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19-076.00 NA Degerstrom: Knox Sidewalks Sargent to Hutchinson Contract lact This agreement is entered into this Z.414 —day of r _t-f>_, 2019, between the City of Spokane Valley ("City") and N.A Degerstrom. Inc. ("Contractor'),pursuant to Title 35 RC W. 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: Knox Avenue Sidewalk Project-Sargent to Hutchinson#0279 Contract#19-076 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 fmi sh 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. Ill. 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. The project was awarded for the bid amount of $375,985.15 (Three hundred seventy five thousand nine hundred eighty five and 15/100 dollars). 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 CONTRACT#19-076 KNOX AVENUE SIDEWALK PROJECT Executed by Contractor ti 1 ,2019. Date �icW4R� 4. s7-c-4R Prmted Name P E., 6-ln>FL21NG Title I� �w/� ^y/��✓,- Signature City of Spokane Valley Mark Calhoun Printed Name City Manager Title Vtillp reSignature CITY OF SPOKANE VALLEY CONTRACT#19-076 KNOX AVENUE SIDEWALK PROJECT 4 SiftM et�cLane VQl BOND NO: 023207906 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The Cityof Spokane Valley,Washington, on ed County,has endedto NA.Drgent to Inc. moon Protect o.0279 a contract for the construction of the project designated as)Cnoz Avenue Sidewalk-Sargent to Hutchinson Protest No.0279 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 Liberty Mutual Insurance Company (Surety), a emporatin, organized under the laws of Massachusetts and licensed to do business in the Slate of Washington as surety and named in the currant list of"aunty Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau ofAccounts,US.TreasmyDryn.,are jointly and severally held and finely bound to the City of Spokane Valley,as Obligee,in the sum of$375985.15 mires hundred seventy five thousand nine hundred eighty five and 15/100 dollars)total Contract amotmt (including Washington State sales tax),subject to the provisions herein. This performance bond shall become mull and void,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall well and fahhfidly perform all of the Principal's obligations under the Contract and mil all the terms and conditions of all duly authorized modification,addition,and changes to said Contract That may hereafter he made,at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall'ademdfy and hold harmless the Obligee from any de&cue In the workmanship and material incorporated Into the work forties period identified bribe Contract and if such performance obligations have not been fidfilled,this bond shall remain to M]face and effect. The Surety for value received agrees that no change,intension of tines,alteration or addition to the teams of the Contract,the specifications accompanying the Contract,orto the work to be perfumed 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 Connect or the wok 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. Tins 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. PRINCIPAL( (.'TORR) N.A Degerstrom.Inc. spumy Liber MIatuu9rssur-mine Company 1 (2. �fl�. i+ 4/19/2019 �.CG L!'LPL'� jL[/(,�/(.7.I�/"Z/t-/ 4/19/2019 Prised Signature �W/\\�✓// Date Surety Signature _ Date Richard A. Stager Diana R.Williams _ PrmodNamo Printed Name V.P. Engineering Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: HUB International Northwest LLC 999 W.Riverside Ave.,Suite 510,Spokane,WA 99201 509-319-2901 Reused 1.1413 CITY OF SPOKANE VALLEY CONTRACT#19-0713 KNOX AVENUE SIDEWALK PROJECT -1e � BOND NO: 023207906 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 N.A.Degerstrom,Inc.(Contractor),as Principal,a contract for the conatmotion of the project designated as Knox Avenue Sidewalk-Sargent to Butehluwa Protect No.0279 in Spokane Valley,Washington,and said Principal isrequired under the mins of the Contract to finish apayment bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Liberty Mutual Insurance Company (Surety), a corporation organized under the laws Massachusetts and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable N Federal Bonds"as published inthe Federal Register by the Audit Staff Bureau of Aces U.S.Titaaaty Dept„are jointly and severally hall and Study bound to the City of Spokane Valley,as Obligee,in the slimy of 2375.985.15(Thee hundred severs•five thousand nine hundred elahiv five and 15/100 dollars) total Contract amount (Including Washington State sales tax),subject tothe provisions herein. This payment bond anal become mill and void,If and when the Principe!,its heirs,eeoutoa,administrators,successors,or assigns shall pay all persons In accordance with chapter.39.08 and 39.12 RCW,including all workers,irises,mechanics,subcontractors, and materialmen,and all perms who shall supply such contactor or subcontractor with provisions and supplies Sr the canying on clench work;and shall indemnify and hoW harmless the Obligee from all loss,castor damage which Obligee may affix by reason ofOre failure of Principal to make such required payments;and if such payment obligations have not beea&Med,this bond shall remain In fall force and effect. The Surety for wane received agrees that no change,extension of time,alteration or addition to die tuns of the Contract,the specifications accompanying the Contract,orto the work to be performed under the Contract shall hi any way acct Its obligation 'r on this Good,except as provided herein,and waive notice deny change,extension of thne,alteration oraddition to the terms of the Contract or dm work performed.The Surety agrees that modifications and changes to the tens and conditions ofd Contract that increase the total amount to be paid the Principal shall automatically increase the obligation tithe 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'day 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 +sett• pRThJOUM ,( TTtACT•OR) N A.Degerstrom,Inc /• z. y Libe M ual-i,s.nonce Company_ a / /i .4,�. 4/19/2019 _ Q C,F.... 4/19/2014 ) Principal Signature al Date SweiyS - Date Richard A. Stager Diana R.Williams - Printed Name PrintedName - V.P. Engineering Attorney-m-Pact The Tide Name,address,and telephone of local°Mee/agentt of Surety Company is: HUB International Northwest LLC 999 W Riverside Ave.,Suite 510,Spokane,WA 99201 509-319-2901 Rav,ad 114 13 CITY OF SPOKANE VALLEY CONTRACT gi9-076 KNOX AVENUE SIDEWALK PROJECT I • This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Ct �sii. Liberty ♦ a-.��7 Liberty Mutual Insurance Company fie Mutual. The Ohio Casualty Insurance Company Certificate No 8200730-985770 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a caporaton duly organized under the laws of the State of Massachusetts,and West Amencan Insurance Company Is a corporation duly organized under the laws of the State of Indiana(herein cojectwey caNed thetompanies),pursuant to and by authonty herein set forth,does hereby name,constitute and appoint, Wm Dinneen II Keith McNally,Erin L Repp,Chris Larson,Crystal A Viehman,Vugmia L Weber,Diana R Williams all of the city of Spokane state of Washington each individually if there be more than one named,its We and lawkl attorney-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its ad and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons N WITNESS WHEREOF,this Power of Attorney has been subscnbed by an authonzed officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 15th day of March 2019 Liberty Mutual Insurance Company 01811q- rt Weir \Nap The Ohio Casualty Insurance Company }p•.°orb pm °ay 11�fp•'04�'f11 West Acromion Insurance Company m a 1912ppo 0 1919 1991 f��J�,%,//�,J w th bV4.ciM+`atas 'bC+... Ee �re3+wi...�a By, ^7�^+"T /' '� r: a wh s e%Y a s M . h. / to c David M Carey,Assistant Secretary a' State of PENNSYLVANIA c m s Canty of MONTGOMERY ss m 2m O m On this 15th day of March , 2019 before me personally appeared David M Carey,villa acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 0 "o 2 Company,The Ohio Casualty Company,and West Amencan Insurance Company,and that he.as such,bang authonzed so to do,execute the foregoing instrument for the purposes=y y > therein contained by signing on behalf of the coryorebons by himself as a duly authanzed offer 5 w c IN WRNESS WHEREOF,I have hereunto subscnbed my name and affixed my notanal seal at King of Prussia,Pennsylvania,on the day and year first abovewntten c 0-0 o rep d 9PA ose"w F4 �� EALTHo PENNSYLVANIA Q< d) O Tenn? Not. Puck �"" " " � //eal O C Cr Uq-MermTTP.Monwomery CautY By.oF y re m 34 MMiCot iEaphe Meth 20.2o21 3 E aim \,� 4� v.nemwve.awaeeo-h urea ease Pastella,Notary Public oro CO o o rem m rzbThis Power of A is made and executed pursuant to and by authonty of the following By-laws and Authorgation of The Ohio Casualty Insurance Company, Liberty Mutual 5 m pc Insurance Company,ny,and West Amencan Insurance Company which resolutions are now in NII face and effect reading as follows o u E ori ARTICLE IV—OFFICERS:Section 12 Power of Attorney r3, o My officer or other ofiael of the Corporation authorized for Nat purpose in wntng by the Chairman or the President,and subject to such limitation as the Chairman or the 19_ a a >. President may prescribe,shall appoint such attorneys-in-fad,as may be necessary to act in behalf of the Corporation to make,execute,seal,ackna.Nedge and delver as surety >0 Tu L any and all undertakings,bonds.recognizances and other surety obligations Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall t m have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so executed, such" Z 15 instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authonty granted to any representabve or attorney- fact-fad under the •-en provisions of this artde may be revoked at any time by tie Board,the Chairman,the President or by the officer or officers granting such power or authonty t? ARTICLE XIII—Execution of Contracts:Seaton 5 Surety Bonds and Undertakings a Any officer of the Company authorized for that purpose in wnbng by the chairman or the president,and subject to such limitations as the chairman or the president may prescnbe, h W shall appoint such attorneys-m-fact,as may be necessary to ad in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bands,reagmzances and other surety obligations Such attorneysin-fad subject to the limitations set forth in Cher respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company,When so executed such instruments shall be as binding as if signed by the president and attested by the secretary Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M Carey,Assistant Secretary to appoint such attorneys-in- fact as may be necessary to ad on behalf of the Company to make,execute,seal,acknoiMedge and deliver as surely any and all undertakings,bonds,recognizances and other surety obligations Authorization—By unanimous consent of the Company's Board of Directors,the Company consents thatfarshmbe or mechanically reproduced signature of any assrstant secretary of the Company,wherever appeanng upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same farce and effect as though manually affixed I,Renee C Llewdlyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the anginal power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,Is in full force and effect and has not been revoked IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 19th day of April 2019 - $e ceS d tea ".%%192e 1991 0 Q�ia �e i°oh H4 sty kY��da Renee Llewellyn,Assistant Secretary LMS-12973 LMIC OCIC WPIC Multi C0_062013 Srrrrs�� BOND NO: 023207907 CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to N.A. Degerstrom, Inc. ("Contractor'), as Principal, a contract for the construction of the project designated as Knox Avenue Sidewalk-Sargent to Hutchinson Project No.0279(the"Contract")in Spokane Valley,Washington. The Principal,existing under and by virtue of the laws of the State of Washington and authorized to do business in the State of Washington,and liberty Mutual Insurance Company organized and existing under the laws of the State of Massachusetts and authorized to transact business in the State of Washington as Surety, am jointly and severally held and bound unto the City of Spokane Valley, hereinafter called Obligee,and are the penal held and bound unto the beneficiaries of the trust fund created by er T16,0.28 RCWAun p Nee penal sum of 5% of the Contract which is ne and A��s tY dollars($ 18,799.26 ),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 19th day of April 2019,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 refereed 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 6028 RCW. NOW THEREFORE,the condition of the obligation is such that the Principal and Surety am 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 CONTRACT#19-076 KNOX AVENUE SIDEWALK PROJECT fi 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. NA.Degerstrom,Inc. LibertyMCompany utual.nsit PRINCIPAL(CONITRACTOR) DI 8 SU�$TY , vl .� 4/19/2019 /41-- ' 4(17 - .��T/�� 4/19/2019. Principal Signature Date Surety Signature Date Richard A. Stager Diana It Williams Printed Name Printed Name V.P. Engineering Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is HUB International Northwest LLC 999 W.Rivensde Ave.,Suite 510,Spokane,WA 99201 509-319-2901 CITY OF SPOKANE VALLEY CONTRACT#19-076 KNOX AVENUE SIDEWALK PROJECT I r Thls Power of Attorney limits the acts of those named herein,and they have no authority to me- bind the Company except in the manner and to the extent herein stated. .% yzt Liberty Liberty Mutual Insurance Company A�' Mutual. The Ohio Casualty Insurance Company Certificate No 8200730-985770 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Stale of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws ofthe Slate of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State ofIndiana lheran collectively called the"Companies"),pursuant to and by authonty herein set forth,does hereby name,m isflute and appoint, Wm Dinneen H Keith McNally,Enn L Repp,Chm Larson,Crystal A Viehman,Virginia! Weber,Diana R Williams all of the city of Spoken state of Washington each ndmdually if there be more than one named,As true and Slut attorney-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons IN WITNESS WHEREOF,this Power of Attorney has been subscnbed by an authonzed officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 15th day of March 2n19 , Liberty Mutual Insurance Company INS toe. ���..yLL.( INap \xsukt The Ohio Casualty Insurance Company FW pg .y�c $ �o#p.Po.i`'se West AmencanenInsurance Company a 1912,e 9% 1919 g 1991 ii . // // En w b'et4 Mt a %1). d r gni.vr- a a/7�/ /(w.'y- c d Wn R� "�a H� aM . H� ay: E David M Carey,Assistant Secretary = -L- State of PENNSYLVANIA > d co County of MONTGOMERY ss m es w w On this 15th day of March , 2019 before me personally appeared David M Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o 452 Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authonzed so to do,execute the foregoing instrument for the purposes=1— y > therein contained bysgning on behalf of the corporations by himself as a duly authorized officer. o W V = IN WITNESS WHEREOF,I have hereunto subscnbed my name and affixed my notanal seal at King of Prussia,Pennsylvania,Cr the day and year first above wntten cL N ✓, 5r` ew`Vl tM w W f- N� COMMONWEALTH Seal ¢P .ew yax y� Noland a..i a w Term Pastels,Nary Pud'� o c d vires MwnM1y,MmW.nery UewiN By: 3 E m �.,b4. s9J0C4 ab c'"i"MnthiEvr"OaCe S 1,201 fferase Pasleha,Notary Public o w (0 \Mry P� u..e..>...n•.wwee.m,dw.b. d al oro ori This Power of Attorney rs made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company,Liberty Mutual£ �' o c Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows `o w W ARTICLE IV-OFFICERS:Section 12 Power of Attorney t'.(3) o m Any officer or other office!of the Corporation authonzed for that purpose in waling by the Chainmen or the President,and subject to such n as the Chairman or the=2 n>. President may presrnbe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,aoknowIdeowledge and deliver as surety >o o aand to any and all undertakings,bonds,recognizanms and other surety obligations Such atlaneysim-fad, to the limitations set form in their respective powers of attorney,shall t A have full power to bind the Coaoration by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so executed. such" Zinstruments shell be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attcmey-m-fact under the c m provisions of this amde may be revoked at any true by the Board,the Chairman,the President orby the officer or officers granting such power or authority ARTICLE XIII-Execution of Contracts:Section 5 Surety Bonds and Undertakings Any officer of the Company authorized for that purpose in writing by the chairman or the president and subject to such Imitations as the chairman or the president may prescnbe,1-0'9 shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and dower as surety any and all undertakings, bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the!Imitations set forth in their respective powers of attorney,shall have Ml power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company When so executed such instruments shall be as binding as if signed by the president and attested by the secretary Certificate of Designation-The President of the Company,acting pursuantto the Bylaws of the Company,authorizes David M Carey.Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appeenrig upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the CompanylMh the same force and effect as though manually affixed I,Renee C Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company and West American Insurance Company do hereby dxhy that the anginal power of attorney of which the foregoing le a full,true and cored copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this !9rh day of April 2010 also% {V ink MSU \1912p 0 1919 1991 0 Sear-- k egos' a .0z`s..4..01.1 g3M01A fl at. y Renee C.UewellYn,Assistant Secretary LMS-12673 LMIC OCIC WAIC Muth Cu 052016 /--""1 NADEGER-03 KBRFMER Lo CERTIFICATE OF LIABILITY INSURANCE GATE 4/18/2019 1 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Nr.'12,2CT Stacie Simpson Hub International Northwest LLC PHONEFAx 999 West Riverside Avenue,Suite 510 (NC.No,Eery:(508)319-2912 (NC.NO Spokane,WA 99201 RaNBB.Stacia.Simpson@hubinternafional.com INSURERS)AFFORDING COVERAGE NAIL II INSURER A:Alaska National Insurance Company 38733 INSURED INSURER a•National Fire&Marine 20079 NA.Degerstrom,Inc. INSURER C: 3303 N.Sullivan Road INSURER D: Spokane Valley,WA 99216 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON DITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUER POLICY NUMBER POLICY EFF POLICY FXP LIMITS LIR INS. MDIMMIDOM^(YI IMMEDIYYYVI A X COMMERCIAL GENERAL IABIUIY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X 18F PS 09101 0/30/2018 6/30/2019 POARMMISES iEa DNaurro(I $ 100,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE Limn-APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY X 28, LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITYMBIINEEDDtSINGLE LIMIT 1,000,000 1,000,000 X ANY AUTO X X 18F AS 09101 6/30/2018 6/30/2019 BODILY INJURY(Perperconl $ OWNED —SCHEDULED AUTOS ONLY AUTOS µµryry BODILY INJURY IPer accident) $ X ANpTICS ONLY X A�IITO ONLp Y IPperacccwAMAGE $ Comp&Coil ded $ 1,000 B UMBRELLA WB X OCCUR EACH OCCURRENCE $ 10,000,000 X EXCESS LAB CLAIMS-MADE 42XSF100017-06 6/30/2018 8/30/2019 AGGREGATE $ 10,000,000 DED X RETENTIONS 0 Following form $ A WORKERS COMPENSATION X STATUTE PRH ANDEMPLOYEas•Wellm YIN 18J WS 09101 10/1/2018 10/1/2019 1,000.000 AANY PROPRE EPJPARTNEXCLUERIEED?ECUTIVE Y x,lA EL EACH ACCIDENT $ EGER/ME(Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,006 If yes describe tinder 1,00%000 DESCRIPTION OF OPERATIONS below 1AE L DISEASE-POLICY LIMIT $ AS RESPECTS KNOX AVENUE SIDEWALK VEHICLES Remarks TCHINSON#07 W attachedNTRACT H19-0 required) PRIMARY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION TO CITY OF SPOKANE VALLEY,CONTRACTING AGENCY, IPS OFFICERS, ELECTED OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS IF REQUIRED BY WRITTEN CONTRACT AND AS GRANTED BY THE ACTUAL INSURANCE POLICY FORMS THAT ARE ATTACHED TO THIS CERTFICATE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SPOKANE VALLEY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10210 EAST SPRAGUE AVE SPOKANE VALLEY,WA 99208 AUDIOR�npE/O BEP $EEIi NTATVE ( ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD air INSURANCE Alaska National Mw al PANY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from a written contract that requires you to obtain this anyone liable for an injury covered by this policy. We agreement from us.) will not enforce our right against the person or organization named in the Schedule. (This agreement This agreement shall not operate directly or indirectly applies only to the extent that you perform work under to benefit any one not named in the Schedule. SCHEDULE Any person or organization for whom the Insured has agreed by written contract to furnish this waiver. 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. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. 18JWS 09101 Insured Endorsement No. Countersigned By WC 00 03 13 (04 84) ar Alaska t tionCOMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. — Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words "you" and "your" Others to Us 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 quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V— or the "loss" under a contract with that person DEFINITIONS in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION II — COVERED AUTO LIABILITY per "accident" and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2) — Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law SECTION II — COVERED AUTO LIABILITY violations) required because of an COVERAGE, Paragraph A.1. Who Is An Insured is "accident"we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating SECTION II — COVERED AUTO LIABILITY an "auto" hired or rented under a COVERAGE, Paragraph A.2.a. (4)— Supplementary contract or agreement in an "employee's" Payments is replaced by the following: name, with your permission, while performing duties related to the conduct (4) All reasonable expenses incurred by of your business. the "insured" at our request, including actual loss of earnings up to $500 a e. Any person or organization for whom you day 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 Alaska Natonal Air INSURANCE DO MO COMPANY c. "Loss" caused by falling objects or SECTION II - COVERED AUTO LIABILITY missiles. COVERAGE, Paragraph A.2.c.-Voluntary Property Damage is added as follows. However, you have the option of having glass breakage caused by a covered "auto's" c. Voluntary Property Damage collision or overturn considered a"loss" under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage Glass Repair—Waiver of Deductible caused by an 'insured", but without liability to a third party, up to$25,000. We No deductible applies to glass breakage, if will not make a Voluntary Property the glass is repaired rather than replaced. Damage payment to anyone who is an "insured" under this policy. SECTION III - PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. - Transportation Expenses is SECTION III - PHYSICAL DAMAGE COVERAGE, replaced by the following Paragraph A.2.-Towing is replaced by the following' a. Transportation Expenses Towing We wnll pay up to $200 per day to a We will pay up to $500 for towing and labor maximum 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 a. Private passenger; (1) Private passenger; b. Truck, (2) Truck, c. Pick-up truck; (3) Pick-up truck; d. Panel ; or (4) Panel; or e. Van (5) 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 eitheSECTION III — PHYSICAL DAMAGE COVERAGE, Causes ofCCoverage.a or Specifiedwili Paragraph A.3. - Glass Breakage - Hitting a Bird fof Loss We wpay or Animal- Falling or Missiles is replaced incurrednc temporaryduring transportation expenses8 ObjectsP the period beginning 48 by the following: hours after the theft and ending, e—Hitting a Bird or Animal regardless of the policy's expiration, Glass Breakage when the covered "auto" is returned to —Falling Objects or Missiles 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: a. Glass Breakage; b. "Loss' caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page 2 of 4 al 41111111 INSURANCE CE lionCOMPANY (2) Specified Causes of Loss only if the SECTION III — PHYSICAL DAMAGE COVERAGE, Declarations indicate that Specified Paragraph A.4.b. — Loss of Use Expenses is Causes of Loss Coverage is provided replaced by the following: for the "auto" withdrawn from service; or b. Loss of Use Expenses—Hired, Rented, (3) Collision only if the Declarations or Borrowed Automobiles indicate that Collision Coverage is provided for the "auto" withdrawn We will pay expenses for which an from service "insured" becomes legally responsible to pay for loss of use of a vehicle hired, SECTION III — PHYSICAL DAMAGE COVERAGE, rented or borrowed without a driver under Paragraph A.4.d. — Airbag Coverage is added as a written rental contract or agreement. follows: We will pay for loss of use expenses, if caused by. d. Airbag Coverage (1) Other than Collision, only if the We will pay for the cost to repair, replace, Declarations indicate that or reset an airbag that inflates for any Comprehensive Coverage is provided reason other than as a result of a for the vehicle withdrawn from collision, if the Declarations indicate that service. the covered "auto" has Comprehensive Coverage or Specified Causes of Loss (2) Specified Causes of Loss only if the Coverage. Declarations indicate that Specified Causes of Loss Coverage is provided SECTION III — PHYSICAL DAMAGE COVERAGE, for the vehicle withdrawn from Paragraph A.4.e. — Rental Reimbursement service. Coverage is added as follows' (3) Collision only if the Declarations e. Rental Reimbursement Coverage 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. (1) Private Passenger, SECTION III — PHYSICAL DAMAGE COVERAGE, (2) Truck; Paragraph A.4.c -Non-Transportation Loss of Use Expenses is added as follows' (3) Pick-up truck; c. Non-Transportation Loss of Use (4) Panel, or Expenses (5) Van We will pay up to $2,000 for non- transportation expense incurred by you, type vehicle under 20,000 lbs of Gross because of "loss" to a covered "auto", if Vehicle Weight. Payment applies in caused by: addition to the otherwise applicable amount of each coverage you have on a (1) Other than Collision, only if the covered "auto". No deductibles apply to Declarations indicate that this coverage. Comprehensive Coverage is provided for the "auto"withdrawn from service; ANIC CA 1150 10 13 Page 3 of 4 INSURANCEar �Ska COMPANY National (1) We will pay only for those expenses SECTION IV — BUSINESS AUTO CONDITIONS - incurred during the policy period Paragraph B.5.b. — Other Insurance is replaced by beginning 24 hours after the "loss" the following: and ending, regardless of the policy's expiration, with the lesser of the b. For Hired Auto Physical Damage following number of days: Coverage, the following are deemed to be covered "autos" you own. (a) The number of days reasonably required to repair or replace the (1) Any covered "auto' you lease, hire, covered "auto". rent, or borrow; and (b) 30 days. (2) Any covered "auto"" hired or rented by your "employee" under a contract (2) This coverage does not apply while in 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. (3) 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. SECTION V — DEFINITIONS — Paragraph C. — "Bodily injury" is replaced by the following SECTION IV — BUSINESS AUTO CONDITIONS - Paragraph B.2. — Concealment, Misrepresentation Or C. "Bodily injury means bodily injury, sickness or Fraud is amended by adding Unintentional Failure disease sustained by a person including death or to Disclose Hazards at the end of Paragraph 8.2 as mental anguish resulting from any of these follows. Mental anguish means any type of mental or emotional illness or disease Unintentional Failure to Disclose Hazards 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 AM. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective 6/30/2018 Policy No. 18FAS09101 Insured:N.A.Degerstrom,Inc Endorsement Countersigned By ©Insurance Services Office, Inc., 2009 ANIC CA 1150 10 13 Page 4 of 4 airAlaska National N.A.Degerstrom,Inc INSURANCE COMPANY Policy#I8FPS09101 Effective 6/30/2018 CONTRACTORS' GENERAL LIABILITY ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW 1. Miscellaneous Additional Insureds 14. In Rem Actions 8 additional insured extensions. 1. MISCELLANEOUS ADDITIONAL INSUREDS Primary and Noncontributory Insurance Section II Who Is An Insured is amended to 2. Damage To Premises Rented to You include as an additional Insured any person or Limit increased to$500,000. organization described in Paragraphs 2.a. through 2.h. below whom you are required to add 3. Medical Payments as an additional insured on this policy under a Limits increased to$15,000. written contract or written agreement. However, Reporting period increased to three years from the written contract or written agreement must be: the date of accident. 1. Currently In effect or becoming effective 4. Non-owned Watercraft during the term of this policy; and Increased to 50 feet. 2. Executed prior to the "bodily injury, 5. Supplementary Payments "property damage"or"personal injury and Cost of bail bonds increased to $10,000. advertising injury", but Daily loss of earnings increased to$500 Only the following persons or organizations 6. Newly Formed Or Acquired Organizations are additional insureds under this Coverage extended to the end of the policy period endorsement and coverage provided to such or the next anniversary of this policy's effective additional insureds is limited as provided date. herein: 7. Liberalization Clause a. State or Governmental Agency or Subdivision or Political Subdivi- 8. Unintentional Failure To Disclose Hazards sions 9. Notice of Occurrence Any state or governmental agency or subdivision or political subdivision 10. Broad Knowledge of Occurrence that has issued a permit in connection with operations performed 11. Bodily Injury-Extension of Coverage by you or on your behalf and that you are required by any ordinance, law or 12. Expected Or Intended Injury building code to include as an Reasonable force - bodily injury or property additional insured on this coverage damage, part is an additional insured, but only with respect to liability for "bodily 13. Blanket Waiver of Subrogation injury", "property damage", "personal Waiver of subrogation where required by written and advertising injury" arising out of contract or written agreement. such operations. ANC GL 1187 07 16 Page 1 of 6 AP Alaska NaURANCE tional PANY The insurance provided to such state e. Owners or Other Interests From or political subdivision does not apply Whom Land Has Been Leased to any "bodily injury", "property damage" or"personal and advertising An owner or other interest from whom injury" arising out of operations land has been leased by you but only performed for that state or political with respect to liability arising out of subdivision. the ownership, maintenance or use of that specific part of the land leased to b. Controlling Interest you and subject to the following additional exclusions- Any persons or organizations with a controlling interest in you but only This insurance does not apply to with respect to their liability arising out of: (1) Any "occurrence" which takes place after you cease to lease (1) Their financial control of you, or that land; or (2) Premises they own, maintain or (2) Structural alterations, new con- control while you lease or occupy struction or demolition operations these premises. performed by or on behalf of such additional insured. This insurance does not apply to structural alterations, new construe- f. Co-owner of Insured Premises tion and demolition operations performed by or for such additional A co-owner of a premises co-owned insured. by you and covered under this insurance but only with respect to the c. Managers or Lessors of Premises co-owners liability as co-owner of such premises. A manager or lessor of premises but only with respect to liability arising out g. Lessor of Equipment of the ownership, maintenance or use of that specific part of the premises Any person or organization from leased to you and subject to the whom you lease equipment. Such following additional exclusions: person or organization is an additional insured only with respect to This insurance does not apply to: their liability for "bodily injury, "property damage" or "personal and (1) Any "occurrence" which takes Advertising injury" caused, in whole place after you cease to be a or in part, by your maintenance, oper- tenant in that premises, or ation or use of equipment leased to you by such person or organization. (2) Structural alterations, new con- A person's or organization's status as struction or demolition operations an additional insured under this performed by or on behalf of endorsement ends when their written such additional insured. contract or written agreement with you for such leased equipment ends. d. Mortgagee, Assignee or Receiver With respect to the insurance A mortgagee, assignee or receiver afforded these additional insureds, but only with respect to their liability the following additional exclusions as mortgagee, assignee, or receiver apply and arising out of the ownership, maintenance, or use of a premises by This insurance does not apply: you. (1) To any "occurrence" which takes This insurance does not apply to place after the equipment lease structural alterations, new construe- expires, or tion or demolition operations performed by or for such additional insured. ANIC GL 1187 07 16 Page 2 of 6 Mil IAlaska CESURANNCational MPANY (2) To "bodily injury, "property additional insured. However, damage", or "personal and even if coverage within the advertising injury' arising out of "products-completed operations the sole negligence of such hazard" is required by the written additional insured. contract, such coverage is available to the additional insured h. Owners, Lessees or Contractors only if the "bodily injury" or "property damage"occurs prior to (1) Such person or organization is an the end of the time period during additional insured for "bodily which you are required by the injury", "property damage" and written contract to provide such "personal and advertising injury" coverage or the expiration date of if, and only to the extent that, the the policy,whichever comes first. injury or damage is caused by negligent acts or omissions of Any insurance provided to an additional you or your subcontractor in the insured designated under Paragraphs 2.a. performance of "your work" to through 2.g. above does not apply to "bodily which the written contract injury" or "property damage" included within applies. This person or organi- the products-completed operations hazard." zation does not qualify as an additional insured with respect to Primary And Noncontributory Insurance injury or damage caused in whole or in part by independent The following is added to the Other Insurance negligent acts or omissions of Condition and supersedes any provision to the such person or organization contrary (2) However, this insurance does not This insurance is primary to and will not seek apply to "bodily injury", "property contribution from any other insurance available to damage" or "personal and advertising injury" arising out of an additional insured under your policy provided an architect's, engineer's, or that surveyor's rendering of or failure to render any professional (1) The additional insured is a services including: Named Insured under such other insurance; and i. the preparing, approving, or failing to prepare or approve (2) You have agreed in writing in a maps, drawings, opinions, contract or agreement that this reports, surveys, change insurance would be primary and orders, design or would not seek contribution from ecrfications, and any other insurance available to o P the additional insured. ii. supervisory, inspection, or Section III -Limits of Insurance, the following is engineering services. added: (3) The insurance provided to this With respect to the insurance afforded to the additional insured, does not additional insureds described in Paragraphs a. cover "bodily injury" or "property through h. above, the most we will pay on behalf damage" caused by your of such additional insured is the amount of negligent acts and omissions in the performance of "your work" insurance: that occurs within the "products- (1) Required by the contract or completed operations hazard", agreement; or unless the written contract contains a specific requirement (2) Available under the applicable that you procure completed Limits of Insurance shown in the operations coverage or coverage Declarations; within the "products-completed operations hazard" for the whichever is less. ANIC GL 1187 07 16 Page 3 of 6 MilP Alaska National INSURANCE COPANY This provision shall not increase the applicable 4. NON-OWNED WATERCRAFT Limits of Insurance shown in the Declaration. A. If endorsement CG 21 09, CG 21 10, CC 24 2. Damage To Premises Rented to You 50, or CG 24 51 is attached to the policy, Paragraph A. 2. g. (2) (b) is replaced by the SECTION III — LIMITS OF INSURANCE, following' Paragraph 6. is replaced by the following' (b) A watercraft that you do not 6. Subject to Paragraph 5. above, the own that is: Damage to Premises Rented to You Limit is the most we will pay under Coverage A (9 Less than 50 feet long. for damages because of "property and damage" to any one premises, while rented to you, or in the case of damage (ii) Not being used to carry by fire, while rented to you or temporarily persons or property for a occupied by you with permission of the charge. owner. B. If Paragraph A. does not apply, Paragraph g. If a limit is shown for Damage to Premises (2) of 2. EXCLUSION under SECTION I — Rented to You the most we will pay under COVERAGES, COVERAGE A — BODILY Coverage A for damages because or "property INJURY AND PROPERTY DAMAGE damage" to any one premises is the Limit shown LIABILITY is replaced by the following. in the Declarations or $500,000, whichever is greater. (2) A watercraft that you do not own that is: 3. MEDICAL PAYMENTS (a) Less than 50 feet long, and A. Section III—Limits of Insurance, Paragraph 7.is replaced by the following: (b) Not being used to carry persons or property for a 7. Subject to Paragraph 5. above the charge. Medical Expense Limit is the most we will pay under Coverage C for all medical 5. SUPPLEMENTARY PAYMENTS expenses because of "bodily injury" sustained by any one person. A. Under Section I -Supplementary Payments - Coverage A and B, Paragraph 1.b., the If a limit is shown for Medical Expense in limit of$250 shown for the cost of bail bonds the Declarations the most we will pay is replaced by$10,000; under Coverage C for all medical expenses because of "bodily injury" B. In Paragraph 1.d., the limit of$250 shown for sustained by any one person is the Limit daily loss of earnings is replaced by$500. shown in the Declarations or $15,000, whichever is greater. 6. NEWLY FORMED OR ACQUIRED ORGANIZATIONS B. This provision 5. (Medical Payments) does not apply if Section I - Coverage C Medical Paragraph 3.a. of Section II-Who Is An Insured Payments is excluded either by the is deleted and replaced by the following' provisions of the Coverage Part or by endorsement. Coverage under this provision is afforded only until the end of the policy period or the next C. Paragraph 1.a.(3)(b)of Section I -Coverage anniversary of this policy's effective date after you C - Medical Payments, is replaced by the acquire or form the organization, whichever is following: earlier (b) The expenses are incurred and reported to us within three years of the date of the accident;and ANIC GL 1187 07 16 Page 4 of 6 Mr Alaska NaURANCE tional 7. LIBERALIZATION CLAUSE 10. BROAD KNOWLEDGE OF OCCURRENCE If we adopt a change in our forms or rules which The following is added to Paragraph 2. of Section would broaden coverage for contractors under IV - Commercial General Liability Conditions - this endorsement without an additional premium Duties in The Event of Occurrence, Offense, charge, your policy will automatically provide the Claim or Suit: additional coverages as of the date the revision is effective in your state You must give us or our authorized representative notice of an "occurrence", offense, claim, or"suit" B. UNINTENTIONAL FAILURE TO DISCLOSE only when the "occurrence", offense, claim or HAZARDS "suit' is known to. SECTION IV — COMMERCIAL GENERAL (1) You, if you are an individual, LIABILITY CONDITIONS — Paragraph 6. — Representations is replaced by the following: (2) A partner, if you are a partnership; 6. Representations (3) An executive officer or the By accepting this policy, you agree: employee designated by you to give such notice, if you are a a. The statements in the Declarations are corporation; or accurate and complete; (4) A manager, if you are a limited b. Those statements are based upon liability company. representations you made to us; and 11. EXPANDED BODILY INJURY c. We have issued this policy in reliance Section V - Definitions, the definition of "bodily upon your representations. injury"is changed to read: The unintentional omission of, or "Bodily injury" means bodily injury, sickness or unintentional error in, any information you disease sustained by a person, including death, provided to us which we relied upon in humiliation, shock, mental anguish or mental issuing this policy will not prejudice your injury by that person at any time which results as rights under this insurance. However, this a consequence of the bodily injury, sickness or provision does not affect our right to collect disease. additional premium or to exercise our rights of cancellation or nonrenewal in accordance 12. EXPECTED OR INTENDED INJURY with applicable laws and regulations. Exclusion a. of Section I - Coverage A - Bodily 9. NOTICE OF OCCURRENCE Injury and Property Damage Liability is replaced by the following- The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - a. "Bodily injury" or "property damage" Duties In The Event of Occurrence, Offense, expected or intended from the Claim or Suit: standpoint of the insured. This exclusion does not apply to "bodily Your rights under this Coverage Part will not be injury" or"property damage" resulting prejudiced if you fail to give us notice of an from the use of reasonable force to "occurrence", offense, claim or "suit" and that protect persons or property. failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence", offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence", offense, claim or"suit." ANIC GL 1187 07 16 Page 5 of 6 l S INSURANCE NE tones' OMPANY 13. BLANKET WAIVER OF SUBROGATION However, this waiver applies only when you have agreed in writing to waive such rights of recovery The Transfer Of Rights Of Recovery Against in a contract or agreement, and only if the Others To Us Condition (Section IV - contract or agreement: Commercial General Liability Conditions) is amended by the addition of the following: 1. Is in effect or becomes effective during the term of this policy; and We waive any right of recovery we may have against any person or organization because of 2. Was executed prior to loss. payments we make for injury or damage arising out of 14. IN REM ACTIONS 1. Your ongoing operations, or Any action in rem against any vessel owned, operated by or for, or chartered by or for you will 2. "Your work" included in the 'products- be treated in the same manner as though the completed operations hazard." action were in personam against you. This endorsement changes the policy to which itis 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. The Information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. Countersigned By Includes copyrighted material of Insurance Services Office, Inc.,with its permission ANIC GL 1187 07 16 Page 6 of 6 N.A.Degerstrom.Inc. Policy#QT6303H547939 Effective 6/30/2018 COMMERCIAL INLAND MARINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET LOSS PAYEES This endorsement modifies insurance provided under the IM PAK COVERAGE FORM. The following is added to Section E — ADDITIONAL b. Pay any claim for loss or damage jointly to you COVERAGE CONDITIONS: and the Loss Payee as your interests may ap- Loss Payable Provision pear. In the event of a Covered Cause of Loss to Covered This endorsement applies to all Covered Property for Properly in which both you and a Loss Payee share which a Loss Payee is on file with us or your insur- an insurable interest,we will: ance agent or insurance broker. a. Adjust the loss or damage with you;and CM T5 60 01 10 ©2009 The Travelers Indemnity company Page 1 of 1 Includes copyrighted material of Insurance Services Office.Inc.with its permission.