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23-093.00 Poe Asphalt Paving Inc. Contract This agreement is entered into this Y'day of 2023, between the City of Spokane Valley ("City")and Poe Asphalt Paving("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: Local Access Preservation Services 2023 Cape Seal Pilot Project-Aggregate Contract 23-093 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$102,301.00. 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. -r Executed by Contractor +5 ,2023. Date Printed Name Title Signature City of Spokane Valley John Hohman Printed Name City Manager Title Signature Rev ised I-8-I h ' "T'`�kane jValley. BOND NO: 107820936 CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County,has awarded to Poe Asphalt Paving,Inc.,as Principal,a contract for the construction of the project designated as 2023 Cape Seal Pilot Project-Aggregate in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Travelers Casualty and Surety Company of America (Surety), a corporation organized under the laws CT and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$102,301 total Contract amount(including Washington State sales tax),subject to the provisions herein. This payment bond shall become null and void,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW,including all workers,laborers,mechanics,subcontractors, and materialmen,and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments;and if such payment obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,except as provided herein,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL(CONTRACTOR) SU TY Trave rs Cas Surety Company of America l�� /f 2 6/13/2023 Principal Si attire Date ✓ Surety Signature Date MCL(1LPp.e Lesha Lehmitz —Printed Name Printed Name {)( jaeo-i" Attorney In Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Stonebraker McQuary Insurance, 616 5th Street, Clarkston, WA 99403 CITY OF SPOKANE VALLEY CONTRACT DOCUMENTS Local Access Preservation Services Cape Seal Pilot Project C-12 'I Travelers Casualty and Surety Company of America AIM Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Lesha Lehmitz of CLARKSTON , Washington , their true and lawful Attomey(s)-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 21st day of April, 2021. 4I ""rly qJ,,1Y Aryl � B 4 i HARTFORD, < MOM State of Connecticut By: City of Hartford ss. Robert L.Rane , enior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. a�P H IN WITNESS WHEREOF,I hereunto set my hand and official seal. N rZ. 0 My Commission expires the 30th day of June,2026 * NOTARY *' . Anna P.Nowik,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President,any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this 13 `day of � t F . "„. •J•fY qhq! .10 11. a >4� ,F i. 'It' Gs • of Kevin E.Hughes,Assi tant Secretary To verify the authenticity of this Power of Attorney,please call us at 1-800-421-3880. Please refer to the above-named Attorneys)-in-Fact and the details of the bond to which this Power of Attorney is attached. CITY Ckllle ,g,,ilFValley BOND NO: 107820936 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Washington,in Spokane County,has awarded to Poe Asphalt Paving Inc.,as Principal,a contract for the construction of the project designated as 2023 Cape Seal Pilot Project-Aggregate. 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 Travelers Casualty and Surety Company of America (Surety), a corporation, organized under the laws of CT and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$102,301 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. 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) SURET Travel s Casualty,on Sur C pany of America 6/13/2023 Principal Signature Date Surety Signature Date -MAX'k--PDe Lesha Lehmitz Printed Name Printed Name ?fec Yti+ Attorney In Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Stonebraker McQuary Insurance, 616 5th Street, Clarkston, WA 99403 i;cd I I4 1 3 CITY OF SPOKANE VALLEY CONTRACT DOCUMENTS Local Access Preservation Services Cape Seal Pilot Project C-11 • Travelers Casualty and Surety Company of America A. Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Lesha Lehmitz of CLARKSTON , Washington , their true and lawful Attomey(s)-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 21st day of April, 2021. a°"�y4ry J�r[r Ay `� aTQy `'< Q ,�', 1 0P1�MMl State of Connecticut By: City of Hartford ss. Robert L.Rana , enior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. rind IN WITNESS WHEREOF,I hereunto set my hand and official seal. �i/� C worn»r My Commission expires the 30th day of June,2026 • .t+ POLIO Anna P.Nowik,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President,any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this #44-..-day of 5.1.4 f it , (�Z� yMw@y yJ�Jr Aye re I NA r � �K kliiedrp(y �`` •, °+�0 + sty LE.HughetantScretary To verify the authenticity of this Power of Attorney,please call us at 1-800-421-3880. Please refer to the above-named Attorney(s)-in-Fact and the details of the bond to which this Power of Attorney is attached. i^', POEASPH-03 JSCHREIBER AC-CPR/Cr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ka.....------ 6/15/2023 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: Spokane Office PHONE FAX Paynewest Insurance,a Marsh McLennan Agency LLC Company (A/C,No,Ext):(509)838-3501 (A/c,No):(866)226-3738 501 N.Riverpoint Blvd.,Ste 403 ADDRESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B: Poe Asphalt Paving Inc INSURER C: 2732 N.Beck Road INSURER D: 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 TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD VD (1MM/DD/YYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR EPP 0633923 11/1/2022 11/1/2023 DAMAGE TO RENTED 300,000 X X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Deductible: 0 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X X EPP 0633923 11/1/2022 11/1/2023 BODILYINJURY(Perperson) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE EPP 0633923 11/1/2022 11/1/2023 AGGREGATE $ 4,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Construction Contract 23-093 Local Access Preservation Services 2023 Cape Seal Pilot Project-Aggregate City of Spokane Valley is included as additional insured(except on work comp)as required by written contract per attached forms.This policy is primary and will not ask for contribution from the additional insured.Waiver of Subrogation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof SpokaneTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Valley ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE diAASikAAL ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -...N POEASPH-01 LLEHMITZ ACC;PRQ' DATE(MM/DD/YYYY) �. CERTIFICATE OF LIABILITY INSURANCE 6/1312023 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 TACT Lesha Lehmitz Stonebraker McQuary PHo No Ext (509)758-5529 I A/C No 616 5th St. tom ): � k PO Box 9 Ilehm' stonebrakermc ua com Clarkston,WA 99403ss. 4 ry INSURER(S)AFFORDING COVERAGE NAIC H INSURER A_SIF IDAHO WORKERS'COMPENSATION 136129 INSURED INSURER B: Poe Asphalt Paving,Inc. INSURER c:_ PO Box 449 INSURER D: Lewiston,ID 83501 ,INSURER E: tt,__ 1 INSURER F: I 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 SUER POLICY EFF POLICY EXP INSD Will),_ POLICY NUMBER (MM/DDtYYYYI (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES(Ea oC1u2e[ ) 1 $ MED EXP(Anyone person) i $ PERSONAL&ADV INJURY ' $ GEtVL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f S 1 POLICY 1 l Ye,: LOC PRODUCTS-COMP/OP AGO S__ OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Es [iL $ ANY AUTO BODILY INJURY(Per person) $ OWNED j SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident)4_$ p� W'JPf PROPERTY AMAGE AUTOS ONLY AUTO ONLY (P_ar accidentg tS_ S I UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE $ I DED I RETENTION$ $ A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY _ STATUTE ER j ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N' X 578551 10/1/2022 10/1/2023 500,000 FILE�EMBEREXCLUDED? I NIA E.L..EACHACGIDENT 1$ ___„_ 500 000 amatory in NH) E.L.DISEASE-EA EMPLOYEEE$ ' If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT;$ I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached M more space is required) 2023 Cape Seal Pilot Project-Aggregate 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 74. (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