURER 0: Spokane WA 99220-3366 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35316263 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 AWL SUER' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER SAMIDD/YYYY) IMM/DD?YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) $ - - PERSONAL 3 ADV INJURY 5 GE %.AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ _ POLICY n, pT I I LOC PRODUCTS-COMP/OPAGG S - — OTHER: _ S AUTOMOBILE LIABILITY -C(MBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY i AUTOS ONLY (Per accident) A UMBRELLA UAB r/'OCCUR f ✓ TL2-681-054523-926 9/1/2018 9/1/2017 EACH OCCURRENCE , S 3,000,000 T EXCESS LIAB CLAIMS-MADE AGGREGATE 5 3.000,000 DED RETENTION$ Products/Completed Ops$ 3,000,000 WORKERS COMPENSATION PER STATUTE- ER 0114- AND EMPLOYERS'LIABILITY Y 1 N — I I ANYPROPRIETORIPARTNER/EXECUTIVE El.EACH ACCIDENT 5 OFFICER/MEMBEREXCLUDED7 NIA ---- (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S If yes,describe under - DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more apace Is required) RE:Folder No.1661-80 Union Pacific Railroad is named as additional insured with respect to the above referenced project and folder number. Waiver of subrogation is included in favor of the additional insured,where required by written contract,and where applicable by law. CERTIFICATE HOLDER CANCELLATION Folder No.1661-60 Union Pacific Railroad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE Attn:nDanielle Allen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1400 Douglas Street Omaha NE 68179 AUTHORIZED REPRESENTATIVE ,M [ee I Valerie Reece G1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 35316263 1 LK 44 19/16-9/17 Excess 1 Donna Smitala 1 4/27/2017 2:58:53 PM (CDT) 1 Page 1 of 1 Inland Asphalt Company PO Box 3366 Spokane,WA 99220-3366 CNI90040112 Insured Policy Number TE2-681-054545-827 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY ANNUAL MEETING NOTICE Your policy is issued by a stock insurance company subsidiary of the Liberty Mutual Holding Company Inc., a Massachusetts mutual holding company. The named insured first named in the Declarations is a member of Liberty Mutual Holding Company Inc. As a member of Liberty Mutual Holding Company Inc., the named insured first named is entitled, among other things,to vote either in person or by proxy at the annual meeting or special meetings of said company. The Annual Meeting of Liberty Mutual Holding Company Inc. is at its offices located at 175 Berkeley Street, Boston, Massachusetts,on the second Wednesday in April each year at ten o'clock in the morning. Members of Liberty Mutual Holding Company Inc.may request a copy of the company's annual financial statements, which are posted on Liberty Mutual's website at www.libertvmutual.com or by writing to Liberty Mutual Holding Company Inc., 175 Berkeley Street, Boston, Massachusetts,02116,Attention: Corporate Secretary. PARTICIPATING PROVISION You may be eligible to participate in the distribution of surplus funds of the company through any dividends that may be declared for this policy. A declaration or payment of dividends is not guaranteed. The amount of any dividends that may be declared shall be to the extent,and upon the conditions fixed and determined by the Board of Directors and in compliance with any laws that apply. In witness whereof,the company has caused this policy to be signed by its President and its Secretary. ,61040/1Kfc7/ SECRETARY PRESIDENT LIL 90 04 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 1 of 1 RAILROAD PROTECTIVE LIABILITY DECLARATIONS V41- Liberty f ` Mutual. INSURANCE Issued by Liberty Mutual Fire Insurance Company Policy Number TE2-681-054545-827 Issuing Office Bala Cynwyd,PA Renewal of New Issue Date 2017-04-28 Account Number 8-036771 Sub Account 0000 Named Insured and Mailing Address Union Pacific 1400 Douglas St Omaha, NE 68179 Form of Business Other Policy Period:The policy period is from 05/15/2017 to 05/15/2018 12:01 A.M.standard time at the Insured's mailing address. Job Location: Folder No. 1661-80 Indiana Ave Street Preservation, Street Preservation Designated Contractor: Designated Contractor Mailing Address: Inland Asphalt Company PO Box 3366 Spokane,WA 99220 Name and Address of Involved Governmental Authority or Other Contracting Party: City of Spokane Valley, 1707 E. Sprague Ave. Suite 106,Spokane Valley,WA 99206 In return for the payment of the premium, and subject to all the terms of this policy,we agree with you to provide the insurance as stated in this policy. LIMITS OF INSURANCE Each Occurrence Limit $ 2,000,000 Aggregate Limit $ 6,000,000 SCHEDULE The declarations are completed on the accompanying"Declarations Extension Schedule(s)". Railroad Protective Liability Coverage Part Premium $ 1,200 Endorsement Premium $ Other Charge(s) $ Amount Payable at Inception $ 1,200 Policywriting Minimum Premium $ Forms Applicable: See Attached Inventory Producer 0002 008060 Marsh Casualty Advisory Representative Countersigned By: 3560 Lenox Rd.,Ste 2400 Atl:: 30326 ta,GA ucer `� ,1&4 Helegda,.1 8843 Baia Cynwyd,PA 390 Authorized Representative LC 00 35 0613 0 2013 Liberty Mutual Insurance.All rights reserved. Includes copyrighted Page 1 of 1 material of Insurance Services Office,Inc.,with its permission. DECLARATIONS EXTENSION SCHEDULE—CLASSIFICATION DESCRIPTIONS Policy number TE2-681-054545-827 Class Code Description 40011 Operations-Railroad NOC -Construction Operations-Operations Performed For Railroads LCS 00 01 0512 ©2012, Liberty Mutual insurance. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DECLARATIONS EXTENSION SCHEDULE Policy Number TE2-681-054545-827 Class Code Premium Basis Rates Premium Contract Cost 40011 445,868 Flat Charge 1,200 LCS 00 02 05 12 ©2012,Liberty Mutual Insurance. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. INVENTORY COVERAGE FORMS/PARTS,ENDORSEMENTS,ENCLOSURES POLICY NUMBER: TE2-681-054545-827 ENDORSEMENT NUMBER: COMMON POLICY CONDITIONS LIL 90 04 06 13 Annual Meeting Notice LC 00 35 06 13 Railroad Protective Liability Declarations LCS 00 01 05 12 Declarations Extension Schedule-Classification Descriptions LCS 00 02 05 12 Declarations Extension Schedule IC 00 42 07 09 Inventory Coverage Forms/Parts,Endorsements,Enclosures IL 00 21 05 02 Nuclear Energy Liability Exclusion Endorsement GENERAL LIABILITY COVERAGE PART FORMS COVERAGES CG 00 35 04 13 Railroad Protective Liability Coverage Form STATE FORMS CG 28 75 12 89 Nebraska Changes- Cancellation and Nonrenewal CG 29 71 06 90 Nebraska Changes-Appraisal EXCLUSIONS CG 21 73 01 15 Exclusion of Certified Acts of Terrorism CG 26 88 01 15 Alaska Exclusion of Certified Acts of Terrorism LC 21 01 06 05 Asbestos Exclusion LC 21 02 06 05 Silica Exclusion Endorsement LC 21 40 06 05 Engineers,Architects or Surveyors Professional Liability Exclusion LC 26 02 06 05 Total Pollution Exclusion Endorsement OTHER LC 99 23 02 06 Sole Agent LC 24 40 04 16 Other Insurance Amendment—Excess Provision NOTICE TO POLICYHOLDER SNI 90 02 01 15 Terrorism Risk Insurance Act THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: C. Under any Liability Coverage, to "bodily injury" or"property damage"resulting from"hazardous "bodily Under any Liability Coverage, to injury" properties"of"nuclear material", if: or"property damage": (1) With respect to which an "insured" under (1) The "nuclear material"(a)is at any"nuclear the policy is also an insured under a nuclear facility" owned by, or operated by or on be- energy liability policy issued by Nuclear En- half of, an "insured" or (b) has been dis- ergy Liability Insurance Association, Mutual charged or dispersed therefrom; Atomic Energy Liability Underwriters, Nu- (2) The"nuclear material"is contained in"spent clear Insurance Association of Canada or fuel" or "waste" at any time possessed, any of their successors, or would be an in- handled, used, processed, stored, trans- sured under any such policy but for its ter- ported or disposed of, by or on behalf of an mination upon exhaustion of its limit of liabil- "insured"; or ity;or (3) The "bodily injury" or "property damage" (2) Resulting from the "hazardous properties" arises out of the furnishing by an "insured" of "nuclear material" and with respect to of services, materials, parts or equipment in which (a) any person or organization is re- connection with the planning, construction, quired to maintain financial protection pur- maintenance, operation or use of any "nu- suant to the Atomic Energy Act of 1954, or clear facility", but if such facility is located any law amendatory thereof, or (b) the "in- within the United States of America,its terri- sured"is, or had this policy not been issued tories or possessions or Canada,this exclu- would be, entitled to indemnity from the sion(3)applies only to"property damage"to United States of America, or any agency such "nuclear facility" and any property thereof, under any agreement entered into thereat. by the United States of America, or any 2. As used in this endorsement: agency thereof, with any person or organi- zation. "Hazardous properties" includes radioactive, toxic or explosive properties. B. Under any Medical Payments coverage, to means "source material", "S expenses incurred with respect to"bodily injury" "Nuclear eamaterial"material"ors rurce material".material", Pe resulting from the "hazardous properties" of "by-product "nuclear material"and arising out of the opera- tion of a "nuclear facility" by any person or or- ganization. IL 00 21 05 02 ©ISO Properties, Inc., 2001 Page 1 of 2 "Source material", "special nuclear material", and (c) Any equipment or device used for the pro- "by-product material" have the meanings given cessing, fabricating or alloying of "special nu- them in the Atomic Energy Act of 1954 or in any clear material"if at any time the total amount of law amendatory thereof. such material in the custody of the "insured" at "Spent fuel" means any fuel element or fuel corn- the premises where such equipment or device ponent,solid or liquid,which has been used or ex- is located consists of or contains more than 25 posed to radiation in a"nuclear reactor". grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams "Waste" means any waste material (a) containing of uranium 235; "byproduct material" other than the tailings or wastes produced by the extraction or concentration (d) Any structure, basin, excavation, premises or of uranium or thorium from any ore processed pri- place prepared or used for the storage or dis- madly for its "source material"content, and (b) re- posal of"waste"; sulting from the operation by any person or organi- and includes the site on which any of the foregoing zation of any "nuclear facility" included under the is located, all operations conducted on such site first two paragraphs of the definition of"nuclear fa- and all premises used for such operations. cility". "Nuclear reactor" means any apparatus designed "Nuclear facility"means: or used to sustain nuclear fission in a self- (a) Any"nuclear reactor"; supporting chain reaction or to contain a critical (b) Any equipment or device designed or used for mass of fissionable material. (1) separating the isotopes of uranium or pluto- "Property damage" includes all forms of radioac- nium, (2) processing or utilizing "spent fuel", or five contamination of property. (3)handling,processing or packaging"waste"; This endorsement is executed by the LIBERTY MUTUAL FIRE INSURANCE COMPANY Premium $ Effective Date Expiration Date For attachment to Policy No. TE2-681-054545-827 Audit Basis Issued To Countersigned by Authorized Representative Issued Sales Office and No. End.Serial No. IL 00 21 05 02 O ISO Properties, Inc., 2001 Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG 00 35 0413 RAILROAD PROTECTIVE LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. (2) The "bodily injury" or "property damage" Read the entire policy carefully to determine rights, arises out of acts or omissions at the "job duties and what is and is not covered. location" which are related to or are in Throughout this policy the words "you" and "your" connection with the "work" described in the refer to the Named Insured shown in the Declarations. Declarations. The words "we", "us" and "our" refer to the company c. Damages because of "bodily injury" include providing this insurance. damages claimed by any person or The word"insured"means any person or organization organization for care, loss of services or death qualifying as such under Section II — Who Is An resulting at any time from the"bodily injury". Insured. 2. Exclusions Other words and phrases that appear in quotation This insurance does not apply to: marks have special meaning. Refer to Section V — a. Expected Or Intended Injury Definitions. SECTION I—COVERAGES "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. COVERAGE A—BODILY INJURY AND PROPERTY This exclusion does not apply to "bodily injury" DAMAGE LIABILITY resulting from the use of reasonable force to 1. Insuring Agreement protect persons or property. a. We will pay those sums that the insured b. Contractual Liability becomes legally obligated to pay as damages "Bodily injury" or "property damage" for which because of"bodily injury"or"property damage" the insured is obligated to pay damages by to which this insurance applies. We will have reason of the assumption of liability in a the right and duty to defend the insured against contract or agreement.This exclusion does not any "suit" seeking those damages. However, apply to liability for damages assumed in a we will have no duty to defend the insured contract or agreement that is a "covered against any"suit" seeking damages for "bodily contract". injury" or "property damage" to which this c. Completed Work insurance does not apply. We may, •at our discretion, investigate any occurrence and "Bodily injury" or "property damage" occurring settle any claim or"suit"that may result. But: after the "work" is completed. The "work" will be deemed completed at the earliest of the (1) The amount we will pay for damages is following times: limited as described in Section III — Limits Of Insurance; and (1) When all the "work" called for in the "contractor's"contract has been completed. (2) Our right and duty to defend ends when we (2) When all the "work" be done at the " have used up the applicable limit of location"hase beencompleted. tto o let "job insurance in the payment of judgments orp ed. settlements. (3) When that part of the "work" done at the No other obligation or liability to pay sums or "job location" has been put to its intended perform acts or services is covered unless use by you, the governmental authority or explicitly provided for under Supplementary other contracting party. Payments—Coverage A. This exclusion does not apply to "bodily injury" b. This insurance applies to "bodily injury" and or "property damage" resulting from the "property damage"only if: existence of or removal of tools, uninstalled (1) The "bodily injury" or "property damage" equipment or abandoned or unused materials. occurs during the policy period;and CG 00 35 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 6 d. Acts Or Omissions Of Insured g. Damage To Owned, Leased Or Entrusted "Bodily injury" or "property damage", the sole Property proximate cause of which is an act or omission "Property damage" to property owned by you of any insured other than acts or omissions of or leased or entrusted to you under a lease or any of "your designated employees". This trust agreement. exclusion does not apply to injury or damage h. War sustained at the "job location" by any of "your designated employees" or employee of the "Bodily injury" or "property damage", however "contractor", or by any employee of the caused, arising,directly or indirectly, out of: governmental authority or any other contracting (1) War, including undeclared or civil war; party (other than you) specified in the (2) Warlike action by a military force, including Declarations. action in hindering or defending against an e. Workers'Compensation And Similar Laws actual or expected attack, by any Any obligation of the insured under a workers' government, sovereign or other authority compensation, disability benefits or using military personnel or other agents; or unemployment compensation law or any (3) Insurrection, rebellion, revolution, usurped similar law. This exclusion does not apply to power, or action taken by governmental any obligation of the insured under the Federal authority in hindering or defending against Employers Liability Act, as amended. any of these. f. Pollution COVERAGE B—PHYSICAL DAMAGE TO "Bodily injury" or"property damage"arising out PROPERTY of the actual, alleged or threatened discharge, 1. Insuring Agreement dispersal, seepage, migration, release or We will pay for "physical damage to property" to escape"of "pollutants" at or from the "job which this insurance applies. The "physical location": damage to property" must occur during the policy (1) Due to the past or present use of the "job period. The "physical damage to property" must location" by you or for you or others for the arise out of acts or omissions at the "job location" handling, storage, disposal, processing or which are related to or in connection with the treatment of waste;or "work"described in the Declarations. The property (2) Due to the dumping or disposal of waste on must be owned by or leased or entrusted to you the "job location" by the "contractor" with under a lease or trust agreement. the knowledge of you or any of "your 2. Exclusions designated employees";or This insurance does not apply to "physical (3) On which you or "contractors" working damage to property": directly or indirectly on any insured's behalf are performing operations if the "pollutants" a. Completed Work are brought on or to the "job location" in Occurring after the "work" is completed. The connection with such operations by you, the "work"will be deemed completed at the earliest "contractor"or"your designated employee". of the following times: However, this subparagraph does not apply (1) When all the "work" called for in the to: "contractor's"contract has been completed. (a) "Bodily injury" or "property damage" (2) When all the "work" to be done at the lob arising out of fuels or lubricants for location"has been completed. equipment used at the"job location". (3) When that part of the "work" done at the (b) "Bodily injury" or "property damage" "job location" has been put to its intended arising out of heat, smoke or fumes from use by you, the governmental authority or a"hostile fire". other contracting party. (4) On which you or "contractors" working This exclusion does nota 1 to directly or indirectly on any insured's behalf damage toproperty" "physical g apply resulting from the are performing operations if the operations existence of tools, uninstalled equipment or are to test for, monitor, clean up, remove, abandoned or unused materials. contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of,"pollutants". Page 2 of 6 ©Insurance Services Office, Inc., 2012 CG 00 35 0413 b. Acts Or Omissions Of Insured 4. Any railroad operating over your tracks is an The sole proximate cause of which is an act or insured. omission of any insured other than acts or SECTION III—LIMITS OF INSURANCE omissions of any of "your designated 1. The Limits of Insurance shown in the Declarations employees". and the rules below fix the most we will pay c. Nuclear Incidents Or Conditions regardless of the number of: Due to nuclear reaction, nuclear radiation or a. Insureds; radioactive contamination or to any related act b. Claims made or"suits"brought; or or condition. d. Pollution c. Persons or organizations making claims or "suits". suits . Due to the discharge, dispersal, seepage, 2. The Aggregate Limit is the most we will pay for the migration, release or escape of "pollutants" sum of all damages because of all "bodily injury", excluded under Exclusion f. Pollution, all "property damage" and all "physical damage to Coverage A. property". SUPPLEMENTARY PAYMENTS—COVERAGE A 3. Subject to Paragraph 2. above, the Each We will pay, with respect to any claim we investigate Occurrence Limit is the most we will pay for the or settle,or any"suit"against an insured we defend: sum of all damages because of all "bodily injury", 1. All expenses we incur. all "property damage" and all "physical damage to property"arising out of any one occurrence. 2. All court costs taxed against the insured in the 4. Subject to Paragraph 3. above, the payment for "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed "physical damage to property"shall not exceed the against the insured. lesser of: 3. All interest on the full amount of any judgment that a. The actual cash value of the property at the accrues after entry of the judgment and before we time of loss; or have paid, offered to pay, or deposited in court the b. The cost to repair or replace the property with part of the judgment that is within the applicable other property of like kind or quality. limit of insurance. The Limits of Insurance of this Coverage Part apply 4. The cost of bonds to release attachments, but only separately to each consecutive annual period and to for bond amounts within the applicable limit of any remaining period of less than 12 months, starting insurance.We do not have to furnish these bonds. with the beginning of the policy period shown in the 5. Expenses incurred by the insured for first aid Declarations, unless the policy period is extended administered to others at the time of an accident, after issuance for an additional period of less than 12 for"bodily injury"to which this insurance applies. months. In that case, the additional period will be deemed part of the last preceding period for purposes 6. All reasonable expenses incurred by the insured at of determining the Limits of Insurance. our request to assist us in the investigation or SECTION IV—CONDITIONS defense of the claim or"suit", including actual loss of earnings up to $250 a day because of time off A. The following Conditions apply to Coverages A from work, and B: 7. Prejudgment interest awarded against the insured 1. Assignment on that part of the judgment we pay. If we make an Assignment of interest under this Coverage offer to pay the applicable limit of insurance, we Part shall not bind us unless we issue an will not pay any prejudgment interest based on endorsement consenting to the assignment. that period of time after the offer. These payments will not reduce the limits of 2. Bankruptcy insurance. Bankruptcy or insolvency of the insured or of SECTION it—WHO IS AN INSURED the insured's estate will not relieve us of our obligations under this Coverage Part. 1. You are an insured. 3. Cancellation 2. Your "executive officers" and directors are a. You may cancel this policy by mailing or insureds, but only with respect to their duties as delivering to us advance written notice of your officers and directors. cancellation. 3. Your stockholders are insureds, but only with respect to their liability as stockholders. CG 00 35 0413 ©Insurance Services Office, Inc.,2012 Page 3 of 6 .ter :•' b. We may cancel this policy by mailing or d. Paragraph b. of this condition does not delivering to you, the "contractor" and any apply to any inspections,surveys,reports or involved governmental authority or other recommendations we may make relative to contracting party designated in the certification, under state or municipal Declarations, at the respective mailing statutes, ordinances or regulations, of addresses last known to us, written notice boilers, pressure vessels or elevators. of cancellation at least 60 days before the 6. Other Insurance effective date of cancellation. c. Notice of cancellation will state the effective The insurance afforded by this policy is: date of cancellation. The policy period will a. Primary insurance and we will not seek end on that date. contribution from any other insurance available to you except if the other d. If this policy is cancelled, any unearned insurance is provided by a contractor other premium will be refunded. If we cancel, the than the designated contractor for the same refund will be pro rata. If you cancel, the operation and"job location";and refund may be less than pro rata. The cancellation will be effective even if we b. If the other insurance is available, we will have not made or offered a refund. share with that other insurance by the e. If notice is mailed, proof of mailing will be method described below. sufficient proof of notice. If all of the other insurance permits contribution by equal shares, we will follow 4. Changes this method also. Under this approach, This policy contains all the agreements each insurer contributes equal amounts between you and us concerning the insurance until it has paid its applicable limit of afforded. You are authorized to make changes insurance or none of the loss remains, in the terms of this policy with our consent.This whichever comes first. policy's terms can be amended or waived only If any of the other insurance does not by endorsement issued by us and made a part permit contribution by equal shares, we will of this policy. contribute by limits. Under this method, 5. Inspections And Surveys each insurer's share is based on the ratio of a. We have the right to: its applicable limit of insurance to the total applicable limits of insurance of all insurers. (1) Make inspections and surveys at any 7. Premium And Premium Audit time; (2) Give you reports on the conditions we a. We will compute all premiums for this find; and Coverage Part in accordance with our rules and rates. (3) Recommend changes. b. Contract cost, the premium base shown in b. We are not obligated to make inspections, the Declarations, means the total cost of surveys, reports or recommendations and the operations described in the any such actions we do undertake relate Declarations. only to insurability and the premiums to be premium We do not make safety c. The shown in the Declarations as inspections. We do not undertake to advance premium is a deposit premium perform the duty of any person or only. At the close of each audit period we organization to provide for the health or will compute the earned premium for that safety of workers or the public. And we do period and send notice to the "contractor" not warrant that conditions: designated in the Declarations. The due date for audit and retrospective premiums is (1) Are safe or healthful; or the date shown as the due date on the bill. (2) Comply with laws, regulations, codes or If the sum of the advance and audit standards. premiums paid for the policy period is c. Paragraphs a.and b.of this condition apply greater than the earned premium, we will not only to us, but also to any rating, return the excess to the contractor advisory,rate service or similar organization designated in the Declarations. which makes insurance inspections, In no event shall the payment of premium be surveys, reports or recommendations. your obligation. Page 4 of 6 ©Insurance Services Office, Inc.,2012 CG 00 35 0413 ,.tea., .rwy 8. Transfer Of Rights Of Recovery Against (2) Notify us as soon as practicable. Others To Us You must see to it that we receive written If the insured has rights to recover all or part of notice of the claim or "suit" as soon as any payment we have made under this policy, practicable. those rights are transferred to us. The insured c. You and any other involved insured must: must do nothing after loss to impair them. At our request, the insured will bring "suit" or (1) Immediately send us copies of any transfer those rights to us and help us enforce demands, notices, summonses or legal them. papers received in connection with the 9. When We Do Not Renew claim or"suit"; (2) Authorize us to obtain records and other If we decide not to renew this Coverage Part, information; we will mail or deliver to the first Named Insured shown in the Declarations written (3) Cooperate with us in the investigation or notice of the nonrenewal not less than 30 days settlement of the claim or defense before the expiration date. against the"suit";and If notice is mailed, proof of mailing will be (4) Assist us, upon our request, in the sufficient proof of notice. enforcement of any right against any person or organization which may be B. The following Conditions apply to Coverage A liable to the insured because of injury or only: damage to which this insurance may 1. Legal Action Against Us also apply. No person or organization has a right under d. No insured will,except at that insured's own this policy: cost, voluntarily make a payment, assume a. To join us as a party or otherwise bring us any obligation, or incur any expense, other than for into a "suit" asking for damages from an first aid,without our consent. insured; or 3. Separation Of Insureds b. To sue us on this policy unless all of its Except with respect to the Limits of Insurance, terms have been fully complied with. this insurance applies: A person or organization may sue us to a. As if each Named Insured were the only recover on an agreed settlement or on a final Named Insured;and judgment against an insured; but we will not be b. Separately to each insured against whom liable for damages that are not payable under claim is made or"suit"is brought. the terms of this policy or that are in excess of the applicable limit of insurance. An agreed C. The following Conditions apply to Coverage B settlement means a settlement and release of only: liability signed by us, the insured and the 1. Appraisal claimant or the claimant's legal representative. If you fail to agree with us on the value of the 2. Duties In The Event Of Occurrence,Claim property, or the amount of loss, either you or • Or Suit we may make written demand for an appraisal a. You must see to it that we are notified as of the loss within 60 days after proof of loss is soon as practicable of an occurrence which filed. In this event, each party will select a may result in a claim. To the extent competent appraiser. The two appraisers will possible, notice should include: select a competent and impartial umpire. The (1) How, when and where the occurrence appraisers will state separately the value of the property and the amount of loss. If they fail to took place; agree, they will submit their differences to the (2) The names and addresses of any umpire. A decision agreed to by any two will be injured persons and witnesses;and binding. Each party will: (3) The nature and location of any injury or a. Pay its chosen appraiser;and damage arising out of the occurrence. b. Bear the other expenses of the appraisal b. If a claim is made or "suit" is brought and umpire equally. against any insured,you must: If we submit to an appraisal, we still retain our (1) Immediately record the specifics of the right to deny the claim. claim or "suit" and the date received; and CG 00 35 04 13 ©Insurance Services Office, Inc.,2012 Page 5 of 6 2. No Benefit To Bailee 6. "Job location" means the job location designated No person or organization, other than you, in the Declarations including any area directly having custody of the property will benefit from related to the "work" designated in the this insurance. Declarations. "Job location"includes the ways next to it. 3. Insured's Duties In The Event Of A Loss 7. "Physical damage to property" means direct and You must: accidental loss of or damage to rolling stock and a. Protect the property, whether or not the loss their contents, mechanical construction equipment is covered by this policy. Any further loss or motive power equipment, railroad tracks, due to your failure to protect the property roadbeds, catenaries, signals, bridges or shall not be recoverable under this policy. buildings. Reasonable expenses incurred in affording 8. "Pollutants" means any solid, liquid, gaseous or such protection shall be deemed to be thermal irritant or contaminant, including smoke, incurred at our request; and vapor, soot, fumes, acids, alkalis, chemicals and b. Submit to us, as soon after the loss as waste. Waste includes material to be recycled, possible, your sworn proof of loss reconditioned or reclaimed. containing the information we request to 9. "Property damage"means: settle the loss and, at our request, make available the damaged property for a. Physical injury to tangible property, including examination. all resulting loss of use of that property. All such loss of use shall be deemed to occur at 4. Legal Action Against Us the time of the physical injury that caused it;or No person or organization has a right under b. Loss of use of tangible property that is not this policy to sue us on this policy unless all of physically injured. All such loss of use shall be its terms have been fully complied with and deemed to occur at the time of the occurrence until 30 days after proof of loss is filed and the that caused it. amount of loss is determined as provided in 10."Suit" means a civilproceedingin which damages this policy. because of"bodilyinjury" or"property damage"to 5. Payment Of Loss which this insurance applies are alleged. "Suit" We may pay for the loss in money, but there includes: can be no abandonment of any property to us. a. An arbitration proceeding in which such SECTION V—DEFINITIONS damages are claimed and to which the insured 1. "Bodily injury" means bodily injury, sickness or must submit or does submit with our consent; disease sustained by a person, including death or resulting from any of these at any time. b. Any other alternative dispute resolution 2. "Contractor" means the contractor designated in proceeding in which such damages are the Declarations and includes all subcontractors claimed and to which the insured submits with working directly or indirectly for that "contractor" our consent. but does not include you. 11."Work" means work or operations performed by 3. "Covered contract" means any contract or the "contractor" including materials, parts or agreement to carry a person or property for a equipment furnished in connection with the work charge or any interchange contract or agreement or operations. respecting motive power, or rolling stock 12."Your designated employee"means: equipment. a. Any supervisory employee of yours at the "job 4. "Executive officer" means a person holding any of location"; the officer positions created by your charter, b. Any employee of yours while operating, constitution, bylaws or any other similar governing attached to or engaged on work trains or other document. railroad equipment at the "job location" which 5. "Hostile fire" means one which becomes are assigned exclusively to the"contractor";or uncontrollable or breaks out from where it was c. Any employee of yours not described in intended to be. Paragraph a. or b. above who is specifically loaned or assigned to the work of the "contractor" for the prevention of accidents or protection of property. Page 6 of 6 ©Insurance Services Office, Inc.,2012 CG 00 35 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEBRASKA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: RAILROAD PROTECTIVE LIABILITY COVERAGE PART A. Paragraphs b. of the Cancellation Condition (3) If we cancel this policy subject to b. (SECTION IV)is replaced by the following: (1) or b. (2) above, we will mail to you, the "contractor" and any other b. (1) If this policy has been in effect for involved governmental authority or 60 days or less, we may cancel this other contracting party designated in policy for any reason. the Declarations, at the respective mailing addresses known to us, (2) If this policy has been in effect for written notice of cancellation stating more than 60 days or if this is a the reasons for cancellation,at least: renewal of a policy we issued, we may cancel this policy only for one (a) 10 days before the effective date or more of the following reasons: of cancellation if we cancel for nonpayment of premium;or (a) Nonpayment of premium; (b) 60 days before the effective date (b) The policy was obtained through of cancellation if we cancel for material misrepresentation; any other reason. (c) Any insured has submitted a (4) We will mail our notice by first class fraudulent claim; mail. A United States Postal Service Certificate of Mailing shall be (d) Any insured has violated the sufficient proof of receipt of notice on terms and conditions of this the third calendar day after the date policy; of the certificate of mailing. (e) The risk originally accepted has B. Paragraph f. of the Cancellation Condition substantially increased; does not apply. (1) Certification to the Director of C. The following is added and supersedes any Insurance of our loss of provisions to the contrary: reinsurance which provided coverage to us for all or a NONRENEWAL substantial part of the underlying risk insured;or 1. If we decide not to renew this policy, we will mail written notice of nonrenewal, (g) The determination by the stating the reasons for nonrenewal, to Director of Insurance that the you, the "contractor" and any involved continuation of the policy could governmental authority or other place us in violation of the contracting party designated in the Nebraska Insurance Laws. Declarations, at least 60 days prior to the expiration date of this policy. CG 28 75 12 89 Copyright, Insurance Services Office, Inc., 1986, 1989 Page 1 of 2 2. Any notice of nonrenewal will be mailed by first class mail to you,the"contractor" and any involved governmental authority or other contracting party designated in the Declarations, at the respective mailing addresses known to us. A United States Postal Service Certificate of Mailing shall be sufficient proof of receipt of notice on the third calendar day after the date of the certificate of mailing. CG 28 7512 89 Copyright,Insurance Services Office,Inc., 1986, 1989 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEBRASKA CHANGES - APPRAISAL This endorsement modifies insurance provided under the following: RAILROAD PROTECTIVE LIABILITY COVERAGE PART The APPRAISAL Condition(Section IV)is replaced by the following: If you fail to agree with us on the value of the property,or the amount of loss,both parties may agree in writing to an appraisal of the loss and to be bound by the results of that appraisal within sixty(60)days after proof of loss is filed. If both parties so agree,then each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree,either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: 1. Pay its chosen appraiser;and 2. Bear the other expenses of the appraisal and umpire equally. If we submit to an appraisal,we will still retain the right to deny the claim. CG 29 71 06 90 Copyright, Insurance Services Office, Inc., 1990 COMMERCIAL GENERAL LIABILITY CG 21 73 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. The following exclusion is added: b. The act is a violent act or an act that is This insurance does not apply to: dangerous to human life, property or TERRORISM infrastructure and is committed by an individual or individuals as part of an effort "Any injury or damage" arising, directly or to coerce the civilian population of the indirectly,out of a"certified act of terrorism". United States or to influence the policy or B. The following definitions are added: affect the conduct of the United States Government by coercion. 1. For the purposes of this endorsement, "any C. The terms and limitations of any terrorism injury or damage"means any injury or damage exclusion, or the inapplicability or omission of a covered under any Coverage Part to which this terrorism exclusion, do not serve to create endorsement is applicable, and includes but is not limited to "bodily injury", "property coverage for injury or damage that is otherwise damage", "personal and advertising injury", excluded under this Coverage Part. "injury" or "environmental damage" as may be defined in any applicable Coverage Part. 2. "Certified act of terrorism"means an act that is certified by the Secretary of the Treasury, in accordance with the provisions Of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: a. The act resulted in insured losses in excess of$5 million in the aggregate,attributable to all types of insurance subject to the Terrorism Risk Insurance Act;and CG 21 73 01 15 ©Insurance Services Office, Inc.,2014 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 26 88 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ALASKA EXCLUSION OF CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. The following exclusion is added: b. The act is a violent act or an act that is This insurance does not apply to: dangerous to human life, property or infrastructure and is committed by an TERRORISM individual or individuals as part of an effort "Any injury or damage" arising out of a "certified to coerce the civilian population of the act of terrorism". United States or to influence the policy or B. The following definitions are added: affect the conduct of the United States Government by coercion. 1. For the purposes of this endorsement, "any C. The terms and limitations of any terrorism injury or damage" means any injury or damage exclusion, or the inapplicability or omission of a covered under any Coverage Part to which this terrorism exclusion, do not serve to create endorsement is applicable, and includes but is not limited to "bodily injury", "property coverage for injury or damage that is otherwise damage", "personal and advertising injury", excluded under this Coverage Part. "injury" or "environmental damage" as may be defined in any applicable Coverage Part. 2. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: a. The act resulted in insured losses in excess of$5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act: and CG 26 88 01 15 ©Insurance Services Office, Inc.,2015 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ASBESTOS EXCLUSION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART GARAGE COVERAGE PART LIQUOR LIABILITY COVERAGE PART MOTOR TRUCK CARGO COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRINTERS LIABILITY COVERAGE PART PRODU(,IS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY—NEW YORK WAREHOUSEMAN'S LEGAL LIABILITY COVERAGE PART This insurance does not apply to any liability,damages,loss,injury,demand,claim or"suit"arising out of or caused by, or allegedly caused by,asbestos either alone or in combination with other substances or factors. LC 21 01 06 05 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA EXCLUSION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART GARAGE COVERAGE PART LIQUOR LIABILITY COVERAGE PART MOTOR TRUCK CARGO COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRINTERS LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY—NEW YORK WAREHOUSEMEN'S LIABILITY COVERAGE PART This insurance does not apply to any liability,damages,loss,injury,demand,claim or"suit"any part of which is caused by,or allegedly caused by,silica in any form or any substance containing silica,either alone or in combination with other substances or factors,whether included in a product or otherwise. LC 21020605 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENGINEERS,ARCHITECTS OR SURVEYORS PROFESSIONAL LIABILITY EXCLUSION This endorsement modifies insurance provided under the following: RAILROAD PROTECTIVE LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2.,Exdusions of Section I—Coverage A,and Paragraph 2.,Exclusions of Section I —Coverage B This insurance does not apply to"bodily injury","property damage"or"physical damage to property"arising out of the rendering of or failure to render any professional services by you or any engineer,architect or surveyor who is either employed or hired by you or employed or hired by a"contractor"performing work on your behalf in such capacity. Professional services include: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,reports, surveys, field orders, change orders or drawings and specifications;and 2. Supervisory,inspection,architectural or engineering activities. LC 21 40 06 05 o THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL POLLUTION EXCLUSION ENDORSEMENT This endorsement modifies insurance provided under the following: • OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY—NEW YORK A. The Pollution Exclusion under Paragraph 2.,Exclusions (a) Request,demand,order or statutory or regulatory of Section I—Coverages—Bodily Injury And Property requirement that any insured or others test for, Damage Liability is replaced by the following: monitor,clean up,remove,contain,treat,detoxify or neutralize,or in any way respond to, or assess the effects of"pollutants";or This insurance does not apply to: (b) Claim or"suit"by or on behalf of a governmental Pollution authority for damages because of testing for, (1) "Bodily injury" or "property damage" which would monitoring, cleaning up, removing, containing, not have occurred in whole or part but for the actual, treating,detoxifying or neutralizing,or in any way alleged or threatened discharge, dispersal, seepage, responding to,or assessing the effects of, "pollu- migration, release or escape of "pollutants" at any tants". time. (2) Any loss,cost or expense arising out of any: LC 26 02 06 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SOLE AGENT This endorsement modifies insurance provided under the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABLITY COVERAGE PART Upon acceptance of the coverage provided under this policy the insured agrees: For the purpose of issuing instructions for the cancellation of this policy,or negotiating or altering terms of this policy, or selecting or rejecting any coverages offered, or agreeing upon settlement of losses, or receiving or receipting for payment of claims,or receiving any notices,or for making premium adjustments the organization named in the Schedule below shall be the sole and irrevocable agent of each insured. The return premiums, premium refunds and dividends, if any, which become payable under this policy are hereby assigned to and the named insured directs the company to pay the same to the organization named in the Schedule below which has assumed and agreed to fulfill all present and future obligations of the insured with respect to the payment of premiums and/or loss reimbursement under said policy. SCHEDULE Inland Asphalt Company PO Box 3366 Spokane,WA 99220 LC 99 23 02 06 Page 1 of 1 Policy Number TE2-681-054545-827 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT--EXCESS PROVISION This endorsement modifies insurance provided under the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY—NEW YORK RAILROAD PROTECTIVE LIABILITY COVERAGE PART The Other Insurance paragraph of Section IV—Conditions is replaced by the following: Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under this policy, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. b. Excess Insurance (1) This insurance is excess over any other insurance available to you that is provided by a contractor, including the designated "contractor", for the same operation and job location designated in the Declarations. (2) When this insurance is excess,we will have no duty to defend the insured against any"suit"if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss,if any,that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance;and (b) The total of all deductible and self-insured amounts under all such other insurance. LC 24 40 04 16 ©2015 Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc..with its permission. POLICYHOLDER DISCLOSURE TERRORISM RISK INSURANCE ACT THIS NOTICE CONTAINS IMPORTANT INFORMATION PURSUANT TO THE TERRORISM RISK INSURANCE ACT. PLEASE READ IT CAREFULLY. In accordance with the Terrorism Risk Insurance Act, including all amendments, ("TRIA" or the "Act"), we are required to provide you with a notice of the portion of your premium attributable to coverage for"certified acts of terrorism,"the federal share of payment of losses from such acts, and the limitation or"cap"on our liability under the Act. Disclosure of Premium The Company has made available coverage for certified acts of terrorism as defined in the Act. If purchased, the portion of your premium attributable to coverage for certified acts of terrorism is shown in the Declarations, Declarations Extension Schedule or elsewhere by endorsement in your policy. Federal Participation In Payment Of Terrorism Losses If an individual insurer's losses from certified acts of terrorism exceed a specified deductible amount,the government will reimburse the insurer for a percentage of losses(the"Federal Share")paid in excess of the deductible, but only if aggregate industry losses from certified acts of terrorism exceed the"Program Trigger". Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to certified acts of terrorism exceed$100 billion in a calendar year and we have met our deductible under the Act,we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion. Nor shall Treasury make any payment for any portion of the amount of such losses that exceeds$100 billion. In such case, insured fosses up to that amount are subject to pro rata allocation in abcordance with procedures established by the Secretary of the Treasury. The Federal Share and Program Trigger by calendar year are: Calendar Year Federal Share Program Trigger 2015 85% $100,000,000 2016 84% $120,000,000 2017 83% $140,000,000 2018 82% $160,000,000 2019 81% $180,000,000 2020 80% $200,000,000 SNI 90 02 01 15 02015 Liberty Mutual Insurance Page 1 of 1