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20-187.00 Etter McMahon et al: Sullivan Wellesley Intersection Improvements Contract No.26)AS AGREEMENT FOR PROFESSIONAL SERVICES Etter,McMahon,Lamberson,Van Wert,and Oreskovich P.0 THIS AGREEMENT is made by and between the City of Spokane Valley,a code City of the State of Washington, hereinafter "City" and Etter, McMahon, Lamberson, Van Wert, and Oreskovich, P.C., 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 shall 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 or unless otherwise agreed to by the Parties,subject to the Rules of Professional Conduct. Agreement for Professional Services—Etter,McMahon condemnation counsel Page 1 of 8 Contract No. 2O/67 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 terminate n date. A, Alp j�t" 3. Compensation. City agrees to the hourly rates as specified in Exhibit 0i, as full compensation for everything done under this Agreement. Firm 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 of the 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: Megan C.Clark Phone: (509)720-5000 Phone: 509-747-9100 Address: 10210 East Sprague Avenue Address:618 W. Riverside Ave.,Ste.210 Spokane Valley,WA 99206 Spokane,WA 99201 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. 7. Certification Reaardin2 Debarment, Suspension, and Other Responsibility Matters — Primary 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 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 Agreement for Professional Services—Etter,McMahon condemnation counsel Page 2 of 8 Contract No. 20/ 7 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's required insurance shall be of the types and coverages as stated below: 1.Commercial general liability insurance shall be at least as broad as ISO occurrence form 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. 2. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. Agreement for Professional Services—Etter,McMahon condemnation counsel Page 3 of 8 Contract No. 20-a 7 3.Professional liability insurance appropriate to Consultant's profession. B. Minimum Amounts of Insurance. Consultant shall maintain the following insurance limits: 1. General liability insurance shall be written with a combined single limit no less than $2,000,000 each occurrence, and $2,000,000 general aggregate. It shall provide that the City,its officers and employees are additional insureds,but only with respect to the Firm's services to be provided under this Contract;and 2.Professional liability insurance shall be written with a combined single limit no less than $2,000,000 per claim and $2,000,000 policy aggregate limit. This is to cover damages caused by the error, omission, or negligent acts related to the professional services to be provided under this Contract. If coverage is to be provided on a claims-made basis, the Firm shall warrant that any policy retroactive date precedes the effective date of the Contract. The coverage must remain in effect for at least two years after the Contract is completed. 3. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. C.Other Insurance Provisions. The Consultant's 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 self-insured pool coverage maintained by City shall be in excess of Consultant's insurance and shall not contribute with it. 2.Consultant shall provide City and all additional insured for this work with written notice of any policy cancellation within two business days of their receipt of such notice. 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, Agreement for Professional Services—Etter,McMahon condemnation counsel Page 4 of 8 Contract No. 'Lois 7 Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Agreement before commencement of the work. 12.Indemnification. Consultant shall indemnify the City,its officers and employees,from and against all direct damages,liability,cost and expense proximately caused by the negligent performance of Consultant's professional obligations under this Agreement, subject to such defenses as Consultant may have under applicable law to a claim for negligence in the performance of its obligations. Consultant shall have no liability hereunder for punitive, consequential, special or other indirect damages. This indemnification is solely for the benefit of the City and no third party beneficiary or other rights shall be created under this section. Consultant's liability shall be limited to the insurance coverage set forth herein. However, should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115,then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City,its officers, officials, employees, and volunteers, the Consultant's liability, including the duty and cost to defend, hereunder shall be only to the extent of the Consultant's negligence. It is further specifically and expressly understood that the indemnification provided herein constitutes the Consultant's waiver of immunity under Industrial Insurance, Title 51, RCW, solely for the purpose of this indemnification. This waiver has been mutually negotiated by the parties. The provisions of this section shall survive the expiration or termination of this Agreement. 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 shall 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. 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. 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). Agreement for Professional Services—Etter,McMahon condemnation counsel Page 5 of 8 Contract No. 20467 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.Assurance of Compliance with Applicable Federal Law. During the performance of this Agreement, the Consultant,for itself,its assignees,and successors in interest agrees as follows: A. 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. B. 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. C.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. D. 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. E. 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: 1. withholding payments to the Consultant under the Agreement until the Consultant complies;and/or 2. cancelling,terminating,or suspending the Agreement, in whole or in part. Agreement for Professional Services—Etter,McMahon condemnation counsel Page 6 of 8 Contract No. 10-6 7 F. 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. G. Pertinent Non-Discrimination Authorities: During the performance of this Agreement, the Consultant 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); Agreement for Professional Services—Etter,McMahon condemnation counsel Page 7 of 8 Contract No. zov.6 7 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.). 22. Business Registration. Consultant shall register with the City as a business prior to commencement of work under this Agreement if it has not already done so. 23.Severability. If any section,sentence,clause,or phrase of this Agreement should be held to be invalid for any reason by a court of competent jurisdiction,such invalidity shall not affect the validity of any other section,sentence,clause,or phrase of this Agreement. 24.Exhibits. Exhibits attached and incorporated into this Agreement are: A. Scope of Services B. Fee Schedule C. Insurance Certificates The Parties have executed this Agreement this 6th day of October ,2020. CI Y OF SPOKANE VALLEY Consultant: Mk atitiRIA. I 004/2A 20 Mark Calhoun,City Manager By:M. Clark Its: Authorized Representative APP' I VE 1 TO FORM: Office the Ci A orney Agreement for Professional Services—Etter,McMahon condemnation counsel Page 8 of 8 Contract No. 20/B 7 EXHIBIT A- SCOPE OF WORK/REPRESENTATION 1. The Consultant will represent the City, and if applicable, its employees and elected officials with respect to City of Spokane Valley v. FNF Investments, Inc. condemnation lawsuit. Specific assignments may include investigation of claims, all aspects of litigation, appeals, and additional legal representation or consultation tasks as assigned by the City. 2.Conflicts of Interest. The Firm or attorney who is selected to represent the City must disclose any actual or potential conflicts of interest,and will be prohibited from engaging in or carrying on,any legal work on behalf of any client that is directly adverse to the City or its interests,without the specific written consent and waiver of the Office of the City Attorney.Waivers will be evaluated on a case-by-case basis.The Firm or attorney engaged to represent the City shall have a continuing duty to disclose such information. The Office of the City Attorney will NOT sign"blanket" waivers. 3. Confidential Information. All confidential communications between the City, its officers,employees or agents, and the Firm, whether oral or written, and all documentation whether prepared by the Firm or the City shall be considered privileged and shall not be disclosed, except by the written consent of the City Attorney. Agreement for Professional Services—Etter,McMahon condemnation counsel Page 1 of 3 Contract No. 20-/g EXHIBIT B—FEE SCHEDULE 1. Each billing statement shall be set forth for each date services were performed: a.A brief summary of the services provided;and b. The number of hours,or fractions of hours spent by each provider;and c.The hourly rates of each provider. 2. Expenses and disbursements shall be shown in detail: a. Air travel shall be approved by the City in advance and is reimbursable at coach rates; and b. The City must NOT be charged for courier service or other expedited mail delivery, unless the urgency was caused by the City or the City requests the service; and c.Billings for experts or consultants retained by the Consultant shall be provided in a substantially similar format as outlined above. 3. Any changes in outside counsel's fee schedule shall be discussed with the City Attorney prior to implementation. 4. The Consultant has been retained because of its expertise. The City shall not be billed for basic general legal or technical research necessary to educate staff or less experienced attorneys without advanced City approval. The City shall not be billed for any time spent in preparing or reviewing the Firm's billings to the City or for internal quality control procedures. Unless approved in advance,the City will not reimburse for time spent by more than one attorney attending meetings,witness interviews,depositions,hearings and the like. 5.FEE SCHEDULE Hourly Rates Megan C.Clark $250.00 Associates: $180.00 Paralegals: $90 Law Clerks $75 Reimbursable expenses shall include: Litigation expenses Disbursements and out-of-pocket expenses Computerized legal research Court reporter appearance fees Deposition(transcription and/or video)fees Fees for retrieval of records Mediation or arbitration fees Court costs and filing fees Payments to outside investigators Expert witnesses and/or expert consultants Court transcripts Agreement for Professional Services—Etter,McMahon condemnation counsel Page 2 of 3 Contract No. 20-J97 Demonstrative aids Witness fees Mileage All Other Items for which the Consultant may advance or incur costs for the City's benefit Agreement for Professional Services—Etter,McMahon condemnation counsel Page 3 of 3 riedu) BURNSBROKERS Malpractice Insurance Experts Lawyers Professional Liability Quote Proposal Etter, McMahon, Lamberson, Van Wert & Oreskovich, P.C. LawyerCare Limits of Liability Deductible Premium Taxes Fees Total $5,000,000/$5,000,000 $10,000/$30,000 Inside Limits Per Claim/Annual $27,590.00 $0.00 $0.00 $27,590.00 Aggregate $5,000,000/$5,000,000 $10,000/$30,000 Inside Limit with Cyber* Per Claim/Annual $28,992.00 $0.00 $0.00 $28,992.00 Aggregate Policy Information: Effective Date: 5/31/2020 Retro Active Date: Full Prior Acts Number of Attorneys: 10 LawyerCare Features: AM Best Rated A+ Superior Financial Category Size XII, $1 Billion to $1.25 Billion Admitted Carrier Endorsements Attached to the Policy: State Amendatory Endorsement Cyber Related Coverage Enhancement Endorsement - Basic Limits PracticeGuard Endorsement CyberCare Coverage with $250,000 Inside Limits with $2,500 Per Claim Deductible for Option 2* Subjectivities to Bind: Signed Notice of Acceptance Completed & Signed LawyerCare Renewal App confirming: No changes to the Attorney Roster or additional Area of Practice(AOP) The Existing AOP % hasn't changed > +/- 5% Answer No to #4 Letterhead Payment of Premium This proposal is for highlighting policy features and does not include all the Policy language. All policy forms and endorsements should be reviewed carefully for coverage intentions. Burns Brokers LLC DBA Burns Brokers Insurance Agency, LLC for CA info@burnsbrokersinsurance.com PO Box 461151 Phone: 720-255-1412 Aurora CO 80046 Fax: 720-255-0644 "! BURNSBROKERS IJ Malpractice Insurance Experts NOTICE OF ACCEPTANCE I accept terms for Lawyers Professional Liability Insurance as indicated below: Named Insured Etter, McMahon, Lamberson, Van Wert & Oreskovich, P.C. Insurance Company LawyerCare Limits of Liability $5,000,000/$5,000,000 Inside Limits Deductible $10,000/$30,000 Per Claim/Annual Aggregate Premium Effective Date 5/31/2020 Retroactive Date Full Prior Acts PAYMENT OPTIONS Payment is due by your effective date /Payment in Full online via echeck at https://burnsbrokersinsurance.epavpolicy.com/ Or make checks payable to Burns Brokers and mail to the PO Box address below Financed Premium Down payment via ACH or credit card through finance company(3% credit card fee) Down payment & installments via ACH draft through finance company Down payment via echeck htt s: burnsbrokersinsurance.e a olic .com Down payment via check payable to Burns Bro ers n� Z V (Signature of Owner, Officer or Partner) (Date I understand that the coverage and premium offered is based on the information contained in the application provided that was completed and signed. The statements and information set forth in the application and supplements are true,complete and accurate as of the date above. I agree that the application and supplements shall become the basis of any coverage that may be issued by the insurer indicated above. This is to acknowledge that I am not aware of any claim and/or circumstances,acts errors or omissions that could result in a professional liability claim that have not been previously disclosed. Any related claims or potential claim matters have been reported on all subsequent applications to the appropriate carrier. I understand that rescission or cancellation of this policy may result in a minimum earned premium of 25%plus fees that the firm will owe to the carrier. Coverage is not bound until confirmation from the carrier is received. Burns Brokers LLC DBA Burns Brokers Insurance Agency,LLC for CA info@burnsbrokersinsurance.com PO Box 461151 Phone:720-255-1412 Aurora CO 80046 Fax:720-255-0644 IPROASSURANCE. LawyerCare LAWYERS PROFESSIONAL LIABLITY INSURANCE RENEWAL APPLICATION Medmarc Casualty Insurance Company•4795 Meadow Wood Lane•Suite 335 West•Chantilly,VA 20151 •800.356.6886.703.652.1300 NOTICE:This professional liability coverage is provided on a Claims Made and Reported basis.Only claims that are first made against the insured and reported to the Company during the policy term are covered,subject to the policy provisions. 1. Name(Primary Firm Name): Etter,McMahon,Lamberson,Van Wert&Oreskovich,P.C. Street Address: 618 West Riverside Avenue,Suite 210 City: Spokane State: WA Zip: 99201 2. Current Area of Practice breakdown(for new additions or changes greater than+ /-5%,please complete a full application): Arbitration/Mediation 1.00% BI/PI Defense 1.00% Corporate General 1.00% Real Estate—Commercial 1.00% Commercial—Plaintiff 3.00% Labor—Employee/Union 8.00% BI/PI Plaintiff 9.00% Local Government/Municipal 9.00% Labor—Management 14.00% Commercial Litigation Defense 16.00% Criminal Defense 17.00% Medical Malpractice Defense 20.00% 3. Current Attorney roster(for new additions or changes,please complete a full application): Name Retro Date Andrew M.Wagley 03/01/2016 Carl J.Oreskovich Full Prior Jeffrey R.Galloway 11/07/2011 Megan C.Clark 10/02/2013 Michael F.Connelly 09/01/2010 Michael J.McMahon Full Prior Ronald A.Van Wert 01/01/2002 Stephen M.Lamberson Full Prior Tyson S.Goss 10/16/2013 William F.Etter Full Prior LC 9002(8/17)©2017 Medmarc Casualty Insurance Company Page 1 of 4 '4. Since completion of the last application,has any lawyer proposed for this insurance: / -."become aware of any claim,or lawsuit,or act,error,omission or specific circumstances which could reasonably be expected 1jd result in a professional liability claim against the firm,any past or present lawyers in the firm,or any predecessor firm? Yes❑ No❑ ii. been the subject of any investigation or disciplinary action? Yes❑No❑ If yes to any of the above,please explain on a separate sheet. Fraud Warning Notices Please read the fraud warning notice for your state: General Fraud Warning-Any person who,with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Alabama Fraud Warning-Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison,or any combination thereof. Arizona Fraud Warning-For your protection,Arizona law requires the following statement to appear on this form.Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. Colorado Fraud Warning-It is unlawful to knowingly provide false,incomplete,or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company.Penalties may include imprisonment,fines,denial of insurance,and civil damages.Any insurance company or agent of an insurance company who knowingly provides false,incomplete,or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. Delaware Fraud Warning-Any person who knowingly,and with intent to injure,defraud or deceive any insurer,files a statement of claim containing any false,incomplete or misleading information is guilty of a felony. District of Columbia Fraud Warning-It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines.In addition,an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Florida Fraud Warning-Any person who knowingly and with intent to injure,defraud,or deceive any insurer files a statement of claim or an application containing any false,incomplete,or misleading information is guilty of a felony of the third degree. Idaho Fraud Warning-Any person who knowingly,and with intent to defraud or deceive any insurance company,files a statement containing any false,incomplete,or misleading information is guilty of a felony. Kentucky Fraud Warning-Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals,for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act,which is a crime. Maine Fraud Warning-It is a crime to knowingly provide false,incomplete or misleading information to an insurance company for the purpose of defrauding the company.Penalties may include imprisonment,fines or a denial of insurance benefits. Maryland Fraud Warning-Any person who knowingly or willfully presents a false or fraudulent claim for payment for a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Massachusetts Fraud Warning-Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information,or conceals for the purpose of misleading information concerning any fact material thereto,may be committing a fraudulent insurance act,which may be a crime and may subject the person to criminal and civil penalties. LC 9002(8/17)©2017 Medmarc Casualty Insurance Company Page 2 of 4 Minnesota Fraud Warning-A person who submits an application or files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. Missouri Fraud Warning-Any person who,with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. New Hampshire Fraud Warning-Any person who,with a purpose to injure,defraud or deceive any insurance company,files a statement of claim containing any false,incomplete,or misleading information is subject to prosecution and punishment for insurance fraud,as provided in RSA 638:20. New Jersey Fraud Warning-Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Ohio Fraud Warning-Any person who,with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Oklahoma Fraud Warning-Any person who knowingly,and with intent to injure,defraud or deceive any insurer,makes any claim for the proceeds of an insurance policy containing any false,incomplete or misleading information is guilty of a felony. Oregon Fraud Warning-Any person who,with an intent to knowingly defraud or knowingly facilitate a fraud against an insurer,submits an application or files a claim containing a false or deceptive statement or a material fact,may be guilty of insurance fraud. Pennsylvania Fraud Warning-Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading,information concerning any fact material thereto commits a fraudulent insurance act,which is a crime and subjects such person to criminal and civil penalties. Tennessee Fraud Warning-It is a crime to knowingly provide false,incomplete,or misleading information to an insurance company for the purpose of defrauding the company.Penalties include imprisonment,fines,and denial of insurance benefits. Vermont Fraud Warning-Any person who,with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud. Virginia Fraud Warning-It is a crime to knowingly provide false,incomplete,or misleading information to an insurance company for the purpose of defrauding the company.Penalties include imprisonment,fines,and denial of insurance benefits. Washington Fraud Warning-It is a crime to knowingly provide false,incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment,fines and denial of insurance benefits. West Virginia Fraud Warning-Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. LC 9002(8/17)©2017 Medmarc Casualty Insurance Company Page 3 of 4 Applicant's Authorization and Certification The undersigned authorized partner,officer or owner of the applicant firm warrants that the statements herein are true,and acknowledges that this company is relying on the accuracy of such information in determing eligibility and qualification for insurance. Completing and signing this application does not bind coverage. Coverage will not be bound,nor will a policy be issued,until the applicant signifies acceptance of the Company's pr m quotation. Signature of Partner,Officer or Owner of Applicant Fi Date: (—S1// t-- � Pp Print or Type Name: tRorrrainVert & G �� e Title: Owner,Attorney at Law For Agent's Use Only (Where Required By Law) Name of Agency: Agency Telephone Address: Number: Agent's Name: Signature: Date: LC 9002(8/17)©2017 Medmarc Casualty Insurance Company Page 4 of 4