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23-037.01 Public Restroom Company Balfour Park ImprovementsPUBLIC 1 RESTROOM COMPANY Building Better Places To Go.S"' CHANGE ORDER TO: Glenn Ritter City of Spokane Valley, WA 10210 E. Sprague Ave. Spokane Valley, WA 99206 PROJECT: Balfour Park No: 1 Date: 9/26/23 The following items have been added to the project and carries the same Terms & Conditions as In our original Offer to Sell. Line Item # City Description Unit Price Total 1 3 Deduction - Client to Pour Post Fittings I $ (650.00) r (1,950.00) CHANGE ORDER TOTAL ($1,950.00) ORIGINAL CONTRACT AMOUNT $850,292.00 NEW REVISED CONTRACT AMOUNT $848,342.00 By: Date• Charles E. Kaufman /President Accepted by: eiud+✓ ��,�✓ ��,'-� Date: io Print Name / Signaf5re 2587 Business Parkway I Minden, NV 894231 www.publicrestroomcompany.com 1:888-888-20601 f:888-888-1448 PUBLRES-01 MBARBATO 1441c"M LY CERTIFICATE OF LIABILITY INSURANCE DATE(M 1 /25/202YYy) 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 endorsements . PRODUCER CONTACT Alpine Insurance Associates 3352 Goni Road Suite 164 Carson City, NV 89706 PHONE FAX (A/c, No, Ext): (775) 829-2345 (A/c, No):(775) 827-7090 E-MAIL ADD E S: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Continental Casualfy 20443 INSURED INSURER B: ValleyFor a Insurance Co 20508 INSURERC:WCF National Insurance Company 40517 The Public Restroom Company INSURER D: Houston Casualty Company 42374 2587 Business Pkwy Minden, NV 89423 INSURER E : INSURER F : COVERAGES CFRTIFICATF NI IMRFR• 0M1IQ1nn1 K1I11knomD• 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 T TYPE OF INSURANCE ADDL p SUBR WVD POLICY NUMBER POLICY EFF /DD POLICY EXP D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 6075680879 6/30/2022 6/30/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED ISES Ea occurrence) 100,000 $ MED EXP (Any oneperson) $ 15,000 PERSONAL& ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑X JECTPRO-- LOC OTHER: Deductible $0 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 Employment Ben. $ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AIUTOS ONLY AUTOS 6075686956 6/30/2022 6/30/2023 (COMBINED e aBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PPe�acciden DAMAGE $ E AUTOS ONLY AUUTOS ONLY $ A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE 6075682504 6/30/2022 6/30/2023 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBT EXCLUDED? �N (Mandatory InNHI If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4008614 6/30/2022 6/30l2023 X PER OTH- START TE ER E.L. EACH ACCIDENT q,000,0pp $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liab. HCC 22 68597 6/30/2022 6/30/2023 Deductible $10k 2,000,000 D Professional Liabili HCC 22 68597 6/30/2022 6/30/2023 Each Incident 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage listed below is included in policy 6075680879 R/L/B Coverage $300,000 / Property in Transit - $2,500 Deductible - $200,000 Limit Builders Risk Limit $1,000,000 / Cargo Insurance $1,000,000 $5,000 deductible Employment Practices Liability 6/30/22 - 6130/23 (Hanover Insurance Company - LH4-H123819-00) / Per Claim $1,000,000 ! Aggregate $1,000,000 Cyber Liability 6/30122 - 6/30/23 (Evolve MGA - ESJO032069815) Cyber Crime limit $250,000 / General Aggregate $2,000,000 / Deductible $10,000 City of Spokane Valley, WA is additionally insured per the General Liability. RE: Project #: 11148 Balfour Park 105 N Balfour Road Spokane, WA 99206 City of Spokane Valley, WA 2426 N Discovery Place Spokane Valley, WA 99216 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. j/AUUTTHORIZED REPRESENTATIVE /j� hJ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD