18-120.00 Inland Asphalt: Euclid Ave Preservation Contract
4/1
This agreement is entered into this 17' day of ALMA 2018, between the City of Spokane Valley
("City")and Inland Asphalt Company("Contractor/,pursuant to Title 35 RCW,as adopted or amended.
In consideration of the terms and conditions contained herein and attached and made a part of this
agreement,the parties agree as follows:
I. The Contractor shall do all work and furnish all tools,materials,and equipment for:
Euclid Avenue Preservation Project#0272
Contract 18-120
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 maybe required for the transfer of materials and for constructing
and completing the work provided for in these Contract Documents except those items
mentioned therein to be furnished by the City.
II. The City hereby promises and agrees with the Contractor to employ, and does employ the
Contractor to provide the materials and to do and cause to be done the above described
work and to complete and finish the same in accord with the project plans and
specification and the terms and conditions herein contained and hereby contracts to pay
for the same according to the referenced specifications and the schedule of unit or
itemized prices at the time and in the manner and upon the conditions provided for in this
contract.
III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators,
successors, and assigns, does hereby agree to full performance of all covenants required
of the Contractor in the contract.
IV. It is further provided that no liability shall attach to the City by reason of entering onto
this contract, except as provided herein.
V. The project was awarded for the bid amount of$1,034,025.00.
IN WITNESS WHEREOF, the Contractor has executed this instrument, on the date
below,and the City has caused this instrument to be executed on the date stated above.
City of Spokane Valley 11 Contract Forms
Euclid Avenue Preservation Project
Executed by Contractor August 6 ,2018.
Date
Al Hughbanks
Printed Name
Constructi 9 M. agtiti a 11#
Title
1St ,
Signature Oa
r,
City of Spokane Valley
Mark Calhoun
Printed Name
City Manager
Title
Signature Revised 1-8-16
•
City of Spokane Valley 12 Contract Forms
Euclid Avenue Preservation Project
CITI'()}
Spokane
i'` ley'
BOND NO: 9294573
CONTRACTOR'S PERFORMANCE BOND
to City of Spokane Valley,Washington
The City of Spokane Valley, Washington, in Spokane County, has awarded to Inland Asphalt Company (Contractor), as
Principal,a contract for the construction of the project designated as Euclid Avenue Preservation Project No. 0272 in Spokane
Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance
with chapter 39.08 Revised Code of Washington(RCW).
The Principal, and Fidelity and Deposit Company of Maryland (Surety), a corporation,
organized under the laws of Maryland and licensed to do business in the State of Washington as surety and named in
the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Stall 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 S 1.034,025.00 total Contract amount(including Washington State sales tax),subject to the provisions herein.
This performance bond shall become null and void, if and when the Principal, its heirs, executors,administrators, successors, or
assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions
of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the
manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee
from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract;and if such
performance obligations have not been fulfilled,this bond shall remain in full force and effect.
The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the
specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation
on this bond, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work
performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total
amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not
required for such increased obligation.
This bond may be executed in two original counterparts, and shall be signed by the parties'duly authorized officers. This bond
will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of
the surety.
Inland Asphalt C• .a oto Fidelity and Deposit Company of Maryland
PRINCIPAL( ► •� ri• SURETY
Principal Signature rate -•z Date -
"IL �U��.� �.7,�s Tina Davis
Printed Name Printed Name
GotiS7��e�D•J
1`14'"1 e'� Attorney-in-Fact
Title Title
Name,address,and telephone of local office/agent of Surety Company is:
Marsh USA Inc.
15 W. South Temple, Suite 700, Salt Lake City, UT 84101 801-533-3624
,
City of Spokane Valley 13 Contract Forms
Euclid Avenue Preservation Project
Sc i dile
Valle
BOND NO: 9294573
CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT)
to City of Spokane Valley,Washington
The City of Spokane Valley, Washington, in Spokane County, has awarded to Inland Asphalt Company (Contractor), as
Principal,a contract for the construction of the project designated as Euclid Avenue Preservation Project No.0272 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 Fidelity and Deposit Company of Maryland (Surety), a corporation
organized under the laws Maryland and licensed to do business in the State of Washington as surety and named in the
current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of
Accounts, U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley, as Obligee,in the
sum of 51,034,025.00 total Contract amount(including Washington State sales tax),subject to the provisions herein.
This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or
assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW, including all workers, laborers, mechanics,
subcontractors,and materialmen,and all persons who shall supply such'contractor or subcontractor with provisions and supplies
for the carrying on of such work;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee
may suffer by reason of the failure of Principal to make such required payments; and if such payment obligations have not been
fulfilled,this bond shall remain in full force and effect.
The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the
specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation
on this bond,except as provided herein,and waives notice of any change,extension of time, alteration or addition to the terms of
the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract
that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and
notice to Surety is not required for such increased obligation.
This bond may be executed in two original counterparts, and shall be signed by the parties'duly authorized officers. This bond
will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of
the surety.
Inland Asphalt Co •a Fidelity and Deposit Company of Maryland
PRINCIPAL(Ct • • Ij0 SURETY
_ Wil. 1l_��i a�_ ��
Principal Signature lap , e to • 4111�� Da - -
iJ. w t Tina Davis
Printed Name Printed Name
�j•v$ [JC'7�r�..)
/444.046.6-,? Attorney-in-Fact
Title Title
Name,address,and telephone of local office/agent of Surety Company is:
Marsh USA Inc.
15 W. South Temple, Suite 700,Salt Lake City, UT 84101 801-533-3624
t,' ;
City of Spokane Valley 14 Contract Forms
Euclid Avenue Preset ration Project
v '
State of UT
County of Salt Lake ss:
On August 06, 2018 ,before me,a Notary Public in and for said County and State,residing
therein,duly commissioned and sworn,personally appeared
Tina Davis
known to me to be Attorney-in-Fact of Fidelity and Deposit Company of Maryland
the corporation described in and that executed the within and foregoing instrument,and known to me to be the person who executed
the said instrument in behalf of the said corporation,and he duly acknowledged to me that such corporation executed the same.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed my official seal,the day and year stated in this certificate above.
My Commission Expires 3/13/2019
Lisa Hall Notary Public
—;�- - — —
1 LISA HALL
1 :/� •�,.�;` N,:itaryPublic
4 Yet"' Sta:i of Utah
Comm. No.681511 •
.442.;.„,"
My Comm.Expires Mar 13,2019
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New
York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
DAVID MCVICKER,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Tina DAVIS,Lisa HALL, Lindsey PLATTNER and Linda NIPPER, all of Salt Lake City,Utah, EACH its
true and lawful agent and Attorney-in-Fact,to make, execute, seal and deliver,for, and on its behalf as surety, and as its act and deed: any
and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon
said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of
the By-Laws of said Companies,and is now in force.
IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 15th day of June,A.D.2017.
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
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Assistant Secretary Vice President
Joshua Lecker David McVicker
State of Maryland
County of Baltimore
On this 15th day of June, A.D. 2017, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, DAVID
MCVICKER,Vice President,and JOSHUA LECKER,Assistant Secretary,of the Companies,to me personally known to be the individuals and officers
described in and who executed the preceding instrument,and acknowledged the execution of same, and being by me duly sworn,deposeth and saith,that
he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that
the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said
Corporations.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written.
tA;IYis%
,,A.Q. 49--,-- ,.a.0.,till Iti
hpnmNN`
s.
Constance A.Dunn,Notary Public
My Commission Expires:July 9,2019
POA-F 020-8022W
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of
the By-Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter,wherever appearing upon a
certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 6TH day of AUGUST ,20 18.
wa ocio3j o��N� � '�+ ,,
,FP"04.,:. 4,e�fyno1 � 4�SWL4.O
umr i•=1 SEAL
— j°' SEALlege
i
Michael Bond,Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT ALL REQUIRED
INFORMATION TO:
Zurich American Insurance Co.
Attn: Surety Claims
1299 Zurich Way
Schaumburg,IL 60196-1056
S op t>F
kane
BOND NO: 9294574
CONTRACT'OR'S RETAINAGE BON[)
to City of Spokane Valley,Washington
The City of Spokane Valley, Washington, in Spokane County, has awarded to Inland Asphalt Company
("Contractor"), as Principal, a contract for the construction of the project designated as Euclid Avenue
Preservation Project No.0272(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 Fidelity and Deposit Company of Maryland
organized and existing under the laws of the State of Maryland and authorized to transact
business in the State of Washington as Surety, arc 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
Fifty One Thousand Seven Hundred One and 251100 dollars (S 51,701_25 ), plus 5% of any
increases in the Contract amount that have occurred or may occur, due to change orders, increases in the
quantities,or the addition of any new item of work.
WHEREAS. on the 25th day of July , 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 fiends.
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 find
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:
I. 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 assi ns.
3. Any suit under this bond must be instituted within the time provided by applicable law.
City of Spokane Valley 15 Contract Forms
Euclid Avenue Preservation Project
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 c c• it'• n behalf of the surety.
Inland Asp-- `m �� Fidelity and Deposit Company of Maryland
PRINCIP �, iy SURETY
Principal Signaturfillp t►a Date--,‹
4/...114 �-S Tina Davis -
Printed-Name Printed Name
4Ns Esc-n ".S /(1411/414 '? Attorney-in-Fact
Title Title
Name,address,and telephone of local oftieefagent of Surety Company is:
Marsh USA Inc.
15 W. South Temple,Suite 700, Salt Lake City, UT 84101 801-533-3624
t•
•
City of Spokane Valley 16 Contract Forms
Euclid A%cam Preset-%atiun Project
State of UT
County of Salt Lake ss:
On August 06, 2018 ,before me,a Notary Public in and for said County and State,residing
therein,duly commissioned and sworn,personally appeared
Tina Davis
known to me to be Attorney-in-Fact of Fidelity and Deposit Company of Maryland
the corporation described in and that executed the within and foregoing instrument,and known to me to be the person who executed
the said instrument in behalf of the said corporation,and he duly acknowledged to me that such corporation executed the same.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed my official seal,the da nd year stated in this certificate above.
My Commission Expires 3/13/2019
/ Lisa Hall Notary Public
,„�, LISA HALL
f�, 1,:el •y Public
Of Utah
• •., F Comm. No.6231511
My Comm.Expires Mar 13,2019
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V, Section 8,of
the By-Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice-President, Secretary, or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a
certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 6TH day of AUGUST ,20 18 .
n« of SEAL
4LLO2J
Michael Bond,Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT ALL REQUIRED
INFORMATION TO:
Zurich American Insurance Co.
Attn: Surety Claims
1299 Zurich Way
Schaumburg,IL 60196-1056
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New
York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland,and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
DAVID MCVICKER,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Tina DAVIS, Lisa HALL,Lindsey PLATTNER and Linda NIPPER, all of Salt Lake City,Utah, EACH its
true and lawful agent and Attorney-in-Fact, to make, execute,seal and deliver,for, and on its behalf as surety, and as its act and deed:any
and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon
said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of
the By-Laws of said Companies,and is now in force.
IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 15th day of June,A.D.2017.
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
S$AL:61 _•_• ,i o f 3 b"\N7A.
1
BY ll'4 ‘.-.4".. /3 4,,,/,' 0 , 46e/
Assistant Secretary Vice President
Joshua Lecker David McVicker
State of Maryland
County of Baltimore
On this 15th day of June, A.D. 2017, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, DAVID
MCVICKER,Vice President,and JOSHUA LECKER,Assistant Secretary,of the Companies,to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith,that
he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that
the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said
Corporations.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written.
'''';iZs"
Constance A.Dunn,Notary Public
My Commission Expires:July 9,2019
POA-F 020-8022W
•
Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER THIS CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.POLICY LIMITS ARE NO LESS THAN THOSE
LISTED,ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW.
This is to Certify that
Inland Asphalt Company 00,
CPM Development Corporation dba NAME AND << • Mutual
PO Box 3366 ADDRESS 1' �1 ��►1L1.
Spokane, WA 99220-3366 OF INSURED INSURANCE
is,at the issue date of this certificate.insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and
Conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued.
EXP DATE
TYPE OF POLICY 0 CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY
❑EXTENDED
POLICY TERM
WORKERS 9/1/2018 WA7-C8D-004095-027 LAW OF THEGE AFFORDEDOOWI UNDER WC EMPLOYERS LIABILITY
LAW OF FOLLOWING STATES:
COMPENSATION WC7-C81-004095-017 WA 'WYates except OH,ND, Bodily Injury by Accident
$1, 000,000Each Accident
-017:WI Bodily Injury By Disease
$1,000,000 Pni(cvi(mit
Bodily Injury By Disease
$1 000,000 Each Person
COMMERCIAL 9/1/2018 TB2-C81-004095-117 General Aggregate
GENERAL LIABILITY $2,000,000
m OCCURRENCE
-Per Project Aggregate included Products/Completed Operations Aggregate
$2,000,000
0 CLAIMS MADE Each Occurrence
$2,000,000
RETRO DATE Personal&Advertising Injury
$2,000,000 Per Person/Organization
Other Other
Damagge to Premises Rented to Medical Exp:$50,000
You:$250.000
AUTOMOBILE 9/1/2018 AS2 C81-004095 127Each Accident—Single Limit
LIABILITY $2,000,000 B.I.And P.D.Combined
IZ1OWNED Each Person
m NON-OWNED Each Accident or Occurrence
HIRED Each Accident or Occurrence
OTHER 9/1/2017-9/1/2018 -AS2-C81-054502-527 -Physical Damage only
-Automobile policy -$10,000 Comp
-$10,000 Coll
-Excess Workers 9/1/2017-9/1/2018 -EW7-68N-004095-347 SIR$250,000
Compensation and Employers (WA) Excess WC-$250,000,000(includes WA stop gap)/EL-$750,000
Liability Per OCC.
ADDITIONAL COMMENTS
RE: Euclid Ave. Preservation Project
City of Spokane Valley is additional insured with respect to the above referenced project. Coverage is primary and non-contributory.
Waiver of subrogation applies.
*If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date.
NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW,) LibertyMutual
BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE
INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE Insurance Group
OF SUCH CANCELLATION HAS BEEN MAILED TO:
City of Spokane Valley Valerie Reece
10210 E. Sprague Ave. Fairfield/049C AUTHORIZED REPRESENTATIVE
v m Spokane Valley, WA 99206 9450 Fairfield Seward Road OH 45014 800-332-3226 8/7/18
OFFICE PHONE DATE ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10
37369174 1 LM 44 1 9/17-9/18 - WA 2/2 1 Donna Smitala 18/23/2017 7:55:31 AM (CDT) 1 Page 1 of 1
LDI COI 268896 02 11
POLICY NUMBER:TB2-C81-004095-117 COM4ERCIAL GENERAL LIABILITY
CG 2010 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended to 1. All work including materials, parts or
include as an additional insured the person(s) or equipment furnished in connection with such
organization(s) shown in the Schedule, but only with work, on the project (other than service,
respect to liability •for "bodily injury", "property maintenance or repairs)to be performed by or
damage or 'personal and advertising injury" on behalf of the additional insured(s) at the
caused,in whole or in part.by: location of the covered operations has been
1. Your acts or omissions: or completed;or
2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the
behalf injury or damage arises has been put to is
in the performance of your ongoing operations for intended use by any person or organization
the additional insured(s) at the location(s) other than another contractor or subcontractor
designated above. engaged kr performing operations for a
principal as a part of the same project
However. C. With respect to the insurance afforded to these
1. The insurance afforded to such additional additional insureds. the following is added to
insured only applies to the extent permitted by Section iii—Limits Of Insurance:
law:and ft coverage provided to the additional insured is
2. If coverage provided to the additional insured is required by a contract or agreement, the most we
requred by a contract or agreement. the wil pay on behalf of the additional insured is the
insurance afforded to such additional insured witI amount of insurance:
not be broader than that which you are required 1. Requred by the contract or agreement or
by the contract or agreement to provide for such
additional insured. 2. Available under The applicable Limits of
B. Wth respect to the insurance afforded to these Insurance shown in the Declarations;
additional insureds, the following additional whichever is less.
exclusions apply: This endorsement shall not increase the
This insurance does nut apply to "body injury" or applicable Limb of Insurance shown in the
'property damage" occurring after: Declarations.
SCHEDULE
Name Of Additional insured Person(s) Location(s)Of Covered Operations
Or Organizatlon(s):
Any owner,lessee,or contractor for whom you have Any location listed in such agreement
agreed to writing prior to a loss to provide liablty
insurance
Information requred to complete this Schedule,if not shown above, will be shown in the Declarations.
CG 2010 0413 C Insurance Services Office, Inc.,2012 Page 1 of 1
Policy Number: TB2-C81-004095-117
issued by. LIBERTY MUTUAL FIRE INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NON-CONTRIBUTORY—SCHEDULED ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
Schedule
Person or Organization: Any person or organization for which such coverage is required by written contract
with the Named Insured
if you ars obligated under a written agreement to provide liability Insurance on a primary,excess.contingent, or
any other basis for any person or organization shown in the Schedule that is an additional insured on this policy,
this policy will apply solely on the basis required by such written agreement If the applicable written agreement
does not specify on what basis the liability insurance will apply,this Insurance shall be excess over any other valid
and collectible insurance available to the additional insured,whether such insurance Is on an excess,contingent or
primary basis.Condition 4 Other Insurance of Section IV is revised accordingly.
•
LD 2410 0811 0 2011 Liberty Mutual Group of Companies.AN rights reserved. Page 1 of 1
Includes copyrighted material of insurance Services Office, Inc.,with
Its permission.
POLICY NUMBER TB2-C81-004095-117 COMVERCIAL GENERAL LIABILITY
CG 2404 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following Is added to Paragraph S. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV—Conditions;
We waive any right of recovery we may have against
the person or organization shown in the Schedule
below because of payments we make for injury or
damage arising out of your ongoing operations or
'your work"done under a contract with that person
or organization and hcluded in the "products-
completed operations hazard".-This waiver applies
only to the person or organization shown in the
Schedule below.
SCHEDULE
Name Of Person Or Organization:
As required by written contract or agreement entered into prior to loss.
Information required to complete this Schedule,If not shown above, will be shown in the Declarations.
CG 24 04 05 09 C Insurance Services Office, inc.,2008 Page 1 of 1