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18-050.00 MDM Construction: Mission Ave Improvements Flora to Barker •J Contract 51- This agreement is entered into this 31 — day of , 2018, between the City of Spokane Valley ("City")and MDM Construction,Inc. ("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: Mission Avenue Improvement Project(Flora Rd to Barker Rd),CEP#0123 Contract 18-050 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$2,966,440.40 including tax. 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 C-1 Contract Forms Mission Avenue Improvement Project t w Executed by Contractor May 29 , 2018. Date Mitch Swenson Printed Name --� Presid- Title Sign ure — City of Spokane Valley • Mark Calhoun Printed Name —'— City Manager Title Int C"t4111\ Signature • City of Spokane ValleyC-2 Mission Avenue Improvement Project Contract Forms okane jValley� BOND NO: 0216372 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington dba MDM Excavation The City of Spokane Valley, Washington, in Spokane County,has awarded to MDM Construction, Inc. (Contractor), as Principal,a contract for the construction of the project designated as Mission Avenue Improvement Project No.0123 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 Berkley Insurance Company (Surety), a corporation, organized under the laws of Delaware 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$2,966,440.40 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract;and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties' duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRI IP• %•NTRACTOR) SURETY - 5-29-18 i -i ay_29, 2018 P cipal Signature Date Surety Signature Date Mitch Swenson Judith C. Kaiser-Smith Printed Name Printed Name President Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: PayneWest Insurance,Inc. Judith A.Rapp,Agent 509-789-7435 501 N.Riverpoint Blvd.,Suite 403, Spokane,WA 99202 P i..,1 1 I I City of Spokane Valley C-3 Contract Forms Mission Avenue Improvement Project Spokane j Valley 0216372 BOND NO: CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington dba MDM Excavation The City of Spokane Valley,Washington, in Spokane County, has awarded to MDM Construction, Inc. (Contractor), as Principal, a contract for the construction of the project designated as Mission Avenue Improvement Project, Project No. 0123 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and Berkley Insurance Company (Surety), a corporation organized under the laws Delaware 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$ *"* total Contract amount (including Washington State sales tax), subject to the provisions herein. ***$2,966,440.40 This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW, including all workers, laborers, mechanics, subcontractors, and materialmen, and all persons who shall supply such contractor or • subcontractor with provisions and supplies for the carrying on of such work; and shall indemnify and hold harmless the Obligee from all loss, cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments;and if such payment obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRI IP (CONTRACTOR) SURETY 5-29-18 61. ,e J,V?ZG LMay 29, 2018 Principal Signature Date Surety Signature Date Mitch Swenson Judith C. Kaiser-Smith Printed Name Printed Name President Attorney-in-Fact Title Title Name,address, and telephone of local office/agent of Surety Company is: PayneWest Insurance,Inc. Judith A.Rapp,Agent 509-789-7435 501 N. Riverpoint Blvd. , Suite 403, Spokane, WA 99202 City of Spokane Valley C-4 Contract Forms Mission Avenue Improvement Project No. BI-7801g - 4. 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 gorganized and existing under the laws of the State of Delaware,having its principal office in Greenwich, CT,has made,constituted I and appointed,and does by these presents make,constitute and appoint:James E.Majeskey II;Judith C. Kaiser-Smith;Judith A. b .E Rapp; Thomas V. A. Davis;Shanalee E. Steele; Jaclyn R. Kruse; or Melissa Wolf of Payne West Insurance, Inc. of Spokane, s' WA its true and 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 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 acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. -This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, a without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following oo resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25,2010: (A• r. • ° RESOLVED,that,with respect to the Surety business written by Berkley Surety,the Chairman of the Board,Chief Executive cOfficer, 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 execute Lbonds, undertakings,recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal o of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and 3 revoke any power of attorney previously granted;and further o°.2 RESOLVED,that such power of attorney limits the acts of those named therein to the bonds,undertakings,recognizances,or 0) other suretyship obligations specifically named therein,and they have no authority to bind the Company except in the manner 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 ▪ further o • RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any a •E 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 3 though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any • .L person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have b ceased to be such at the time when such instruments shall be issued. s IN WITNESS WHEREOF, the Coy has c• s • these presents to be signed and attested by its appropriate officers and its o corporate seal hereunto affixed this day o ;,. , 7 I _ a WO Attest: Berkle Insurance Compan rl (Seal) By r By Ira Lede an Jef •el •fter c „ Executive Vice President&Secretary en o i• : esident lg . WARNING:THIS POWER INVALID IF NOT PRINTED ON BLUE"BERKLEY"SECURITY PAPER. E 2 I STATE OF CONNECTICUT) ) ss; o COUNTY OF FAIRFIELD ) `o -0 Sworn to before me,a Notary Public in the State of Connecticut,thisday o' by Ira S. t,ederman • 2 and Jeffrey M. Hatter who are sworn to me to be the Executive Vice Pre 'de t and Secret.;, n the Senior Vice President, �s respectively,of Berkley Insurance Compact(ARIA C.RUNDBAKEN >, NOTARY PUBLIC -07L o MY COMMISSION EXPIRES otary Public;State of Connecticut APRIL 30,201.9 V E; CERTIFICATE z I,the undersigned,Assistant Secretary of BERKLEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct z tr 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 ?)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 3 t of this date. Given under my hand and seal of the Company,this 29th day of .411/ 2018 -/_ (Seal) i �S� Vincent P.Forte • t - Spokane .. Valley- BOND NO: 0216373 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 Mission Avenue Improvement Project, Project No. CIP 0123 (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 by chapter 60.28 RCW, in the penal sum of 5% of the Contract, which is *** dollars ($ 148,322.00 ), 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. ***One Hundred Forty Eight Thousand Three Hundred Twenty Two t No/100*** WHEREAS, on the 29th day of May , 2018, 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 60.28 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. City of Spokane Valley C-5 Contract r,l ilH Mission Avenue Improvement Project 1 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. PRINCIP (CONTRACTOR) SURETY ff'' 5- 1a _ - d.y� Gde47\ ,`?;Yf May 29, 2018 incipal Signature Date Surety Signature Date £Flitch Swenson Judith C. Kaiser-Smith Printed Name Printed Name President Attorney-in-Fact Title Title Name, address, and telephone of local office/agent of Surety Company is: PayneWest Insurance, Inc. Judith A. Rapp, Agent 509-789-7435 501 N. Riverpoint Blvd., Suite 403, Spokane, WA 99202 City of Spokane Valley C-6 Contract Forms Mission Avenue Improvement Project • No. BI-7801g 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 g organized and existing under the laws of the State of Delaware,having its principal office in Greenwich,CT,has made,constituted o and appointed,and does by these presents make,constitute and appoint:James E.Majeskey II;Judith C. Kaiser-Smith;Judith A. • .E Rapp; Thomas V. A. Davis;Shanalee E. Steele; Jaclyn R. Kruse; or Melissa Wolf of Payne West Insurance, Inc. of Spokane, S' WA its true and 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 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 acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. cn ca) • This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, z without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following c resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25,2010: .›y RESOLVED,that,with respect to the Surety business written by Berkley Surety,the Chairman of the Board,Chief Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant Secretary are Te hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to execute bonds, undertakings,recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal = of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and 33 • revoke any power of attorney previously granted;and further o ss ° 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 •L 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 Is further c ` RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any n.• power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or CA E • as other suretyship obligation of the Company;and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any g .` person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have .b ceased to be such at the time when such instruments shall be issued. y c IN WITNESS WHEREOF, the Con any has c. s • these presents to be signed and attested by its appropriate officers and its c o corporate seal hereunto affixed this day o• ,; ���s�.r , o Attest: //' Berkle Insurance Compan • (Seal) ByrBy Le Ira de an Je e i .haffter c „ Executive Vice President&Secretary en o i'- esident • 2 WARNING:THIS POWER INVALID IF NOT PRINTED ON BLUE"BERKLEY"SECURITY PAPER. b E STATE OF CONNECTICUT) • •— ) 55. E COUNTY OF FAIRFIELD ) • Sworn to before me, a Notary Public in the State of Connecticut,this Clay o ,r 'Ol/ by Ira S. Lederman .Y and Jeffrey M. Hafter who are sworn to me to be the Executive Vice. Pre de t and Secret r, < the Senior Vice President, • respectively,of Berkley Insurance Comparlg1ARIA C.RUNDBAKEN ' �s NOTARY PUBLIC / t ' MY COMMISSION EXPIRES otary Public,State of Connecticut o APRIL 30,209 171-* CERTIFICATE Z I, the undersigned,Assistant Secretary of BERKLEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct • t 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 °�'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 s of this date. Given under my hand and seal of the Company,this 29th day of M �/ 2018 (Seal) � '"1111111, Vincent P.Forte -----3.'IN MDMCONS-02 CLONGINOTTI ACRO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/25/2018 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(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). NTACT PRODUCER NACOME: Spokane Office PHONE No,Ext):(509)8384501I FAX c,Na):(509)838 511 PayneWest Insurance Inc. E-MAI 501 N.Riverpoint Blvd.,Ste 403 ADDRkss: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Condnental Western Insurance Company 10804 INSURED INSURER B: MDM Construction Inc.dba MDM Excavation INSURER C: PO Box 2006 INSURER D: Hayden,ID 83835 INSURERE: 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. AUDI SUBR POUCY EFF POUCY EXP IN TYPE OF INSURANCE INsD INVD POUCY NUMBER 4MM/DD/YYYYI (MM/DD/YYYYI UMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 V/ CLAIMS-MADE X OCCUR X X CPA6025924 09/01/2017 09/01/2018 PREMIEEsr?Ercurrence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECQT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 A AUTOMOBILE UABIUTY (Ea acccidenntSINGLE LIMIT $ 1,000,000 X ANY AUTO X X CPA6025924 09/01/2017 09/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE� ONLY _ AUTOS BODILY BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS ONLDY VI?accRdeT DAMAGE $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE 10,000,000 EXCESS UAB CLAIMS-MADE CPA6025924 09/01/2017 09/01/2018 AGGREGATE $ DED RETENTION$ Aggregate $ 10,000,000 WORKERS COMPENSATION STATUTEPER ETH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEN(A E.L.EACH ACCIDENT $ OF CE�t itNH))EXCLUDED? 1I�w E.L.DISEASE-EA EMPLOYEE $ DsCdTiOuO 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) Project No CIP 0123,Mission Avenue Improvement Project(Flora Rd to Barker Rd),Contract*18-050 The City of Spokane Valley is additional Insured as per attached form. Coverage is primary and non-contributory. Waiver of Subrogation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Spokane Valle THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City P y ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave Spokane,WA 99206 AUTHORIZED REPRESENTATIVE I ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MDMCONS-02 CLONGINOTTI AC RC,* CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/25/2018 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(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 PHONE I(A/C,No):( ) Spokane PayneeInsurance,Inc. FAX (A/c,No,Ext):(509)838-3501 509 838-3511 501 N.Riverpoint Blvd.,Ste 403 ADDRESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:AIaska National Ins.Co. 38733 INSURED INSURER B: MDM Construction Inc.dba MDM Excavation INSURER C: PO Box 2006 INSURER D: Hayden,ID 83835 INSURERE: 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. ILICY EXP NSR ADDLTYPE OF INSURANCE IVSD SUER POLICY NUMBER (MM/LDDY/YYYYI IMM/DD/YYYY) LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES(EaEoccu ence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY .INET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY (Ea acccidentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ AURTEO�S ONLY _WNED SCHEDULED SWULNEDp BODILY INJURY(Per accident) $ AUTOS ONLY — AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE —$ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A TH- WORKERS EMPLOYERS'COMPENSATION PER STATUTE ER Y/N I 8DWS08844 04/01/2018 04/01/2019 1,000,000 v ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory n NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 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) Project#CIP 0123,Contract#18-050,Mission Avenue Improvement Project(Flora Rd to Barker Rd) CERTIFICATE HOLDER CANCELLATION 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. 10210 E Sprague Ave Spokane,WA 99206 AUTHORIZED REPRESENTATIVE I 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 1 - 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 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the insured: a. A Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. b. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the"products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: (1) Insureds; (2) Claims made or"suits" brought;or (3) Persons or organizations making claims or bringing"suits". 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 ill-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 "properly 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 II—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 injury", "property damage" or "per and such person or organization have agreed 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 the equipment lease expires. (a) Any "occurrence" which takes place after you cease to be a (5) State, Municipality, Governmental tenant in that premises. Agency Or Subdivision Or Other Political Subdivision — Permits Or (b) Structural alterations, new con- Authorizations Relating To struction or demolition operations Premises performed by or on behalf of such additional insured. Any state, municipality, govern- mental agency or subdivision or (2) Mortgagee,Assignee Or Receiver 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, governmental agency or This insurance does not apply to subdivision or other political structural alterations, new con- subdivision has issued a struction or demolition operations permit or authorization in performed by or on behalf of such connection with premises additional insured. 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, teased 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 similar exposures; or (b) Structural alterations, new con- struction or demolition operations _ CL CG 04 92 09 16 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 written contract or written (ii) Operations performed by you agreement. This exclusion or on your behalf for which 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. (ii) Any express warranty unau- (b) This insurance does not apply to thorized by you; "bodily injury', property dam- age"or"personal (iii),and advertising Any physical h sisal 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, demonstration,testing, or the Any person(s) or organization(s) with substitution of parts under a controlling interest in the Named instructions from the menu- Insured but only with respect to their facturer, and then liability arising out of: 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 to or normally undertakes to structural alterations, new con- make in the usual course of struction or demolition operations business, in connection with performed by or for such person(s) the distribution or sale of the or organization(s). 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 or sale by you, have (a) Any person(s) or organization(s) been labeled or relabeled or (referred to as vendor), but only used as a container, part or with respect to "bodily injury" or ingredient of any other thing "property damage" arising out of or substance by or for the "your products" which are vendor;or distributed or sold in the regular course of the vendor's business. CL CG 04 92 09 16 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 replaced by the following: the products. (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 Paragraph 2.a. Duties In The Event Of Insureds, the following additional provisions 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. You must see to it that we are notified as not a {1) through A.1.c.(8) above does soon as practicable of an "occurrence" or an not apply: 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 (1) You, if you are an individual; hazard"; or (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 while rented to you or temporarily damage arising out of the "occurrence" occupied by you with permission of the or offense. 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- However, that portion of the contract for paragraph j.(6) of Paragraph 2. Exclusions a lease of premises that indemnifies any of Section I — Coverage A — Bodily Injury 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 III -- 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 Coverage Subparagraph 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 insurance; (a) Snow removal; (b) (v) Coverage only applies for those limited Road maintenance, but not construction liability companies who have established or resurfacing;or a date of formation as recorded within (c) Street cleaning; the filed state articles of organization, certificates of formation or certificates of G. NEWLY FORMED OR ACQUIRED ORGANIZA- organization; and TION, PARTNERSHIP OR LIMITED LIABILITY 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 partnership agreement or partnership is deleted and replaced by the following: 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 II -- Who Is An Insured is deleted and replaced by the following: a. Majority interest of more than 50% if you 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 under Paragraph 3. of Section II — Who Is c. Majority interest of more than 50% as an 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 organize- 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 0916 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 to your insurance as of the date we implement This provision does not affect our right to collect 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 G00001. RECOVERY AGAINST OTHERS N. INCIDENTAL MEDICAL MALPRACTICE The following is added to Paragraph 8. Transfer 1. Paragraph 2.a.(1)(d) of Section Il — 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 B. Exclusions such person or organization(s) be added as an 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, advertising injury", employment, training or monitoring of others by that insured, if the"occurrence"which caused the However: "bodily injury"or"property damage",or the offense which caused the "personal and advertising a. The insurance afforded to such additional 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 additional insured is a Named Insured. Section III-Limits Of Insurance: No other coverage or limit in the policy applies to If coverage provided to the additional insured is loss or damage insured by this coverage. required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Includes copyrighted material of Insurance Services CL CG 20 71 09 16 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 Rental Reimbursement Coverage provided by part of any contract or agreement: 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. stage. 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- sion of Section II-Covered Autos Liability Cover- (3) Security deposits not returned by the lessor; age is amended as follows: (4) Costs for extended warranties, Credit The Limit of Insurance in paragraph A.2,a.(4) is increased $1,000.uranLife 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 lectable 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 V 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"foss"of currency, coins,securities or contraband. ible for any owned "auto" will apply for that coverage. No deductible applies to this coverage extension. No deductible will apply to "loss" caused by M. TOWING fire or lightning. Paragraph A.2. Towing of Section III - Physical 3. Hired Auto Physical Damage Coverage is Damage Coverage, is replaced by the following: subject to the following: If a private passenger type "auto" or light truck a. If symbol 8 is shown in the Covered Auto "auto"(0-10,000 Lbs.GVW)is provided both 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 redly above, coverage provided under will pay up to $250 for towing and labor costs in this provision will be excess over any carred 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 is the consequence of an "accident" for "auto"and any are discharged in an attempt to ex- re- tinguish a fire, we will pay the lesser of the actual wht oh you are mleoney ry loss and as a cost of recharging or replacing such fire extin salt of which a monetary is sustained cost of re by the leasing or rental concern. guis 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". ganization other than an individual, partnership,joint venture or limited li- 2. No deductible applies to this coverage. 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 Y 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 Uninsured And Underinsured Motorists 5. We will pay up to an additional $300 for the 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 "ac- 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 care,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 her spouse while working in a business of 1. The following is added to Section II Covered Autos Liability Coverage: selling,servicing,repairing or parking"au- tos". 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 "autos". (2) Your partners or members, if you are 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 U. LIBERALIZATION sion Coverage. No deductible will apply to "toss"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 09/11/2018 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(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 # Alaska National Ins. Co.38733 INSURER A : INSURED INSURER B : MDM Construction Inc. dba MDM Excavation INSURER C : PO Box 2006 INSURER D : 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 18IPS0884409/01/201809/01/2019 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 18IAS0884409/01/201809/01/2019 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$ 18ILU0884409/01/201809/01/2019 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE$ 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) Project No CIP 0123, Mission Avenue Improvement Project (Flora Rd to Barker Rd) , Contract # 18-050 The City of Spokane Valley is additional insured as per attached form. Coverage is primary and non-contributory. Waiver of Subrogation applies. 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. 10210 E Sprague Ave 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 DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All Projects Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 3.A For all sums which the insured becomes legally Any payments made under Coverage for C obligated to pay as damages caused by damages or under Coverage for medical IA, "occurrences" under Section Coverage and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit IC, under Section Coverage which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above:shall they reduce any other Designated Construction Project General Aggregate Limit 1. A separate Designated Construction Project for any other designated construction project General Aggregate Limit applies to each shown in the Schedule above. designated construction project, and that limit 4. is equal to the amount of the General The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. 2. The Designated Construction Project General However, instead of being subject to the Aggregate Limit is the most we will pay for the General Aggregate Limit shown in the A, sum of all damages under Coverage except Declarations, such limits will be subject to the damages because of "bodily injury" or applicable Designated Construction Project "property damage" included in the "products- General Aggregate Limit. completed operations hazard", and for medical C expenses under Coverage regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 Page 1 of 2 B.C. For all sums which the insured becomes legally When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard"is IA, "occurrences"under SectionCoverage and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury"or"property damage"included in the IC, under SectionCoveragewhich cannot be "products-completed operations hazard"will attributed only to ongoing operations at a single reduce the Products-completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above:Aggregate Limit nor the Designated Construction Project General Aggregate Limit. 1.A Any payments made under Coverage for CD. damages or under Coverage for medical If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned and under the General Aggregate Limit or the then restarted, or if the authorized contracting Products-completed Operations Aggregate parties deviate from plans, blueprints, designs, Limit, whichever is applicable; andspecifications or timetables, the project will still be deemed to be the same construction project. 2. Such payments shall not reduce any Designated Construction Project General E.III The provisions of SectionLimits Of Insurance Aggregate Limit.not otherwise modified by this endorsement shall continue to apply as stipulated. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date The information below is issued at 12:01 A.M. standard time at your mailing address shown in the policy. required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective September1, 201 8 Policy No. 1 8I PS 08844 Insured MDM Construction Inc Endorsement No. Bernie Raven Countersigned ByInland Insurance/Spokane Valley ©Insurance Services Office, Inc., 2008 CG 25 03 05 09Page 2of 2 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict coverage. Read the entire policy carefully to determine rights, duties, and what is and is not covered. Throughout this policy, the words “you” and “your” refer to the Named Insured shown in the Declarations. The words “we”, “us”, and “our” refer to This condition does not apply to any the company providing this insurance.person(s) or organization(s) to the extent that subrogation against that person or Other words and phrases that appear in quotationorganization is waived prior to the “accident” marks have special meaning. Refer to or the “loss” under a contract with that person in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply per “accident” and, unless otherwise specified, are, Paragraph A.2.a. (2) – subject to all of the terms, conditions, exclusions and is replaced by the following: deductible provisions of the policy, to which it is attached. Up to $10,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an , Paragraph A.1. Who Is An Insured is “accident” we cover. We do not have amended to include:to furnish these bonds. . Any “employee” of yours while operating , Paragraph A.2.a. (4) – an “auto” hired or rented under a is replaced by the following: contract or agreement in an “employee’s” name, with your permission, while performing duties related to the conduct All reasonable expenses incurred by of your business.the “insured” at our request, including actual loss of earnings up to $500 a Any person or organization for whom youday because of time off from work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of “autos" covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. ANIC CA 1150 10 13 Page 1 of 4 “Loss” caused by falling objects or missiles. , Paragraph A.2.c. – is added as follows: However, you have the option of having glass breakage caused by a covered “auto’s” collision or overturn considered a “loss” under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage caused by an “insured”, but without liability to a third party, up to $25,000. WeNo deductible applies to glass breakage, if will not make a Voluntary Propertythe glass is repaired rather than replaced. Damage payment to anyone who is an “insured” under this policy., Paragraph A.4.a. – is , replaced by the following: Paragraph A.2. – is replaced by the following: We will pay up to $200 per day to a We will pay up to $500 for towing and labormaximum of $1,500 for temporary costs incurred each time a covered “auto”transportation expense incurred by you that is a:because of the total theft of a covered “auto” that is a: Private passenger; Private passenger; Truck; Truck; Pick-up truck; Pick-up truck; Panel ; or Panel; or Van Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the type vehicle under 20,000 lbs. of Gross labor must be performed at place of Vehicle Weight. We will pay only for disablement. those covered “autos” for which you carry either Comprehensive or Specified , Causes of Loss Coverage. We will pay Paragraph A.3. – for temporary transportation expenses is replaced incurred during the period beginning 48 by the following: hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”. If you carry Comprehensive Coverage for the damaged covered “auto”, we will pay the following under Comprehensive Coverage: Glass Breakage; “Loss” caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page 2 of 4 Specified Causes of Loss only if the ,Declarations indicate that Specified Paragraph A.4.b. – isCauses of Loss Coverage is provided replaced by the following:for the “auto” withdrawn from service; or Collision only if the Declarations indicate that Collision Coverage is provided for the “auto” withdrawn We will pay expenses for which anfrom service. “insured” becomes legally responsible to pay for loss of use of a vehicle hired,, rented or borrowed without a driver underParagraph A.4.d. – is added as a written rental contract or agreement.follows: We will pay for loss of use expenses, if caused by: Other than Collision, only if the We will pay for the cost to repair, replace, Declarations indicate thator reset an airbag that inflates for any Comprehensive Coverage is providedreason other than as a result of a for the vehicle withdrawn fromcollision, if the Declarations indicate that service.the covered “auto” has Comprehensive Coverage or Specified Causes of Loss Specified Causes of Loss only if theCoverage. Declarations indicate that Specified Causes of Loss Coverage is provided, for the vehicle withdrawn fromParagraph A.4.e. – is added as follows: service. Collision only if the Declarations indicate that Collision Coverage is provided for the vehicle withdrawn We will pay up to $75 per day for rental from service.reimbursement expenses incurred by you for the rental of an “auto” because of However, the most we will pay for any“loss” to a covered “auto” that is a: expenses for loss of use is $200 per day, to a maximum of $1,500. Private Passenger; Truck; Paragraph A.4.c. – is added as follows:Pick-up truck; Panel; or Van We will pay up to $2,000 for non- type vehicle under 20,000 lbs. of Gross transportation expense incurred by you, Vehicle Weight. Payment applies in because of “loss” to a covered “auto”, if addition to the otherwise applicable caused by: amount of each coverage you have on a covered “auto”. No deductibles apply to Other than Collision, only if the this coverage. Declarations indicate that Comprehensive Coverage is provided for the “auto” withdrawn from service; ANIC CA 1150 10 13 Page 3 of 4 We will pay only for those expenses – incurred during the policy periodParagraph B.5.b. – is replaced by beginning 24 hours after the “loss”the following: and ending, regardless of the policy’s For Hired Auto Physical Damage expiration, with the lesser of the following number of days:Coverage, the following are deemed to be covered “autos” you own: The number of days reasonably Any covered “auto” you lease, hire, required to repair or replace the covered “auto”.rent, or borrow; and 30 days. Any covered “auto”” hired or rented by your “employee” under a contract This coverage does not apply whilein that individual “employee’s” name, there are spare or reserve “autos”with your permission, while available to you for your operations.performing duties related to the conduct of your business. The Rental Reimbursement Coverage described above does not However, any “auto” that is leased, hired, apply to a covered “auto” that is rented or borrowed with a driver is not a described or designated as a covered covered “auto”. “auto” on Rental Reimbursement Coverage Form CA 99 23. – Paragraph C. – is replaced by the following: – Paragraph B.2. – Concealment, Misrepresentation Or “Bodily injury” means bodily injury, sickness or Fraud is amended by adding disease sustained by a person including death or at the end of Paragraph B.2. as mental anguish resulting from any of these. follows: Mental anguish means any type of mental or emotional illness or disease If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. Endorsement Effective September 1, 2018 Policy No. 18IAS08844 Insured MDM Construction Inc Endorsement No. Countersigned By © Insurance Services Office, Inc., 2009 ANIC CA 1150 10 13 Page 4 of 4