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19-162.00 Poe Asphalt Paving: Street & Stormwater Maintenance & RepairContract No. 19-162 AGREEMENT FOR SERVICES Poe Asphalt Paving Inc. Street and Stormwater Maintenance and Repair THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and Poe Asphalt Paving Inc., hereinafter "Consultant," jointly referred to as "Parties." IN CONSIDERATION of the terms and conditions contained herein, the Parties agree as follows: 1. Work to Be Performed. Consultant shall provide all labor, services, and material to satisfactorily complete the Scope of Services, attached as Exhibit A. A. Administration. The City Manager or designee shall administer and be the primary contact for Consultant. Prior to commencement of work, Consultant shall contact the City Manager or designee to review the Scope of Services, schedule, and date of completion. Upon notice from the City Manager or designee, Consultant shall commence work, perform the requested tasks in the Scope of Services, stop work, and promptly cure any failure in performance under this Agreement. B. Representations. City has relied upon the qualifications of Consultant in entering into this Agreement. By execution of this Agreement, Consultant represents it possesses the ability, skill, and resources necessary to perform the work and is familiar with all current laws, rules, and regulations which reasonably relate to the Scope of Services. No substitutions of agreed -upon personnel shall be made without the prior written consent of City. Consultant represents that the compensation as stated in paragraph 3 is adequate and sufficient for the timely provision of all professional services required to complete the Scope of Services under this Agreement. Consultant shall be responsible for the technical accuracy of its services and documents resulting therefrom, and City shall not be responsible for discovering deficiencies therein. Consultant shall correct such deficiencies without additional compensation except to the extent such action is directly attributable to deficiencies in City -furnished information. C. Standard of Care. Consultant shall exercise the degree of skill and diligence normally employed by professional consultants engaged in the same profession, and performing the same or similar services at the time such services are performed. D. Modifications. City may modify this Agreement and order changes in the work whenever necessary or advisable. Consultant will accept modifications when ordered in writing by the City Manager or designee, so long as the additional work is within the scope of Consultant's area of practice. Compensation for such modifications or changes shall be as mutually agreed between the Parties. Consultant shall make such revisions in the work as are necessary to correct errors or omissions appearing therein when required to do so by City without additional compensation. 2. Term of Contract. This Agreement shall be in full force and effect upon execution and shall remain in effect until completion of all contractual requirements have been met as determined by City. Consultant shall Street & Stormwater Maintenance and Repair - 2020 Page 1 of 9 Contract No. 19-162 complete its work by December 31,2020, unless the time for performance is extended in writing by the Parties. The City may extend the contract for up to four additional one year terms, which will commence on or about January 1 or each year and end on December 31 of that year. The City will give the contractor written notice of its intent to extend the contract at least 60 days before the contract term expires. The total duration of the Contract shall not exceed five years. Either Party may terminate this Agreement for material breach after providing the other Party with at least 10 days' prior notice and an opportunity to cure the breach. City may, in addition, terminate this Agreement for any reason by 10 days' written notice to Consultant. In the event of termination without breach, City shall pay Consultant for all work previously authorized and satisfactorily performed prior to the termination date. 3. Compensation City agrees to pay Consultant an agreed upon hourly rate up to a maximum amount of $1,500,000 as full compensation for everything done under this Agreement, as set forth in Exhibit B. Consultant shall not perform any extra, further, or additional services for which it will request additional compensation from City without a prior written agreement for such services and payment therefore. 4. Payment. Consultant shall be paid monthly upon presentation of an invoice to City. Applications for payment shall be sent to the City Finance Department at the below -stated address. City reserves the right to withhold payment under this Agreement for that portion of the work (if any) which is determined in the reasonable judgment ofthe City Manager or designee to be noncompliant with the Scope of Services, City standards, City Code, and federal or state standards. 5. Notice. Notices other than applications for payment shall be given in writing as follows: TO THE CITY: TO THE CONSULTANT: Name: Christine Bainbridge, City Clerk Name: Poe Asphalt Paving Inc. Phone: (509) 720-5000 Phone: 208-777-0498 Address: 10210 East Sprague Avenue Address: 2732 N. Beck Road Spokane Valley, WA 99206 Post Falls, ID 83854 6. Applicable Laws and Standards. The Parties, in the performance of this Agreement, agree to comply with all applicable federal, state, and local laws and regulations. Consultant warrants that its designs, construction documents, and services shall conform to all federal, state, and local statutes and regulations. 7. Certification ReQardine Debarment. Suspension, and Other Responsibility Matters — Prima Covered Transactions. A. By executing this Agreement, the Consultant certifies to the best of its knowledge and belief that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; 2. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust Street & Storrawater Maintenance and Repair - 2020 Page 2 of 9 Contract No. 19-162 statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (A)(2) of this certification; and 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (federal, state, or local) terminated for cause or default. B. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this Agreement. 8. Relationship of the Parties. It is understood and agreed that Consultant shall be an independent contractor and not the agent or employee of City, that City is interested in only the results to be achieved, and that the right to control the particular manner, method, and means in which the services are performed is solely within the discretion of Consultant. Any and all employees who provide services to City under this Agreement shall be deemed employees solely of Consultant. The Consultant shall be solely responsible for the conduct and actions of all its employees under this Agreement and any liability that may attach thereto. 9.Ownership of Documents. All drawings, plans, specifications, and other related documents prepared by Consultant under this Agreement are and shall be the property of City, and may be subject to disclosure pursuant to chapter 42.56 RCW or other applicable public record laws. The written, graphic, mapped, photographic, or visual documents prepared by Consultant under this Agreement shall, unless otherwise provided, be deemed the property of City. City shall be permitted to retain these documents, including reproducible camera-ready originals of reports, reproduction quality mylars of maps, and copies in the form of computer files, for the City's use. City shall have unrestricted authority to publish, disclose, distribute, and otherwise use, in whole or in part, any reports, data, drawings, images, or other material prepared under this Agreement, provided that Consultant shall have no liability for the use of Consultant's work product outside of the scope of its intended purpose. 10. Records. The City or State Auditor or any of their representatives shall have full access to and the right to examine during normal business hours all of Consultant's records with respect to all matters covered in this Agreement. Such representatives shall be permitted to audit, examine, make excerpts or transcripts from such records, and to make audits of all contracts, invoices, materials, payrolls, and record of matters covered by this Agreement for a period of three years from the date final payment is made hereunder. 11. Insurance. Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by Consultant, its agents, representatives, employees, or subcontractors. A. Minimum Scope of Insurance. Consultant shall obtain insurance of the types described below: 1. Automobile liability insurance covering all owned, non -owned, hired, and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. 2. Commercial general liability insurance shall be at least as broad as ISO occurrence form Street & Stormwater Maintenance and Repair - 2020 Page 3 of 9 Contract No. 19-162 CG 00 01 and shall cover liability arising from premises, operations, stop -gap independent contractors and personal injury, and advertising injury.. City shall be named as an additional insured under Consultant's commercial general liability insurance policy with respect to the work performed for the City using an additional insured endorsement at least as broad as ISO CG 20 26. 3. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. B. Minimum Amounts of Insurance. Consultant shall maintain the following insurance limits: 1. Automobile liability insurance with a minimum combined single limit for bodily injury and property damage of no less than $1,000,000 per accident. 2. Commercial general liability insurance shall be written with limits no less than $1,000,000 for each occurrence, and $2,000,000 for general aggregate. C. Other Insurance Provisions. The policies are to contain, or be endorsed to contain, the following provisions for automobile liability and commercial general liability insurance: 1. Consultant's insurance coverage shall be primary insurance with respect to the City. Any insurance, self-insurance, or insurance pool coverage maintained by City shall be in excess of Consultant's insurance and shall not contribute with it. 2. Consultant shall fax or send electronically in .pdf format a copy of insurer's cancellation notice within two business days of receipt by Consultant. 3. If Consultant maintains higher insurance limits than the minimums shown above, City shall be insured for the full available limits of commercial general and excess or umbrella liability maintained by Consultant, irrespective of whether such limits maintained by Consultant are greater than those required by this Agreement or whether any certificate of insurance furnished to the City evidences limits of liability lower than those maintained by Consultant. 4. Failure on the part of Consultant to maintain the insurance as required shall constitute a material breach of the Agreement, upon which the City may, after giving at least five business days' notice to Consultant to correct the breach, immediately terminate the Agreement, or at its sole discretion, procure or renew such insurance and pay any and all premiums in connection therewith, with any sums so expended to be repaid to City on demand, or at the sole discretion of the City, offset against funds due Consultant from the City. D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, Consultant shall furnish acceptable insurance certificates to the City Clerk at the time Consultant returns the signed Agreement, which shall be Exhibit C. The certificate shall specify all ofthe parties who are additional insureds, and shall include applicable policy endorsements, and the deduction or retention level. Insuring companies or entities are subject to City acceptance. If requested, complete Street & Stormwater Maintenance and Repair - 2020 Page 4 of 9 Contract No. 19-162 copies of insurance policies shall be provided to City. Consultant shall be financially responsible for all pertinent deductibles, self -insured retentions, and/or self-insurance. 12. Indemnification and Hold Harmless. Consultant shall, at its sole expense, defend, indemnify, and hold harmless City and its officers, agents, and employees, from any and all claims, actions, suits, liability, loss, costs, attorney's fees, costs of litigation, expenses, injuries, and damages of any nature whatsoever relating to or arising out of the wrongful or negligent acts, errors, or omissions in the services provided by Consultant, Consultant's agents, subcontractors, subconsultants, and employees to the fullest extent permitted by law, subject only to the limitations provided below. Consultant's duty to defend, indemnify, and hold City harmless shall not apply to liability for damages arising out of such services caused by or resulting from the sole negligence of City or City's agents or employees pursuant to RCW 4.24.115. Consultant's duty to defend, indemnify, and hold City harmless against liability for damages arising out of such services caused by the concurrent negligence of (a) City or City's agents or employees, and (b) Consultant, Consultant's agents, subcontractors, subconsultants and employees, shall apply only to the extent of the negligence of Consultant, Consultant's agents, subcontractors, subconsultants, and employees. Consultant's duty to defend, indemnify, and hold City harmless shall include, as to all claims, demands, losses, and liability to which it applies, City's personnel -related costs, reasonable attorneys' fees, the reasonable value of any services rendered by the office of the City Attorney, outside consultant costs, court costs, fees for collection, and all other claim -related expenses. Consultant specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. These indemnification obligations shall not be limited in any way by any limitation on the amount or type of damages, compensation, or benefits payable to or for any third party under workers' compensation acts, disability benefit acts, or other employee benefits acts. Provided, that Consultant's waiver of immunity under this provision extends only to claims against Consultant by City, and does not include, or extend to, any claims by Consultant's employees directly against Consultant. Consultant hereby certifies that this indemnification provision was mutually negotiated. 13. Waiver. No officer, employee, agent, or other individual acting on behalf of either Party has the power, right, or authority to waive any of the conditions or provisions of this Agreement. A waiver in one instance shall not be held to be a waiver of any other subsequent breach or nonperformance. All remedies afforded in this Agreement or by law shall be taken and construed as cumulative and in addition to every other remedy provided herein or by law. Failure of either Party to enforce at any time any of the provisions of this Agreement or to require at any time performance by the other Party of any provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the validity of this Agreement or any part thereof. 14. Assignment and Delegation. Neither Party may assign, transfer, or delegate any or all of the responsibilities of this Agreement or the benefits received hereunder without prior written consent of the other Party. 15. Subcontracts. Except as otherwise provided herein, Consultant shall not enter into subcontracts for any of the work contemplated under this Agreement without obtaining prior written approval of City. Street & Stormwater Maintenance and Repair - 2020 Page 5 of 9 Contract No. 19-162 16. Confidentiality. Consultant may, from time -to -time, receive information which is deemed by City to be confidential. Consultant shall not disclose such information without the prior express written consent of City or upon order of a court of competent jurisdiction. 17. Jurisdiction and Venue. This Agreement is entered into in Spokane County, Washington. Disputes between City and Consultant shall be resolved in the Superior Court of the State of Washington in Spokane County. Notwithstanding the foregoing, Consultant agrees that it may, at City's request, be joined as aparty in any arbitration proceeding between City and any third party that includes a claim or claims that arise out of, or that are related to Consultant's services under this Agreement. Consultant further agrees that the Arbitrator(s)' decision therein shall be final and binding on Consultant and that judgment may be entered upon it in any court having jurisdiction thereof. 18. Cost and Attorney's Fees. The prevailing party in any litigation or arbitration arising out of this Agreement shall be entitled to its attorney's fees and costs of such litigation (including expert witness fees). 19. Entire Agreement. This written Agreement constitutes the entire and complete agreement between the Parties and supersedes any prior oral or written agreements. This Agreement may not be changed, modified, or altered except in writing signed by the Parties hereto. 20. Anti -kickback. No officer or employee of City, having the power or duty to perform an official act or action related to this Agreement shall have or acquire any interest in this Agreement, or have solicited, accepted, or granted a present or future gift, favor, service, or other thing of value from any person with an interest in this Agreement. 21. Business Registration. Prior to commencement of work under this Agreement, Consultant shall register with the City as a business if it has not already done so. 22. Severability. If any section, sentence, clause, or phrase ofthis Agreement should be held to be invalid for any reason by a court of competent j urisdiction, such invalidity shall not affect the validity of any other section, sentence, clause, or phrase of this Agreement. 23. Exhibits. Exhibits attached and incorporated into this Agreement are: A. Scope of Services B. Contract Rates C. Insurance Certificates D. Assurance of compliance with applicable federal law The Parties have executed this Agreement this 8 ay of Al2 C,1, .2020 CITY OF SPOKANE VALLEY A an, (�J, 6t--- — Mark Calhoun, City Manager Consultant: — /d* By: Brian Poe Its: Authorized Representative Street & Stormwater Maintenance and Repair - 2020 Page 6 of 9 Contract No. 19-162 ATTEST: Christine Bainbridge, City Clerk . APPROVED AS TO FORM: Office o t e City , y Street & Stormwater Maintenance and Repair - 2020 Page 7 of 9 Contract No. 19-162 Exhibit D — Assurance of Compliance with Applicable Federal Law During the performance of this Agreement, the Consultant, for itself, its assignees, and successors in interest (hereinafter referred to as the "Consultant") agrees as follows: 1. Compliance with Regulations: The Consultant shall comply with the federal laws set forth in Section 7 of this Exhibit ("Acts and the Regulations") relative to non-discrimination in federally -assisted programs of the U.S. Department of Transportation, Washington State Department of Transportation (WSDOT), as they may be amended from time -to -time, which are herein incorporated by reference and made a part of this Agreement. 2. Non-discrimination: The Consultant, with regard to the work performed by it during this Agreement, shall not discriminate on the grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials and leases of equipment. The Consultant shall not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations, including employment practices when the contract covers any activity, project, or program set forth in Appendix B of 49 CFR Part 21. 3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations, either by competitive bidding, or negotiation made by the Consultant for work to be performed under a subcontract, including procurements of materials, or leases of equipment, each potential subcontractor or supplier shall be notified by the Consultant of the Consultant's obligations under this Agreement and the Acts and the Regulations relative to non-discrimination on the grounds of race, color, or national origin. 4. Information and Reports: The Consultant shall provide all information and reports required by the Acts, the Regulations, and directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the City or the WSDOT to be pertinent to ascertain compliance with such Acts, Regulations, and instructions. Where any information required of Consultant is in the exclusive possession of another who fails or refuses to furnish the information, the Consultant shall so certify to the City or the WSDOT, as appropriate, and shall set forth what efforts it has made to obtain the information. 5. Sanctions for Noncompliance: In the event of a Consultant's noncompliance with the non-discrimination provisions of this Agreement, the City will impose such contract sanctions as it or the WSDOT may determine to be appropriate, including, but not limited to: a. withholding payments to the Consultant under the Agreement until the Consultant complies; and/or b. cancelling, terminating, or suspending the Agreement, in whole or in part. 6. Incorporation of Provisions: The Consultant shall include the provisions of paragraphs one through six of this Exhibit in every subcontract, including procurements of materials and leases of equipment, unless exempt by the Acts, the Regulations and directives issued pursuant thereto. The Consultant shall take action with respect to any subcontract or procurement as the City or the WSDOT may direct as a means of enforcing such provisions, including sanctions for noncompliance. Provided, that if the Consultant becomes involved in, or is threatened with litigation by a subcontractor or supplier because of such direction, the Consultant may request that the City enter into any litigation to protect the interests of the City. In addition, the Consultant may request the United States to enter into the litigation to protect the interests of the United States. 7. Pertinent Non -Discrimination Authorities: During the performance of this Agreement, the Consultant Street & Stormwater Maintenance and Repair - 2020 Page 8 of 9 Contract No. 19-162 agrees to comply with the following non-discrimination statutes and authorities; including but not limited to: Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of race, color, national origin); and 49 CFR Part 21; The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. §4601), (prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal -aid programs and projects); Federal -Aid Highway Act of 1973, (23 U.S.C. §324 et seq.), (prohibits discrimination on the basis of sex); Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. §794 et seq.), as amended, (prohibits discrimination on the basis of disability); and 49 CFR Part 27; The Age Discrimination Act of 1975, as amended, (42 U.S.C. §6101 et seq.), (prohibits discrimination on the basis of age); Airport and Airway Improvement Act of 1982, (49 USC §471, Section 47123), as amended, (prohibits discrimination based on race, creed, color, national origin, or sex); The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of the terms "programs or activities" to include all of the programs or activities of the Federal -aid recipients, sub -recipients and contractors, whether such programs or activities are Federally funded or not); Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the operation of public entities, public and private transportation systems, places of public accommodation, and certain testing entities (42 U.S.C. §§ 12131-12189) as implemented by Department of Transportation regulations at 49 C.F.R. parts 37 and 38; The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. §47123) (prohibits discrimination on the basis of race, color, national origin, and sex); Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low -Income Populations, which ensures Non-discrimination against minority populations by discouraging programs, policies, and activities with disproportionately high and adverse human health or environmental effects on minority and low-income populations; Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency guidance, national origin discrimination includes discrimination because of Limited English proficiency (LEP). To ensure compliance with Title VI, you must take reasonable steps to ensure that LEP persons have meaningful access to your programs (70 Fed. Reg. at 74087 to 74100); and Title IX of the Education Amendments of 1972, as amended, which prohibits you from discriminating because of sex in education programs or activities (20 U.S.C. § 1681 et seq.). Street & Stormwater Maintenance and Repair - 2020 Page 9 of 9 Attachment A Scope of Services City Direction (Responsibilities) The City shall oversee and direct repair operations as deemed to be in the best interest of the City. All activities shall be directed by the Street Maintenance Superintendent. The Maintenance Superintendent and Contractor will work together to schedule projects as they come up. The City reserves the right to approve the number of personnel and type of equipment to be used at any time. Contractor Responsibilities Contractor shall submit weekly reports to the City when work is performed. The weekly reports shall include the daily breakdown of work performed including labor, equipment, and material usage. Work Plan The City shall develop the yearly work plan. This includes activities listed below. The City shall set up a meeting at the beginning of the year to outline the plan. The Work plan is subject to change throughout the year based on need. Daily or Weekly Work Plans The Contractor shall submit an email to City designated staff documenting the daily or weekly work plans, including where the Contractor will be working and what activities will be performed. Asphalt Repair — Pavement Removal and Replacement Including Overlays The work includes traffic control, mobilization, excavating, and disposal of up to 4" +/- of existing pavement, preparation for new pavement, and placement and compaction of up to 4" +/- of HMA in accordance with the currently adopted WSDOT Standard Specifications, the currently adopted Spokane Regional Pavement Cut Policy, and the Special Provisions. This intent is to match existing pavement by repairing larger problem areas identified by City personnel. Contractor shall provide a paving crew that has the capability of saw cutting, removing and replacing asphalt in areas up to, but not limited to 40' x 1000' (approximate). Shouldering roadways without curbs shall also be required after the asphalt repair is complete. Width, length and depth of the shouldered areas will vary. The Contractor shall have the means to provide a small paving crew that has the capability of saw cutting, removing, replacing, and compacting new asphalt for pothole repair ranging in size from 2' x 2' up to 10' x 10'. This work may also include slurry seals, micro seals or other surface treatments. Shoulder Repair and Gravel Road Grading The work consists of grading the gravel portion of the roadway adjacent to the pavement on streets without curbing. General shoulder repair requires the use of a motor grader for excavating and grading the shoulders, dump truck for hauling off excavated debris, and delivering additional crushed gravel materials if needed, roller for compacting the placed materials, and a 2,000 gallon minimum water truck for providing dust control if performed outside of the wet season. Street sweeping shall be required after shouldering to clean any remaining materials from traveled surfaces. This work is generally accomplished in the early spring. Gravel Road Grading consists of grading the unpaved streets in the City. Traffic control may be required in these areas. Gravel or dirt streets shall be crowned and graded to a two percent cross slope to remove potholes and ruts. This activity may be accomplished with a motor grader, roller for compacting the placed materials and 2,000 minimum gallon water truck. This work is generally accomplished in the early spring and late fall. Crack Sealing The work consists of crack sealing activities on City arterials and local access streets. Proper methods and techniques shall be utilized for Crack Sealing procedures. Grazing and cleaning the cracks with compressed air shall be utilized in the preparation prior to filling. Crack seal material may be supplied by the City. Sidewalk and Path Repair The work consists of removal and replacement of damaged or displaced Portland cement concrete sidewalks, curbs, gutters and asphalt pathway segments. Work performed in this service shall conform to City of Spokane Valley standards and to the currently adopted WSDOT Standard Specifications. Guardrail Repair The -work consists of the repair or replacement of existing guardrails damaged by accidents occurring within the City. Work performed in this service shall conform to the currently adopted WSDOT Standard Specifications. Fencing Repair The work consists of the repair or replacement of existing chain link fencing damaged by accidents occurring within the City. Work performed in this service shall conform to the currently adopted WSDOT Standard Specifications. Drainage Structure Repair and Installation The work consists of installation and repair of drainage structures, excavation and disposal of material. Drainage structures include but are not limited to catchbasins, drainage pipe, culverts, pervious gravel sump drains, and drywells. Repair of drywells shall also include saw cutting existing pavement, removal and replacement of drain rock. Work performed in this service shall conform to the currently adopted WSDOT Standard Specifications and the City of Spokane Valley Standard Plans. Miscellaneous Services This work may consist of miscellaneous street and stormwater maintenance and repair services needed to maintain the City street systems. This work may include sinkhole repair, water district fees, storm event cleanup, and other miscellaneous needs. 2020 Street and Stormwater Maintenance and Repair Services Contract Project # 19-162 Spo7Q'W.01V10kOeaN ' IIey- -Rs SCF E_D .yt, .war, a ..a` x Y.M JLF A REGULAR• IOURS `' � m `g p k, 4s .c..,.� ,» Fyn• mMw,r+;'A^•v, r3k�aww. ,<mtin>+ :�+.�,i''L "+tl%,«:i3:.;'++I'1, ..@i` �,..'q'. R�' ..,?�' �r'V .ym M.+M�•.•^,L•-M• r 't,+r' ' Pokk halt d„r^r4r.'�'.6�ir .• �.-..,,✓w.,, .. !! b.'rl�y .liY�.' . a �Sr` �.rr Paving, ,r,,.. � i, r+,,o•f6`� Item . .1,.. '�c. sl~ 9rks4 � � .t '4.,¢�$�' q"'i•".4�:� r+ i' '^Gi. ('" gw;fix Trades #.' `f s t'�°^' vy,Ry.,k »:7 5++.. .tyl Y,! •�.4Y'Fd. } £ Y`M q "L i M �' 1'< '-2'�+W�:XTu+P^^iw+" • .n :,:ice .�r� Qc�upationI»rk��'. «P"' yp' y/!'J ��° �n '^li�,R. 3tT+ 4S.P.% r •; Hours u� :++4 �« �u�� ..ww MN1F..rt�. i :., K . ,� `'%+ a ., '��: ;�xRate�� P ��Pm M •�npYyP + .v � „Total 1 *** Superintendent 300 $71.57 $21,471.00 2 *** Foreman 300 $69.17 $20,751.00 3 Cement Masons Journey Level 240 $66.60 $15,984.00 4 Fence Erectors Fence Erector 20 $45.14 $902.80 5 Flaggers Journey Level 2000 $49.00 $98,000.00 6 Laborers General Laborer 2400 $57.33 $137,592.00 7 Laborers Asphalt Raker 120 $58.67 $7,040.40 8 Laborers Concrete Crewman 220 $61.30 $13,486.00 9 Laborers Guard Rail 10 $65.00 $650.00 10 Laborers Pipelayer 130 $61.88 $8,044.40 11 Laborers Traffic Control Supervisor 40 $50.00 $2,000.00 12 Power Equipment Operators Blade(finish & bluetop) 200 $66.10 $13,220.00 13 Power Equipment Operators H.D. Mechanic 30 $66.14 $1,984.20 14 Power Equipment Operators Paving Machine 200 $65.77 $13,154.00 15 Power Equipment Operators Rollerman 400 $65.77 $26,308.00 16 Power Equipment Operators Screed Operator 200 $65.77 $13,154.00 17 Power Equipment Operators Power Broom 90 $65.77 $5,919.30 18 Power Equipment Operators Backhoes & Hoe Ram 30 $65.77 $1,973.10 19 Power Equipment Operators Vactor Guzzler, Super Sucker 10 $52.02 $520.20 20 Power Equipment Operators Roto Mill 90 $65.77 $5,919.30 21 Power Equipment Operators Posthole Auger or Punch 10 $70.00 $700.00 22 Power Equipment Operators Backhoe (45,000 GW & under) 380 $65.77 $24,992.60 23 Truck Drivers Dump Truck (E. WA-690) 900 $65.23 $58,707.00 24 Truck Drivers Dump Truck & Trailer (E. WA-690) 500 $65.23 $32,615.00 25 Truck Drivers Other Trucks (E. WA-690) .30 $64.58 $1,937.40 26 Truck Drivers Transit Mixer 10 $51.06 $510.60 Schedule A - Regular Hours 1 $527,536.30 �6`• P9Y..tS.a +ws SCHEQIJLE�B`C)VETj`H1R t`'r "�+.:i, .sa .. �,n.-., s, j°,°a�, . x Y YA2•"X,N." nnw . •'tom �...�-,.v .. ..,,,,c, - a..r,. �. *-'x'. �s s$.. ,3�"° E,t�,d" s�.t0.d ,.-.+.. ,..e�.rv«•.:i.",+�.'ii.`di'9:'.,:.�•41 ...,ew?k�,e:.a#�..E.�.a� .�.. p,..� }:�ltem # r•, ti4y -m ,-.kTrade��6 Z ;aN,i', r. r �� at,:.Occupatiuri „�. 3 u " � "".'N':�:+�`�24`'r�rn,:5r�"-','fie*. }SOT Hours a�;N- ., •. .�d�c'�Sc't Rate ;' t ";'�mra�C'+.: •fx,:".ti:o+"°' c Totalµ 27 *** Superintendent 50 $78.07 $3,903.50 28 *** Foreman • 50 $76.07 $3,803.50 29 Cement Masons Journey Level 20 $87.45 $1,749.00 30 Fence Erectors Fence Erector 5 $67.72 $338.60 31 Flaggers Journey Level 50 $63.00 $3,150.00 32 Laborers General Laborer 75 $63.37 $4,752.75 33 Laborers Asphalt Raker 25 $65.05 $1,626.25 34 Laborers Concrete Crewman 20 $80.92 $1,618.40 35 Laborers Guard Rail 5 $97.50 $487.50 36 Laborers Pipelayer 15 1 $92.89 $1,393.35 37 Laborers Traffic Control Supervisor 5 $65.00 $325.00 38 Power Equipment Operators Blade(finish & bluetop) 20 $72.24 $1,444.80 39 Power Equipment Operators H.D. Mechanic 5 $72.28 $361.40 40 Power Equipment Operators Paving Machine 20 $71.82 $1,436.40 41 Power Equipment Operators Rollerman 40 $71.82 $2,872.80 42 Power Equipment Operators Screed Operator 20 $71.82 $1,436.40 43 Power Equipment Operators Power Broom 10 $71.82 $718.20 44 Power Equipment Operators Backhoes & Hoe Ram 5 $71.82 $359.10 45 Power Equipment Operators Vactor Guzzler, Super Sucker 5 $78.03 $390.15 46 Power Equipment Operators Roto Mill 5 $71.82 $359.10 47 Power Equipment Operators Posthole Auger or Punch 5 $105.00 $525.00 48 Power Equipment Operators Backhoe (45,000 GW & under) 30 $71.82 $2,154.60 49 Truck Drivers Dump Truck (E. WA-690) 5 $70.61 $353.05 50 Truck Drivers Dump Truck & Trailer (E. WA-690) 40 $70.61 $2,824.40 51 Truck Drivers Other Trucks (E. WA-690) 10 $69.79 $697.90 "52Truck Drivers Transit Mixer 5 $75.00 $375.00 Schedule B - Overtime Hours $39,456.15 F.dw���ePv t'.iwttk'o', SCHEDULES �.n*aeeYb+w+�var�e FsaetiroN.ta.+vwn: �.,� f +4:1'�w+w^u. �{�M�pFi.:Q4+KNs�ft`�+:"*{•rRs :}W`g'","':",1^" -'*' '+a°R.rt.k vupw(+ke °y.. +yIyWJ^�ny.:+Fn:+.y�"Jb, "C hRt 4� 9} � i !r.+y+N' N."i �+ �`{.,.._y�. SeS. °h .'e •'2 'h � 'k w � Yti 'S'$ .in. E UIP ENT H�WRS� � � � �Y `� :�: �� •�` ` �'� �� �`` ��� is' `�":«, -s+.r �F .k Item`#.EquIPP?€nt*T.Y %r t, ... «..r.�. �1awz pti eel' e� aaa.:' 4 ^..+ewvr.. +. .ns k'D"�.ti<`"ah ' �"rn"�':e"+.'°"` �+c}�'� ^Y.. �•W""`r»• U itT a annQga4titY sG '. p'.�'., x" i"? `a.in f •:, '+ av w e "$ 'fr.."':w.""' °k't;"`` ourl ,R a 4 .�p.,.' •`' `<T,Qt. 53 1 Ton Truck Hour 600 $19.55 $11,730.00 54 1 Ton/Trailer Hour 25 $8.05 $201.25 55 1/2 Ton Truck Hour 150 $6.90 $1,035.00 56 160 Blade Hour 250 $74.75 $18,687.50 57 3 Axle Tilt Trailer Hour 75 $31.05 $2,328.75 58 5th Wheel/Lowboy Hour 125 $102.35 $12,793.75 59 Arrowboard Day 50 $50.00 $2,500.00 60 Asphalt Saw Hour 25 $21.85 $546.25 61 Backhoe Hour 25 $46.00 $1,150.00 62 Broce Broom Hour 150 $49.45 $7,417.50 63 Chop Saw Hour 20 $2.30 $46.00 64 Crack/Joint Sealer Hour 250 $64.69 $16,172.50 65 DD-110 Roller or Equivalent Hour 50 $80.00 $4,000.00 66 DD-34 Roller or Equivalent Hour 300 $42.00 $12,600.00 67 End Dump Truck Hour 400 $62.10 $24,840.00 68 End Dump/Pup Hour 200 $81.65 $16,330.00 69 Grade Roller Hour 35 $47.15 $1,650.25 70 Hoe Pack Hour 20 $44.10 $882.00 71 Jumping Jack Wacker Hour 30 1 $2.30 $69.00 72 Nuclear Densometer Hour 150 $5.75 $862.50 73 Paver Hour 150 $225.00 $33,750.00 74 Plate Wacker Hour 10 $3.00 $30.00 75 Skip loader Hour 200 $42.55 $8,510.00 76 Super Dump Hour 450 $79.35 $35,707.50 77 Traffic Control Vehicle Hour 400 $20.00 $8,000.00 78 Variable Message Sign Day 40 $150.00 $6,000.00 79 Water Truck - LG Hour 200 $59.80 $11,960.00 80 Water Truck - SM Hour 200 1 $48.30 $9,660.00 Schedule C - Equipment Hours $249,459.75 SCHEDULED r MATERIALS ' ` § . .y . Unit prices include materials only. Lafior and Equi0m6nt,wilI.be paid separately. Item # , Mat6rial Type Unit Type Quantity UriitYrice Total, 81 HMA CL. 3/8" PG 641-1-28 Ton 5000 $61.50 $307,500.00 82 HMA CL. 1/2" PG 641-1-28 Ton 1000 $58.00 $58,000.00 83 CRUSHED SURFACING TOP COURSE Ton 1500 $7.50 $11,250.00 84 CRUSHED SURFACING BASE COURSE Ton 200 $7.50 $1,500.00 85 GRAVEL BACKFILL FOR 1DRYWELLS Ton 700 $11.00 $7,700.00 86 TACK OIL Gallon 1500 $3.00 $4,500.00 87 PRECAST CONCRETE DRYWELL TYPE A EA 7 $960.00 $6,720.00 88 PRECAST CONCRETE DRYWELL ITYPEB EA 7 $1,284.00 -$8,988.00 89 CATCH BASIN TYPE 1 EA 5 $634.80 $3,174.00 90 CATCH BASIN TYPE 2 EA 5 $1,627.20 $8,136.00 91 TYPE 1 INLET EA 3 $634.80 $1,904.40 92 GRATE INLET TYPE 2, WSDOT EA 3 $1,350.00 $4,050.00 Schedule D - Materials $423,422.40 SCHEDULE SCHEDULE SCHEDULE SCHEDULE $527 75 TOTAL SCHEDULE A -DI $1,239,874.60 Pn17ASPH-01 DALLEN ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDmm) 2/20/2020 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 OOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTRORIZED 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). PRODUCER Stonebraker McQuary 616 5th St. PO Box 9 CONTACT NAME: PHONE FAX (A/C, No, Ext): (509) 758-6529 (A/C, No):(509) 758-5311 ADDRESS: CustomerService@stonebrakermcquary.com INSURERS AFFORDING COVERAGE NAIC # Clarkston, WA 99403 INSURERA:Phoenix Insurance Company 25623 INSURED INSURER B : Travelers Property Casualty Insurance Company - Main 36161 INSURER C: Idaho State Insurance Fund 36129 Poe Asphalt Paving, Inc. INSURER D : PO Box 449 Lewiston, ID 83501 INSURER E INSURER F : rnvGaer_cc r`FRTIGIr`ATI= WIIMRFR• RFVICIf1N NIIMRPR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLID EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Contractual X DT-CO-1537P996-PHX-19 11/1/2019 11/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES a occurrence 300,000 $ X X MED EXP (Any oneperson) $ 10,000 XCU, Sep of Insured PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jEaT LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 WA Stop Gap $ 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS p X AUTOS ONLY X AUTOS ONLY 810-OL841684-19-26-G 11/1/2019 11/1/2020 C aMBINEeDtSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PPe�acEc,dent AMAGE $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP-71-1492823-19-26 11/1/2019 11/1/2020 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 578551 10/1/2019 10/1/2020 X PTT TE ERH E.L. EACH ACCIDENT 600,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required This Certificate of Insurance neither affirmatively nor negatively amends, extends, nor alters the coverage afforded by the policy or policies numbered in this certificate. The City of Spokane Valley is additional insured per written contract on general liability as respects the 2020 Street & Stormwater Maintenance project. Insurance is Primary and NonContributory. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Spokane Valley 11707 E Sprague Ave Ste 103 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POEASPH-01 DALLEN ACORO"° CERTIFICATE OF LIABILITY INSURANCE �..•--�' DATE(MM/DD/YYYY) 11/24/2020 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). PRODUCER CONTACT NAME: PHONE (A/C, No, Ext): (509) 758-5529 (A/c, No): (509) 758-5311 Stonebraker McQuary 616 5th St. PO Box 9 E-MAIL CustomerService@stonebrakermcquary.com Clarkston, WA 99403 INSURERS AFFORDING COVERAGE NAIC # INSURERA: Phoenix Insurance Company 25623 INSURED INSURER B: Travelers Indem Co of Conn 25682 INSURER C : Travelers Property Casualty Insurance Company - Main 36161 Poe Asphalt Paving, Inc. INSURER D : SlF 36129 PO Box 449 Lewiston, ID 83501 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Contractual X X D-CO-1537P996-PHX-20 11/1/2020 11/1/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 300,000 $ X MED EXP (Any oneperson) $ 10,000 X XCU, Sep of Insured PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECT El LOC OTHER: $1,000 PD Deductible GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 X Stop Gap Liab $ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X X 810-OL841684-20-26-G 11/1/2020 11/1/2021 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP-7H492823-20-26 11/1/2020 11/1/2021 EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 DED X RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X 578551 10/1 /2020 10/1 /2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 2020-2021 Street and Stormwater Contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Spokane Valley 10210 E Sprague Ave Spokane Valley, WA 99206 C� ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POEASPH-01 LLEHMITZ ACORO"° CERTIFICATE OF LIABILITY INSURANCE �..•--�' DATE(MM/DD/YYYY) 10/28/2021 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). PRODUCER CONTACT Lesha Lehmitz NAME: PHONE FAX (A/C, No, Ext): (A/C, No): Stonebraker McQuary 616 5th St. PO Box 9 E-MAIL Ilehmitz@stonebrakermcquary.com Clarkston, WA 99403 INSURERS AFFORDING COVERAGE NAIC # INSURER A:SIF 36129 INSURED INSURER B : INSURER 7 Poe Asphalt Paving, Inc. INSURER D : PO Box 449 Lewiston, ID 83501 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICYEl JJECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A X 578551 10/1 /2021 10/1 /2022 PER OTH- STATUTE ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 21-22 Street and Stormwater Contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Spokane Valley _ 10210 E Sprague Ave Spokane Valley, WA 99206 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD fCOAHt� RKR.IH1S' MRllriM SA.flON Policy Number: 578551 - 1010112021 INSURED Poe Asphalt Paving Inc PO Box 449 Lewiston, ID 83501-0449 UW520 Agent: 79 Stonebraker-McQuary Agency Group In PO Box 9 Clarkston, WA 99403-0009 (509) 758-5529 ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY TO WHICH IT IS ATTACHED AND IS EFFECTIVE ON THE DATE ISSUED UNLESS OTHERWISE STATED WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). This agreement shall not operate directly or indirectly to benefit anyone not named in the schedule. Schedule 1. Waiver Type ,f Specific Waiver/ Specific Job in Favor of: Job Description: M rXBlanket Waiver Any person or organization for whom the named insured has agreed by written contract to furnish this waiver. 2. Premium The premium charge for this endorsement shall be $250.00 for a specific waiver and $250.00 for a blanket waiver. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/01/2021 Policy No: 578551 Endorsement No. Insured: Poe Asphalt Paving Inc Premium $250.00 Insurance Company: State Insurance Fund WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY WC000313 © Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved. TO. ex 83720 - Boise, 1D 3720-o04.4. - 208--332-2:100 POEASPH-01 CERTIFICATE OF LIABILITY INSURANCE DATE IMMID --- - --- 11124120.44 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 IS . . . .................. . I ----k4 PRODUCER Stonebraker McQuary 616 6th St, PO Box 9 Clarkston, WA 99403 INSURED Poe Asphalt Paving, Inc. PO Box 449 Lewiston, ID 83601 509) 768-6529 ["^^iknc]O N : 0 758-6311 -' :ustomerSery ce0stonebrakermcg la ...... ..... CcvkFtAGE Phoenix Insurance Company Travelers Indem,-Co of Conn 25682 Travelers Property Casualty Insurance Company - main 36161 COVERAGES COVERAGE . ..... . . ................. . . REVISl9LN—NL1M-Q.EW 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, SUB, R A'66)-L' POLICY EFF TYPE OF INSURANCE POLICY NUMBER 1, . YL J= -ffla --------------- - - . ..... (1101190Im. -0� LIMITS ..LT& A X GENERAL LIABILITY EACH QCCURRENGE 1,000,000 CLAIMS -MADE I "X'l OCCUR X X D-CO-1637P996-PHX.20 1111/2020 11/11/2021 DAMAGE TO RENTED 300,000 .... . ..... J.COMMERCIAL X Contractual MET) EXP 9f$ p so!) , 10000iq p - o - f - Insured IT I sured PE S L ADV INJURY 1,000,00 . . ......... . ....... .. GEN'L AGGREGATE LIMIT APPLIES PER 2,000,000 .. ... ------ POLICY ['K %8LOC $ aaa ------ X 0 1 VHER: $1 100() PD Deductible Stop Gap Llab " 0 . .......... . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ..... ....... 1,000,000 X ANY AUTO X X 810-OL841684-20-26-G 11111112020 1111/2021 A' 8 )ILY,INJURY Perpqrs . .... . .... OVVF SCHEDULED A01' ONLY AUIOS AD ObDo N X ZVS ONLY AWOM A E $ d -11, [EXcrSS � 1--.- ------- . ..... . 15. U, U UMBRELLA LIAR 'CUR 0" X LIAR CLAIMS MADE CUP-7H492823-20-26 11/112020 1111/2021 AGGREGATE $ 4,000,000 406"000 2, LXi RETENTIONS...... RETENTION $ 10'000� WORKERSCOMPENSATION I W I�T Ix_ AND EMPLOYERS LIABILITY YIN X $78651 10/112020 10/1/2021 ANY PROPRIETORIPARTNER/FXECUTIVE NIA 0 YJM�V) EXCLUDED? Ran5','.H'M n U aTA1V1 E'l, A9q!Pf-iW- ... .. .. ... 121 1) CASE -,EA EMFL OYEE 600,000 1 —1-1-1-1-1 500,000 I yas, describe under I7ESCRIPTION.OF 600,000 . . . . .......... . . . . . . . ..................... . . ------- . . . ............ .. . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 2020-2021 Street and Storrnwater Contract . . ........... . . . AUTHORIZED REPRESENTATIVE City of Spokane Valley 10210 E Sprague Ave —..— —I.— —. —.. I ACORD 25 (2016/03) 0 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POEASPH-03 DPAINTER ACORO CERTIFICATE OF LIABILITY INSURANCE FMT1MM/DDYYYY) 1/9/2021 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). PRODUCER CONTACT NAME: PHONE FAX (A/C, No, EXt): (509) 838-3501 (A/C, No):(866) 226-3738 Spokane Office PayneWest Insurance, a Marsh McLennan Agency LLC Company 501 N. Riverpoint Blvd., Ste 403 Spokane, WA 99202 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Cincinnati Insurance Company 10677 INSURED INSURER B: Idaho State Insurance Fund 36129 INSURER C7 Poe Asphalt Paving Inc INSURER D 7 2732 N. Beck Road Post Falls, ID 83854 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X EPP0633923 11/l/2021 11/l/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 300,000 $ MED EXP (Any one person) $ 5,000 PERSONAL R ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY [X] JECTPRO- LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUUTOS ONLY X X EPP0633923 11/l/2021 11/l/2022 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EPP0633923 11/l/2021 11/l/2022 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 578551 10/1/2021 10/1/2022 PER OTH- STATUTE ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Spokane Valley Contracts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spokane Valle Y p Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E 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 �,�•'-� POEASPH-03 ACORU' �,- CERTIFICATE OF LIABILITY INSURANCE MNEIGHBORS DATE (MMroDnmY)10/28/2022 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 endorsements . PRODUCER Spokane Office PayneWest Insurance, a Marsh McLennan Agency LLC Company 501 N. Rive oint Blvd., Ste 403 Spokane, WA 99202 c TACT Jim Majeskey (aCTN , Et): (609) 789-7430 FAX No): ma'eske a newest.com INSURERS AFFORDING COVERAGE NAIC tl INSURER A: Cincinnati Insurance Company 10677 INSURED Poe Asphalt Paving Inc 2732 N. Beck Road Post Fails, ID 83854 INSURER 8 : INSURER C : INSURER D : INSURER E INSURER F : 1'AVFR2Ar_FC rFRTIFIr:ATF KIHMRFR• REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X X EPP 0633923 11/1/2022 11/1/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED ence)MED $ 300,000 EXP oneperson) 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑X J Re LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOpSWN p AUTOS ONLY AUOTOS ONLY Ll X X EPP 0633923 11/1/2022 11/1/2023 COMBINED SINGLE LIMIT cident)X $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident _ $ PeOra denDAMAGE $ $ A X UMBRELLA LIAB EXCESS UA9 X OCCUR CLAIMS -MADE EPP 0633923 11/1/2022 11/1/2023 EACH OCCURRENCE _$ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY CCPROPREIEETgO�RIPARTNER/EXE' UT"v : IFanda= in NH) EXCLUDED' If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER I OTH- A ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) City of Spokane Valley Contracts City of Spokane Valley 10210 E Sprague Ave Spokane Valley, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 130FARPH-n3 ISCHRFIRFP ACORO' �� CERTIFICATE OF LIABILITY INSURANCE E (MM/D DIYYYY) 1DATE 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). PRODUCER S okane Office Marsh McLennan Agency LLC 501 N. Riverpoint Blvd., Ste 403 Spokane, WA 99202 CONTACT NAME: (A/CNNo, Ext): (509) 838-3501 (AA/C, No):(866) 226-3738 ADDRE S: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Company 10677 INSURED INSURER B : INSURER C : Poe Asphalt Paving Inc INSURER D : 2732 N. Beck Road Post Falls, ID 83854 INSURER E INSURER F : rnvcoer_Gc rPOTIPWATIP All I1IARFR• RFVISION NUMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X EPP 11/1/2023 11/1/2024 EACH OCCURRENCE $ 1,000,000 ETORENTED DAMAGE AMA ES R occurrence) e PREMISES 500,000 $ MED EXP (Any oneperson) $ 10,000 GEN'L PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY F7X JR O- LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X X EPP 0633923 11/1/2023 11/1/2024 Ea aBcideDtSINGLE LIMIT $ 1,000,000 BODILY INJURY Per person)$ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR I CLAIMS -MADE EPP 0633923 11/1/2023 11/1/2024 EACH OCCURRENCE $ 4,000,000 I AGGREGATE $ DED RETENTION $ Aggregate 4,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICER/MEMBER EXCLUDED? ECUTIVE ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Spokane Valley Contracts rAW CI I ATInti SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spokane Valle Y p y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave Spokane Valley, WA 99206 AUTHORIZED P'yAREGS�,E,N\T�/jA/TAIV E j^\RE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 11 /8/23, 8:22 AM POE ASPHALT PAVING INC 0 STATE OF WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage WA UBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? License No. License Expiration November 8, 2023 409 018 683 191, 377-00 POE ASPHALT PAVING INC POE ASPHALT PAVING INC Account is current. Quarter 3 of Year 2023 "51 to 75 Workers" Employer Services Help Line, (360) 902-4817 Yes POEASP*333NM 11 /29/2023 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51 .l 2.050 and 51.16.190). hftps:Hsecure.Ini.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=409018683&LIC=POEASP*333NM&VIO=&SAW=false&ACCT=l9137700 1 /1