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23-108.00 Inland Asphalt Co. Contract This agreement is entered into this 1Z4:11 day oflAlt,) , 2023, between the City of Spokane Valley ("City")and Inland Asphalt Company("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: Broadway at I-90 Preservation Project-Phase 1,No.341 Contract 23-108 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. 11. 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$1,282,828.00. IN WITNESS WHEREOF,the Contractor has executed this instrument,on the date below, and the City has caused this instrument to be executed on the date stated above. City of Spokane Valley C-1 Contract Forms Broadway at 1-90 Preservation Project Executed by Contractor May 31st ,2023. • Date Jared Boucher Printed Name CONSTRUCTION MANAGER Title OeiLa✓l ---�— Signature City of Spokane Valley John Hohman Printed Name City Manager Title Sig nature Rcxi,,ed I-8-16 • City of Spokane Valley C-2 Contract Forms Broadway at I-90 Preservation Project (IT)OF 1�10011"\111111%, � S jVa1ley. BOND NO: 9430625 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley,Spokane County,Washington,has awarded to Inland Asphalt Company(Contractor),as Principal, a contract for the construction of the project designated as Broadway at 1-90 Preservation-Phase 11 Project No.0341 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Fidelity and Deposit Company of Maryland (Surety), a corporation, organized under the laws of Illinois and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$ 1,282,828.00 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. 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 CPM Development Corporation dba Inland Asphalt Company Fid li and e osit Oe peny of ryland .--a o 05.31.20 . 'ncipal Signature D e Sue Si e - _ Date l—3-0,r'= TDvc,111 Linda Lee Nipper Printed Name Printed Name - - �j ,S+Cf zCA.J W% (�J aYk Y- Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Marsh USA LLC 15 W South Temple Ste 700, Salt Lake City UT 84101 206.257.8943 11111 City of Spokane Valley C-3 Contract Forms Broadway at 1-90 Preservation Project CITE OF • 4, Valley' BOND NO: 9430625 CONTRACTOR'S PAYMENT BOND(FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley,Spokane County,Washington,has awarded to Inland Asphalt Company(Contractor),as Principal, a contract for the construction of the project designated as Broadway at 1-90 Preservation-Phase 1 Project No. 0341 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)and chapter 60.28 RCW. The Principal, and Fidelity and Deposit Company of Maryland (Surety), a corporation organized under the laws of Illinois 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$ 1,282,828.00 total Contract amount,subject to the provisions herein. This payment bond shall cover any and all taxes incurred pursuant to Titles 50 and 51 RCW,taxes imposed on the Principal pursuant to Title 82 RCW, and any additional sales taxes. 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, 39.12, and 60.28 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;shall pay all taxes due pursuant to Titles 50,51,and 82 RCW;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) SURETY �-- - - - CPM Development Corporation dba Inland Asphalt Company Fidelity a Depo it Company of Marytarid 05.31.20 3 \ nncipal Signature Date ety re Jt3►.r,„ ]o,c,i, Linda Lee Nipper Printed Name Printed Name - l or-S-4-r csc .cam c\"koa G,/ Attorney-in-Fact Title t7 Title Name,address,and telephone of local office/agent of Surety Company is: Marsh USA LLC 15 W South Temple Ste 700, Salt Lake City UT 84101 206.257.8943 • City of Spokane Valley C-4 Contract Forms Broadway at I-90 Preservation Project V ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY • FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Linda Lee Nipper , its true and lawful agent and Attorney-in-Fact,to make, execute, seal and deliver,for, and on its behalf as surety,and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies, as fully and amply,to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 1 l th day of July,A.D.2019. ' q""04r, "�Y tt,, Y AY +.Mier ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND By: Robert-D. Murray Vice President- a, By: Dawn E.Brown Secretary State of Maryland County of Baltimore On this I Ith day of July, A.D. 2019, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified, Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. • •n � ..y ,11;�r,:�� Constance A.Dunn,Notary Public ` �'>> My Commission Expires:July 9,2023 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D. Murray,Vice President,in pursuance of authority granted by Article V, Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Linda Lee Nipper , its true and lawful agent and Attorney-in-Fact,to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies, as fully and amply,to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 11th day of July,A.D.2019. V'Q?3a01"°Z;;' t= mow! ' . % .4 "_ =o= 3 SEAL taoe Afj it iffigir w44w.M�� ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND By: Roberi D.Murray Vice President By: Dawn E.Brown Secretary State of Maryland County of Baltimore On this 11th day of July, A.D. 2019, before the subscriber, a Notary Public of the State of Maryland,duly commissioned and qualified, Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. i 7't•f h f .,tt;z Constance A.Dunn,Notary Public 1.: My Commission Expires:July 9,2023 Rom CERTIFICATE OF LIABILITY INSURANCE YYYY) 6/2/ D/D/DATE(MM/D 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 Liberty Mutual Insurance Co. National Insurance East CONTACT Valerie Reece 2000 Westwood Dr. (A/C.No.Ext): 513 867 3822 FAX (A/c.No): Wausau,WI 54401 E-MAIL ADDRESS: Oldcastle.certs@LibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# www.LibertyMutual.com INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED INSURER e: Liberty Insurance Corporation 42404 Inland Asphalt Company(120-SPO) INSURER C: CPM Development Corporation dba INSURER D: PO Box 3366 Spokane,WA 99220-3366 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 69693385 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A ✓ COMMERCIAL GENERAL LIABILITY TB2-C81-004095-112 9/1/2022 9/1/2023 EACH OCCURRENCE $2,000,000 -./ CLAIMS-MADE ✓ OCCUR DAMAGE TO RENTED XCU Coverage Included PREMISES(Ea occurrence) $300,000 ✓ Primary/Non-Contributory MED EXP(Any one person) $50,000 ✓ Separation of Insured ❑✓ Q✓ PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ✓ jEFO LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AS2-C81-004095-122 9/1/2022 9/1/2023 MBINED NGLE LIMIT $ (Ea accident)SI 2,000,000 ✓ ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED ❑� AS2-C81-054502-522 9/1/2022 9/1/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS l Ph scai Damage only:HIRED NON-OWNED y g y: PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Comprehensive Ded$10,000 (Per accident) Collision Ded$10,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WA7-C8D-004095-022 9/1/2022 9/1/2023 STATUTE EORH AND EMPLOYERS'LIABILITY Y/N All except OH,ND,WA,WY OFAN MEMBEREXC UDED?ECUTIVE N N/AEl E.L.EACH ACCIDENT $1,000,000 B (Mandatory in NH) WC7-C81-004095-012 9/1/2022 9/1/2023 E.L.DISEASE-EA EMPLOYEE $1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below WI,MN E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Broadway at 1-90 Preservation Project-Phase 1,No.341 City of Spokane Valley are included as additional insured as regards operations of the named insured as required by written contract.Coverage is primary and non-contributory.Waiver of subrogation applies as allowed by law. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spokane Valley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10210 E Sprague Ave,Spokane Valley,WA 99206 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE • Valerie Reece )elf z z ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 69693385 1 LM 44 109.22-09.23 Standard 10-2 Excess $13M AUTO 1 Erin Celing 18/12/2022 11.10:38 AM (CDT) 1 Page 1 of 1 POLICY NUMBER:TB2-C81-004095-110 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only with work, on the project (other than service, respect to liability for "bodily injury', "property maintenance or repairs) to be ormed by or damage" or "personal and advertising injury" on behalf of the additional insured(s)) at the caused,in whole or in part,by location of the covered operations has been 1. Your acts or omissions;or completed;or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf; injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization the additional insured(s) at the location(s) � than another contractor subcontractor designated above. engaged in performing operations for a principal as a part of the same project. However: C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III—Limits Of Insurance: law;and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required a contract or we required by a contract or agreement, the will pay on behalf of the aadditiionalt�insuredos the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contract or agreement;or by the contract or agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply. This endorsement shall not increase the This insurance does not apply to "bodily injury' or applicable Limits of Insurance shown in the "property damage"occurring after: Declarations. SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): Any owner,lessee,or contractor for whom you have Any location listed in such agreement agreed in writing prior to a loss to provide liability insurance Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 2010 0413 C Insurance Services Office, Inc.,2012 Page 1 of 1 Policy Number:AS2-C81-004095-120 Issued by: Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED-NONCONTRIBUTING This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form.This endorsement does not alter coverage provided in the Coverage form. Schedule Name of Persons)or Organizations(s): Any person or organization where the Named Insured has agreed by written contract to include such person or organization Regarding Designated Contract or Project: Any Each person or organization shown in the Schedule of this endorsement is an"insured"for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The following is added to the Other Insurance Condition: If you have agreed in a written agreement that this policy will be primary and without right of contribution from any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement was executed prior to the "bodily injury" or "property damage", then this insurance will be primary and we will not seek contribution from such insurance. AC 84 23 08 11 ©2010, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER:TB2-C81-004095-110 COMMERCIAL GENERAL LIABILITY CG24040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of your ongoing operations or "your work"done under a contract with that person or organization and included in the"products- completed operations hazard".This waiver applies only to the person or organization shown in the Schedule below. SCHEDULE Name Of Person Or Organization: As required by written contract or agreement entered into prior to loss. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 23-/08 ACORO® CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDD/YYYY) r �� 9/12/2023 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 LibertyMutual Insurance Co. National Insurance East 500 N3rd St, Suite 300 Wausau, WI 54403 CONTACT NAME: Valerie Reece PHONE 513-867-3822 No E-MAIL ADDRESS: Oldcastle.certs Libert Mutual.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Liberty Mutual Fire Insurance Company 23035 www.LibertyMutual.com INSURED CPM Development Corporation (120-SPO) DBA Inland Asphalt Company INSURERB: Liberty Insurance Corporation 42404 INSURERC: INSURER D : P.O. Box 3366 Spokane WA 99220-3366 INSURER E : INSURER F : COVERAGES CERTIFICOTF NIIMRFR• 79')n)rzQ RFVMInM NIIIIUIIi 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD/YYYY LIMITS A ✓ COMMERCIALGENERALLIABILITY CLAIMS -MADE OCCUR Primary/Non-Contributory �/ ,/ TB2-081-004095-113 XCU Coverage Included 9/1/2023 9/1/2024 EACH OCCURRENCE $2000000 DAMAGE TO RENTED PREMISES Eaoccurrence $300 000 ✓ MED EXP (Any one person) $ 50 OOO ✓ Separation of Insured PERSONAL BADV INJURY $2 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓❑ ECT LOC GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGG $1 O 000 000 1 $ OTHER: A AUTOMOBILE LIABILITY ✓ ✓ AS2-C81-004095-123 9/1 /2023 9/1 /2024 COMBINED SINGLE LIMIT Ea accident $ 2 000,000 ✓ BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY AS2-C81-054502-523 Physical Damage only: y g y' Comprehensive Ded $10,000 9/1/2023 9/1/2024 Per accident) ( ) $ PROPERTY DAMAGE Per accident)$ $ Collision Ded $10 000 A UMBRELLALIAB ,/ OCCUR ✓ ✓ TL2-681-054523-923 9/1/2023 9/1/2024 EACH OCCURRENCE $5000000 EXCESS LIAB CLAIMS -MADE (General Liability) ✓ AGGREGATE s5,000,000 DED I I RETENTION $ Products/Completed Ops s5,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? ❑N NIA ✓ WA7-C8D-004095-023 All except OH, ND, WA, WY 9/1 /2023 9/1 /2024 V STATUTE OERH E.L. EACH ACCIDENT $ 1 00O 000 E.L. DISEASE - EA EMPLOYEE $ 1 0 B (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WC7-C81-004095-013 WI MN 9/1 /2023 9/1 /2024 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Washington Stop Gap ✓ ✓ TB2-C81-004095-113 9/1/2023 9/1/2024 BI Each Accident $1,000,000 Employers Liability Coverage BI Aggregate Limit $1,000,000 BI Each Employee $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Broadway at 1-90 . City of Spokane Valley is listed as additional insured with regards to the general liability, automobile liability, and excess liability policies, on a primary and non-contributory basis, where required by written contract. Waiver of subrogation is included in favor of the additional insured, where required by written contract, and where applicable by law. Cityy of Spokane Valley 10210 E. Sprague Avenue Spokane Valley WA 99206 9a10 Ly a 4 W-11 I Lei 01 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 Valerie Reece ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 76202538 1 8-004095 1 AMAT 09.23-09.24 Standard WA Stop Gap I Erin Celing 1 9/12/2023 9:40:16 AN (CST) I Page 1 of 16