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19-070.00 NA Degerstrom: University Preservation Dishman to 16th Contract This agreement is entered into this `(t day of1/4l( , 2019, between the City of Spokane Valley ("City")and N,4,MEG6t5780t9,lN'(`Contractor ),pursuant to Title 35 RC W, as adopted or amended In consideration of the teens 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: University Road Preservation Project#0287 Contract 19-070 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City. II. The City hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. 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. V. The project was awarded for the bid amount of$3,121,354.50 plus applicable sales tax. IN WITNESS WHEREOF, the Contractor has executed this instrument, on the date below, and the City has caused this instrument to be executed on the date stated above. City of Spokane Valley 14 Contract Forms University Road Preservation Project Executed by Contractor H A , 2019. Dale RLCttAlQD A . sfl462 Printed Name vp., EAGaJEERING Title Signature City of Spokane Valley A• Mark Calhoun Printed Name City Manager Title Signature �� •.v City of Spokane Valley 15 Contract Forms University Road Preservation Project suc s BOND NO: 023207896 CONTRACTOR'S PERFORMANCE 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 University Road Preservation Project No 0287 in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a performance band in accordance with chapter 39.08 Revised Code of Washington(RC W). The Principal, and Liberty Mutual Insurance Company (Surety), a corporation, organized under the laws of Massachusetts 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 hound to the City of Spokane Valley,as Obligee.in the sum of$5,399,155.05 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 fill farce 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 PRINCIPAL(CONTRACTOR) N.A.Degerstrom,Inc SURETY Liberty(� Mutual Insurance Company 1nIjG 4/5/2019 01 4/5/2019 Principal Signature Date Sm ignature Date j I cu-4RD A . si-AW Crystal Viehman Printed Name ,-�/� Printed Name ENG-IN INC- Attorney-in-Fact Title z 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 u.,i.:,n lel; Pits of Spokane Valley 16 Contract Forms Jinn/emit)Road Preservation Project SookandOC%.111.6 BOND NO: 023207896 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 construction of the project designated as University Road Preservation Project No. 0287 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 IRCW) 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 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$3,399,155.05 total Contract amount(including Washington State sales taxi,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. PRINCIPAL(CONTRACTOR) N.A Degerstrom,Inc. SURETY /�Liiberty Mutual Insurance Company rA , 4/5/2019 LienLIA, 4/5/2019 Principal Signature Date Sure ignature Date RicH4RD A. snAc.42 Crystal AViehman Printed Name Printed Name VPS EEN GINwANJG 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 a.,iLi City of Spokane Valley i7 Contract Mons University Road Pieservation Project This Power of Attorney limits the acts of those named herein,and they have no authority to law bind the Company except in the manner and to the extent herein stated. r,`d t Liberty Liberty Mutual Insurance Company /►YL 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 oaporahon duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collecbvely called thetornpanleC),pursuantto and by authority herein set forth,does hereby name,constitute and appoint, Wm Dinneen,H Keith McNally,Erin L Repp,Chris Larson,Crystal A Neiman,Virginia L Weber,Diana R Williams all of the city of Spokane state of Washington each individually if there be more than one named,its true and lawful adamey-m-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 obligabons.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 subsmbed by an authorized 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 \XS, p Viso, OISUp The Ohio Casualty Insurance Company aeaof e p du�fp+'°s.+64om West American Insurance Company 5 1912 a+ 1919 a 1991 ��\�((y"�a,-����j/ J 6 /Son -o 1 2V�� r YO MnUYI D B44 c `1 -Y'/yIII + x 'xM< + ? dM + F� y: x c David M Carey,Assistant Secretary = so -2 State of PENNSYLVANIA a o 5 County of MONTGOMERY ss m w cs c o oo 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 0 452 Company,The Oho Casualty Company,and West Amencan Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes=1(73 v > therein contained by signing on behalf of the corporations by himself as a duly authorized officer 2w d 6 IN WITNESS WHEREOF,I have hereuntosubsonbed my name and affixed my notarial seal at King of Prussia,Pennsylvania,an the day and year first above written c a N .. FA3 M c� �etop p.F89 COwrw WIIAHxll eexanvuu n Qa ado mee.nriX Pity Public y ;'/Sal o C0 w MMTXoneravv.tnpenwy Crawly By: /&d- dm c m o � Mx Comiwmr Expires rA.mv,2o2e 3 E ai" Mine;r..+r"weAwe.wer Noe eresa Pastel's,Notary Public Gm and No 0 rim This Power of Attorney is made and executed pursuant to and by authonty of the fallowing By-laws and Authonzatons of The Ohio Casualty Insurance Company, Lrbedy Mutual£o' o c Insurance Company,and West Amencan Insurance Company which resdubons are now in full force and effect reading as follows `o ami E ai ARTICLE IV-OFFICERS Section 12 Power of Attorney Z' o m Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President.and subjectto such limitation as the Chairman or the- ID a President may presmbe,shall appoint such attorneysin-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,adnowledge and deliver as surety >I o To c any and all undertakings,bonds,recognizances and other surety obligations Such attorneys-in-fad,subject to the limitations set forth in their respective powers of attorney,shall t N 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"`o 15.Z u instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-rn-fact under the E CO" prowsrons of this article may be revoked at any tine by the Board,the Chairman,the President or by the officer or officers granting such power orauthonty o0 ARTICLE XIII-Execution of Contracts:Seaton 5 Surety Bonds and Undertakings o Any officer of the Company authorized for that purpose in venting by the chairman or the president,and subject to such limitation as the chairman or the president may prescabe,12,1 shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,actiodedge and driver as surety any and all undedakmgs, bonds,recagnizances and other surety obligations Such attorneys-in-fad subject to the limitations set forth in their 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,authonzes 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,adnowledge and deliver as surety any and al undertakings,bonds,recognlvances and other surety obligations Authorization-By unanimous ent of The Company's Board of DrreGars,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appeanng upon a certfied copy of any power of attorney issued by the Company in connection oath surety bonds,shall be valid and binding upon The Company with 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 Amencan Insurance Company do hereby certdythat 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 farce and effect and has not been revoked IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 5th day of April , 201Y I ! ; a 9a99c / rg ByReneeC Hewellm'Assistant Secretary H 44 F LM542873 LMIC OOIO WPIC Multi G0_082018 BOND NO: 023207897 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 University Road Preservation Project No. 0287 (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, are jointly and severally held and bound unto the City of Spokane Valley, hereinafter called Obligee, and are similarly held and bound unto the beneficiaries of the trust fund created by chapter 6028 RCW, in the penal sum of 5% of the Contract, which is One Hundred Fifty Six Thousand Sixty Seven and 72l100 dollars($ 156,067.72 ), 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 5th 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 referred to as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under chapter 60.28 RCW. NOW THEREFORE,the condition of the obligation is such that the Principal and Surety are held and bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW in the aforesaid sum. This bond, including any proceeds therefrom,is subject to all claims and liens and in the same manner and priority as set forth for retained percentages in chapter 60.28 RCW. The condition of this obligation is also such that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund purposes of chapter 60.28 RCW to the Obligee,and indemnify and hold the Obligee harmless from any and all loss, costs, and damages that the Obligee may sustain by release of the earned retained funds to the Principal,then upon notification of such satisfaction and release of the Surety by the Obligee,this obligation shall be null and void. PROVIDED HOWEVER,that: 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 assigns. 3. Any suit under this bond must be instituted within the time provided by applicable law. City of Spokane Valley IR Contact Fauns University Road 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 executing on behalf of the surety. PRINCIPAL(CONTRACTOR) N.A.Degerstrom,Inc. SURETY Liberty Mutual Insurance Company n O jti Q 4/5/2019 0.1)341-- 4(5/2019 Principal Signature Date Sunature Date aici4A-. s l-c•Epp Crystal A Viehman Printed Name Printed Name V, P., at46_,,,t4e,N61 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 C' of Spokane Valley 19 Contract Forms University Road Piesen anon Project r r This Power of Attorney limits the acts of those named herein,and they have no authority to ee- bind the Company except in the manner and to the extent herein stated. '% ,A•t- Liberty `_—' Liberty Mutual Insurance Company Company Mutual. The Ohio Casualty Insurance Company Certificate No 8200730-985770 West Amencan Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS.That The Ohm Casualty Insurance Company is a corporation duty organized under the laws of the Stale of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the Stale of Indiana(herein mlledwely called the"Companies"),pursuant to and by authonty herein set fat,does hereby name,constMe and appoint, Wm Dinneen H Keith McNally,Erin L Repp,Chns Larson,Crystal A Vichman,Virginia L Weber,Diana R Williams all of the sty of Spokane state of Washington each individually if there be more than one named,its true and lawful attorney-in-fact to make, execute,seal,acknowledge and delurer,for and on its behalf as surety and as its act and deed,any and at 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 IR WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized 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 �WSukt yiv [that �,\Xetq, The Ohio Casualty Insurance Company aOwxPINoxa'b 0m .il' wy6 -onxoe.,'�fom West Amencan Insurance Company 03a m �97ao JJo+ix919r� s� i"T9915e '7 /7 co w ami M w fi+' 3x XV rea'MMxx�s By. /�",+y _ Mw1 c — David M Carey,Assistant Secretary `` State of PENNSYLVANIA > m= County of MONTGOMERY ss m m 0 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 0 `o a Company,The Ohio Casualty Company,and West Amencan Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes=1— `w > therein contained by signing on behalf of the corporations by himself as a duly authonzed officero w V (73 IN WITNESS WHEREOF,I have hereunto subsmbed my name and affixed my notanal seal at Ing of Prussia,Pennsylvania,on the day and year first abovewnhen. a m co g> PA,??,,, vM Oi 4y4'�,,,ax fire COWONWYLTN Of PENNSYLVANIA ¢P irouriarsardi a`• -5 ,Mr•PINION.NOW".Wb ac � MnVw Mo,rnip.Maironvy County By: m m C m Mvwniw.Nm a.WINrav[n n,x21 3 E a)« v'£ Monte,P.x.rr..iMa.m.w�Mw.r erase Pastella,Notary Public o m CO \�°� too oum This Power of Attorney is made and executed pursuant to and by authority of the fdlovwng By-laws and Authonzahms of The Ohio Casualty Insurance Company, Liberty Mutual «o' o c Insurance Company,and West Amencan Insurance Company which resolutions are now in NII force and effect reading as fellows o v E ori ARTICLE IV-OFFICERS'Section 12 Power of Attorney z'. o Any oficer or other olFcial d Ne Capoatien authorized for that purpose in wnhng by the Chalnnan or the President,,and subject to such limitation as the Chairman or Mea n p > President may presmbe,shall appoint such attomeysm-fact as may be necessary to act in behalf of the Coporaton to make,execute,seal,acknowledge and ddwer as surety >o m c any and all undertakings,bonds,recognizances and other surety obligations Such attorneys-m-fact,subject to the limitations set forth in their respective powers of attorney,shall c N >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 "co Zinstmments shall be as binding as if signed by the President and attested to by the Secretary My power or authonty granted to any representative or attorney-in-fact under the LP en provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority ARTICLE XIII-Execution of Contracts Section 5 Surety Bonds and Undertakngs §.2 My officer of the Company authonzed for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,h« shall appoint such attemeysin-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety 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 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,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations Authorization-By unanimous consent of the Companys Board of Directors,the Company consents that facsimile or mechanicallyreproduced signature of any assistant secretary of the Company,wherever appeanng upon a certified copy of any power of attorney issued by the Company in connecbm with surety bonds,shall be valid and binding upon the Company with 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 cethty that the anginal power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by card Companies,is in NII 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 5th day of April , 2019 totteu,t., Sy area Wath 1972 9“,,,,a41 ft 1997 b�h ,.v �E each re y Renee Llewellyn,Assistant Secretary LMS.12873 LMIC OGIG WAIC Multi D1_062018 NADEGER-03 KBREMER AICOR O' CERTIFICATE OF LIABILITY INSURANCE DATE 15 `-� 4/5//201920/9 YYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. This CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must 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 NQS?CT Stacia Simpson Hub International Northwest LLCHONE FAX 999 West Riverside Avenue,Suite 510 j HO No.ENO.(509)37 9-2972 LAR:,No): Spokane,WA 99201 FAohss StaCia.SimpsonQhubinternational.com INSURER'S)AFFORDING COVERAGE NAICO INSURER A•Alaska National Insurance Company 38733 INSURED INSURER a:National Fire&Marine 20079 N.A.Degerstrom,Inc. INSURER C 3303 N.Sullivan Road INSURER o. 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 TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR ADOL SUER POUCY EFF POLICY EXP LIR TYPE OF INSURANCE IVSD WVD POUCY NUMBER IMM/DONYWI (MMJODIYYYYI UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE XJ OCCUR X X 18F P509101 6/30/2018 6/30/2019 pRFMRFS(Ee oacuvancel 100,000 MED EXP(MY me person) 15,000 PERSONAL BADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000/ POLICY X JECi LOC PRODUCTS-COMP/OP AGO 2,000'000 OTHER WA STOP GAP 1,000,000 A AUTOMOBILELIBIUTY (Fa= leen° INGLE LIMIT 1,000,000/ X ANY AUTO X X 18F AS 09101 6/30/2018 8/30/2019 BODILY INJURY(Per person) OWNED —SCHEDULED AUTOS ONLY AUTOS BODILY BODILY INJURYd (Perao eN) _ X AL S ONLY X NlIT05OPPpe0rao6oOntppIMAGE Comp 8 Coll ded 1,000 B UMBRELLA LIAR X OCCUR EACH OCCURRENCE 10,000,000 X EXCESS LMB CLAIMS-MADE 42X5F100017-06 6/30/2018 6/30/2019 AGGREGATE 10,000,000 DEO X RETENTIONS 0 Following form A AND EMPLOYRKERS ERS' X STATUTE OERH ANY PROPRIETORIPARTNEWE%ECUTIVE YIN 18J WS 09101 10/1/2018 10/1/2019 1,000,000 prr R0/1 EMBER EXCLUDED? Y NIA EL EACH ACCIDENT (m0 J Wryln NH) EL DISEASE-EA EMPLOYEE 1,000,000 the;.describe under DESCRIPTION OF OPERATIONS below E1L DISEASE-POLICY LIMIT 1'000'000 UNIVERSIITOF ROPERATIONS AD PRESERVATION PROJEC (ACORD NO 0287 TRANSPORTATION BOARD PROJECT NOR-3.208(O10)-1 AND CONTRACT NO.19-070 PRIMARY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION TO CITY OF SPOKANE VALLEY,CONTRACTING AGENCY, IT'S OFFICERS, ELECTED OFFICIALS,AGENTS,EMPLOYEES,AND VOLUNTEERS AND MODEL IRRIGATION DISTRICT 18,VARELA 8 ASSOCIATES INC AND THEIR OFFICERS,ELECTED OFFICIALS,EMPLOYEES,AGENTS AND VOLUNTEERS AS 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 10210 EAST SPRAGUE AVE ACCORDANCE WITH THE POLICY PROVISIONS SPOKANE VALLEY,WA 99208 AUTORIZED REPRESENTATIVE / ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SINSURANCENational COMPANY 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 Al EES Y l 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 Al.. 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 115010 13 Page 1 of 4 INSURANCEAlaska al a C MP NY 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 111 — PHYSICAL DAMAGE COVERAGE, replaced by the following: Paragraph A.2.—Towing is replaced by the following: a. Transportation Expenses Towing We will 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 e. Van (4) Panel, or type vehicle under 20,000 lbs. of Gross (5) Van 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 SECTION III — PHYSICAL DAMAGE COVERAGE, either Comprehensive or Specked Paragraph A.3. — Glass Breakage — Hitting a Bird Causes of Loss Coverage. We willpay or Animal — Falling Objects or Missiles is replaced for temporary transportation expenses by the following: incurred during the period beginning 48 hours after the theft and ending, Glass Breakage—Hitting a Bird or Animal regardless of the policy's expiration, —Falling Objects or Missiles when the covered "auto" is returned to use or we pay for its"loss". If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss" caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page 2 of 4 Alaska AV INSURANCE COMPANY (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 toss 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 Alaska National ar INSURANCE COMPANY (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 B.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 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 6/30/2018 Policy No. 18FAS09I01 Insured:NA.Degerstrom,Inc. Endorsement Countersigned By ®Insurance Services Office, Inc, 2009 ANIC CA 115010 13 Page 4 of 4 MrAlaskaNational N.A.Degerstrom,Inc. INSURANCE COMPANY Policy#18FPS09101 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 5. Supplementary Payments 2. Executed prior to the "bodily injury", PP rY Y "property damage'or"personal injury and Cost of bail bonds increased to$10,000. advertising injury", but Daily loss of earnings increased to$500 6. NewlyFormed Or Acquired Organizations Only the following persons or organizations 9 9 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 8. Unintentional Failure To Disclose Hazards Subdivision or Political Subdivi- 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 11. Bodilyinjury Extension of Coverage connection with operations performed 1 ry- 9 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 13. Blanket Waiver of Subrogation with respect to liability for °bodily inWaiver of subrogation where required bywritten drya, "property dumagei, "personal 9 Q and advertising injury" arising out of contract or written agreement. such operations ANIC GL 1187 07 16 Pagel of6 fl Alaska National INSURANCE COMPANY 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 construc- 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 9. 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 construc- expires; or tion or demolition operations performed by or for such additional insured ANIC GL 1187 0716 Page 2 of 6 atirAlaskaNational INSURCE COPANY (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 specifications; and any other insurance available to 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 insurance: the performance of "your work" that occurs within the "products- (1) Required by the contract or completed operations hazard", unless the written contract agreement; or contains a specific requirement that you procure completed (2) Available under the applicable operations coverage or coverage Limits of Insurance shown in the within the "products-completed Declarations; operations hazard" for the whichever is less ANIC GL 1187 07 16 Page 3 of 6 NSURlar Alaska r: National IANE COMPANY 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, CG 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 (i) 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 of 1111 Alaska National INSURANCE COMPANY 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" 8. 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 SI NIW a CNational SURANCOMPANY 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 ttf 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 tens 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 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. 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 Property 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 15 60 01 10 ®2009 The Travelers Indemnity Company Page 1 of 1 Includes copyrighted matenal of Insurance Services Office,Inc with its permission NADEGER-03KBREMER DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/26/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Kristy Bremer CONTACT PRODUCER NAME: Hub International Northwest LLC PHONEFAX (509) 319-2909 (A/C, No, Ext):(A/C, No): 999 West Riverside Avenue, Suite 510 E-MAIL Kristy.Bremer@hubinternational.com Spokane, WA 99201 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Alaska National Insurance Company38733 INSURER A : INSURED INSURER B : N.A. Degerstrom, Inc. INSURER C : 3303 N. Sullivan Road INSURER D : Spokane Valley, WA 99216 INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFPOLICY EXP INSRADDLSUBR TYPE OF INSURANCEPOLICY NUMBERLIMITS (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A 1,000,000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ 500,000 DAMAGE TO RENTED X 19FPS091016/30/20196/30/2020 CLAIMS-MADEOCCUR XX $ PREMISES (Ea occurrence) Per Project Aggregat15,000 X MED EXP (Any one person)$ Emp Liab/Stop Gap1,000,000 X PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ 2,000,000 X PRO- POLICYLOC PRODUCTS - COMP/OP AGG$ JECT STOP GAP1,000,000 OTHER:$ A 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) X 19FAS091016/30/20196/30/2020 XX ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ PROPERTY DAMAGE XX HIREDNON-OWNED (Per accident)$ AUTOS ONLYAUTOS ONLY $ A 10,000,000 XX UMBRELLA LIAB OCCUR EACH OCCURRENCE$ 19FLU091016/30/20196/30/2020 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE$ 0 X DEDRETENTION$ $ A PEROTH- X WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 18J WS 0910110/1/201810/1/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ Y N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) UNIVERSITY ROAD PRESERVATION PROJECT NO. 0287 - TRANSPORTATION BOARD PROJECT NO 8-3-208(010)-1 AND CONTRACT NO. 19-070 PRIMARY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION TO CITY OF SPOKANE VALLEY, CONTRACTING AGENCY, IT'S OFFICERS, ELECTED OFFICIALS, AGENTS, EMPLOYEES, AND VOLUNTEERS AND MODEL IRRIGATION DISTRICT 18, VARELA & ASSOCIATES INC AND THEIR OFFICERS, ELECTED OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS AS REQUIRED BY WRITTEN CONTRACT AND AS GRANTED BY THE ACTUAL INSURANCE POLICY FORMS THAT ARE ATTACHED TO THIS CERTFICATE. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SPOKANE VALLEY ACCORDANCE WITH THE POLICY PROVISIONS. 10210 EAST SPRAGUE AVE SPOKANE VALLEY, WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONTRACTENHANCEMENT 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. 2.a. organization described in Paragraphs 2.h. through 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. , 5. Supplementary Payments l 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 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 13. Blanket Waiver of Subrogation Waiver of subrogation where required by written contract or written agreement. such operations. ANIC GL 1187 07 16 Page 1 of 6 e.Owners or Other Interests From The insurance provided to such state Whom Land Has Been Leased or political subdivision does not apply An owner or other interest from whom 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 (1) out of: place after you cease to lease (1) Their financial control of you, or that land; or (2)(2) Premises they own, maintain or 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 f. Co-owner of Insured Premises structural alterations, new construc- 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 g. Lessor of Equipment only with respect to liability arising out 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 (1) 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- 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) This insurance does not apply to place after the equipment lease structural alterations, new construc-expires; or tion or demolition operations performed by or for such additional insured. ANIC GL 1187 07 16 Page 2 of 6 (2) , additional insured. However, , personal and even if coverage within the "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 which you are required by the written contract to provide such 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 2.a. insured designated under Paragraphs 2.g. through which the written contract applies. This person or organi- the products- 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 Other Insurance The following is added to the negligent acts or omissions of Conditionand 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 contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a to render any professional Named Insured under such other services including: insurance; and i. the preparing, approving, or (2) You have agreed in writing in a failing to prepare or approve contract or agreement that this maps, drawings, opinions, insurance would be primary and reports, surveys, change would not seek contribution from orders, design or any other insurance available to specifications; and 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 a. additional insureds described in Paragraphs cover "bodily injury" or "property . through h above, the most we will pay on behalf of such additional insured is the amount of negligent acts and omissions in insurance: the performance of "your work" 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 4. NON-OWNED WATERCRAFT This provision shall not increase the applicable Limits of Insurance shown in the Declaration. A CG 21 09, CG 21 10, CG 24 . If endorsement 50, or CG 24 51 is attached to the policy, 2. Damage To Premises Rented to You Paragraph A. 2. g. (2) (b) is replaced by the following: SECTION III LIMITS OF INSURANCE, 6. Paragraph is replaced by the following: (b) A watercraft that you do not own that is: 6. 5. Subject to Paragraph above, the Damage to Premises Rented to You Limit (i) Less than 50 feet long: A is the most we will pay under Coverage and ses, while (ii) Not being used to carry rented to you, or in the case of damage persons or property for a by fire, while rented to you or temporarily charge. occupied by you with permission of the owner. B. Ag. If Paragraph . does not apply, Paragraph (2) 2. EXCLUSION SECTION l of under If a limit is shown for Damage to Premises COVERAGES, COVERAGE A BODILY Rented to You the most we will pay under INJURY AND PROPERTY DAMAGE A Coverage LIABILITY is replaced by the following: in the Declarations or $500,000, whichever is (2) A watercraft that you do not own greater. that is: 3. MEDICAL PAYMENTS (a) Less than 50 feet long; and A.Section lll Limits of Insurance , Paragraph (b) Not being used to carry 7. is replaced by the following: persons or property for a charge. 7. Subject to Paragraph 5. above the Medical Expense Limit is the most we will 5. SUPPLEMENTARY PAYMENTS Coverage C pay under for all medical A.Section I - Supplementary Payments Under sustained by any one person. - Coverage AB1.b and , Paragraph ., the limit of $250 shown for the cost of bail bonds If a limit is shown for Medical Expense in is replaced by $10,000; the Declarations the most we will pay under Coverage C for all medical B.1.d., In Paragraph the limit of $250 shown for daily loss of earnings is replaced by $500. sustained by any one person is the Limit shown in the Declarations or $15,000, 6. NEWLY FORMED OR ACQUIRED whichever is greater. ORGANIZATIONS B. This provision 5. (Medical Payments) does 3.a.Section II - Who Is An Insured Paragraph of Section I - Coverage C Medical not apply if is deleted and replaced by the following: Payments is excluded either by the provisions of the Coverage Part or by Coverage under this provision is afforded only endorsement. until the end of the policy period or the next C.1.a.(3)(b) of Section I - Coverage Paragraph acquire or form the organization, whichever is C - Medical Payments , is replaced by the earlier. following: (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 7. LIBERALIZATION CLAUSE 10. BROAD KNOWLEDGE OF OCCURRENCE 2.Section If we adopt a change in our forms or rules which The following is added to Paragraph of IV - Commercial General Liability Conditions - would broaden coverage for contractors under Duties in The Event of Occurrence, Offense, this endorsement without an additional premium Claim or Suit: charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state. You must give us or our authorized representative 8. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS known to: (1) SECTION IV COMMERCIAL GENERAL You, if you are an individual; LIABILITY CONDITIONS6. Paragraph (2) A partner, if you are a Representations is replaced by the following: partnership; 6.Representations (3) An executive officer or the employee designated by you to By accepting this policy, you agree: give such notice, if you are a corporation; or a. The statements in the Declarations are accurate and complete; (4) A manager, if you are a limited liability company. b. Those statements are based upon representations you made to us; and 11. EXPANDED BODILY INJURY c. We have issued this policy in reliance Section V - Definitions upon your representations. The unintentional omission of, 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 disease. provision does not affect our right to collect additional premium or to exercise our rights of 12. EXPECTED OR INTENDED INJURY cancellation or nonrenewal in accordance with applicable laws and regulations. a.Section I - Coverage A - Bodily Exclusion of Injury and Property Damage Liability is 9. NOTICE OF OCCURRENCE replaced by the following: 2.Section The following is added to Paragraph of a. IV - Commercial General Liability Conditions - expected or intended from the Duties In The Event of Occurrence, Offense, standpoint of the insured. This Claim or Suit: Your rights under this Coverage Part will not be from the use of reasonable force to prejudiced if you fail to give us notice of an protect persons or property. failure is solely due to your reasonable belief that covered under this Coverage Part. However, you shall give written noti aware that this insurance may apply to such ANIC GL 1187 07 16 Page 5 of 6 13. BLANKET WAIVER OF SUBROGATION However, this waiver applies only when you have agreed in writing to waive such rights of recovery Transfer Of Rights Of Recovery Against The in a contract or agreement, and only if the Others To Us Condition (Section IV - contract or agreement: Commercial General Liability Conditions) is 1. amended by the addition of the following: Is in effect or becomes effective during the term of this policy; and We waive any right of recovery we may have 2. against any person or organization because of Was executed prior to loss. payments we make for injury or damage arising 14. IN REM ACTIONS out of: 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. -be treated in the same manner as though the action were in personam against you. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date The information below is issued at 12:01 A.M. standard time at your mailing address shown in the policy. required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective 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 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT SCHEDULE The information below is required only when this endorsement is issued subsequent to commencement of the policy.