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17-002.00 MDM Excavation: Euclid Ave Reconstruction Flora to Barker Contract This agreement is entered into this 4 day of , 2017, between the City of Spokane Valley ("City") and MDM Construction, Inc, db MDM Excavation ("Contractor"), pursuant to Title 35 RCW, as adopted or amended. In consideration of the terms and conditions contained herein and attached and made a part of this agreement,the parties agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Euclid Avenue Reconstruction Project#0251 Contract 17-002 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City. II. The City hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. • III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City by reason of entering onto this contract, except as provided herein. V. The project was awarded for the bid amount of$2,293,403.15. 1 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 April 26 , 2017. Date Mitch Swenson Printed Name Pr- .ident Title Signature r r City of Spokane Valley Aar K e& koLAI\ Printed Name City Manager Title \(\11\94_ CalGIAE,g,,,— Signature Revised I-8-1G 2 *jockano,e\ift., BOND NO:Q208810 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to MDM Construction. Inc. dba MDM Excavation (Contractor),as Principal,a contract for the construction of the project designated as Euclid Avenue Reconstruction Project , Project No.0251 in Spokane Valley,Washington,and said Principal is required to furnish a bond for performance of all obligations under the Contract. The Principal,and Berkley Insurance Company (Surety),a corporation,organized under the laws of the State of Washington 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.wo S.Treawo sury Dept ainety ere jointly and severally held and firmly bound to the City of Spokane Valley,in the sum of Thousand Four Hundred Three Dollars and 15/100 US Dollars($2,293,403.15 ) Total Contract Amount,subject to the provisions herein. The statutory 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; 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 no required for such increased obligation. This bond may be executed in two (2) original counterparts, and shall be signed by the parties' duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. • RINOIPM,JCONTRACTOR) SURETY , ' olumitio d MDM truMtit , In.. dba MDM Excavation Berkley Insurance Company `��. � uRN g ��i,,� " . ' •-17 Y7tV)V7,2aea- °.1144'841. rli Fiiptipa1Iratilfe%• ' Date Surety Signature 4-26-2017 MO'SL SEAL /if i • L•11 J �vwenio ` � .......••'. �,,, Judith C. Kaiser-Smith %ii'FtAwA�&�� + • ' 3 �wnUUtllUr P,Canted Name :' Printed Name ,. moi, '''j• ••l4eede i PP Attorney-in-Fact - 4 ' Title •j , �k` Title j a Name,address,and telephone of local office/agent of Surety Company is: PayneWest Insurance, Inc. Judith A. Rapp,Agent 501 N. Riverpoint Blvd., Suite 403, Spokane, WA 99202 509-789-7435 Approved as to form: City of Spokane Valley Attorney,County of Spokane Date ,. CITY(lane BOND NO: 0208810 CONTRACTOR'S NON-FEDERAL PAYMENT BOND to City of Spokane Valley,Washington The City of Spokane Valley. Washington, in Spokane County. has awarded to MDM Construction, Inc. dba MDM Excavation (Contractor).as Principal.a contract for the construction of the project designated as Euclid Avenue Reconstruction Project ,Project NoD251 in Spokane Valley,Washington.and said Principal is required under the terms of the Contract to furnish a payment bond in accord with Title 39.08 Revised Code of Washington(RCW). The Principal.and Berkley Insurance Company (Surety).a corporation organized under the laws of the State of Washington and Iicensed 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 Two Million Two Hu dred Ninety Three bound to the City of Spokane Valley,in the sum Of Thousand Four Hundred Three Dollars and 15/100 US Dollars (S 2,293,403.15 1 Total Contract Amount.subject to the provisions herein. The statutory 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 RCW 39.08 and 39.12 including all workers.laborers.mechanics,subcontractors,and materiaimen.and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work,and all taxes incurred on said Contract under Title 50 and 51 RCW and all taxes imposed on the Principal under Title 82 RCW 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 no required for such increased obligation. This bond may be executed in two (2)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 behalfof the surety. %Q M:CIP (CONTRACTOR) SURETY owun►►nll�, .,t•,°"1 MDM{ nstitiag•• , In dba MDM Excavation Berkley Insurance Company 1('',/ ,..,.:-.•-•Lel/ *VILA•°"'' ..i...1,/... ' •r -- •- / .. Py .AL =_ -. ' Pugcip_ _ am `� •r. ate urety Signature 4-26-2017 ! es•. •A Q, : M i.tc -Swen c E •. -' mmn►►m0 L• .F.. _ h ti i1`h C. Kaiser-Smith r tntpd a ie y Printed Name • " =-� f 1,-,...?",,,-,..` 2res% en ,V� Attorney-in-Fact '��r Title.e..No.��yti Title y `-r '„ ,B'/4"vpr di:ttttt'i° Name.address,and telephone of local office/agent of Surety Company is: PayneWest Insurance, Inc. Judith A. Rapp,Agent 501 N. Riverpoint Blvd., Suite 403, Spokane, WA 99202 509-789-7435 Approved as to form: City of Spokane Valley Attorney,County of Spokane Date No.BI-7801f POWER OF ATTORNEY ,. BERKLEY INSURANCE COMPANY WILMINGTON,DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly a organized and existing under the laws of the State of Delaware,having its principal office in Greenwich, CT,has made,constituted ea •and appointed,and does by these presents make,constitute and appoint:James E.Majeskey II;Judith C. Kaiser-Smith;Judith A. 7 IRapp; Thomas V.A. Davis;Shanalee E. Steele; or Jaclyn R. Kruse of Payne West Insurance,Inc. of Spokane, WA its true and 'is .0-lawful Attorney-in-Fact,to sign its name as surety only as delineated below and to execute,seal,acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed i •E Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed and .n acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. cn En a E This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following o resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25,2010: > ‘- .� c° RESOLVED, that, with respect to the Surety business written by Berkley Surety Group, the Chairman of the Board, Chief E o Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant o ° Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to wexecute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the o -i• orporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such °' a"' attorney-in-fact and revoke any power of attorney previously granted;and further a,o RESOLVED,that such power of attorney limits the acts of those named therein to the bonds,undertakings,recognizances,or uother suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner H and to the extent therein stated;and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and -o further :E .3 RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any o bo Q„.5 power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or .= g other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as t 3 though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any E person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have d ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, the Company has caused these presents to be signed and attested by its appropriate officers and its ., o corporate seal hereunto affixed this -ft-day of aee.-j ,2016. o_.� Attest: Berkley Insurance Company eel I - F (Seal) By {� B . �i,+a el 1 All o' s _ Ira S.Lederman Je 4, after 1 o'',1 - ..-.7, � _ Executive Vice President&Secretary S'r or V ;• President 8 2 WARNING;THIS POWER INVALID IF NOT PRINTED ON BLUE"BERKLEY"SECURITY PAPER, -0 8 n STATE OF CONNECTICUT) I; , ) ss: COUNTY OF FAIRFIELD ) Sworn to before me, a Notary Public in the State of Connecticut,thisday of O , 2016,by Ira S.Lederman and ,5 Jeffrey M. Hailer who are sworn to me to be the Executive Vice President and G�•Secretary, and a Senior Vice President, cti g respectively, of Berkley Insurance Company.MARIA C.RUNDBAKEN NOTARY PUBLIC ,r.�,•;y4 �1( MY COMMISSION EXPIRES Notary Public, State of Connecticut 1 o APRIL 30,2019 0 CERTIFICATE 4 I, the undersigned,-Assistant Secretary of BERKLEY INSURANCE COMPANY,DO HEREBY CERTIFY that the foregoing is a true, correct 5 and complete copy of the original Power of Attorney;that said Power of Attorney has not been revoked or rescinded and that the authority of the t)Attorney-in-Fact set forth therein,who executed the bond or undertaking to which this Power of Attorney is attached,is in full force and effect as Y of this date. Given-udder my hand and seal of the Company,this26th day of April A/017 T — n uAli1, (Seal) — - / A Vincent_. •rte y, •- s ' Please verify the authenticity of the instrument attached to this Power by: Toll-Free Telephone: (800) 456-5486; or Electronic Mail: BSGInquiry@berkleysurety.com Any written notices, inquiries, claims or demands to the Surety on the bond attached to this Power should be directed to: Berkley Surety Group 412 Mount Kemble Ave. Suite 310N Morristown, NJ 07960 Attention: Surety Claims Department Or Email: BSGClaim@berkleysurety.com Please include with all communications the bond number and the name of the principal on the bond. Where a claim is being asserted, please set forth generally the basis of the claim. In the case of a payment or performance bond, please also identify the project to which the bond pertains. - - - Berkley Surety Group is an operating unit of W. R. Berkley Corporation that underwrites surety business on behalf of Berkley Insurance Company, Berkley Regional Insurance Company and Carolina Casualty Insurance Company. BOND NO: 0208811 ,'valley° CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to MDM Construction, Inc. dba MDM Excavation("Contractor"),as Principal, a contract for the construction of the project designated as the Euclid Avenue Reconstruction Project, Project No. 0251 (the "Contract") in Spokane Valley, Washington. The Principal, existing under and by virtue of the laws of the State of Washington and authorized to do business in the State of Washington, and Berkley Insurance Company organized and existing under the laws of the State of Delaware and authorized to transact business in the State of Washington as Surety, are jointly and severally held and bound unto the City of Spokane Valley, hereinafter called Obligee, and are similarly held and bound unto the beneficiaries of the trust fund created b chapter 60.28 RCW, in the penal sum of 5% of the Contract, which is One Hundred Fourteen Th?m galx Hundred dollars ($ 114,670.16 ), .s'Pventy and 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 , 20_,7 the said Principal and Obligee herein executed and entered.into the Contract. WHEREAS, said Contract and chapter 60.28 RCW require the Obligee to withhold from the Principal the sum of 5% from monies earned by the Principal on estimates during the progress of the construction, hereinafter referred to as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under chapter 60.28 RCW. NOW THEREFORE,the condition of the obligation is such that the Principal and Surety are held and bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW in the aforesaid sum. This bond, including any proceeds therefrom, is subject to all claims and liens and in the same manner and priority as set forth for retained percentages in chapter 60.28 RCW. The condition of this obligation is also such that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund purposes of chapter 6028 RCW to the Obligee, and indemnify and hold the Obligee harmless from any and all loss, costs, and damages that the Obligee may sustain by release of the earned retained funds to the Principal,then upon notification of such satisfaction and release of the Surety by the Obligee,this obligation shall be null and void. PROVIDED HOWEVER,that: 1. The Surety shall be liable under this obligation as Principal. The Surety will not be discharged or released from liability for any act,omission or defenses of any kind or nature that would not also discharge Principal. 2. This obligation shall be binding upon and inure to the benefit of the Principal,the Surety,the Obligee,the beneficiaries of the trust fund created by chapter 60.28 RCW and their respective heirs, executors,administrators,successors and assigns. 3. Any suit under this bond must be instituted within the time provided by applicable law. i 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 officerceexecuting on behalf of the surety. l picric P., a( ,a► � •CTOR) MDM Construction, SURETY Berkl-y Insurance Company -F+111•..L�-N- ' .f. Inc. dba MDM Excavation 4�h~l iffgei,. `d __—T-7- '�.s..�� -��. ..,. �i,i41 � ` 4/26/2017 • .••` ,••fi'rincipj :-a . ✓ Date Surety Signature Date •-l' .,J.,tc - brjG® Judith C. Kaiser—Smith - �; prinfe4W e a c Printed Name - _v ;§ _ ,....t-',`'IIeSi��l"�nt= C.', Attorney—in—r^^act '• `� -.✓12,x, `ffe' ®,fi; Title /� `S ✓J��'��m Name,�dci ss.. g telephone of local office/agent of Surety Company is: ) - eWest Insurance Inc. Judith A. Rap ' A_ent 501 N. Riverpoint Blvd. , Suite 403, Spokane, WA 99202 (509) 789—'7435 .,:titwtt t IA No.BI-7801f y POWER OF ATTORNEY BERKLEY INSURANCE COMPANY ' WILMINGTON,DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly 2 organized and existing under the laws of the State of Delaware,having its principal office in Greenwich, CT,has made,constituted „ and appointed,and does by these presents make,constitute and appoint:James E.Majeskey H;Judith C. Kaiser-Smith;Judith A. i "Rapp; Thomas V.A. Davis;Shanalee E. Steele;or Jaclyn R. Kruse of PayneWest Insurance,Inc. of Spokane, WA its true and .0 lawful Attorney-in-Fact,to sign its name as surety only as delineated below and to execute,seal, acknowledge and deliver any and .0 all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed 178 .°Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed and 1 .o acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. col cil raijR This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following o 0 resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25,2010: .�o RESOLVED, that, with respect to the Surety business written by Berkley Surety Group, the Chairman of the Board, Chief 0 c Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant , = Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to cd = execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the O y corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such 3 ° attorney-in-fact and revoke any power of attorney previously granted;and further ¢. g RESOLVED,that such power of attorney limits the acts of those named therein to the bonds,undertakings,recognizances,or other suretyship obligations specifically named therein,and they have no authority to bind the Company except in the manner H 5 and to the extent therein stated;and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and -0 further ct RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any o to p..a power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as 5 3 though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any 1 person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have o r ceased to be such at the time when such instruments shall be issued. -o IN WITNESS WHEREOF, the Company has caused these presents to be signed and attested by its appropriate officers and its ., o corporate seal hereunto affixed this",day of Qf f cam(. ,2016. Attest:. Berkley Insurance Company es .1' (,Seal) r--- By I iita.r.A1 ii o H 4 r Ira S.Lederman Je' .1 : after o �"' . Executive Vice President&Secretary ' S.nior V = President 2 WARNING:THIS POWER INVALID IF NOT PRINTED ON BLUE"BERKLEY"SECURITY PAPER -0 E P. N STATE OF CONNECTICUT) Cl. CO L 'E ) ss: 2 COUNTY OF FAIRFIELD ) ° Notaryy 4' by � �, Sworn to before me, a Public in the State of Connecticut, this da of 2016, Ira S. Lederman and Jeffrey M. Hatter who are sworn to me to be the Executive Vice president and Secretary,y, and e Senior Vice President, § _`'d respectively, of Berkley Insurance Company.MARIA C.flUNDBAKEN .31/421-1--. G.• ,e."-�-ty4: �/t 74 NOTARY PUBLIC Q MY COMMISSION EXPIRES Notary Public, State of Connecticut Io APRIL 30,2019 C7 ,0 CERTIFICATE 4 I,the undersigned,Assistant Secretary of BERKLEY INSURANCE COMPANY,DO HEREBY CERTIFY that the foregoing is a true, correct and complete copy of the original Power of Attorney;that said Power of Attorney has not been revoked or rescinded and that the authority of the aUi Attorney-in-Fact set forth therein,who executed the bond or undertaking to which this Power of Attorney is attached,is in full force and effect as i of this date. %_ . - Given under my hand and seal of the Company,this 26th day of April �,/ 01.7 Vincent •rrte , Please verify the authenticity of the instrument attached to this Power by: Toll-Free Telephone: (800) 456-5486; or Electronic Mail: BSGInquiry a@berkleysurety.corn Any written notices, inquiries, claims or demands to the Surety on the bond attached to this Power should be directed to: Berkley Surety Group 412 Mount Kemble Ave. Suite 310N Morristown, NJ 07960 Attention: Surety Claims Department Or Email: BSGClaim@berkleysurety.com • Please include with all communications the bond number and the name of the y - principal on the bond. Where a claim is being asserted, please set forth generally;__:, : the basis of the claim. In the case of a payment or performance bond, please atso� identify the project to which the bond pertains. Berkley Surety Group is an operating unit of W. R. Berkley Corporation that underwrites surety business on behalf of Berkley Insurance Company, Berkley Regional Insurance Company and Carolina Casualty Insurance Company. MDMCONS-02 BSOUDER ACORN' CERTIFICATE OF LIABILITY INSURANCE DATE 05(01/2017) 05/01/2017 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER NAME:CONTACT Spokane Office 509 838-3501 �FAx ) PayneWest Insurance,Inc. (7/8,10,Ext):( ) (A/c,No):(509 838-3511 501 N.Riverpoint Blvd.,Ste 403 E-MAILDSS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Western Insurance Company _10804 INSURED INSURER B: MDM Construction Inc INSURER C: DBA:MDM Excavation P.O.Box 2006 INSURER D: Hayden,ID 83835 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 l/ CLAIMS-MADE X OCCUR CPA6025924 09/01/2016 09/01/2017 DRGEEoENTD nG3) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY 1,000,000 ✓ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000to POLICY X 5T8f LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,006A. A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X X CPA6025924 09/01/2016 09/01/2017 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOSBODILYBODILY INJURY(Per accident) $ AUTOS ONLY _ AUU OILY (PerracGtle^t�AMAGE A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE CPA6025924 09/01/2016 09/01/2017 AGGREGATE _$ 4,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N/A Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) City of Spokane Valley and its officers,elected officials,employees,agents and volunteers,Spokane County and its officers,elected officials,employees, agents and volunteers and Consolidated Irrigation District 19 and its officers,elected officials,employees,agents and volunteers are named as additional insured per policy forms with primary and non-contributory wording. Waiver of subrogation and per project aggregate per policy forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Spokane County Consolidated Irrigation District 19 1026 West Broadway Avenue AUTHORIZED REPRESENTATIVE Spokane,WA 99260 &44,46-6-d- (+ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CLCG00200112 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR GENERAL LIABILITY PLATINUM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. PROPERTY DAMAGE TO BORROWED EQUIPMENT 1. Paragraph 2.j. of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perform operations at the time of loss. 2. SECTION III-LIMITS OF INSURANCE is deleted and replaced by the following: The most we will pay in any one "occurrence" for"property damage" to borrowed equipment is $15,000. This limit of insurance is the most we will pay regardless of the number of: a. Insureds; b. Claims made or"suits"brought;or c. Persons or organizations making claims or bringing"suits". 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of$250 as applicable to property damage as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any"suits" seeking those damages;and your duties in the event of an "occurrence", claim, or "suit"apply irrespective of the application of the deductible amount. c. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken;you shall promptly reimburse us for such part of the deductible amount as we have paid. B. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT 1. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A(SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: a. A Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shdwn in the Declarations. b. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the"products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought;or (3) Persons or organizations making claims or bringing"suits". CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 1 of 4 Office,Inc.,with its permission c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. d. The limits shown in the Declarations for Each Occurrence,Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A(SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which cannot be attributed only to ongoing operations at a single designated construction project away from premises owned by or rented to the insured: a. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable;and b. Such payments shall not reduce any Single Construction Project General Aggregate Limit. 3. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of"bodily injury"or"property damage"included in the"products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit or the Single Construction Project General Aggregate Limit. 4. If the applicable construction project away from premises owned by or rented to the insured has been abandoned, delayed,or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. C. LIMITED JOB SITE POLLUTION 1. Exclusion f.under Section I-Coverage A is replaced by the following: 2. Exclusions This insurance does not apply to: f. Pollution (1) "Bodily injury"or"property damage" arising out of the actual, alleged or threatened discharge, dispersal,seepage,migration,release or escape of"pollutants": (a) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize,or in any way respond to,or assess the effects of,"pollutants";or (b) At or from a storage tank or other container, ducts or piping which is below or partially below the surface of the ground or water or which, at any time, has been buried under the surface of the ground or water and then subsequently exposed by erosion, excavation or any other means if the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants"arises at or from any premises,site or location which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the "pollutants" are brought on or to the premises,site or location in connection with such operations by such insured,contractor or subcontractor. Subparagraph(b)does not apply to"bodily injury"or"property damage"arising out of heat, smoke or fumes from a"hostile fire". (2) Any loss,cost or expense arising out of any: (a) Request, demand,order or statutory or regulatory requirement issued or made pursuant to any environmental protection or environmental liability statutes or regulations that any insured test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to,or assess the effects of,"pollutants";or Page 2 of 4 Includes copyrighted material of Insurance Services CL CG 00 20 01 12 Office, Inc.,with its permission (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring,cleaning up, removing, containing,treating, detoxifying, or neutralizing or in any way responding to or assessing the effects of,"pollutants". However,this paragraph does not apply to liability for those sums the insured becomes legally obligated to pay as damages because of"property damage"that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or"suit"by or on behalf of a governmental authority. 2. With respect to "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge,dispersal,seepage,migration, release or escape of"pollutants": a. The"Each Occurrence Limit"shown in the Declarations does not apply. b. Paragraph 7.of Limits Of Insurance(Section III)does not apply. c. Paragraph 1.of Section III-Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought;or (3) Persons or organizations making claims or bringing"suits". d. The following are added to Section III-Limits Of Insurance: 8. Subject to 2.or 3.above,whichever applies,the most we will pay for the sum of: a. Damages under Coverage A;and b. Medical expenses under Coverage C because of "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge,dispersal,seepage, migration,release or escape of"pollutants"is$100,000 aggregate. 9. Subject to 8. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of"bodily injury" sustained by any one person arising out of the actual, alleged or threatened discharge,dispersal,seepage,migration,release or escape of"pollutants". D. VOLUNTARY PROPERTY DAMAGE 1. The following is added to Section 1 -COVERAGES: We will pay, at your request for"property damage"to that part of any property: a. Which you or any subcontractors working directly or indirectly on your behalf are performing operations;or b. That must be restored,repaired or replaced because"your work"was incorrectly performed on it. This insurance applies only to "property damage"to property of others while in your care, custody, or control,and arising out of operations away from your insured premises and incidental to your business. Exclusions j.(3),(4),(5)and(6)do not apply to this coverage. This insurance does not apply to "property damage" included within the "explosion hazard", the "collapse hazard"or the"underground property damage hazard". 2. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION III - LIMITS OF INSURANCE is replaced by the following: A. Limits of Insurance 1. Unless a higher limit is shown in the Declarations,the most we will pay in any one"occurrence"for "property damage"under this endorsement is$15,000. 2. Unless a higher limit is shown in the Declarations, the most we will pay for all covered "occurrences"during any one policy period is$15,000 Aggregate Limit of Insurance. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 3 of 4 Office, Inc.,with its permission The Limits of Insurance of this endorsement apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case,the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance,including those with respect to our right and duty to defend the insured against any"suits"seeking those damages; and your duties in the event of an"occurrence", claim, or"suit"apply irrespective of the application of the deductible amount. c. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken;you shall promptly reimburse us for such part of the deductible amount as we have paid. 4. For the purposes of the coverage provided by D.VOLUNTARY PROPERTY DAMAGE, SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: In the event of loss covered by this endorsement, the insured shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs at actual cost to the insured, excluding prospective profit or overhead charges of any nature. Any property so paid for or replaced shall, at our option, become our property. Any payment made by us shall not constitute an admission of liability by an insured,or by us. b. Paragraph 4.Other Insurance is amended as follows: (1) Paragraph 4.a. Primary Insurance is deleted. (2) Subparagraphs(1)and(2)of paragraph 4.b. Excess Insurance are deleted and replaced with the following: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis. All other provisions that apply to paragraph 4. Other Insurance contained in the Commercial General Liability Coverage Form are applicable. 5. For the purposes of the coverage provided by D.VOLUNTARY PROPERTY DAMAGE, the following definitions are added to SECTION V-DEFINITIONS: a. "Collapse hazard" includes "structural property damage" and any resulting "property damage" to any other property at any time. b. "Explosion hazard"includes"property damage"arising out of blasting or explosion. The"explosion hazard" does not include "property damage" arising out of the explosion of air or steam vessels, piping under pressure, prime movers,machinery or power transmitting equipment. c. "Structural property damage" means the collapse of or structural injury to any building or structure due to: (1) Grading of land, excavating, borrowing, filling, back-filling, tunneling, pile driving, cofferdam work or caisson work;or (2) Moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support of that building or structure. d. "Underground property damage hazard" includes "underground property damage" and any resulting"property damage"to any other property at any time. e. "Underground property damage" means "property damage" to wires, conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any apparatus used with them beneath the surface of the ground or water,caused by and occurring during the use of mechanical equipment for the purpose of grading land, paving, excavating, drilling, borrowing, filling, back-filling or pile driving. Page 4 of 4 Includes copyrighted material of Insurance Services CL CG 00 20 01 12 Office, Inc.,with its permission • COMMERCIAL GENERAL LIABILITY CL CG 04 92 09 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ULTRA PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGE EXTENSIONS Provision Name Of Coverage Extension Included or Limit of Insurance A. Miscellaneous Additional Insureds Included B. Expected Or Intended Injury Or Damage Included C. Knowledge Of Occurrence Included D. Legal Liability—Damage To Premises Rented To You(Fire, Lightning, $300,000 Explosion,Smoke, Or Leakage From Automatic Fire Protective Systems) E. Medical Payments $10,000 F. Mobile Equipment Redefined Included G. Newly Formed Or Acquired Organization, Partnership Or Limited Liability Included Company And Extended Period Of Coverage H. Who Is An Insured—Amendment Included I. Non-Owned Watercraft(Increased to maximum length of less than 51 Included feet) J. Supplementary Payments—increased Limits 1. Bail Bonds $3,000 2. Loss Of Earnings $1,000 K. Unintentional Omission Or Unintentional Error In Disclosure Included L. Waiver Of Transfer Of Rights Of Recovery Against Others Included M. Liberalization Clause Included N. Incidental Medical Malpractice Included The above is a summary only.Please consult the specific provisions that follow for complete information on the extensions provided. The provisions of the Commercial General Liability additional insured on your policy, provided Coverage Part apply except as otherwise provided in that: this endorsement. This endorsement applies only if a. The written contract or written agreement such Coverage Part is included in this policy. is: A. MISCELLANEOUS ADDITIONAL INSUREDS (1) Currently in effect or becoming 1. Section 11—Who is An Insured is amended effective during the term of this to include as an insured any person or policy;and organization (referred to as an additional (2) Fully executed by you and the insured below) described in Paragraphs additional insured prior to the "bodily A.1.c.(1) through A.1.c.(8) below when you and such person or organization have agreed injury", "property damage" or "per- In writing in a contract or agreement that sonal and advertising injury". such person or organization be added as an CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 7 with its permission b. The insurance afforded by this provision performed by or on behalf of does not apply to any person or such additional insured. organization included as an additional (4) Lessor Of Leased Equipment insured by a separate endorsement issued by us and made a part of this Any person(s) or organization(s) policy or coverage part. from whom you lease equipment but only with respect to liability for"bodily c. Only the following persons or organi- injury", "property damage" or "per- zations are additional insureds under this sonal and advertising injury" caused, provision, with coverage for such in whole or in part, by your additional insureds limited as provided maintenance, operation or use of herein: equipment leased to you by such (1) Managers Or Lessors Of Premises person(s)or organization(s). A manager or lessor of premises but A person's or organization's status only with respect to liability arising as an additional insured under this out of the ownership, maintenance or endorsement ends when their written use of that part of the premises contract or written agreement with leased to you and subject to the you for such leased equipment ends. following additional exclusions: This insurance does not apply to any This insurance does not apply to: "occurrence" which takes place after (a) Any "occurrence" which takes the equipment lease expires. place after you cease to be a (5) State, Municipality, Governmental tenant in that premises. Agency Or Subdivision Or Other (b) Structural alterations, new con- Political Subdivision — Permits Or lzatlons Relating To struction or demolition operations Premises performed by or on behalf of such additional insured. Any state, municipality, govern- (2) Mortgagee,Assignee Or Receiver mental agency or subdivision or other political subdivision subject to A mortgagee, assignee, or receiver the following additional provisions: but only with respect to their liability (a) This insurance applies only with as mortgagee, assignee, or receiver respect to: and arising out of the ownership, maintenance, or use of a covered (i) The following hazards for premises by you. which the state, municipality, This insurance does not apply to governmental agency or structural alterations, new con- subdivision or other political struction or demolition operations subdivision has issued performed by or on behalf of such permit or authorization in additional insured. connection with premises you own, rent or control and (3) Owners Or Other Interests From to which this insurance Whom Land Has Been Leased applies: An owner or other interest from (1.1) The existence, whom land has been leased to you maintenance, repair, but only with respect to liability construction, erection arising out of the ownership, mainte- or removal of adver- nance or use of that part of the land tising signs, awnings, leased to you and subject to the canopies, cellar following additional exclusions: entrances, coal holes, driveways, manholes, This insurance does not apply to: marquees, hoist away (a) Any "occurrence" which takes openings, sidewalk place after you cease to lease vaults, street banners that land. or decorations and (b) Structural alterations, new con- similar exposures;or struction or demolition operations CL CG 04 92 0916 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 7 with its permission (1.2) The construction, erec- The insurance afforded the tion or removal of vendor does not apply to: elevators;or (i) "Bodily injury" or "property (1.3) The ownership, main- damage" for which the tenance or use of any vendor is obligated to pay elevators covered by damages by reason of the this insurance. assumption of liability in a (ii) Operations performed by you written contract or written or onyour behalf for which agreement. This exclusion does not apply to liability for the state, municipality, damages that the vendor governmental agency or would have in the absence of subdivision or other political the written contract or written subdivision has issued a agreement; permit or authorization. (b) This insurance does not apply to (ii) Any express warranty unau- thorized"bodily injury", "property dam- age" by you; or"personal and advertising (iii)Any physical or chemical injury" arising out of operations change in the product made performed for the state, munici- intentionally by the pality, governmental agency or vendor; subdivision or other political (iv)Repackaging, except when subdivision. unpacked solely for the (6) Controlling Interest purpose of inspection, Any person(s) or organization(s)with demonstration,testing,or the a controlling interest in the Named substctions fromof partse anu- Insured but only with respect to their instructions the mthen liability arising out of: facturer, and then repackaged in the original (a)Their financial control of you;or container; • (b) Premises they own, maintain or (v) Any failure to make such control while you lease or occupy inspections, adjustments, these premises. tests or servicing as the vendor has agreed to make This insurance does not apply toy o structural alterations, new con- mor enin the undertakescourse of struction or demolition operations makebusiness, n usual with performed by or for such person(s) the in connection sale the or organization(s). the distribution or sale of the products; (7) Co-Owner Of Insured Premises (vi)Demonstration, installation, A co-owner of a premises co-owned servicing or repair opera- by you and covered under this tions, except such operations insurance but only with respect to the performed at the vendor's co-owner's liability as co-owner of premises in connection with such premises. the sale of the product; (8) Vendors (vii) Products which, after distri- bution(a) Any person(s) or organization(s) sale you, have (referred to as vendor), but only been labb sale orr relabeled or used as a container, part or with respect to "bodily injury" or "property damage"arising out of ingredient of any other thing "yourproducts" which are orsubstance by or for the vendor;or distributed or sold in the regular course of the vendor's business. CL CG 04 92 0916 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 7 with its permission (viii)"Bodily injury" or "property 3. With respect to the insurance afforded to the damage" arising out of the additional insureds within this Provision A. sole negligence of the Miscellaneous Additional Insureds, the vendor for its own acts or following is added to Section III — Limits Of omissions or those of its Insurance: employees or anyone else The most we will pay on behalf of the acting on its behalf. How- additional insured is the amount of insurance: ever, this exclusion does not apply to: a. Required by the written contract or (1.1) The exceptions written agreement;or contained in Sub- b. Available under the applicable Limits Of paragraphs (iv) or(vi); Insurance shown in the Declarations; or whichever is less. (1.2) Such inspections, ad- This endorsement shall not increase the justments, tests or applicable Limits Of Insurance shown in the servicing as the Declarations. vendor has agreed to make or normally B. EXPECTED OR INTENDED INJURY OR undertakes to make in DAMAGE the usual course of Exclusion 2.a. Expected Or Intended Injury of business, in con- Section I — Coverage A — Bodily Injury And vection with the Property Damage Liability is deleted and distribution or sale of the products. replaced by the following: (b) This insurance does not apply to a. Expected Or Intended Injury Or Damage any insured person or organi- "Bodily injury"or"property damage"expected zation, from whom you have or intended from the standpoint of the acquired products, or any insured. This exclusion does not apply to ingredient, part or container, "bodily injury" or"property damage" resulting entering into, accompanying or from the use of reasonable force to protect containing such products. persons or property. 2. With respect to coverage provided by this C. KNOWLEDGE OF OCCURRENCE Provision A. Miscellaneous Additional Insureds, the following additional provisions Paragraph 2.a. Duties In The Event Of apply: Occurrence, Offense, Claim Or Suit of Section IV— Commercial General Liability Conditions a. Any insurance provided to an additional is deleted and replaced by the following: insured designated under Paragraphs • A.1.c.(1) through A.1.c.(8) above does a. You must see to it that we are notified as not apply: soon as practicable of an "occurrence" or an offense which may result in a claim only (1) To "bodily injury" or "property when the "occurrence" or offense is known damage" included within the to: "products-completed operations hazard"; or (1) You,if you are an individual; (2) To "bodily injury", "property damage" (2) A partner,if you are a partnership; or "personal and advertising injury" (3) A manager, if you are a limited liability arising out of the sole negligence of company;or such additional insured. (4) An "executive officer" or the "employee" b. The insurance afforded to such additional designated by you to give such notice, if insured only applies to the extent you are an organization other than a permitted by law. partnership or a limited liability company. c. The insurance afforded to such additional To the extent possible,notice should include: insured will not be broader than that which you are required to provide by the (i) How, when and where the "occurrence" written contract or written agreement. or offense took place; CL CG 04 92 0916 Includes copyrighted material of Insurance Services Office,Inc., Page 4 of 7 with its permission (ii) The names and addresses of any injured you, or in the case of damage by fire, persons and witnesses;and lightning, explosion, "smoke", or leakage from automatic fire protective systems, (iii)The nature and location of any injury or damage arising out of the "occurrence" while rented you or offense. occupied by youu with permission of the temporarily owner. D. LEGAL LIABILITY — DAMAGE TO PREMISES This limit will apply to all damage RENTED TO YOU (Fire, Lightning, Explosion, proximately caused by the same event, Smoke, Or Leakage From Automatic Fire whether such damage results from fire, Protective Systems) lightning, explosion, "smoke", leakage If damage to premises rented to you is not from automatic fire protective systems,or otherwise excluded from this policy or coverage other covered causes of loss or any part,then the following provisions apply: combination thereof. 1. Under Section I — Coverage A — Bodily 4. Subparagraph b.(1)(a)(ii) of Paragraph 4. Injury And Property Damage Liability, the Other Insurance of Section IV — last paragraph (after the exclusions) is Commercial General Liability Conditions deleted and replaced by the following: is deleted and replaced by the following: Exclusions c.through n.do not apply to dam- (ii) That is fire, lightning, explosion, "smoke" age by fire, lightning, explosion, "smoke", or or leakage from automatic fire protective leakage from automatic fire protective systems insurance for premises rented to systems to premises while rented to you or you or temporarily occupied by you with temporarily occupied by you with the permission of the owner; permission of the owner. A separate limit of 5. Subparagraph a. of Definition 9. "Insured insurance applies to this coverage as contract" of Section V — Definitions is described in Section III — Limits Of deleted and replaced by the following: Insurance. a. A contract for a lease of premises. 2. The paragraph immediately after Sub- paragraph j.(6) of Paragraph 2. Exclusions However, that portion of the contract for of Section I — Coverage A — Bodily Injury a lease of premises that indemnifies any And Property Damage Liability is deleted person or organization for damage by and replaced by the following: fire, lightning, explosion, "smoke" or leakage from automatic fire protective Paragraphs (1), (3) and (4) of this exclusion systems to premises while rented to you do not apply to "property damage" (other or temporarily occupied by you with than damage by fire, lightning, explosion, permission of the owner is not an "smoke", or leakage from automatic fire "insured contract". protective systems) to premises, including 6. As used in this Provision D. Legal Liability— the contents of such premises, rented to you Damage To Premises Rented To You: for a period of seven or fewer consecutive days.A separate limit of insurance applies to "Smoke" does not include smoke from Damage To Premises Rented To You as agricultural smudging, industrial operations described in Section III — Limits Of or"hostile fire". Insurance. E. MEDICAL PAYMENTS 3. Paragraph 6. of Section III — Limits Of If Coverage C — Medical Payments is not Insurance is deleted and replaced by the otherwise excluded from this policy or coverage following: part, the Medical Expense Limit is changed, 6. Subject to Paragraph 5. above, the subject to the terms of Section Ill — Limits Of greater of: Insurance,to the greater of: a. $300,000;or a. $10,000;or b. The Damage To Premises Rented b. The Medical Expense Limit shown in the To You Limit shown in the Declarations. Declarations, F. MOBILE EQUIPMENT REDEFINED is the most we will pay under under Co • f.(1) of Definition 12. "Mobile A for damages because of "property equipment"of Section V—Definitions is deleted damage" to premises while rented to and replaced by the following: CL CG 04 92 0916 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 7 with its permission (1) Equipment with a gross vehicle weight of partnership or limited liability company 1,000 pounds or more and designed primarily are the same or similar to the operations for: of insureds already covered under this (a) Snow removal; insurance; (b) (v) Coverage only applies for those limited Road maintenance, but not construction or resurfacing;or liability companies who have established a date of formation as recorded within (c) Street cleaning; the filed state articles of organization, G. NEWLY FORMED OR ACQUIRED ORGANIZA- orgaficat of formation or certificates of TION, PARTNERSHIP OR LIMITED LIABILITY organization;and COMPANY AND EXTENDED PERIOD OF (vi)Coverage only applies for those part- COVERAGE nerships who have established a date of formation as recorded within a written Paragraph 3. of Section II—Who Is An Insured is deleted and replaced by the following: partnership agreement or partnership certificate. 3. Any organization you newly acquire or form, H. WHO IS AN INSURED—AMENDMENT other than a joint venture, and over which you maintain ownership or: The last paragraph of Section Il — Who Is An a. Majority interest of more than 50% if you Insured is deleted and replaced by the following: are a corporation; No person or organization is an insured with b. Majority interest of more than 50% as a respect to the conduct of any: general partner of a newly acquired or a. Current partnership or limited liability formed partnership;and/or company, unless otherwise provided for c. Majority interest of more than 50% as an under Paragraph 3. of Section II — Who Is An Insured; owner of a newly acquired or formed limited liability company; b. Current joint venture;or will qualify as a Named Insured if there is no c. Past partnership, joint venture or limited other similar insurance available to that liability company; organization. However, for these organiza- that is not shown as a Named Insured in the tions: Declarations. (i) Coverage under this provision is afforded I. NON-OWNED WATERCRAFT only until the next anniversary date of this policy's effective date after you Subparagraph (2) of Exclusion 2.g. Aircraft, acquire or form the organization, Auto Or Watercraft of Section I— Coverage A partnership or limited liability company, —Bodily Injury And Property Damage Liability or the end of the policy period,whichever is deleted and replaced by the following: is earlier; (2) A watercraft you do not own that is: (ii) Section I—Coverage A—Bodily Injury (a) Less than 51 feet long; and And Property Damage Liability does not apply to "bodily injury" or "property (b) Not being used to carry persons or damage" that occurred before you property for a charge. acquired or formed the organization, J. SUPPLEMENTARY PAYMENTS—INCREASED partnership or limited liability company; LIMITS (iii)Section I — Coverage B — Personal Section I — Supplementary Payments — And Advertising Injury Liability does Coverages A And B is changed as follows: not apply to' "personal and advertising injury" arising out of an offense 1. The limit shown in Paragraph 1.b. for the committed before you acquired or formed cost of bail bonds is changed from $250 to the organization, partnership or limited $3,000;and • liability company; 2. The limit shown in Paragraph 1.d.for loss of (iv)Coverage applies only when operations earnings because of time off from work is of the newly acquired organization, changed from$250 a day to$1,000 a day. CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 6 of 7 with its permission K. UNINTENTIONAL OMISSION OR UNINTEN- M. LIBERALIZATION CLAUSE TIONAL ERROR IN DISCLOSURE The following is added to Section IV — The following provision is added to Paragraph 6. Commercial General Liability Conditions: Representations of Section IV — Commercial If we adopt a mandatory attachment form change General Liability Conditions: which broadens coverage under this edition of However, the unintentional omission of, or the Commercial General Liability CG0001 for no unintentional error in, any information given or additional charge, and those changes are provided by you shall not prejudice your rights intended to apply to all insureds under this edition under this insurance. of CG0001, that change will automatically apply This provision does not affect our right to collect to your insurance as of the date we implement additional premium or to exercise our right of the change in your state. This liberalization cancellation or non-renewal. clause does not apply to changes implemented through introduction of a subsequent edition of L. WAIVER OF TRANSFER OF RIGHTS OF the Commercial General Liability form CG0001. RECOVERY AGAINST OTHERS N. INCIDENTAL MEDICAL MALPRACTICE The following is added to Paragraph 8. Transfer 1. Paragraph 2.a.(1)(d) of Section II — Who Is Of Rights Of Recovery Against Others To Us An Insured does not apply to a physician, of Section IV — Commercial General Liability nurse practitioner, physician assistant, nurse, Conditions: emergency medical technician or paramedic We waive any right of recovery we may have employed by you if you are not in the against any person or organization because of business or occupation of providing medical, payments we make for injury or damage arising paramedical, surgical, dental, x-ray or out of your ongoing operations or"your work"and nursing services. included in the "products-completed operations 2. This provision is excess over any other valid hazard" when you have agreed in a written and collectible insurance whether such contract or written agreement that any right of insurance is primary, excess, contingent or recovery is waived for such person or on any other basis. Any payments by us will organization. This waiver applies only to the follow Paragraph 4.b. of Section IV — person(s) or organization(s) agreed to in the Commercial General Liability Conditions. written contract or written agreement and is subject to those provisions. This waiver does not apply unless the written contract or written agreement has been executed prior to the"bodily injury"or"property damage". However, if any person or organization is separately scheduled on a separate waiver of transfer of rights of recovery which is attached to this policy,then this waiver does not apply. • CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 7 with its permission COMMERCIAL GENERAL LIABILITY CL CG 20 71 09 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES, • CONTRACTORS OR OTHERS - COMPLETED OPERATIONS - AUTOMATIC STATUS, INCLUDING PRIMARY NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO IS AN INSURED is amended For purposes of this endorsement,throughout to include as an additional insured any person(s) the policy, the terms"you"and"your" refer to • or organization(s) when you are obligated by the Named Insured shown in the Declarations. virtue of a written contract or agreement that such person or organization(s) be added as an B. Exclusions additional insured to your policy. With respect to the insurance afforded to these Such person(s) or organization(s) is an additional additional insureds, the following additional insured only with respect to liability for "bodily exclusions apply to "bodily injury" and "property injury" or "property damage" or "personal and damage"arising out of: advertising injury"caused, in whole or in part by: 1. The rendering of or failure to render any (1) Acts or omissions of the Named Insured; professional services by you or on your behalf, or but only with respect to either or both of the following operations: (2) The acts or omissions of those acting on behalf of the Named Insured;, a. Providing engineering, architectural or surveying services to others in your and included in the "products-completed capacity as an engineer, architect or operations hazard" surveyor;and This insurance applies only when you are required b. Providing, or hiring independent to add the additional insured by virtue of a written professionals to provide, engineering, contract or agreement, provided the contract or architectural or surveying services in agreement is: connection with construction work you 1. Currently in effect or becomes effective during perform. the term of this policy; and This exclusion applies even if the claims against 2. Was executed prior to the "bodily injury" or any insured allege negligence or other "property damage" or "personal and wrongdoing in the supervision, hiring, employment, of others by advertising injury". that training insured, if the"occurrence"which h caused the However: "bodily injury"or"property damage",or the offense a. The insurance afforded to such additional which caused the "personal and advertising insured only applies to the extent permitted by injury", involved the rendering of, or the failure to law;and render,any professional architectural,engineering or surveying services. b. If coverage provided to the additional insured 2. Subject to Paragraph 3. below, professional is required by a contract or agreement, the services include: insurance afforded to such additional insured will not be broader than that which you are a. Preparing,approving,or failing to prepare required by the contract or agreement to or approve, maps, shop drawings, provide for such additional insured. opinions, reports, surveys, field orders, • " change• orders, ' or • drawings • and specifications;and CL CG 20 71 09 16 Includes copyrighted material of Insurance Services Page 1 of 2 Office, Inc.,with its permission b. Supervisory or inspection activities D. Other Insurance performed as part of any related For purposes of this endorsement,the following is architectural or engineering activities. added to the Section IV- Commercial General 3. Professional services do not include services Liability Conditions, 4. Other Insurance within construction means, methods, condition and supersedes any provision to the techniques, sequences and procedures contrary: employed by you or performed by or for the This insurance is excess of all other insurance construction manager, its employees or its available to an additional insured whether on a subcontractors in connection with your primary, excess, contingent or any other basis. ongoing operations. But, if required by a written contract or written C. Limits of Insurance agreement to be primary and noncontributory,this With respect to the insurance afforded to these insurance will be primary to and will not seek contribution from any insurance on which the additional insureds,the following is added to Section III-Limits Of Insurance: additional insured is a Named Insured. If coverage provided to the additional insured is No other coverage or limit in the policy applies to required by a contract or agreement,the most we loss or damage insured by this coverage. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. • This endorsement shall not increase the applicable Limits of Insurance shown in the • Declarations. Page 2 of 2 Includes copyrighted material of Insurance Services CL CG 20 71 0916 Office, Inc.,with its permission COMMERCIAL AUTO CL CA 01 49 02 15 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE EXPANSION ENDORSEMENT - PLATINUM This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to the coverages provided by this endorsement,the provisions of the Business Auto Coverage Form apply unless modified by this endorsement. A. NEWLY ACQUIRED OR FORMED ORGANIZA- ganization is liable for"bodily injury"or"prop- TIONS erty damage": because of the conduct of an "insured" under Paragraphs a. or b. under The following is added to Paragraph A.1.Who Is An Insured of Section II-Covered Autos Liability Paragraph A.1.Who Is An Insured of Section II-Covered Autos Liability Coverage, caused Coverage: by an"accident"and resulting from the owner- Any organization you newly acquire or form,other ship, maintenance or use of a covered"auto"; than a partnership,joint venture or limited liability 2. The written contract or agreement described company or any organization excluded either by above must have been executed prior to the this Coverage Part or by endorsement, and over "accident" that caused the "bodily injury" or which you maintain ownership or majority interest "property damage"and be in effect at the time of more than 50 percent will qualify as a Named of such"accident"; Insured. However: 3. The insurance afforded to any such additional 1. This insurance does not apply to any newly ac- "insured"does not apply to any"accident"be- quired or formed organization that is an "in- yond the period of time required by the written sured" under any other automobile policy or contract or agreement described above; would be an "insured" under such policy but for its termination or the exhaustion of its Limit 4. The most we will pay on behalf of such addi- of Insurance. tional"insured(s)"is the lesser of: 2. Coverage does not apply to "bodily injury" or a. The Limits of Insurance specified in the "property damage" that occurred before you written contract or agreement described acquired or formed the organization. above;or 3. Coverage under this provision is afforded only b. The Limits of Insurance shown in the Dec- until the 180th day after you acquire or form larations. the organization or the end of the policy pe- This provision shall not increase the Limit of rind,whichever is earlier. Insurance shown in the Declarations in this B. ADDITIONAL INSURED BY CONTRACT OR policy or coverage part;and AGREEMENT 5. The following changes are made to Paragraph The following is added to Paragraph A.1..Who Is 5. Other Insurance of B. General Conditions An Insured of Section II- Covered Autos Liability under Section IV-Business Auto Conditions: Coverage: a. The following is added to Paragraph 5.a.: When you have agreed in a written contract or If required by the written contract or agreement to include a person or organization as agreement described above, the insur- an additional "insured", such person or organiza- ance afforded to the additional insured un- tion is included as an "insured" subject to the fol- der this provision will be primary to, and lowing: will not seek contribution from, the addi- 1. Such person or organization is an additional tional insured's own insurance. "insured"only to the extent such person or or- b. Paragraph b.c.Is deleted in its entirety.... CL CA 01 49 02 15 Includes copyrighted material of Insurance Services Page 1 of 5 Office,Inc.,with its permission 6. Paragraph A.1.c. under Section II - Covered 2. We will also pay reasonable and necessary Autos Liability Coverage is deleted in its en- expenses to facilitate the return of the stolen tirety. "auto"to you. 7. The definition of"insured contract"under Sec- 3. It is agreed and understood and it is our stated tion V-Definitions is amended to add the fol- intent that expenses incurred by you under the lowing: Transportation Expenses Coverage Exten- sionAn "insured contract" does not include that will not also be covered or paid under the part of any contract or agreement: Rental Reimbursement Coverage provided by this endorsement or any rental reimbursement That pertains to the ownership, maintenance coverage added by separate endorsement to or use of an "auto" and which indemnifies a this policy. person or organization for other than the vicar- H. EXTENDED COVERAGE-AIRBAGS ious liability of such person or organization for "bodily injury"or"property damage"caused by The following is added to Exclusion B.3.a.of Sec- your operation or use of a covered"auto". tion III- Physical Damage Coverage: However,a person or organization is an addi- However, this exclusion does not apply to the un- tional"insured"under this provision only to the intended discharge of an airbag. extent such person or organization is not This coverage is excess over any other collectible named as an "insured" by separate endorse- insurance or warranty providing such airbag cov- ment to this policy. erage.. C. EMPLOYEES AS INSUREDS I. AUTO LOAN/LEASE GAP COVERAGE The following is added to Paragraph A.1. Who Is The following is added to Section III - Physical An Insured Section II - Covered Autos Liability Damage Coverage, Paragraph C. Limits of Insur- Coverage: ance. Any"employee"of yours is an"insured"while us- 4. In the event of a total "loss" to a covered ing a covered"auto"you don't own,hire or borrow "auto",we will pay any unpaid amount due on in your business or your personal affairs. the lease or loan for a covered"auto", less: D. INCREASED COVERAGE-BAIL BONDS a. The amount under the Physical Damage The Supplementary Payments Coverage Exten- Coverage section of the policy;and sion of Section II-Covered Autos Liability Cover- b. Any: age is amended as follows: (1) Overdue lease/loan payments at the The Limit of Insurance in paragraph A.2.a.(2) is time of the"loss"; increased to$5,000. E. INCREASED COVERAGE - LOSS OF EARN- (2) Financial penalties imposed under a INGS lease for excessive use, abnormal wear and tear or high mileage; The Supplementary Payments Coverage Exten- (3) Security deposits not returned by the sion of Section II-Covered Autos Liability Cover- lessor; age is amended as follows: The Limit of Insurance in paragraph A.2.a.(4) is (4) Costs for extended warranties,Credit increased to$1,000. Life Insurance, Health, Accident or Disability Insurance purchased with F. FELLOW EMPLOYEE COVERAGE the loan or lease; and The Fellow Employee Exclusion contained in Sec- (5) Carry-over balances from previous tion II-Covered Autos Liability Coverage does not loans or leases. apply. This coverage is excess over any other col- J. GLASS REPAIR-NO DEDUCTIBLE lectabie insurance. G. COVERAGE EXTENSION-TRANSPORTATION The following is added to Paragraph D.Deductible EXPENSES of Section III- Physical Damage Coverage: Paragraph A.4.a. Transportation Expenses of Any Comprehensive Coverage deductible shown Section III-Physical Damage Coverage is in the Declarations does not apply to "loss" to amended as follows: glass when you elect to patch or repair rather than replace the glass. 1. The Limits of Insurance are increased to$75 K. INCREASED COVERAGE - ELECTRONIC per day to a maximum of$2,500. •EQUIPMENT • .. .. • .. Page 2 of 5 Includes copyrighted material of Insurance Services CL CA 01 49 02 15 Office, Inc.,with its permission The$1,000 limit indicated in Paragraph C.1.b.un- The following is added to Paragraph A.4. Cover- der Section III-Physical Damage Coverage is in- age Extensions of Section III - Physical Damage creased to$2,500. Coverage: L. EXTENDED COVERAGE - PERSONAL PROP- If hired "autos" are covered "autos" for Covered ERTY Autos Liability Coverage and if Physical Damage The following is added to Paragraph A.4. Cover- Coverage is provided for any"auto"you own,then the Physical Damage coverages provided are ex- age Extensions of Section III - Physical Damage tended to "autos" you lease, rent, hire or borrow Coverage: from someone other than your"employees", part- Physical Damage Coverage on a covered "auto" ners or members of their households subject to the may be extended to"loss"to your personal prop- following: erty or,if you are an individual,the personal prop- 1. The most we will pay in any one "loss"is the erty of a family member, that is in the covered lesser of: "auto"at the time of"loss"and caused by an"ac- cident"and resulting from the ownership, mainte- a. The actual cash value of the"auto"; nance or use of a covered"auto". b. The cost to repair or replace the"auto";or The insurance provided by this coverage exten- c. $100,000. sion is excess over any other collectible insur- ance. The most we will pay for any one"loss"un- 2. Paragraph 1.above is subject to a deductible. - der this coverage extension is$500. However,our The deductible shall be equal to the amount of payment for"loss"to personal property will only be the highest deductible shown for any owned for the account of the owner of the property. "auto" of the same classification for that cov- erage. In the event there is no owned"auto" Under this provision, personal property does not of the same classification,the highest deduct- include and we will not pay for"loss"of currency, ible for any owned "auto" will apply for that coins,securities or contraband. coverage. No deductible applies to this coverage extension. No deductible will apply to "loss" caused by M. TOWING fire or lightning. Paragraph A.2. Towing of Section III - Physical 3. Hired Auto Physical Damage Coverage is Damage Coverage,is replaced by the following: subject to the following: If a private passenger type "auto" or light truck a. If symbol 8 Is shown in the Covered Auto "auto"(0-10,000 Lbs.GVW)is provided both Corn- section of the Declarations page for any of prehensive and Collision Coverage,we will pay up the Physical Damage coverages,then the to$150 for towing and labor costs incurred each Hired Auto Physical Damage coverage time such"auto" is disabled. If a medium, heavy described in this endorsement does not or extra-heavy truck or extra-heavy Truck-tractor apply. "auto"(greater than 10,000 Lbs.GVW)is provided b. Other than indicated in Paragraphs a. di- both Comprehensive and Collision Coverage, we rectly above, coverage provided under will pay up to$250 for towing and labor costs in- this provision will be excess over any curred each time such "auto" is disabled. How- other collectible insurance or coverage. ever,the labor must be performed at the place of disablement. 4. In addition to the limit set forth in Paragraph 1. N. FIRE EXTINGUISHER RECHARGE above we will pay up to $500 per day, to a maximum of$3,500 per"loss"for: The following is added to Paragraph A.4. Cover- a. Any costs or fees associated with the age Extensions of Section IV- Physical Damage "loss"to a hired"auto";and Coverage: When fire extinguishers are kept in your covered b. Loss of use of the hired"auto",provided it "auto"and any are discharged in an attempt to ex- tinguish a fire,we will pay the lesser of the actual which you are legally liable, and as a re- ost of recharging or replacing such fire extin- suit of which a monetary loss Is sustained cost oby the leasing or rental concern. r(s). deductible applies to this coverage However, Paragraph A.4.b. Loss of Use Ex- Nopenses under Section III- Physical Damage Coy- 0. HIRED AUTO PHYSICAL DAMAGE COVER- erage of the Business Auto Coverage Form does AGE not apply. •• • P.• RENTAL REIMBURSEMENT•COVERAGE • • • • CL CA 01 49 02 15 Includes copyrighted material of Insurance Services Page 3 of 5 Office, Inc.,with its permission We will pay for rental reimbursement expenses in- (3) Your members or managers, if you curred by you for the rental of an"auto" because are designated in the Declarations as of"loss"to a covered"auto". a limited liability company; 1. Payment applies in addition to the otherwise (4) Your executive officers if you are des- applicable amount of each coverage you have ignated in the Declarations as an or- on the covered"auto". ganizatlon other than an individual, 2. No deductible applies to this coverage. partnership,joint venture or limited Ii- ability company; and 3. We will pay only for those expenses incurred (5) The spouse of any person named in during the policy period beginning 24 hours af- Paragraphs 1.a.(1). through 1.a.(4) ter.the"loss"and ending,regardless of the ex- while a resident of the same house- piration date of the policy, with the lesser of hold; the following number of days: a. The number of days when the covered Except: "auto"has been repaired or replaced,or (a) Any"auto"owned by that individ- ualb. 45 days. or by any member of his or her household. 4. Our payment is limited to the lesser of the fol- (b) Any"auto"used by that individual lowing amounts: or his or her spouse while working • a. Necessary and actual expenses incurred; in a business of selling,servicing, or repairing or parking"autos". b. Not more than$75 for any one day; 2. Changes In Auto Medical Payments And 5. We will pay up to an additional $300 for the Uninsured And Underinsured Motorists Coverages reasonable and necessary expenses you in- cur to remove your materials and equipment The following is added to Who Is An Insured: from the covered"auto"and replace such ma- Any individual named in 1.a above and his or terials and equipment on the rental"auto", her"family members"are"insured"while"oc- 6. This coverage does not apply while there are cupying" or while a pedestrian when being spare or reserve "autos" available to you for struck by any"auto"you don't own except: your operations. Any"auto"owned by that individual or by any 7. If"loss"results from the total theft of a covered "family member". "auto"of the"private passenger type",we will 3. Changes in Physical Damage Coverage pay under this coverage only that amount of your rental reimbursement expenses which is Any private passenger type "auto" you don't not already provided for under the Physical own, hire or borrow is a covered "auto"while Damage Coverage Extension of the Business in the pare,custody or control of any individual Auto Coverage Form or any endorsements named in Q.1.a. above or his or her spouse thereto while a resident of the same house-hold ex- However, this provision does not apply to the cept: extent that rental reimbursement is provided a. Any"auto"owned by that individual or by by separate endorsement to this policy. any member of his or her household;or Q. DRIVE OTHER CAR COVERAGE b. Any"auto"used by that individual or his or 1. The following is added to Section II-Covered her spouse while working in a business of Autos Liability Coverage: selling,servicing,repairing or parking"au- Autos a. Any"auto"you don't own, hire or borrow 4. The most we will pay for the total of all dam- is a covered "auto"for Liability Coverage ages under Covered Autos Liability Uninsured while being used by: Motorists Coverage and Underinsured Motor- (1) You,if you are designated in the Dec- ists Coverage is the Limit Of Insurance shown larations as an individual; in the Declarations as applicable to owned (2) Your partners or members, if you are "autos". designated in the Declarations as a 5. Our obligation to pay for, repair, return or re- partnership or joint venture; place damaged or stolen property under Phys- ical Damage Coverage, will be reduced by a •• • ••• •- •. •• • •• •• •• •• • deductible equal to the amount of the highest • • ••• Page 4 of 5 Includes copyrighted material of Insurance Services CL CA 01 49 0215 Office, Inc.,with its permission deductible shown for any owned private pas- prejudice the coverage provided to you. However, senger type "auto" applicable to that cover- this provision does not affect our right to collect age. If there are no owned private passenger additional premium or exercise our right of cancel- type "autos", the deductible shall be$250 for lation or nonrenewal. Comprehensive Coverage and$500 for Colli- sion Coverage. No deductible will apply to U. LIBERALIZATION "loss"caused by fire or lightning. If we revise this endorsement to provide greater 6. Additional Definition coverage without additional premium charge, we will automatically provide the additional coverage As used in this DRIVE OTHER CAR Provi- to all endorsement holders as of the day the revi- sion: sion is effective in your state. "Family member" means a person related to the individual named in 1.a. by blood, mar- riage or adoption who is a resident of the indi- vidual's household, including a ward or foster child. R. KNOWLEDGE OF AN ACCIDENT,CLAIM,SUIT OR LOSS The following is added to Paragraph A.2.of Sec- tion IV-Business Auto Conditions: Your obligation to provide prompt notice of an"ac- cident", claim, "suit" or"loss"is satisfied if you or a person designated by you to be responsible for insurance matters is notified of, or in any manner made aware of an"accident",claim,"suit"or"loss" and provides us such notice as soon as practica- ble S. WAIVER OF SUBROGATION BY CONTRACT OR AGREEMENT The following is added to Paragraph A.5 of Sec- tion IV-Business Auto Conditions: We waive any right of recovery we may have against a person or organization because of pay- ments we make for "bodily injury" or "property damage"when you and such person or organiza- tion have agreed in writing in a contract or agree- ment to waive such right of recovery,provided: 1. Such written contract or agreement was: a. Made prior to the"accident" or"loss" resulting in the covered "bodily injury" or"property damage"; and b. Was in effect at the time of the covered"bodily in- jury"or"property damage". 2. The covered "bodily injury" or"property damage" must arise out of the operations specified in such written contract or agreement. 3. At our request you must provide us with a copy of the aforementioned written contract or agreement. T. UNINTENTIONAL OMISSIONS The following is added Paragraph B.2.of Section IV-Business Auto Conditions: If you fail to disclose any hazards existing at the • inception date of this policy, such failure will not • •• •- •• • • -- • CL CA 01 49 02 15 Includes copyrighted material of Insurance Services Page 5 of 5 Office, Inc.,with its permission MDMCONS-02BSOUDER DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/01/2017 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Spokane Office PHONEFAX (509) 838-3501(509) 838-3511 (A/C, No, Ext):(A/C, No): PayneWest Insurance, Inc. E-MAIL 501 N. Riverpoint Blvd., Ste 403 ADDRESS: Spokane, WA 99202 INSURER(S) AFFORDING COVERAGENAIC # Continental Western Insurance Company10804 INSURER A : INSURED INSURER B : MDM Construction, Inc. INSURER C : DBA MDM Excavation INSURER D : P.O. Box 2006 Hayden, ID 83835 INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFPOLICY EXP INSRADDLSUBR TYPE OF INSURANCEPOLICY NUMBERLIMITS (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A 1,000,000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ 300,000 DAMAGE TO RENTED X CPA602592409/01/201709/01/2018 CLAIMS-MADEOCCUR XX $ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ 2,000,000 X PRO- POLICYLOC PRODUCTS - COMP/OP AGG$ JECT WA STOP GAP1,000,000 OTHER:$ A 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) X CPA602592409/01/201709/01/2018 XX ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ PROPERTY DAMAGE HIREDNON-OWNED (Per accident)$ AUTOS ONLYAUTOS ONLY $ A 10,000,000 XX UMBRELLA LIAB OCCUR EACH OCCURRENCE$ CPA602592409/01/201709/01/2018 EXCESS LIAB CLAIMS-MADE AGGREGATE$ Aggregate10,000,000 DEDRETENTION$ $ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE; Euclid Avenue Reconstruction Project, Spokane Valley Capital Improvement Project No. 0251 SVPW Bid No.; 17-002 City of Spokane Valley, Spokane County, Union Pacific Railroad Company and Consolidated Irrigation District 19 are listed as additional insured per the attached policy forms. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 11703 E Sprague Suite B-3 Spokane, WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD