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18-015.00 WM Winkler: Appleway Trail Sullivan to Corbin
Contract T This agreement is entered into this 1 s day of1ru , 2018, between the City of Spokane Valley ("City")and Wm.Winkler Company("Contractor"),psuant 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: Appleway Trail Project#0237 Contract 18-015 in accordance with and as described in the project plans and specification,and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City. II. The City hereby promises and agrees with the Contractor to employ,and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors,and assigns,does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City by reason of entering onto this contract,except as provided herein. V. The project was awarded for the bid amount of$1,980,763.96. IN WITNESS WHEREOF,the Contractor has executed this instrument,on the date below, and the City has caused this instrument to be executed on the date stated above. City of Spokane Valley 20 Contract Forms Appleway Trail Project Executed by Contractor January 22 ,2018. Date Brian J.Winkler Printed Name President Title Signa City of Spokane Valley Mark Calhoun Printed Name City Manager Title Signature 14%i'od I-s-It, City of Spokane Valley 21 Contract Forms Applcway Trail Project t • 2. I11, x . 1 .6j' '. BOND NO: 106821591 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County,has awarded to Wm. Winkler Company (Contractor),as Principal,a contract for the construction of the project designated as Annlewav Trap Project No.fZ in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The principal, and Travelers Casualty and Surety Company of America (Surety), a corporation, organized under the laws of Connecticut and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sunt of SI.980.763.96 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications,additions,and changes to said Contract that may hereafter be made,at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contrach and if such performance obligations have not been fulfilled,this bond shall remain in,frill force and effect The Surety for value received agrees that no change,extension of time,alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. Wm.Winkler Company Travelers Casualty and Surety CompanyblAme,lca PRINCIPAL(CONTRACTOR) SURETY 1/22/2018 _3122d018 `*- Signature + � tiac Signattm Date Surety Signature _ "Mate *Wrier Thomas V A Davis • -?/fie- Printed Name ; tde ^' Attorney-in-Fact - �%' Tit/7e Title /174 ',,,,,..p1aitue,address,and telephone of local office/agent of Surety Company is: f avneVyest insurance. Inc.: 501 N. Rtya<tpoint Blvd.. Suite 403: Spokane,WA 99202 14,xt. .f! 1.1.1= City of Spokane Valley 22 Contract Fonna Appleway Tran.Project Ramie . 00 '• BOND NO: 106821591 CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley,Washington, in Spokane County,has awarded to Wm. Winkler Company (Contractor),as Principal,a contract for the construction of the project designated as ikualewav Trail Project No.=in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Pte, and Travelers Casualty and Surety Company of America (Surety), a corporation organized under the laws Connecticut and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$1.980.763.96 total Contract amount('eluding Washington State sales tax),subject to the provisions herein. This payment bond shall become null and void,if and when the Principal,its heirs,executors,administrators,successors,.or assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW,including all workers,laborers,mechanics,subcontractors, and materialmen,and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments;and if such payment obligations have not been thinned,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,except as provided herein,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. Wm.Winkler Company Travelers Casualty and Surety Company of America P 30„, (CONTRACTOR isiff 1/22/20187fZO $ -,,; Signature Date Surety Signature etc - ! Bnk Win nor Thomas V ADavis - ' Pfinted�+t�tite= Printed Name _ N' t" Attorney-fn-Fact .:- Title J'JJ gueladdrem,and telephone of local office/agentof Surety Company is: payneWest Insurance. Inc.: 501 N Riverpoint Slvcj„Suite 493: Spokane.WA 9229 City of Spokane Valley 23 Contract Forms Appleway Trail Project WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER - r �_, POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 231661 Certificate No. O O 7 2 8 6 0 5 9 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company,St.Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Thomas V A Davis,Jaclyn R.Kruse,Judith C.Kaiser-Smith,James E.Majeskey II,Judith A.Rapp,Shanalee E.Steele,and Marla J.Davenport of the City of Spokane ,State of Washington ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or per tttgd in anv.n.ttions or gr ceedings allowed by law. ; . 5th -I) ITNE$s HEREOF,,the Companies have caused this instr trfdnt,t be signed and the co orate seals to be hereto affixed,this day pfitgs , 2017 Farmington Casualty CoTP t t St.Paul Mercury Insurance Company .•.. .., i Fidelity and Guaranty jns ran �g pan l Travelers Casualty and Surety Company r'!r` r •j Fidelity and Guaranty nsufal' ce nderw kers,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company ?G,,s04,� , �.?,,, ,�.£rRE \�'14..1Ny�G9 4115..!!!SUq� N,p\iv ANo�,G Tp4wA4Y y 40 O��.P r �"o 4 P 4.e.- .+� Q. P- w 9 �,' • g o 1977 m of _ t1t, aeORA4::•:nt i u m,ED 0 1982 O h , ,o• ?,,, wird f, £ �- E: o+ HARTFORD, .e (/HyRCOWL�l a 2 • �' F, 1951 1.1- 1 '� --SE AL Io" -WEAL), m cONtt n i GONt6 +• N 1896 s 4.a \ ti .i o• oJt 1e e �+ o \\ s G ". '4. a + ar 1 y=� d q., '90:�wux,Mcc w�NMN 15 ....•.N `br '�+ + . '�? AMtfi State of Connecticut By: r . ,ri City of Hartford ss. Robert L.Raney,Senior Vice President On this the 5th day of July 2017,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. 0.111T In Witness Whereof,I hereunto set my hand and official seal. i ' W K/" C . V My Commission expires the 30th day of June,2021. •-•PUMA * Marie C.Tetreault,Notary Public s 58440-5-16 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Iansujrance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and Unitid Slates Fi1elitand Guaranty Company do hereby certify that the above and foregoing s is a true and correct copy of the Power of Attorney executed by said Compapi w 'ch is in hill for e awry and has not been revoked. vk 71 xd =.'s IN TESTIMONY WHEREOF,I have hereunto set my hand and ' ed thes s {aid~ ti anies this Z dayof 5' T2 Z rt '- ' , NY Kevin E.Hughes,Assistant Sec taffy. • = = �� pI.SU,� 11. er y*0,' 4a O'0 JAF�».MSGqtyQ6`ivi ..1N.SRAU Aeq o a 405,1 ANO 01"Rtry °Y ts .2Lf -^'..yVW ,4414.‘ + Q t98 . O; 1951 s 4j SAL jo7 HARTFOik%81 to,„, ar f ! :� LRwrvcf.. 1S.ANV Y9.......:*t� 61 . we. To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER RELEASE OF RETAINAGE BOND Bond No.106821592 KNOW ALL PERSONS BY THESE PRESENTS,That we,Wm. Winkler Company herein referred to as the Principal, and Travelers Casualty and Surety Company of America , as Surety, are held and firmly bound unto City of Spokane Valley ,herein referred to as Obligee in the penal sum of Ninety Nine Thousand Thirty Eight Dollars and 20/100 ($99,038.20 ), for the payment of which we bind ourselves, our legal representatives, successors and assigns,jointly and severally,firmly by these presents. WHEREAS, Principal has entered into a construction contract with Obligee dated the 22nd January, 2018 for the construction of Appleway Trail Project CIP#0237 hereinafter referred to as property, which contract is by reference made a part hereof. Principal, as contractor, and Obligee agree to release of retainage bond in lieu of retainage as specified in contract with Obligee guaranteeing the satisfactory performance of said contract in accordance with terms therein. NOW, THEREFORE, the condition of this obligation is such that, the if the above bounden Principal shall make repayment or pay claims to all persons who shall have done or performed any work or labor upon and/or shall have furnished material or fixtures in connection with the mechanical subcontract work completed by Wm.Winkler Company on the aforesaid property and shall effect cancellation of any and all inscriptions of which may be filed as a result of the mechanical subcontract work completed by Wm.Winkler Company , and any and all costs and attorney's fees in connection therewith,otherwise to be in full force and effect. In no event shall the penal sum of this bond exceed Ninety Nine Thousand Thirty Eight Dollars and 20/100 ($99,038.20 ) The amount of this bond shall be reduced by and to the extent of any payment or payments made in good faith hereunder. SIGNED,SEALED and DATED this 22nd day of January , 2018 . • f. Wm. Winkler Company - - ' • • • y t‘" 4S Travelers Casualty and Surety,Comp my of America By• Thomas V A Davis Attbr>'iey-it-Vabt ' WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER AA, POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 231661 Certificate No. O 0 7 2 8 6 0 6 0 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Thomas V A Davis,Jaclyn R.Kruse,Judith C.Kaiser-Smith,James E.Majeskey II,Judith A.Rapp,Shanalee E.Steele,and Marla J.Davenport of the City of Spokane ,State of Washington ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of,guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or perpitte,0 in any-Aions or r ceedings allowed by law. . ... . 'IN \ , ct «� 5th IN WITNESS WHEREOF,the Companies have caused this instrumen;td be signal l and tl i;'eorporate seals to be hereto affixed,this day of irly - 2017 ;„',' ; Y t--1,,.i ` t -- Farmingtont,' - 'k•' r'. '. Casualty Conspany� *,,t , 't;' ” St.Paul Mercury Insurance Company ��'' _ Fidelity and Guarantyinsuran�_f_pmpatly5 . Travelers Casualty and Surety Company - Fidelity and Guaranty InsuMjice"Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company . R+,4. GI.SUA ; *"E 6 pH ,N INSU 1."AN r,(d, sue4,,, % �ry ,,� sof•......SG9 JPY� .Dqa 4311:‘, �T O®` pw ly eO*15TY.tkO O S rtl f1 ‘ti� "'^^'r�.Mtr()? ` Z JfeP�PypA�f�h 4�W.GRAlP;I^ ta - �.- ti ,i�19sz O G 4« cn• m �: i'g • Sy ? 195 12F� tetSEAL o ziWo t% 4 � y o• �` �r �d ii.....),) Ll p09 MY"*/ 1 ,, AIN - State of Connecticut By: f� ,r y City of Hartford ss. Robert L.Raney,Senior Vice President On this the 5th day of July 2017 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G•TEr In Witness Whereof,I hereunto set my hand and official seal. 'C ' V\W w" e• My Commission expires the 30th day of June,2021. * PUMA * Marie C.Tetreault,Notary Public 41/4 58440-5-16 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER - -- - This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurrance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United .ates Fk eli' and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Compantes;mwhic is i full force nd effect and has not been revoked. _ - q.::*. -� - `- -,..•.- •7; IN TESTIMONY WHEREOF,I have hereunto set my hand an fi t °ed the s of sa}d C ISanies •this ZZ day of cJ C W��y "= Z0( f " ‘; F ' teeto... I '' ''''' '''''' ..,;\:.$Kevin E.Hughes,Assistant Sec tary - :: `' v, CN F\0.E 6 y \0.N INSG y 1NSUq 0.,.ty ANO Y C(CO�ygP.pq�,t�' Q : 7 PO.y......4. 4JL:!..! t1::,..(. sJ d` Y�1?0. H1• 4 OSt 98%O i _ XYZ.: *lit:APMp4�FtCF W�jjCP�ORq�;'�P, s, p y� *.‘z*0��a ® ` i961 � ' �'S6AL o �+ o' �' n 7 4 `'0 78.96 ti� 1 a . o• 44Lt ! oa 58l�LtY . o ? -,RAac 4:.:.''Nv is... rc y1 ' F •t�' AIN0 To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER t i ® DATE(MM/DDNYYY) A�D CERTIFICATE OF LIABILITY INSURANCE 01/22/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Parker,Smith&Feek,Inc. PHONE 425-709-3600 FAX 425-709-7460 2233 112th Avenue NE (A/C. � Ext): (A/C,No): Bellevue,WA 98004 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Charter Oak Fire Insurance Co. INSURED INSURER B: Travelers Indemnity Co. Wm Winkler Company PO Box 430 INSURER c: Travelers Prop.Casualty Co.of Amer. Newman Lake,WA 99025 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSRDDL SUBR PPOLICY NUMBER (MM/DDY/YYYY) (MMIDD/ EXP LIMITS LTR INSR WVD, A GENERAL LIABILITY DTCO6F734249C0F17 4/1/2017 4/1/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY X PREMISES(Ea occurrence) $ 500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X PD Ded:$1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X T LOC $ B AUTOMOBILE LIABILITY DT8106F7342491ND17 4/1/2017 4/1/2018 Eaaccliden)INGLE LIMIT $ 1,000,000 X ANY AUTO X BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ C UMBRELLA LIAB X OCCUR CUP3J1291601726 4/1/2017 4/1/2018 EACH OCCURRENCE $ 9,000,000 X EXCESS LIAB CLAIMS-MADE X AGGREGATE $ 9,000,000 DED X RETENTION$ 10,000 $ A WORKERS COMPENSATION DTCO6F734249COF17 WC STATU-TORY LIMITS X T H- AND EMPLOYERS'LIABILITY YIN **V1/A Ga /Em to ers 4/1/2017 4/1/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A Stop Gap/Employers y E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Liability 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ (ryes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) Contract No. 18-015-Appleway Trail Project,CIP 0237,Spokane Valley,WA.City of Spokane Valley and its officers,elected officials,employees,agents,and volunteers is an additional insured on the general liability,automobile and excess liability policies per the attached endorsements/forms. Per project aggregate applies on the general liability policy per the attached endorsements/forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 10210 East Sprague Ave. AUTHORIZED REPRESENTATIVE Spokane Valley,WA 99206 i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION II — COVERED CONDITIONS: • AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5.Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and . first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory. conduct of another"insured". CA T4 74 0216 0 2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: DT-CO-6F734249-COF-17 ISSUE DATE: 04-11 -1 7 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, GENERAL AGGREGATE ' IN A WRITTEN CONTRACT WHICH IS IN EFFECT LIMIT SHOWN ON THE DURING THIS POLICY PERIOD, TO PROVIDE A DECLARATIONS SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION t), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated "project"shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated"pro- "Aggregate Limit for any other designated ject", and that limit is equal to the amount of project shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of "bodily injury" or "prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION I), and less of the number of: for all medical expenses caused by accidents un- sgsm a. Insureds; der COVERAGE C. (SECTION I), which cannot be attributed only to operations at a single desig- b. Claims made or"suits"brought; or nated "project"shown in the Schedule above: c. Persons or organizations making claims 1. Any payments made under COVERAGE A. or bringing"suits". for damages or under COVERAGE C. for medical expenses shall reduce the amount CG D2 11 11 03 Copyright,The Travelers Indemnity Company,2003 Page 1 of 2 010280 COMMERCIAL GENERAL LIABILITY available under the General Aggregate Limit gregate Limit, and not reduce the General Aggre- or the Products-Completed Operations Ag- gate Limit nor the Designated Project General gregate Limit, whichever is applicable; and Aggregate Limit. 2. Such payments shall not reduce any Desig- D. For the purposes of this endorsement the Defini- nated Project General Aggregate Limit. tions Section is amended by the addition of the C. When coverage for liability arising out of the following definition: "products-completed operations hazard" is pro- "Project" means all work performed by or for you vided, any payments for damages because of pursuant to a separate written contract. "bodily injury" or "property damage" included in E. The provisions of SECTION III — LIMITS OF the "products-completed operations hazard" will INSURANCE not otherwise modified by this en- reduce the Products-Completed Operations Ag- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright,The Travelers Indemnity Company, 2003 CG D2 11 11 03 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such • damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to , "prop- additional insured by this endorsement still is sured does not apply to "bodily injury", excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove,drawings and specifications;and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice should include: CG D2 46 08 05 d 2005 The St. Paul Travelers Companies, Inc. - Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS: claim or"suit"and the date received;and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a in- receive written notice of the claim or"suit" as person or organization as an additional soon as practicable. sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the"personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ®2005 Th'e St. Paul Travelers Companies, Inc. CG D2 46 08 05 • UMBRELLA (3) Any statute, ordinance or regulation relat- borrow while it is being used in your busi- ing to the sale, gift, distribution or use of ness. alcoholic beverages. None of the following is an insured under(1) This exclusion applies only if you are in the or(2)above: business of manufacturing, distributing, sell- (a) Any person employed by or engaged ing, serving or furnishing alcoholic beverages. in the duties of an auto sales agency, This exclusion does not apply to "bodily in- repair shop, service station, storage jury"or"property damage"to which any policy garage or public parking place that of "underlying insurance" listed in the you do not operate; SCHEDULE OF UNDERLYING INSURANCE (b) The owner or lessee of any "auto" of the DECLARATIONS of this insurance, or hired by or for you or loaned to you, any renewal or replacement thereof, applies and any agent or employee of such or would apply but for the exhaustion of its owner or lessee. limits of liability. Coverage provided will follow the same provisions, terms, definitions, ex- b. Except as respects the"auto hazard": clusions, limitations and conditions of the pol- (1) Your executive officers,employees,direc- icy(ies)of"underlying insurance" listed in the tors or stockholders while acting within SCHEDULE OF UNDERLYING INSURANCE the scope of their duties;and of the DECLARATIONS of this insurance. (2) Any person or organization while acting SECTION II—WHO IS AN INSURED. as real estate manager for you. 1. If you are designated in the Declarations as: c. Any organization you newly acquire or form, a. An individual, you and your spouse are insur- other than a partnership or joint venture, and eds, but only with respect to the conduct of a over which you maintain ownership or major- business of which you are the sole owner. ity interest,will be deemed to be a Named In- sured. However, coverage does not apply to: b. A partnership or joint venture, you are an in- sured. Your members, your partners, and (1) "Bodily injury" or "property damage" that their spouses are also insureds, but only with occurred before you acquired or formed respect to the conduct of your business. the organization;and c. A limited liability company, you are an in- (2) "Personal injury" or "advertising injury" sured. Your members are also insureds, but arising out of an "offense" committed be- only with respect to the conduct of your busi- fore you acquired or formed the organiza- ness. Your managers are insureds, but only tion. with respect to their duties as your managers. d. Any person or organization having proper d. An organization other than a partnership,joint temporary custody of your property if you die, venture or limited liability company, you are but only: an insured. (1) With respect to liability arising out of the e. A trust, you are an insured. Your trustees are maintenance or use of that property; and also insureds, but only with respect to their (2) Until your legal representative has been duties as trustees. appointed. 2. Each of the following is also an insured: e. Your legal representative if you die, but only a. As respects the"auto hazard": with respect to duties as such.That represen- (1) Anyone using an "auto" you own, hire or tative will have all your rights and duties un- borrow including any person or organiza- der this insurance. tion legally responsible for such use pro- f. Any other person or organization insured un- vided it is with your permission; and der any policy of the "underlying insurance" listed in the SCHEDULE OF UNDERLYING (2) Any of your executive officers, directors, INSURANCE of the DECLARATIONS of this partners, employees or stockholders, op- insurance for whom youhave agreed in a erating an "auto" you do not own, hire or written contract executed prior to loss to pro- vide insurance.This insurance is subject to all Page 6 of 13 Copyright,The Travelers Indemnity Company,2003 UM 00 01 11 03 UMBRELLA the limitations upon coverage under such pol- Non cumulation of Personal and Advertising In- icy of "underlying insurance", and, the limits jury Limit— If"personal injury"and/or"advertising of insurance afforded to such person or or- injury" is sustained by any one person or organi- ganization will be: zation during the policy period and during the pol- i) The difference between the "underlying icy period of one or more prior and/or future poli- insurance" limits and the minimum limits cies that include a COMMERCIAL EXCESS of insurance which you agreed to provide; LIABILITY (UMBRELLA) INSURANCE policy for or the insured issued by us or any affiliated insur- ance company, the amount we will pay is limited. (ii) The limits of insurance of this policy This policy's Personal and Advertising Injury Umit whichever is less. will be reduced by the amount of each payment If the minimum limits of insurance you agreed made by us and any affiliated insurance company to provide such person or organization in a under the other policies because of such "per- written contract are wholly within the"underly- sonal injury"and/or"advertising injury". ing insurance",this policy shall not apply. 5. Subject to 2. or 3. above, whichever applies, the No person or organization is an insured with re- Each Occurrence Limit is the most we will pay for spect to the conduct of any current or past part- the sum of damages under Coverage A because nership or joint venture that is not shown as a of all"bodily injury"and"property damage"arising Named Insured in the Declarations. out of any one"occurrence". No person is an insured as respects "bodily in- Non cumulation of Each Occurrence Limit—If one jury" to a fellow employee unless insurance for "occurrence" causes "bodily injury" and/or "prop- such liability is afforded by the "underlying insur- erty damage" during the policy period and during ante". the policy period of one or more prior and/or 111—LIMITS OF INSURANCE. fu- ture policies that include a COMMERCIAL EX- SECTIONCESS LIABILITY (UMBRELLA) INSURANCE 1. The Limits of Insurance shown in the Declarations policy for the insured issued by us or any affiliated and the rules below fix the most we will pay re- insurance company, the amount we will pay is gardless of the number of: limited. This policy's Each Occurrence Limit will a. Insureds; be reduced by the amount of each payment made by us and any affiliated insurance company under b. Claims made or"suits"brought;or the other policies because of such"occurrence". c. Persons or organizations making claims or To determine the limit of our liability, all "bodily injury" bringing "suits". and "property damage" arising out of continuous or 2. The Products-Completed Operations Aggregate repeated exposure to the same general conditions Limit is the most we will pay under Coverage A shall be considered one"occurrence". for damages because of injury and damage in- The limits of this insurance apply separately to each cluded in the "products-completed operations consecutive annual period and to any remaining hazard". period of less than 12 months. The policy period 3. The General Aggregate Limit is the most we will begins with the effective date shown in the Declara- pay for damages under Coverage A and Cover- tions. If the policy period is extended after issuance age B, except: for an additional period of less than 12 months, the a. Damages because of injury and damage in- additional period will be deemed part of the last cluded in the "products-completed operations preceding period. hazard";and SECTION IV—CONDITIONS. b. Damages because of injury and damage in- 1. APPEALS. cluded in the"auto hazard". a. If the insured or the insured's "underlying in- 4. Subject to 3.above, the Personal and Advertising surer" elects not to appeal a judgment which Injury Limit is the most we will pay under Cover- exceeds the "applicable underlying limit", we age B for the sum of all damages because of all may do so. "personal injury" and all "advertising injury" sus- b. If we do, we will pay all costs of the appeal. tained by any one person or organization. We will also pay all costs on appeals related UM 00 01 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 7 of 13 UMBRELLA POLICY NUMBER: CUP-3J129160-17-26 ISSUE DATE: 04/19/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT -- OTHER INSURANCE - DESIGNATED PERSONS OR ORGANIZATIONS FOR WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT TO PROVIDE INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY(UMBRELLA) INSURANCE SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS Person or Organization: ANY PERSON OR ORGANIZATION THAT QUALIFIES AS AN INSURED UNDER PARAGRAPH 2.F. OF SECTION II - WHO IS AN INSURED. • .i o o Project or Location: Eivm ANY PROJECT FOR A PERSON OR ORGANIZATION THAT IS SHOWN IN THE PERSON OR ORGANIZATION SECTION OF THIS SCHEDULE, IF THE WRITTEN CONTRACT IN gym WHICH YOU HAVE AGREED TO PROVIDE INSURANCE FOR THAT PERSON OR ORGANIZATION FOR THAT PROJECT SPECIFICALLY REQUIRES THAT THE INSURANCE PROVIDED BY THIS POLICY TO SUCH PERSON OR ORGANIZATION APPLY ON A PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBUTORY BASIS. ammm .= m moss 0 -r Nome PROVISIONS or location shown in that schedule, if the written con- = tract in which you have agreed to provide insurance The following is added to Paragraph 10., OTHER IN- for that person or organization specifically requires SURANCE.. of SECTION IV—CONDITIONS.: that this insurance apply on a primary basis or a pri- However, for any person or organization shown in the mary and non-contributory basis, this insurance will Schedule Of Designated Persons Or Organizations that qualifies as an insured under Paragraph 2.f. of apply as if other insurance available to that person or organization under which that person or organization SECTION II —WHO IS AN INSURED for the project qualifies as a named insured does not exist, and we • UM 06 39 02 14 O 2013 The Travelers Indemnity Company.AY rights reserved. Page 1 of 2 006330 UMBRELLA will not share with that other insurance. But this insur- which covers that person or organization as an addi- ance still is excess over any valid and collectible other tional insured or as any other insured that does not insurance. whether such insurance is stated to be qualify as a named insured. primary. contributing, excess, contingent or otherwise, Page 2 of 2 ©2013 The Travelers Indemnity Company.All rights reserved. UM 06 39 02 14 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1404103129 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: FAX PHONE Qbslfs-!Tnjui!'!Gffl-!Jod/ 536.81:.4711536.81:.8571 (A/C, No): (A/C, No, Ext): 3344!223ui!Bwfovf!OF E-MAIL ADDRESS: Cfmmfwvf-!XB!:9115 INSURER(S) AFFORDING COVERAGENAIC # Dibsufs!Pbl!Gjsf!Jotvsbodf!Dp/ INSURER A : INSURED Usbwfmfst!Joefnojuz!Dp/ INSURER B : Xn!Xjolmfs!Dpnqboz Usbwfmfst!Qspq/!Dbtvbmuz!Dp/!pg!Bnfs/ INSURER C : QP!Cpy!541 Ofxnbo!Mblf-!XB!::136 INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: UIJT!JT!UP!DFSUJGZ!UIBU!UIF!QPMJDJFT!PG!JOTVSBODF!MJTUFE!CFMPX!IBWF!CFFO!JTTVFE!UP!UIF!JOTVSFE!OBNFE!BCPWF!GPS!UIF!QPMJDZ!QFSJPE JOEJDBUFE/!!OPUXJUITUBOEJOH!BOZ!SFRVJSFNFOU-!UFSN!PS!DPOEJUJPO!PG!BOZ!DPOUSBDU!PS!PUIFS!EPDVNFOU!XJUI!SFTQFDU!UP!XIJDI!UIJT DFSUJGJDBUF!NBZ!CF!JTTVFE!PS!NBZ!QFSUBJO-!UIF!JOTVSBODF!BGGPSEFE!CZ!UIF!QPMJDJFT!EFTDSJCFE!IFSFJO!JT!TVCKFDU!UP!BMM!UIF!UFSNT- FYDMVTJPOT!BOE!DPOEJUJPOT!PG!TVDI!QPMJDJFT/!MJNJUT!TIPXO!NBZ!IBWF!CFFO!SFEVDFE!CZ!QBJE!DMBJNT/ ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSRWVD EUDP7G84535:DPG29 GENERAL LIABILITY 2-111-111 B FBDI!PDDVSSFODF% 502031295020312: EBNBHF!UP!SFOUFE 611-111 DPNNFSDJBM!HFOFSBM!MJBCJMJUZ Y% QSFNJTFT!)Fb!pddvssfodf* 21-111 DMBJNT.NBEFPDDVSNFE!FYQ!)Boz!pof!qfstpo*% 2-111-111 QE!Efe;!%2-111 QFSTPOBM!'!BEW!JOKVSZ% 3-111-111 HFOFSBM!BHHSFHBUF% 3-111-111 HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS;QSPEVDUT!.!DPNQ0PQ!BHH% QSP. % QPMJDZMPD KFDU DPNCJOFE!TJOHMF!MJNJU 2-111-111 EU9217G84535:JOE29 AUTOMOBILE LIABILITY C 502031295020312: )Fb!bddjefou*% CPEJMZ!JOKVSZ!)Qfs!qfstpo*% Y BOZ!BVUP BMM!PXOFETDIFEVMFE CPEJMZ!JOKVSZ!)Qfs!bddjefou*% BVUPTBVUPT OPO.PXOFE QSPQFSUZ!EBNBHF % IJSFE!BVUPT )Qfs!bddjefou* BVUPT % DVQ4K23:2712937UJM 2-111-111 UMBRELLA LIAB D 502031295020312: FBDI!PDDVSSFODF% PDDVS 2-111-111 Y EXCESS LIAB DMBJNT.NBEFBHHSFHBUF% 21-111 % EFESFUFOUJPO% XD!TUBUV.PUI. WORKERS COMPENSATION EUDP7G84535:DPG29 B UPSZ!MJNJUTFS 502031295020312: AND EMPLOYERS' LIABILITY Y / N !++!XB!Tupq!Hbq0Fnqmpzfst 2-111-111 BOZ!QSPQSJFUPS0QBSUOFS0FYFDVUJWF F/M/!FBDI!BDDJEFOU% N / A PGGJDFS0NFNCFS!FYDMVEFE@ Mjbcjmjuz 2-111-111 (Mandatory in NH) F/M/!EJTFBTF!.!FB!FNQMPZFF% Jg!zft-!eftdsjcf!voefs 2-111-111 F/M/!EJTFBTF!.!QPMJDZ!MJNJU% EFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Dpousbdu!Op/!29.126!.!Bqqmfxbz!Usbjm!Qspkfdu-!DJQ!1348-!Tqplbof!Wbmmfz-!XB/!Djuz!pg!Tqplbof!Wbmmfz!boe!jut!pggjdfst-!fmfdufe!pggjdjbmt-!fnqmpzfft-!bhfout-!boe wpmvouffst!jt!bo!beejujpobm!jotvsfe!po!uif!hfofsbm!mjbcjmjuz-!bvupnpcjmf!boe!fydftt!mjbcjmjuz!qpmjdjft!qfs!uif!buubdife!foepstfnfout0gpsnt/!!Qfs!qspkfdu!bhhsfhbuf bqqmjft!po!uif!hfofsbm!mjbcjmjuz!qpmjdz!qfs!uif!buubdife!foepstfnfout0gpsnt/ CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Djuz!pg!Tqplbof!Wbmmfz AUTHORIZED REPRESENTATIVE 21321!Fbtu!Tqsbhvf!Bwf/ Tqplbof!Wbmmfz-!XB!::317 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD 2!pg!9)MBT12* 3!pg!9)MBT12* 4!pg!9)MBT12* 5!pg!9)MBT12* 6!pg!9 7!pg!9 8!pg!9 9!pg!9