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24-076.01A1TreeServiceTreeRemovalTrimmingServices Spokane Valley 10210 E Sprague Avenue• Spokane Valley WA 99206 Phone: (509)720-5000 •Fax:(509)720-5075 ♦www.spokanevalley.org Email:cityhallgspokanevalley.org November 22, 2024 Contract No. 24-076.01 Al Tree Service 25921 N Dalton Road Deer Park, WA 99006 Re:Implementation of 2025 option year, Agreement for Tree Removal and Trimming Services, Contract number 24-076, executed May 23, 2024. Dear Mr. Harm: The City executed an Agreement for provision of Tree Removal and Trimming Services on May 23, 2024,by and between the City of Spokane Valley, hereinafter"City", and Al Tree Service, hereinafter"Contractor" and jointly referred to as"Parties." The original Agreement states that it was for one year, with three optional one-year terms possible if the parties mutually agree to exercise the options each year. This is the first of three possible option years that can be exercised and runs through December 31, 2025. The City would like to exercise the 2025 option year of the Agreement. The Compensation shall not exceed $ 45,000. The history of the annual renewals, including dollar amounts, is set forth as follows: Original contract amount .$45,000 2025 Renewal .... $45,000 All of the other contract provisions contained in the original Agreement shall remain in place and remain unchanged in exercising this option year. If you are in agreement with exercising the 2025 option year, please sign below to acknowledge the receipt and concurrence to perform the 2025 option year. Please return two copies to the City for execution, along with current insurance information. A fully executed original copy will be mailed to you for your files. CITY OF SPOKANE VALLEY Al TREE SERVICE C-12( , ititki,yr ,r_____-_-_ 1.,_,,,y, g. e't-il John Ho an, City Manag r Name 0co'QI Ge"CU Title APPROVED AS T FORM: Office f the Ci Attorney AEP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/06/2024 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 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: Aaron LeBlanc Rothert Insurance PHONE(A/C,No,Exq: (509-483-3030 FAX No): 509-487-8355 c/o North Town Insurance ADDRESS: aaron@northtowninsurance.Com 5727 N Division Street INSURER(S)AFFORDING COVERAGE NAIC# Spokane WA 99208 INSURER A: Atlantic Casualty Insurance Company 42846 INSURED INSURER B Al Tree Service LLC INSURER C: 25921 N Dalton Rd. INSURER D: INSURER E: Deer Park WA 99006 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTED $ 2,000,000 CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A Y L065012021-1 08/01/2024 08/01/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JrJCO LOC PRODUCTS-COMP/OPAGG $ Included OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) THIS CONTRACT IS REGISTERED AND DELIVERED AS A SURPLUS LINE COVERAGE UNDER THE INSURANCE CODE OF THE STATE OF WASHINGTON,TITLE 48 RCW. IT IS NOT PROTECTED BY ANY WASHINGTON STATE GUARANTY ASSOCIATION LAW. RON ROTHERT INSURANCE, INC./ Tree Trimming&Pruning Certificate holder is added as an additional insured 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. City of Spokane Valley 10210 E Sprague Avenue AUTHORIZED REPRESENTATIVE Spokane WA 99206 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ® R AC L CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/20/2024 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 CONTNAME: Joseph Joseph Armand North Town Insurance INC No.Extl: (509)483-3030 FAX INC. (509)413-0900 5727 N Division St E-MAIL ADDRESS: joseph@northtowninsurance.com Spokane,WA 99208 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Ohio Security 24082 INSURED INSURER B: Al Tree Service LLC INSURER C: 25921 N Dalton Rd INSURER D: Deer Park,WA 99006 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 95954416-651862 REVISION NUMBER: 6 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. ADDL SUBR POLICY EFF POLICY EXP INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ • OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Y BAS63026546 03/16/2024 03/16/2025 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N 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 E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Tree Trimming and Pruning CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE 7) ':.....t..wizi..„, I (JJA) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by JJA on 05/20/2024 at 03:07PM ^7r { 41.1.6 STATE OF WASH1NGTON Department of Labor&Industries Certificate of Workers' Compensation Coverage November 22, 2024 WA UBI No. 604 314 671 L&I Account ID 243,437-01 Legal Business Name Al TREE SERVICE LLC Doing Business As Al STUMP REMOVAL Workers'Comp Premium Status: Account is current. Estimated Workers Reported Quarter 3 of Year 2024"11 to 20 Workers" (See Description Below) Account Representative Employer Services Help Line, (360)902-4817 Licensed Contractor? Yes License No. AITRETS827OP License Expiration 09/17/2026 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190).