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20-104.00 Skycorp: Barker/BNSF Grade Separation Building Demolition Phase t Contract This agreement is entered into this day of 1 Unit), 2020, between the City of Spokane Valley ("City")and SKI COTT)Llt,("Contractor"),pursuant to Title 35 RCW, as adopted or amended. In consideration of the terms and conditions contained herein and attached and made a part of this agreement,the parties agree as follows: I. The Contractor shall do all work and furnish all tools,materials,and equipment for: Barker/BNSF Grade Separation Project-Building Demolition Phase#0143 Contract 20-104 in accordance with and as described in the project plans and specification,and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City. II. The City hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors,and assigns,does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City by reason of entering onto this contract, except as provided herein. V. The project was awarded for the bid amount of$58,728.30,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 13 Contract Forms Barker/BNSF GSP-Building Demolition Phase I • Executed by Contractor l q( Z b 4-4 , 2020. l Date Sky/t✓ / '// Printed Nam Press d vt,4- Title �J/ Signature / City of Spokane Valley p Mark Calhoun Printed Name City Manager Title Si ture City of Spokane Valley I Contract I orms Barker/BNSF GSP-Building Demolition Phase Q (Jf Jl1iV BOND NO: 53590 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Skycorp Ltd (Contractor),as Principal,a contract for the construction of the project designated as)garker/BNSF Grade Separation Proiect- Buildine Demolition Phase No,0143 in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Western National Mutual Insurance Company (Surety), a corporation, organized under the laws of MN 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.,arc jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of S 63,955.00 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications,additions,and changes to said Contract that may hereafter be made,at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract;and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change,extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. Surety reserves the right to notification on changes greater than 25%of the original contract 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) SURETY 6- 3-2vZv 6/5/zo Principal Signature / Date/ Surety StgnPt Skycorp Ltd �JL7"l—'/ G,J4/GIG` Western National Mutual Insurance Company Printed Name Printed Name /"7 l s o�—�d - Kevin Degoinner Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Alliant Insurance Services 3977 Harbour Pointe Blvd SW Mukileto WA 98275 425-740-5225 `�pI.AIUTL. SEAL la,` City of Spokane Valk), 115 ���O,: FormsContract Fou BarkerBNSF GSP-Building Demolition Plum '•.,,....�►........�, �V WRITERN NATIONAL rArrda,bnAya nsamy POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Western National Mutual Insurance Company, a Minnesota mutual insurance company, does make,constitute and appoint: Kevin Deggfnpor Its true and lawful Attomey(s)-In-Fact,with full power and authority for and on behalf of the Company as surety,to execute and deliver and affix the seal of the Company thereto(If a seal Is required)bond,undertakings recognizances or other written obligations in the nature thereof, (other than ball bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self-Insurance workers compensation bonds guaranteeing payment of benefits, hazardous waste remodlation bonds or black lung bonds),as follows: All written Instruments in an amount not to exceed an aggregate of Seven Million Five Hundred Thousand end 001100(;7,500,D00) for any single obligation,regardless of the number of instruments issued for the obligation. and to bind Western National Mutual Insurance Company thereby, and all of the acts of said Attorneys-in-Fact, pursuant to these presents, are ratified and confirmed.This appointment is made under and by authority of the board of directors at a meeting held on September 28,2010. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of Western National Mutual Insurance Company on September 28,2010: RESOLVED that the president,any vice president,or assistant vice president in conjunction with the secretary or any assistant secretary, may appoint attorneys-In-fact or agents with authority as defined or limited in the Instrument evidencing the appointment in each case,for and on behalf of the company to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds,and said officers may remove any such attorney-hi-fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond,undertaking,recognizance,or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president,any vice president or assistant vice president,and attested and sealed(if a seal be required)by any secretary or assistant secretary,or (II) when signed by the president,any vice president or assistant vice president,secretary or assistant secretary,and countersigned and sealed(if a seal be required)by a duly authorized attorney-In-fad or agent;or (iii) when duly executed and sealed(if a seal be required)by one or more attorneys-in-fad or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the Company to such person or persons. RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company;and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF,Western National Mutual Insurance Company has caused these presents to be signed by its proper officer and its corporate seal to be affixed this 16th day of December ,2015. ti;iea cS ~T• k t(SEALi�� ;4044bil 1471:A 611:7 • - •'''''''Mlr`IN Jon R.Hebelsen,Secretary Larry A.Byers,Sr.Vice President STATE OF MINNESOTA,COUNTY OF DAKOTA On this 16th day of December. 2015, personally came before me,Jon R.Hebeisen and Larry A.Byers and to me known to be the individuals and officers of the Western National Mutual Insurance Company who executed the above instrument,and they each acknowledged the execution of the same,and being by me duly sworn,did severally dispose and say;that they are the said officers of the corporation aforesaid,and that the seal affixed to the above Instrument Is the seal of the corporation,and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. ' JENFIFER A YOUNG INF NOTARY PUBLIC-MINNESOTA 7.• faYtxlhtl fEXP11te80 ovum Jennifer A.Young,Notary Public My commission expires January 31,2021 CERTIFICATE I,the undersigned,assistant secretary of the Western National Mutual Insurance Company,a Minnesota corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked;and furthermore,that the Resolutions of the board of directors set forth in the Power of Attorney,are now in force. `N'MMr'L Nl/T'''y tAri E(SEAL) '1 r,1yC� 'NH`` 1 Signed and sealed at the City of Edina,MN this 2nd day of Juno ,2020 Jennifer A.Young,Assistant Secretary ,.---NN SKYCLTD-01 ASANTORELLI ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYY) `- 5/28/2020 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 License#0C36861 Farr Stephanie Voss Alliant Insurance Services,Inc. PHONE FAX 3977 Harbour Pointe Blvd SW (EA�/CDRp,�No,Eat):(425)740-5239 (A_/C,No): _ AD Mukilteo,WA 98275 bs:Stephanie.Voss@alliant.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:GuideOne National Insurance Company 14167 INSURED INSURER B:Austin Mutual Insurance Company -.. 13412 Skycorp LTD. INSURER C: 526 NW Ave Ste.11 INSURER D: Arlington,WA 98223 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 ADDL SUBR POUCY EFF POUCY EXP LTR TYPE OF INSURANCE INSD,WVD POLICY NUMBER IMMIDD/YYYY) IMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 ✓ CLAIMS-MADE X OCCUR ENV562001277-01 4/4/2020 4/4/2021 DAMAGES(RENTED 50,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 2,000,000 / GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ POLICY X Zia LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABRJTY CO aentSINGLE LIMIT) $ 1,000,000 ANY AUTO B1P7793M 4/4/2020 4/4/2021 BODILY INJURY(Per person) $ _ AURTEO�pS ONLY X SCHEDULED BODILY INJURYp (Per accident) $ X A�TOS ONLY X AUTO0 ONLY (Per a cident)AMAGE $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE ENV562002773-00 4/16/2020 4/4/2021 AGGREGATE $ 1,000,000 ------ DED I RETENTION$ $ A WORKERS COMPENSATION 4 PER AND EMPLOYERS'LIABILITY STATUTE ERH ENV562001277-01 4/4/2020 4/4/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ E.L.EACH ACCIDENT $ QFFICER/MEMBER EXCLUDED? N/A' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1'000'000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability ENV562001277-01 4/4/2020 4/4/2021 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES fACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Barker/BNSF Grade Separation Project-Build Demolition Phase,CIP#0143;Contract No 20-104 City of Spokane Valley is Additional Insured with respect to General Liability for the Ongoing and Completed Operations of the named insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. Community&Public Works Department 10210 E.Sprague Avenue Spokane,WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location(s) Of Covered Operations Or Organization(s): Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your poky. Information required to complete this Schedule, if not Shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only with sions apply: respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury'' caused. "property damage" occurring after. in whole or n part, by: 1. Al work, including materials, parts or equip- 1. Your acts or omissions; or merit furnished in connection with such work, 2 The acts or omissions of those acting on your behalf; on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the n the performance of your ongoing operations for the location of the covered operations has been additional insured(s) at the location(s) designated completed; or above. 2 That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor cr subcontractor engaged n performing operations fcr a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004. Page 1 of 1 POLICY NUMBER: ENV562001277-01 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person or organization for whom you are In respect to any location where the named insured is performing operations when you and such person or performing "your work". organization have agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section I — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described n the schedule of this endorsement performed for that additional insured and included In the "products- completed operations hazard". CG 20 37 07 04 CO ISO Properties, Inc., 2004 Page 1 of 1 SKYCORP LTD Page 1 of i STATE OF WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage June 3, 2020 WA UBI No. 603 077 334 L&I Account ID 210,436-00 Legal Business Name SKYCORP LTD Doing Business As SKYCORP LTD Workers' Comp Premium Status: Call L&I account representative for account status. Estimated Workers Reported Incomplete premium report received. (See Description Below) Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor? Yes License No. SKYCOL*899DD License Expiration 03/06/2021 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 https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=603 077334&LIC=SK... 6/3/2020 Page 1 of 1 BUSINESS INFORMATION o%-porak dr� l bra- j S Business Name: SKYCORP,LTD UBI Number: 603 077 334 Business Type: WA PROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 526 N WEST AVE STE 11,ARLINGTON,WA, 98223-1251,UNITED STATES Principal Office Mailing Address: Expiration Date: 01/31/2021 Jurisdiction: UNITED STATES,WASHINGTON Formation/Registration Date: 01/12/2011 Period of Duration: PERPETUAL Inactive Date: Nature of Business: ANY LAWFUL PURPOSE REGISTERED AGENT INFORMATION Registered Agent Name: NORTHWEST REGISTERED AGENT,LLC Street Address: 906 W 2ND AVE STE 100, SPOKANE,WA, 99201, UNITED STATES Mailing Address: GOVERNORS Title Governors Type Entity Name First Name Last Name GOVERNOR INDIVIDUAL SKYLER WALDAL https://ccfs.sos.wa.gov/ 6/3/2020 brmen-k-- C1fkec..1._ SAM Search Results List of records matching your search for : Search Term : SKYCORP LTD* Record Status: Active,Inactive No Search Results June 03,2020 6:06 PM https://www.sam.gov Page 1 of 1 SKYCORP LTD Page 1 of 3 L&I regional offices are closed to public visits until further notice. Offices can still help you by phone from 8 a.m.to 5 p.m.weekdays (except state holidays). Use the phone number for your closest regional office(httos://Ini.wa.aov/aaencv/contact/#office-locations),or you can call the Office of Information and Assistance at 360-902-5800. wa.!y,o,stale OepammM,a Labor&Industries(httos://Ini.wa.gov) SKYCORP LTD Owner or tradesperson 526 NW AVE SUITE 11 Principals ARLINGTON,WA 98223 WALDAL,SKYLER ASPEN,PRESIDENT 360-926 8989 SNOHOMISH County WALDAL,SKYLER ASPEN,SECRETARY NORTHWEST REGISTERED AGENT LLC,AGENT ALLEN,TIM,AGENT (End:03/13/2012) Doing business as SKYCORP LTD WA UBI No. Business type 603 077 334 Corporation License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active Meets current requirements. License specialties GENERAL License no. SKYCOL*899DD Effective—expiration 03/04/2011—03/06/2021 Bond Liberty Mutual Ins Co $12,000.00 Bond account no. 023014733 Received by L&I Effective date 03/04/2011 02/11/2011 Expiration date Until Canceled Insurance https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603077334&LIC=SKYCOL*899DD&SAW= 6/3/2020 SKYCORP LTD Page 2 of 3 Guideone National Insurance Co $1,000,000.00 Policy no. ENV562001277 Received by L&I Effective date 04/03/2020 04/04/2019 Expiration date 04/04/2021 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings Cause no. 14-2-27117-4 Dismissed Complaint filed by Complaint against bond(s)or savings WASTE MANAGEMENT NATIONAL SERVICES 023014733 INC Complaint date Complaint amount 11/04/2014 $65,808.38 Cause no. 14-2-25552-7SEA Dismissed Complaint filed by Complaint against bond(s)or savings EMERALD CITY FENCE RENTALS LLC 023014733 Complaint date Complaint amount 09/23/2014 $3,552.66 Cause no. 14-2-05547-0 Dismissed Complaint filed by Complaint against bond(s)or savings ALASKA CASCADE FINANCIAL SERVICES INC 023014733 Complaint date Complaint amount 08/12/2014 $2,750.91 L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Certifications & Endorsements OMWBE Certifications No active certifications exist for this business. Apprentice Training Agent No active Washington registered apprentices exist for this business.Washington allows the use of apprentices registered with Oregon or Montana.Contact the Oregon Bureau of Labor&Industries or Montana Department of Labor &Industry to verify if this business has apprentices. Workers' Comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Call L&l account representative for 210,436-00 account status. Doing business as SKYCORP LTD Estimated workers reported Incomplete premium report received. L&I account contact TO/LINDSEY THURGOOD*(360)902-5385-Email:@Ini.wa.gov Public Works Requirements https://secure.Ini.wa.gov/verify/Detail.aspx?UBI=603077334&LIC=SKYCOL*899DD&SAW= 6/3/2020 SKYCORP LTD Page 3 of 3 Verify the contractor is eligible to perform work on public works projects. Required Training—Effective July 1,2019 Exempt from this requirement. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace Safety & Health Check for any past safety and health violations found on jobsites this business was responsible for. No inspections during the previous 6 year period. https://securelni.wa.gov/verify/Detail.aspx?UBI=603077334&LIC=SKYCOL*899DD&SAW= 6/3/2020