25-038.00InternationalMaterialsTestingGeotechnical2025-2028On-CallGeotechServicesContract No. 25-038
AGREEMENT FOR PROFESSIONAL SERVICES
Intermountain Materials Testing & Geotechnical
THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State
of Washington, hereinafter "City" and Intermountain Materials Testing & Geotechnical, 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. Consultant
shall complete its work by December 31, 2028, unless the time for performance is extended in writing by
the Parties.
Agreement for Professional Services (with professional liability coverage) Page 1 of 10
Contract No. 25-038
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 termination
date.
3. Compensation. Each item of work under this Agreement shall be provided by task assignment pursuant
to the Scope of Services, Exhibit A. The hourly and unit rates for each assignment shall be the rates shown
in the Fee Schedule, Exhibit B. The amount established for each assignment shall be the maximum amount
payable for that assignment unless modified in writing by the City. The total payable for all task assignments
shall be limited to a maximum amount of $300.000.00. Consultant 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.
The rates, as shown in Exhibit B, may be amended each calendar year by the express written agreement of
the City and the Consultant. The rate increase or decrease shall be negotiated by the City and Consultant
and shall not be increased or decreased by more than the percent change in the Consumer Price Index for
All Urban Consumers (CPI-U). The reference point will be the CPI-U for September and the index base
period is 1982-1984=100. The source of this percent change shall be the "U.S. Department of Labor, Bureau
of Labor Statistics.
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:
Name: Marci Patterson, City Clerk
Phone: (509) 720-5000
Address: 10210 East Sprague Avenue
Spokane Valley. WA 99206
TO THE CONSULTANT:
Name: Intermountain Materials Testing &
Geotechnical
Phone: 509-474-9764
Address: 9401 E. Appleway Blvd.
Spokane Valley. WA 99206
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. Consultant states that its designs,
construction documents, and services shall conform to all federal, state, and local statutes and regulations.
7. Certification Rep-arding Debarment, Suspension, and Other Resr)onsibilitc Matters — Primar-,
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;
Agreement for Professional Services (with professional liability coverage) Page 2 of 10
Contract No. 25-038
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
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. Automobile liability insurance covering all owned, non -owned, hired, and leased
Agreement for Professional Services (with professional liability coverage) Page 3 of 10
Contract No. 25-038
vehicles. Coverage shall be at least as broad as Insurance Services Office (ISO) form CA
0001.
2. 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.
3. Workers' compensation coverage as required by the industrial insurance laws of the
State of Washington.
4. Professional liability insurance appropriate to Consultant's profession.
B. Minimum Amounts of Insurance. Consultant shall maintain the following insurance limits:
1. Automobile liability insurance with a minimum combined single limit for bodily injury
and property damage of $1,000,000 per accident.
2. Commercial general liability insurance shall be written with limits no less than
$2,000,000 each occurrence, and $2,000,000 general aggregate.
3. Professional liability insurance shall be written with limits no less than $2,000,000 per
claim and $2,000,000 policy aggregate limit.
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.
Agreement for Professional Services (with professional liability coverage) Page 4 of 10
Contract No. 25-038
D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating
of not less than A:V11.
E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement,
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 and Hold Harmless. Consultant shall, at its sole expense, defend, indemnify, and
hold harmless City and its officers, agents, and employees, from any and all claims, actions, suits, liability,
loss, costs, attorney's fees, costs of litigation, expenses, injuries, and damages of any nature whatsoever
relating to or arising out of the wrongful or negligent acts, errors, or omissions in the services provided by
Consultant, Consultant's agents, subcontractors, subconsultants, and employees to the fullest extent
permitted by law, subject only to the limitations provided below.
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. Assienment 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. Notwithstanding the foregoing, Consultant agrees that it may, at City's request, be joined as a
party in any arbitration proceeding between City and any third party that includes a claim or claims that
Agreement for Professional Services (with professional liability coverage) Page 5 of 10
Contract No. 25-038
arise out of, or that are related to Consultant's services under this Agreement. Consultant further agrees
that the Arbitrator(s)' decision therein shall be final and binding on Consultant and that judgment may be
entered upon it in any court having jurisdiction thereof.
18. Cost and Attornev'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 or arbitration (including expert
witness fees).
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. Business Reeistration. Consultant shall register with the City as a business prior to commencement
of work under this Agreement if it has not already done so.
22. Assurance of Comnliance with Aanlicable 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. Consultant shall comply with the federal laws set forth in
subsection G, below ("Pertinent Non -Discrimination Authorities") relative to non-discrimination
in federally -assisted programs as adopted or amended from time -to -time, which are herein
incorporated by reference and made a part of this Agreement.
B. Non-discrimination. 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. 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 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 Consultant of Consultants'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. 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, 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.
Agreement for Professional Services (with professional liability coverage) Page 6 of 10
Contract No. 25-038
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 Consultant under the Agreement until Consultant complies;
and/or
2. Cancelling, terminating, or suspending the Agreement, in whole or in part.
F. Incorporation of Provisions. Consultant shall include the provisions of Section 22 of this
Agreement in every subcontract, including procurements of materials and leases of equipment,
unless exempt by the Acts, regulations and directives issued pursuant thereto. 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
Consultant becomes involved in, or is threatened with litigation by a subcontractor or supplier
because of such direction, Consultant may request that the City enter into any litigation to protect
the interests of the City. In addition, 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; and 49 Part
26;
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 U.S.C. §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 Vl 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);
Agreement for Professional Services (with professional liability coverage) Page 7 of 10
Contract No. 25-038
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);
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.).
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 proposal
C. Insurance Certificates
The Parties have executed this Agreement this / U T uday of A Prz 1 t- . 20_?=Y
CITY OF SPOKANE VALLEY
01
_ A? _.._-
John 11ohman, City Manager
AS
the City
FORM:
Consultant:
By:
Its: Authorized Representative
Agreement for Professional Services (with professional liability coverage) Page 8 of 10
Exhibit A - Scope of Services
Material Testing Services for Capital Improvement Projects
Each item of work under this AGREEMENT will be provided by task assignment. Each assignment's
scope of work will be determined by the City with input from the CONSULTANT. The hourly and unit
rates for each scope of work will use the negotiated rates shown in Exhibit B. The amount established for
each assignment will be the maximum amount payable for that assignment unless modified in writing by
the AGENCY. The AGENCY is not obligated to assign any specific number of tasks to the
CONSULTANT, and the AGENCY's and CONSULTANT'S obligations hereunder are limited to tasks
assigned in writing. Task assignments may include but are not limited to, the following types of work:
Scope of Services to include, but not limited to:
1. Proctor sampling and testing of existing subgrade soils
2. Aggregate sampling and testing
3. Compaction testing for subgrade, trench backfilling, crushed surfacing material and Hot Mix
Asphalt.
4. HMA quality assurance testing including aggregate gradation, oil content and air voids (Va)
5. Concrete testing including slump, air entrainment and compression strength testing.
Material testing services completed in accordance with the current WSDOT Construction Manual
and the WSDOT Standard Specifications as amended by the City of Spokane Valley Standard
Specifications.
Task assignments made by the AGENCY shall be issued in writing by a Formal Task Assignment
Document is substantially the same format as the exemplar from attached hereto.
An assignment shall become effective when a formal Task Assignment Document is signed by the
CONSULTANT and the AGENCY, except that emergency actions requiring a 24-hour or less response
can be handled by an oral authorization. Such oral authorization shall be followed up with a Formal Task
Assignment Document within four working Days, and any billing rates agreed to orally (for individuals,
subconsultants, or organizations, or organizations whose rates were not previously established in the
AGREEMENT) shall be provisional and subject to final negotiation and acceptance by the AGENCY.
Formal Task Assignment Document
Task Number
The general provisions and clauses of Agreement #XX-XXX shall be in full force and effect
for this Task Assignment
Consultant:
Proiect Title:
COSY Proiect Number:
Maximum Amount Pavable Per TaskAssienment:
etion Date:
Description of Work:
(Note attachments and give brief description)
Agency Project Manager Signature: Date:
Oral Authorization Date:
Date:
Consultant Signature: Date:
Agency Approving Authority: Date:
Intermountain Materials Testing & Geotechnical Exhibit B
9401 E. Appleway Ave.
Spokane Valley, WA 99206
(509)474-9764
Unit Rates for Materials Testing and Sampling Services
To: City of Spokane Valley
Project: COSV On -Call Materials Testing Proposal No.:
Spokane Valley, WA Proposal Date: 3/12/25
Item Unit
Description Units Price
Soils/A. aregate Sampling & Testin_g (1, 2)
Inspector & Equipment for Sampling & Testing (3)
hrs
85.00
Geotechnical Engineer
hrs
175.00
Maximum Density/Optimum Moisture Test
each
175.00
Sieve Analysis Test
each
150.00
Fractured Face Test
each
175.00
Sand Equivalent Test
each
175.00
Liquid Limit/Plasticity Index Test
each
220.00
Site Concrete, Samplina & Testing 11, 2)
Inspector & Equipment for Inspection, Sampling & Testing (3)
hrs
85.00
(includes: slump, air, temperature, cylinders cast & report)
Compressive Strength Test, per cylinder
each
30.00
HMA Sampling & Testing (1, 2)
Inspector & Equipment for Sampling & Testing (3)
hrs
85.00
Theoretical Maximum ("Rice") Density Test
each
150.00
Oil Content, Ignition Test
each
175.00
Sieve Analysis Test
each
150.00
HMA Volumetrics, Gyratory Test, per specimen
each
375.00
Fractured Faces Test
each
175.00
Sand Equivalent Test
each
175.00
Uncompacted Void Content Test
each
175.00
Cores (drill, sample, density), per core
each
150.00
Other Items
Overtime Surcharge (rate plus in excess of 8 hrs/day,
units
40 hrs/week, weekends, & holidays)
Project Manager
hrs
125.00
Nuclear Densometer
days
40.00
Vehicle Mileage
mi
0.85
On -Call Sample Collection or Prep. (1-hour minimum except on
hrs
85.00
nays when we are onsite performing otner services)
1 Services will be provided from portal to portal, on an on -call, part-time basis in
accordance with the unit prices listed above.
2 Services require 24-hours advance notice.
3 A 3-hour minimum charge applies to field testing services.
Thank you for the opportunity to submit this estimate. Please call if you have any questions or require additional information.
By:
Kyle L. Sanlord
Construction Services Manager
Intermountain Materials Testing
www.imi-testing.com
�1
Exhibit C
A`OR[7 CERTIFICATE OF LIABILITY INSURANCE DATE
(MMID02N5 n
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(les) 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 GUMAGI NAME: Nicole Goodman
Graybeal Group, Inc. PHONE 541-371-2812 FAX
(A/C. No EAU, WC,Nol:
4206 W 24th Ave, Suite A104 A.nicole@graybealgroup.com
Kennewick
INSURED
Waltek II Inc
DBA: Intermountain Materials Testing
PO Box 2801
Pasco
INSURER(S) AFFORDING COVERAGE ! NAIC 0
WA 99338 _INSURER_A: Western National Mutual Insurance Company 15377
INSURERB: Pacific Insurance Co LTD 10046
INSURER C :
INSURER D :
INSURER E :
WA 99302 INCIIRFR F
COVERAGES CERTIFICATE NUMBER! RFVICI[1N NIIMRPR-
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 ADDL,SUBR POLICY EFF POUCYEXP
LTR TYPE OF INSURANCE INSL' ylyo POLICY NUMBER iMMIDD+YYYv; IMMIDDrYYYY; LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
ul SI�A��'TO RENTED - _--
CLAIMS -MADE J OCCUR PREMISES +Ea occurrencel $ 100,000
X WA Stop Gap MED EXP (An, one person) $ 5,000
A Y Y CPP1338250 4/1/2024 4/1/2025 PERSONAL & AOV INJURY $ 1,000,000
GEN'LAGGREGAIELIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
- --
I- PRO- j�� ---�--- -
POLICY IXl JECT [' LOC PRODUCTS-COMProPAGG $ 2,000,000
—.
OTHER: $
AUTOMOBILE LIABILITY ''OM IN IN L $ 1,000,OOU
(€a accident)
_.. -_
X ANY AUTO BODILY INJURY (Per person) $
A OWNED SCHEDULED AUTOS ONLY AUTOS Y Y CPP1337311 4/1/2024 4/1(Per accident) )
/2025 BODILY INJURY Pidt $
HIRED NON -OWNED PROPERTYDAMAGE
$
AUTOS ONLY AUTOS ONLY iPer accident)
,S
X UMBRELLALIAB X OCCUR
EACH OCCURRENCE $ 4,000,000
A EXCESS LIAB _ CLAIMS -MADE Y Y UMB1056317 4/1/2024 4/1/2025
AGGREGATE $ 4,000,000
DED X RETENTION $ 10,000
_
$
WORKERS COMPENSATION X
AND EMPLOYERS' LIABILITY -_
IN STATUTE ER
Y❑
A OFFANYCER(MEMB REXCLUDED? TNER/EXECUTtVE
NIA CPP1338250 4/1/2024 4/1/2025 EL EACH ACCIDENT $ 1,000,000
(Mandatory in NH) E.L. DISEASE - EAEMPLOYEEI$ 1,000,000
If yes, describe under -- -
DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000.000
Each $ 1,000,000
B Professional Liability Claims Made
retro Date 6-24-2009 010HO663825-24 06/24/2024 06/24/2025 Aggregate $ 2,000,000
Deductible S 30.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Verdis Takisaki II and Department of Air Force are additional insured as respects to general and auto liability when required by written contract per blanket
additional insured forms WN GL 139 06 18 and WN CA 80 06 19 included. Waiver of subrogation applies as respects to both general liability and auto liability.
Primary and Non -Contributory applies per general liability form WN GL 139 06 18 and auto liability form WN CA 80 06 19.
ADAL HP SERE Gym, B1306
FAFB Project #FA462024F0109
VTII Project #92404
1%,Ak1C r1VLLJCr%
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Verdis Takisaki II ACCORDANCE WITH THE POLICY PROVISIONS.
1620 N Mamer Rd Bldg C, Suite 100 ( AUTHORIZED REPRESENTATIVE
Spokane Valley WA 99216 � ��z616'a
988-2015 ACORD CORPORATION. All rights reserved
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
WN GL 139 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - CONTRACTORS -
OPERATIONS AND COMPLETED OPERATIONS -
WITH ADDITIONAL INSURED REQUIREMENT
IN CONSTRUCTION CONTRACT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Additional Insured — Operations
A. Section II — Who Is An Insured is amended
to include as an additional insured:
(1) Any person or organization for whom you
are performing operations when you and
such person or organization have agreed
in writing in a contract or agreement that
such person or organization be added as
an additional insured on your policy; and
(2) Any other person or organization you are
required to add as an additional insured
under the contract or agreement de-
scribed in Paragraph 1. above.
Such person(s) or organization(s) is an add-
tional insured only with respect to liability for
"bodily injury", "property damage" or "per-
sonal and advertising injury" caused, in
whole or in part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on
your behalf;
in the performance of your ongoing opera-
tions for the additional insured.
B. With respect to Additional Insured - Opera-
tions, coverage is limited as follows:
This insurance does not apply to "bodily in-
jury" or "property damage" occurring after:
(1) All work, including materials, parts or
equipment furnished in connection with
such work, on the project (other than ser-
vice, maintenance or repairs) to be per-
formed by or on behalf of the additional
insured(s) at the location of the covered
operations has been completed; or
WN GL 139 06 18
(2) That portion of "your work" out of which
the injury or damage arises has been put
to its intended use by any person or or-
ganization other than another contractor
or subcontractor engaged in performing
operations for a principal as a part of the
same project.
2. Additional Insured — Completed Operations
A. Section II — Who Is An Insured is amended
to include as an additional insured:
(1) Any person or organization for whom you
are performing operations when you and
such person or organization have agreed
in writing in a contract or agreement that
such person or organization be added as
an additional insured on your policy; and
(2) Any other person or organization you are
required to add as an additional insured
under the contract or agreement de-
scribed in Paragraph 1. above.
Such person(s) or organization(s) is an addi-
tional insured only with respect to liability for
"bodily injury", "property damage" or "per-
sonal and advertising injury" caused, in whole
or in part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on
your behalf;
and included in the "products -completed op-
erations hazard".
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 2
B. With respect to Additional Insured — Com-
pleted Operations, coverage is limited as fol-
lows.-
(1) A person or organization's status as an in-
sured under Additional Insured — Com-
pleted Operations continues only for the
period of time required by any written con-
tract or agreement.
(2) The insurance provided to the additional
insured does not apply to "bodily injury",
"property damage" or "personal and ad-
vertising injury" arising out of "your work"
for which a consolidated (wrap-up) insur-
ance program has been provided by the
prime contractor -project manager or
owner of the construction project in which
you are involved.
3. Primary and Noncontributory
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek con-
tribution from any other insurance available to an
additional insured under your policy provided that:
(1) The additional insured is a Named Insured un-
der such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be pri-
mary and would not seek contribution from
any other insurance available to the additional
insured.
4. Other Provisions Applicable to Additional In-
sured — Operations and Additional Insured —
Completed Operations
A. The Amendment of Insured Contract Defink
tion (Endorsement CG 24 26) does not apply
to an additional insured.
B. The coverage provided under Paragraph f. of
the definition of "insured contract" under Sec-
tion V — Definitions does not apply to an ad-
ditional insured under this endorsement un-
less required by a written contract or
agreement.
C. The insurance afforded to such additional in-
sured only applies to the extent permitted by
law; and
If coverage provided to the additional insured
is required by a contract or agreement, the in-
surance afforded to such additional insured
will not be broader than that which you are re-
quired by the contract or agreement to provide
for such additional insured.
WN GL 139 06 18
D. With respect to the insurance afforded to
these additional insureds, the following is
added to Section III — Limits Of Insurance:
If coverage provided to the additional insured
is required by a contract or agreement, the
most we will pay on behalf of the additional
insured is:
(1) The minimum amount required by the
contract or agreement; or
(2) The Limits of Insurance shown in the Dec-
larations;
whichever is less.
This endorsement shall not increase the ap-
plicable Limits of Insurance shown in the Dec-
larations.
E. With respect to the insurance afforded to
these additional insureds, the following addi-
tional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "per-
sonal and advertising injury" arising out of the
rendering of, or the failure to render, any pro-
fessional architectural, engineering or survey-
ing services, including:
(1) The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders, change orders or drawings and
specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against an additional insured allege negli-
gence or other wrongdoing in the supervision,
hiring, employment, training or monitoring of
others by that insured, if the "occurrence"
which caused the "bodily injury' or "property
damage", or the offense which caused the
"personal and advertising injury", involved the
rendering of or failure to render any profes-
sional services by you with respect to your
providing engineering, architectural or survey-
ing services in your capacity as an engineer,
architect or surveyor.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 2 of 2
WN CA 80 06 19
BUSINESS AUTO ENHANCEMENT EDGE ENDORSEMENT
The Business Auto Enhancement Edge Endorsement is an optional endorsement that provides coverage
enhancements. The following is a summary of broadened coverages provided by this endorsement No coverage is
provided by this summary, refer to the following endorsement for changes in your polity.
SUMMARY OF COVERAGES
PAGE
Accidental Airbag Deployment Coverage
5
Audio, Visual and Data Electronic Equipment — Limit Amended
5
Auto Loan/Lease Gap Coverage
5
Blanket Additional Insured
3
Blanket Waiver of Subrogation
5
Broadened Definition of Insured includes:
• Newly Acquired Organizations for up to 180 Days
2
• Employees as Insureds
2
• Subsidiaries in Which You Own 50% or More
2
Deductible Waiver for Glass Repair
4
Employee Hired Auto
6
Fellow Employee Coverage
3
Hired Auto Physical Damage Coverage
3,6
Knowledge of Accident,. Claim, Suit or Loss
5
Loss Of Use Expenses - Amended
3
Personal Effects
3
Primary and Noncontributory If Required by a Written Contract or Written Agreement
6
Rental Reimbursement Coverage
4
Supplementary Payments - Amended:
• Bail Bonds up to $5,000
3
• Loss of Earnings up to $500/Day
3
Temporary Substitute Vehicle Physical Damage
2
Towing
3
Transportation Expense Limits —Amended
3
Unintentional Failure to Disclose Hazards
6
WN CA 80 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 6
WN CA 80 0619
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO ENHANCEMENT EDGE ENDORSEMENT
This endorsement modifies the insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement The SECTIONS of the Business Auto Coverage Form identified in this endorsement will be
amended as shown below.
SECTION 1 — COVERED AUTOS COVERAGE e. Any organization which is newly acquired or
AMENDMENTS formed by you and over which you maintain
A. Temporary Substitute Vehicle Physical Damage majority ownership. However, coverage under
this provision:
SECTION I — COVERED AUTOS, C. Certain
Trailers, Mobile Equipment And Temporary
Substitute Autos is amended by adding the
following:
If a covered "auto" you own is out of service
because of its:
a. Breakdown:
b. Repair:
c. Servicing;
d. "Loss", or
e. Destruction;
the Physical Damage Coverages provided by the
Business Auto Coverage Form for that disabled
covered "auto" are extended to any "auto" you do
not own while used with the permission of its owner
as a temporary substitute for the covered "auto"
that is out of service.
SECTION II — COVERED AUTOS LIABILITY
COVERAGE AMENDMENTS
A. Who Is An Insured
SECTION II — COVERED AUTOS LIABILITY
COVERAGE, A. Coverage, 1. Who Is An Insured
is amended to add:
d. Any legally incorporated subsidiary of yours in
which you own more than 50% of the voting
stock on the effective date of this coverage
form.
However, "insured" does not include any
subsidiary of yours that is an "insured" under
any other automobile liability policy or would be
an 'insured" under such policy but for
termination of such policy or the exhaustion on
such policy's limits of insurance.
(1) is afforded only for the first 180 days after
you acquire or form the organization or until
the end of the policy period, whichever
comes first;
(2) does not apply to "bodily injury" or "property
damage" that results from an "accident'
that occurred before you formed or
acquired the organization;
(3) does not apply to any newly acquired or
formed organization that is a joint venture
or partnership: and
(4) does not apply to an "insured" under any
other automobile liability policy or would be
an "insured" under such a policy but for
termination of such policy or the exhaustion
of such policy's limits of insurance.
L Any "employee" of yours is an "insured" while
using a covered "auto" you don't own, hire or
borrow in your business or your personal
affairs.
g. Any "employee" of yours is an "insured" while
operating a covered "auto" hired or rented
under a contract or agreement in the
"employee's" name, with your permission, while
performing duties related to the conduct of your
business.
WN CA 80 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 6
B. Blanket Additional Insured
SECTION II — COVERED AUTOS LIABILITY
COVERAGE, A. Coverage,1. Who is An Insured,
paragraph c. is amended to add the following:
Any person or organization who is required under a
written contract or agreement between you and that
person or organization, that is signed and executed
by you before the "bodily injury" or "property
damage" occurs and that is in effect during the
policy period, to be named as an additional insured
is an "insured" for Liability Coverage, but only for
damages to which this insurance applies and only
to the extent that persons or organization qualifies
as an "insured" under the Who Is An Insured
provision contained in Section II.
C. Liability Coverage Extensions — Supplementary
Payments
SECTION 11 — COVERED AUTOS LIABILITY
COVERAGE, A. Coverage, 2. Coverage
Extensions, a. Supplementary Payments is
amended by replacing subparagraphs (2) and (4)
with the following:
(2) Up to $5,000 for cost of bail bonds (including
bonds for related traffic law violations) required
because of an "accident" we cover. We do not
have to furnish these bonds.
(4) All reasonable expenses incurred by the
"insured" at our request, including actual loss of
earnings up to $500 a day because of time off
from work.
D. Fellow Employee Coverage
SECTION II — COVERED AUTOS LIABILITY
COVERAGE, B. Exclusions, 5. Fellow Employee,
the following is added:
Co -Employee Lawsuit Defense Cost
Reimbursement
If a suit seeking damages for "bodily injury' to any
fellow "employee" of the "insured" arising out of and
in the course of the fellow "employee's"
employment or while performing duties related to
the conduct of your business, or a suit seeking
damages brought by the spouse, child, parent,
brother or sister of that fellow "employee", is
brought against you, we will reimburse reasonable
costs that you incur in the defense of such matters.
Any reimbursement made pursuant to this
sub -section will be in addition to the limits of liability
set forth in the Declarations.
SECTION III — PHYSICAL DAMAGE COVERAGE
AMENDMENTS
A. Towing
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage, 2. Towing, is amended by adding the
following:
2. Towing
We will pay up to $250 for towing and labor
costs incurred each time a covered "auto" is
disabled. However, the labor must be
performed at the place of disablement This
$250 limit is reduced by any applicable towing
limit shown in the declarations.
Regardless of the number of disablements, the
maximum amount we will pay under this
endorsement for all towing and labor costs
combined during any one year is $2,500.
B. Transportation Expense — Limits Amended
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage, 4. Coverage Extensions, a.
Transportation Expenses is amended by replacing
$20 per day/$600 maximum limit with $50 per
day/$1000 maximum.
C. Hired Auto Physical Damage — Loss Of Use
Expenses — Limits Amended
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage, 4, Coverage Extensions, b. Loss of
Use Expenses is amended by replacing the $20
per day/$600 maximum limit with $50 per day/$750
maximum IimiL
D. Personal Effects Coverage
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage, 4. Coverage Extensions is
amended by adding the following:
c. Personal Effects
We will pay up to $500 for "loss" to personal
effects, which are:
(1) Owned by an "insured": and
(2) In or on your covered "auto."
This coverage applies only in the event of the total
theft of your covered "auto." No deductible applies
to this coverage.
WN CA 80 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 6
E. Glass Repair — Deductible Waiver
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage, 3. Glass Breakage — Hitting A Bird
Or Animal — Falling Objects Or Missiles, is
amended by adding the following:
No deductible will apply to glass breakage if such
glass is repaired, in a manner acceptable to us,
rather than replaced.
F. Hired Auto Physical Damage
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage is amended by adding the following:
5. Hired Auto Physical Damage
If hired "autos" are covered "autos" for Liability
Coverage and if Comprehensive, Specified
Causes of Loss, or Collision coverages are
provided under this coverage form for any
"auto" you own, then the Physical Damage
Coverages provided are extended to "autos"
you hire of like kind and use, subject to the
following:
a. The most we will pay for any one "loss" is
$50,000 or the actual cash value or cost to
repair or replace, whichever is less, minus
a deductible;
b. The deductible will be equal to the largest
deductible applicable to any owned "auto"
for that coverage. Any Comprehensive
deductible does not apply to "loss" caused
by fire or lightening;
c. Hired Auto Physical Damage coverage is
excess over any other collectible insurance;
and
d. Subject to the above limit, deductible and
excess provisions we will provide coverage
equal to the broadest coverage applicable
to any covered "auto" you own.
If a limit for Hired Auto Physical Damage is
indicated in the Declarations, then that limit
replaces, and is not added to, the $50,000 limit
indicated above.
G. Rental Reimbursement
SECTION III — PHYSICAL DAMAGE COVERAGE
A. Coverage, is amended by adding the following:
6. Rental Reimbursement
This coverage applies only to a covered "auto"
of the private passenger or light truck type as
follows:
a. We will pay for rental reimbursement
expenses incurred by you for the rental of a
private passenger or light truck type "auto"
because of `loss" to a covered private
passenger or light truck type "auto".
Payment applies in addition to the
otherwise applicable amount of each
coverage you have on a covered private
passenger or light truck type "auto." No
deductibles apply to this coverage.
b. We will pay only for those expenses
incurred during the policy period beginning
24 hours after the "loss" and ending,
regardless of the policy's expiration, with
the lesser of the following number of days:
(1) The number of days reasonably
required to repair or replace the
covered private passenger or light truck
type "auto". If "loss" is caused by theft,
this number of days is added to the
number of days it takes to locate the
covered private passenger or light truck
type "auto" and return it to you; or
(2) 30 days.
c. Our payment is limited to the lesser of the
following amounts:
(1) Necessary and actual expenses
incurred, or
(2) $50 per day, up to a maximum of
$1,000.
WN CA 80 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 6
d. This coverage does not apply while there
are spare or reserve private passenger or
light truck type "autos" available to you for
your operations.
e. If "loss" results from the total theft of a
covered "auto" of the private passenger or
light truck type, we will pay under this
coverage only that amount of your rental
reimbursement expenses which is not
already provided for under SECTION III —
PHYSICAL DAMAGE COVERAGE, A.
Coverage, 4. Coverage Extensiom
For the purposes of this Rental Reimbursement
coverage, light truck is defined as a truck with a
gross vehicle weight of 10,000 lbs. or less as
defined by the manufacturer as the maximum
loaded weight the auto is designed to carry.
H. Accidental Airbag Deployment Coverage
SECTION III — PHYSICAL DAMAGE COVERAGE,
A. Coverage is amended by adding the following:
7. Accidental Airbag Deployment Coverage
We will pay to reset or replace factory installed
airbag(s) in any covered "auto" for accidental
discharge, other than discharge due to a
collision loss.
This coverage is applicable only if
comprehensive coverage applies to the covered
"auto".
This coverage is excess over any other
collectible insurance or reimbursement by
manufacturer's warranty.
I. Auto Loan/Lease Gap Coverage
SECTION III PHYSICAL DAMAGE COVERAGE,
Item A., Coverage, is amended by adding the
following:
8. Auto Loan/Lease Gap Coverage
This coverage applies only to a covered "auto"
described or designated in the Schedule or in
the Declarations as including physical damage
coverage.
In the event of a covered total "loss" to a
covered "auto" described or designated in the
Schedule or in the Declarations, we will pay any
unpaid amount due on the lease or loan for a
covered "auto" less:
a. The amount paid under the Physical
Damage Coverage Section on the policy;
and
b. Any:
(1) Overdue lease/loan payments at the
time of the "loss";
(2) Financial penalties imposed under a
lease for excessive use, abnormal wear
and tear or high mileage;
(3) Security deposits not returned by the
lessor,
(4) Costs for extended warranties, Credit
Life Insurance, Health, Accident or
Disability Insurance purchased with the
loan or lease; and
(5) Carry-over balances from previous
loans or leases.
J. Audio, Visual and Data Electronic Equipment —
Limit Amended
SECTION III - PHYSICAL DAMAGE COVERAGE,
C. Limits of Insurance, 1.b. is amended by
replacing the $1000 limit with a $2,500 limit
SECTION IV — BUSINESS AUTO CONDITIONS
AMENDMENTS
A. Duties In The Event Of Accident, Claim, Suit Or
Loss Amended
SECTION iV — BUSINESS AUTO CONDITIONS,
A. Loss Conditions, 2. Duties In The Event Of
Accident, Claim, Suit Or Loss, a. is amended by
adding the following:
This condition applies only when the "accident" or
"loss" is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) An executive officer or insurance manager, if
you are a corporation; or
(4) A member or manager, if you are a limited
liability company.
But, this section does not amend the provisions
relating to notification of police, protection or
examination of the property which was subject to
the "loss".
B. Blanket Waiver of Subrogation
Section iV — BUSINESS AUTO CONDITIONS, A.
Loss Conditions, 5. Transfer of Rights of
Recovery Against Others to Us, is amended by
adding the following exception:
However, we waive any right of recovery we may
have against any person or organization to the
extent required of you by a written contract signed
and executed prior to any "accident" or "loss",
provided that the "accident" or "loss" arises out of
operations contemplated by such contract. The
waiver applies only to the person or organization
designated in such contract
WN CA 80 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 6
C. Unintentional Failure to Disclose Hazards
SECTION IV — BUSINESS AUTO CONDITIONS,
B. General Conditions, 2. Concealment,
Misrepresentation Or Fraud, is amended by
adding the following paragraph:
If you unintentionally fail to disclose any hazards
existing at the inception date of the policy, or during
the policy period in connection with any additional
hazards, we will not deny coverage under this
Coverage Part because of such failure.
D. Employee Hired Auto
SECTION IV — BUSINESS AUTO CONDITIONS,
B. General Conditions, 5. Other Insurance,
paragraph b. is deleted and replace by the
following:
b. For Hired Auto Physical Damage Coverage, the
following are deemed to be a covered "auto"
you own:
(1) Any covered "auto" you lease, hire, rent or
borrow.
(2) Any covered "auto" hired or rented by your
"employee" under a contract in that
individual "employee's" name, with your
permission, while performing duties related
to the conduct of your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
E. Primary and Noncontributory If Required By
Written Contract or Written Agreement
SECTION IV — BUSINESS AUTO CONDITIONS,
B. General Conditions, 5. Other Insurance c., the
following is added and supersedes any provision to
the contrary:
This Coverage Form's Covered Autos Liability
Coverage is primary to and will not seek
contribution from any other insurance available to
an "insured" under your policy provided that:
(1) Such "insured" is a Named Insured under such
other insurance: and
(2) You have agreed in writing in a contract or
agreement that this insurance would be primary
and would not seek contribution from any other
insurance available to such "insured".
WN CA 80 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 6
COMMERICAL GENERAL LIABILITY
CG MU 0009 06 22
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
The Commercial General Liability Enhancement Endorsement is an optional endorsement that provides coverage
enhancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is
provided by this summary, refer to following endorsement for changes in your policy.
SUMMARY OF COVERAGES
PAGE
Bodily Injury And Property Damage Liability
• Non Owned Watercraft Up To 50 Feet...................................................................................2
Property Damage Liability
• Elevators..............................................................................................................................3
• Fire, Lightning, Explosion Or Sprinkler Leakage Exception....................................................3
• Borrowed Equipment ($25,000 Per Occurrence, $50,000 Aggregate,
$2,500 Deductible Per Occurrence....................................................................................3
Supplementary Payments — Amended
• Bail Bonds Up To$5,000......................................................................................................3
• Loss of Earnings Up To $500/Day.......................................................................................3
Who Is An Insured Amendments
• Employee Bodily Injury To A Co-Employee...........................................................................A
• Newly Formed Or Acquired Organizations For Up To 180 Days.............................................4
• Blanket Additional Insured — Vendors — As Required By Contract.........................................4
• Blanket Additional Insured — Lessor Of Leased Equipment....................................................6
• Blanket Additional Insured — Managers Or Lessors Of Premises............................................6
• Blanket Additional Insured — State Or Governmental Agency Or Subdivision
Or Political Subdivision — Permits Or Authorizations............................................................7
• Blanket Additional Insured — State Or Governmental Agency Or Subdivision
Or Political Subdivision — Permits Or Authorizations Relating To Premises .........................8
Damage To Premises Rented To You —$300,000............................................................................9
Medical Payments Increased Limit — $10,000 Or Amount Shown on Declarations ............................9
Conditions
• Knowledge of Occurrence, Offense, Claim Or Suit Amended................................................9
• Unintentional Failure To Disclose Hazards.............................................................................9
• Waiver of Subrogation.........................................................................................................10
Insured Contract Amended..............................................................................................................10
Personal And Advertising Injury Redefined
• Televised, Videotaped Or Electronic Publication..................................................................10
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 10
COMMERCIAL GENERAL LIABILITY
CG MU 0009 06 22
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
This endorsement modifies the insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement
will be amended as shown below.
SECTION I — COVERAGES AMENDMENTS
COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY
A. Non Owned Aircraft Or Watercraft
Item 2. Exclusions, Paragraph g. is replaced by the following:
g. Aircraft, Auto Or Watercraft
"Bodily injury' or "property damage" arising out of the ownership, maintenance, use or entrustment to others of
any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation
and "loading or unloading".
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the super-
vision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the
"bodily injury' or "property damage" involved in the ownership, maintenance, use or entrustment to others of any
aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises you own or rent;
(2) A watercraft you do not own that is:
(a) Less than 50 feet long; and
(b) Not being used to carry persons or property for a charge;
This Subparagraph (2) applies to any person, who with your expressed or implied consent, either uses or is
responsible for the use of the watercraft:
(3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by
or rented or loaned to you or the insured;
(4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft:
or
(5) "Bodily injury' or "property damage" arising out of:
(a) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify
under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility
law or other motor vehicle insurance law where it is licensed or principally garaged; or
(b) The operation of any of the machinery or equipment listed in Paragraph f. (2) or f. (3) of the definition of
"mobile equipment'.
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 10
B. Damage To Property Coverage Extensions
Item 2. Exclusions, Paragraph j. is replaced by the following:
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person,
organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for
any reason, including prevention of injury to a person or damage to another's property;
(2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or control of the insured;
(5) That particular part of real property on which you or any contractors or subcontractors working directly or
indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or
(6) That particular part of any property that must be restored, repaired or replaced because `your work" was
incorrectly performed on iL
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning,
explosion or sprinkler leakage) to premises, including the contents of such premises, rented to you for a period of
seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as
described in SECTION III — LIMITS OF INSURANCE. However, the provisions of this paragraph do not apply if
coverage for Damage To Premises Rented To You is excluded by endorsement.
Paragraph (2) of this exclusion does not apply if the premises are `your work" and were never occupied, rented or
held for rental by you.
Paragraphs (3) and (4) of this exclusion do not apply to the use of elevators.
Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement.
Paragraph (4) of this exclusion does not apply to "property damage" to borrowed equipment while not being used to
perform operations at the jobsite. Subject to Paragraph 2. of SECTION III — LIMITS OF INSURANCE, the rules below
fix the most we will pay for "property damage" under this provision:
(1) $25,000 any one "occurrence", regardless of the number of persons or organizations who sustain damages
because of that "occurrence'
(2) $50,000 annual aggregate; and
(3) We will pay only for damages in excess of $2,500 as a result of any one "occurrence", regardless of the number
of persons or organizations who sustain damages because of that "occurrence". We may, or if required by law,
pay all or any part of any deductible amount, if applicable, to effect settlement of any claim or "suit'. Upon notice
of our payment of a deductible amount, you shall promptly reimburse us for the part of the deductible amount we
paid.
Paragraph (6) of this exclusion does not apply to "property damage" included in the "products -completed operations
hazard".
The insurance provided for "property damage" from the use of elevators and for "property damage" to borrowed
equipment is excess over any other valid and collectible property insurance (including any deductible portion thereof)
available to the insured whether primary, excess, contingent or on any other basis.
C. Damage To Premises Rented To You
Item 2. Exclusions, the last paragraph is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion or sprinkler leakage to premises while
rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to
this coverage as described in Paragraph 6. of SECTION III — LIMITS OF INSURANCE.
CG MU D009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 10
COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY
D. Personal And Advertising Injury
Item 2. Exclusions is amended by replacing Sub -paragraphs b. and c. with the following:
b. Material Published With Knowledge Of Falsity
"Personal and advertising injury' arising out of oral, written, televised, videotaped or electronic publication, in any
manner, of material, if done by or at the direction of the insured with knowledge of its falsity.
c. Material Published Prior To Policy Period
"Personal and advertising injury' arising out of oral, written, televised, videotaped or electronic publication, in any
manner, of material whose first publication took place before the beginning of the policy period.
SUPPLEMENTARY PAYMENTS — COVERAGES A AND B
E. Supplementary Payments — Coverages A and B
Item 1. is amended by replacing Subparagraphs b. and d. with the following:
b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of
any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fumish these bonds.
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the
claim or "suit", including actual loss of earnings up to $500 a day because of time off from work.
SECTION II — WHO IS AN INSURED AMENDMENTS
A. Employee Bodily Injury To A Co -Employee
Paragraph 2. a. (1) is replaced by the following:
However, none of these "employees" or `volunteer workers" are insureds for "bodily injury' or "personal and
advertising injury":
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a
limited liability company), to a co -"employee" while in the course of his or her employment or performing duties
related to the conduct of your business, or to your other "volunteer wormers" while performing duties related to the
conduct of your business;
(b) To the spouse, child, parent, brother or sister of the co -"employee" or "volunteer worker" as a consequence of
Paragraph (1)(a) above;
(c) For which there is any obligation to share damages with or repay someone else who must pay damages because
of the injury described in Paragraph (1)(a) or (b) above; or
(d) Arising out of his or her providing or failing to provide professional health care services.
However, if a suit seeking damages for "bodily injury" or "personal and advertising injury' to any co -"employee" or
other "volunteer worker" arising out of and in the course of the co -"employee's" or "volunteer worker's" employment or
while performing duties related to the conduct of your business, or a suit seeking damages brought by the spouse,
child, parent, brother or sister of the co -"employee" or other "volunteer worker', is brought against you or a
co -"employee" or a 'volunteer worker', we will reimburse the reasonable costs that you incur in providing a defense to
the co -"employee" or `volunteer worker" against such matters. Any reimbursement made pursuant to this sub -section
will be in addition to the limits of liability set forth in the Declarations.
B. Newly Acquired Organizations
Paragraph 3. a. is replaced by the following:
a. Coverage under this provision is afforded only until the 180"' day after you acquire or form the organization or the
end of the policy period, whichever is earlier;
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 10
The following are added:
C. Blanket Additional Insured —Vendors —As Required By Contract
1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
(referred to throughout this endorsement as vendor) with whom you have agreed in a written contract, executed
prior to loss, to name as an additional insured, but only with respect to "bodily injury" or "property damage" arising
out of "your products" which are distributed or sold in the regular course of the vendor's business.
However,
a. The insurance afforded to such vendor only applies to the extent permitted by law; and
b. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such
vendor will not be broader than that which you are required by the contract or agreement to provide for such
vendor.
2. With respect to the insurance afforded to these vendors, the following additional exclusions apply:
a. The insurance afforded the vendor does not apply to:
(1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the
assumption of liability in a contract or agreement This exclusion does not apply to liability for damages
that the vendor would have in the absence of the contract or agreement;
(2) Any express warranty unauthorized by you,
(3) Any physical or chemical change in the product made intentionally by the vendor;
(4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the
substitution of parts under instructions from the manufacturer, and then repackaged in the original
container,
(5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make
or normally undertakes to make in the usual course of business, in connection with the distribution or sale
of the products;
(6) Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of the product;
(7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container,
part or ingredient of any other thing or substance by or for the vendor; or
(8) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or
omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does
not apply to:
(i) The exceptions contained in Subparagraphs (4) or (6); or
(i) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale of the
products.
3. This Provision C. does not apply:
a. To any insured person or organization from whom you have acquired such products, or any ingredient, part or
container, entering into, accompanying or containing such products:
b. To any vendor for which coverage as an additional insured specifically is scheduled by endorsement; or
c. When liability included within the "products -completed operations hazard" has been excluded for such product
either by the provisions of the coverage part or by endorsement
4. With respect to the insurance afforded to these vendors, the following is added to Section III — Limits Of
Insurance:
If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the
vendor is:
a. The minimum amount required by the contractor agreement; or
b. The Limits of Insurance shown in the Declarations;
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 10
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations,
S. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against an additional insured allege negligence or other
wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the
"occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the
"personal and advertising injury", involved the rendering of or failure to render any professional services
by you with respect to your providing engineering, architectural or surveying services in your capacity as
an engineer, architect or surveyor.
D. Blanket Additional Insured — Lessor Of Leased Equipment
1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a
contract or agreement, executed prior to loss, that such person(s) or organization(s) be added as an additional
insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily
injury", "property damage" or "personal and advertising injury' caused by your negligent acts or omissions in the
maintenance, operation or use of equipment leased to you by such person(s) or organization(s).
However, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
c. Does not apply to any "occurrence" which takes place after the equipment lease expires;
A person's or organzation's status as an additional insured under this endorsement ends when their contract or
agreement with you for such leased equipment ends.
2. With respect to the insurance afforded to the Lessor, the following additional exclusions apply:
"Bodily injury" or "property damage" arising out of:
(1) The assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages
that the Lessor would have in the absence of the contract or agreement;
(2) Any express warranty made by the Lessor;
(3) The demonstration, installation, servicing, inspections, adjustments, tests, repair, or maintenance operations
by or for the Lessor;
(4) The negligence or strict liability of the Lessor for its own acts or omissions or those of its employees or
anyone else acting on its behalf, or
(5) Any failure on the part of the Lessor to provide information, instructions and/or warnings with respect to the
maintenance, use or operation of the equipment
3. Wrth respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is:
a. The minimum amount required by the contract or agreement: or
b. The Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of insurance shown in the Declarations.
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 10
4` with respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing
in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"
which caused the "bodily injury" or "property damage", or the offense which caused the "personal and
advertising injury', involved the rendering of or failure to render any professional services by you with respect
to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or
surveyor.
E. Blanket Additional Insured — Managers Or Lessors Of Premises
1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured, but
only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to
you, subject to the following additional exclusions:
This insurance does not apply to:
a. Any "occurrence" which takes place after you cease to be a tenant in that premises.
b. Structural alterations, new construction or demolition operations performed by or on behalf of such additional
insured.
However:
a. The insurance afforded to such additional insured only applies to the extent permitted by law: and
b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded
to such additional insured will not be broader than that which you are required by the contract or agreement
to provide for such additional insured.
2. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
Oflnsurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is:
a. The minimum amount required by the contract or agreement; or
b. The Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
3. Wlth respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
a. "Bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing
in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"
which caused the "bodily injury' or "property damage", or the offense which caused the "personal and
advertising injury', involved the rendering of or failure to render any professional services by you with respect
to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or
surveyor.
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 10
F. Blanket Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision — Permits
Or Authorizations
Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or
subdivision or political subdivision with whom you have agreed in a written contract, executed prior to loss, to name
as an additional insured, subject to the following provisions:
1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or
governmental agency or subdivision or political subdivision has issued a permit or authorization.
However.
a. The insurance afforded to such additional insured only applies to the extent permitted by law: and
b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded
to such additional insured will not be broader than that which you are required by the contract or agreement
to provide for such additional insured,
2. This insurance does not apply to:
a. "Bodily injury', "property damage" or "personal and advertising injury" arising out of operations performed for
the federal government, state or municipality; or
b. "Bodily injury' or "property damage" included within the "products -completed operations hazard".
3. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement the most we will pay on
behalf of the additional insured is:
a. The minimum amount required by the contract or agreement; or
b. The Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
4. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
a. "Bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing
in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"
which caused the "bodily injury' or "property damage", or the offense which caused the "personal and
advertising injury', involved the rendering of or failure to render any professional services by you with respect
to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or
surveyor.
G. Blanket Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision — Permits
Or Authorizations Relating To Premises
Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or
subdivision or political subdivision with whom you have agreed in a written contract, executed prior to loss, to name
as an additional insured, subject to the following provision:
1. This insurance applies only with respect to the following hazards for which the state or governmental agency or
subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent
or control and to which this insurance applies:
a. The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk
vaults, street banners or decorations and similar exposures; or
b. The construction, erection or removal of elevators; or
CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 10
c. The ownership, maintenance or use of any elevators covered by this insurance.
However,
a. The insurance afforded to such additional insured only applies to the extent permitted by law; and
b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded
to such additional insured will not be broader than that which you are required by the contract or agreement
to provide for such additional insured.
2. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
Oflnsurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is:
a. The minimum amount required by the contract or agreement; or
b. The Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
3. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications, or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing
in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"
which caused the "bodily injury" or "property damage", or the offense which caused the "personal and
advertising injury', involved the rendering of or failure to render any professional services by you with respect
to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or
surveyor.
SECTION III — LIMITS OF INSURANCE AMENDMENTS
A. Damage To Premises Rented To You
Paragraph 6. is replaced by the following:
6. Subject to Paragraph 5. above, the most we will pay under Coverage A for damages because of "property
damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion or
sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner is the greater
Of
a. $300,000; or
b. The amount shown next to the Damage To Premises Rented To You Limit in the Declarations.
However, the provisions of this paragraph do not apply if Damage To Premises Rented To You Coverage is
excluded by endorsement
B. Medical Expense Limit
Paragraph 7. is replaced with the following:
7. Subject to Paragraph S. above, the most we will pay under Coverage C for all medical expenses because of
"bodily injury" sustained by any one person is the greater of:
a. $10,000: or
b. The amount shown next to the Medical Expense Limit in the Declarations.
This insurance does not apply if coverage for Medical Expenses is excluded either by the provisions of the
coverage part or by endorsement
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SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS AMENDMENTS
A. Knowledge Of Occurrence
Item 2. Duties In The Event Of Occurrence, Offense, Claim or Suit is amended by adding the following:
e. You must give us or our authorized representative prompt notice of an "occurrence", claim or loss only when the
"occurrence", claim or loss is known to:
(1) You, if you are an individual;
(2) A partner, if you area partnership;
(3) An executive officer or insurance manager, if you are a corporation; or
(4) A member or manager, if you are a limited liability company.
B. Other Insurance
Item 4.Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced by the following:
(ii) That is fire, lightning, explosion or sprinkler leakage insurance for premises rented to you or temporarily occupied
by you with permission of the owner;
C. Unintentional Failure To Disclose Hazards
Item 6. Representations is replaced by the following:
6. Representations And Unintentional Failure To Disclose Hazards
a. By accepting this policy, you agree:
(1) The statements in the Declarations are accurate and complete;
(2) Those statements are based upon representations you made to us; and
(3) We have issued this policy in reliance upon your representations.
b. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny
coverage under this Coverage Part because of such failure, However, this provision does not affect our right
to collect additional premium or exercise our right of cancellation or non -renewal.
D. Waiver of Subrogation
Item 8. Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following:
We waive any right of recovery we may have because of payments we make for injury or damage arising out of your
ongoing operations or "your work" done under a written contract, executed prior to loss, requiring such waiver with
that person or organization and included in the "products -completed operations hazard". However, our rights may
only be waived prior to the "occurrence" giving rise to the injury or damage for which we make payment under this
Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring
"suit" or transfer those rights to us and help us enforce those rights.
SECTION V — DEFINITIONS AMENDMENTS
A. Insured Contract Amended
Paragraph 9. a. is replaced by the following:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies
any person or organization for damage by fire, lightning, explosion or sprinkler leakage to premises while rented
to you or temporarily occupied by you with permission of the owner is not an "insured contract":
B. Personal And Advertising Injury Redefined
Paragraph 14. d. and e. are replaced by the following:
d. Oral, written, televised, videotaped or electronic publication of material that slanders or libels a person or
organization or disparages a person's or organization's goods, products or service;
e. Oral, written, televised, videotaped or electronic publication of material that violates a person's right of privacy,
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POLICY NUMBER:
WNCU1160418
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED PROJECT(S) -
AGGREGATE LIMIT
This endorsement modified insurance provided under the following:
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
SCHEDULE
DESIGNATED PROJECT
A. The Designated Project Aggregate Limit is the most
we will pay for the sum of all "ultimate net loss" in
excess of the "retained limit" under COVERAGE A.
BODILY INJURY AND PROPERTY DAM AG E LI-
ABILITY, which can be attributed solely to ongoing
operations at a single designated "project" shown
in the Schedule above, regardless of the number of:
1. Insureds;
2. Claims made or "suits" brought; or
3. Persons or organizations making claims or
bringing "suits".
B. A separate Designated Project Aggregate Limit
applies to each designated "project", and that limit
is equal to the amount of the Aggregate Limit
shown in the Declarations.
C. The Designated Project Aggregate Limit does not
apply to "ultimate net loss" arising out of "bodily in-
jury" or "property damage" included in the "products -
completed operations hazard" or arising out of the
ownership, maintenance or use of a "covered auto."
D. Any payments made under Paragraph A. of this
endorsement shall reduce the Designated Project
Aggregate Limit for that designated "project'. Such
payments shall not reduce the Aggregate Limit
shown in the Declarations nor shall they reduce any
other Designated Project Aggregate Limit for any
other designated "project" shown in the Schedule
above.
E. The Each Occurrence limit shown in the Declara-
tions is the most we will pay for "ultimate net loss"
in excess of the "retained limit" under Coverage A
because of all "bodily injury' and "property damage"
arising out of any one "occurrence".
F. For all "ultimate net loss" under COVERAGE A.,
which cannot be attributed solely to ongoing oper-
ations at a single designated "project" shown in the
Schedule above:
1. Any payments made for "ultimate net loss" un-
der COVERAGE A shall reduce the amount
available under the Aggregate Limit; and
2. Such payments shall not reduce any Desig-
nated Project Aggregate Limit.
WN CU 116 04 18 Page 1 of 2
Includes copyrighted material of the Insurance Service Office, Inc., with its permission.
G. The "Maximum Annual Aggregate Limit" is the most
we will pay for the sum of all "ultimate net loss" un-
der one or more Designated Project Aggregate Lim-
its and Aggregate Limit.
H. For the purposes of this endorsement, SECTION
V — DEFINITIONS is amended by the addition of
the following definitions:
1. "Maximum Annual Aggregate Limit" means an
amount equal to two times the Aggregate Limit
shown in the policy declarations.
2. "Project" means an area at which you are per-
forming operations pursuant to a contract or
agreement, other than any premises, site or lo-
cation which is or was at anytime owned or oc-
cupied or managed by, or rented or loaned to
you.
I. The provisions of SECTION III — LIMITS OF IN-
SURANCE not otherwise modified by this endorse-
ment shall continue to apply.
WN CU 116 0418 Page 2 of 2
Includes copyrighted material of the Insurance Service Office, Inc., with its permission.
POLICY NUMBER: CPP 1338250 00
COMMERCIAL GENERAL LIABILITY
CG 04 42 11 03
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
STOP GAP - EMPLOYERS LIABILITY COVERAGE
ENDORSEMENT - WASHINGTON
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Limits Of Insurance _
Bodily Injury By Accident S 1, 000, 000 Each Accident
Bodily Injury By Disease $ 1,000,000 Aggregate
Limit
Bodily Injury By Disease $ 1, 000, 000 Each Employee
(If no entry appears above, the information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
A. The following is added to Section I - Cover-
b. This insurance applies to "bodily injury
ages:
by accident" or "bodily injury by dis-
COVERAGE - STOP GAP - EMPLOYERS LIABIL-
ease" only if:
ITY
(1) The:
1. Insuring Agreement
(a) "Bodily injury by accident" or
a. We will pay those sums that the in-
"bodily injury by disease" takes
sured becomes legally obligated by
place in the "coverage terri-
Washington Law to pay as damages
wry";
because of "bodily injury by accident"
(b) "Bodily injury by accident" or
or "bodily injury by disease" to your
"bodily injury by disease" arises
"employee" to which this insurance ap-
out of and in the course of the
plies. We will have the right and duty
injured "employee's" employ -
to defend the insured against any suit'
ment by you; and
seeking those damages. However, we
(c) "Employee", at the time of the
will have no duty to defend the insured
injury, was covered under a
against any suit seeking damages to
which this insurance does not apply.
worker's compensation policy
"workers
We may, at our discretion, investigate
and subject to a com-
any accident and settle any claim or
pensation law" of Washington;
"suit" that may result. But:
and
(1) The amount we will pay for dam-
(2) The:
ages is limited as described in Sec-
(a) "Bodily injury by accident" is
tion III - Limits Of Insurance; and
caused by an accident that oc-
(2) Our right and duty to defend end
curs during the policy period; or
when we have used up the appli-
(b) "Bodily injury by disease" is
cable limit of insurance in the pay-
caused by or aggravated by
ment of judgments or settlements
conditions of employment by
under this coverage.
you and the injured "employ-
No other obligation or liability to pay
ee's" last day of last exposure
to the conditions causing or ag-
sums or perform acts or services is
covered unless explicitly provided for
gravating such "bodily injury by
under Supplementary Payments.
d
idsease" occurs during the poli-
cy period.
CG 04 42 11 03 Copyright, ISO Properties, Inc., 2003 Page 1 of 4
c. The damages we will pay, where recov
e. Violation Of Law
ery is permitted by law, include dam-
"Bodily injury by accident" or "bodily
ages:
injury by disease" suffered or caused
(1) For:
by any employee while employed in vi-
(a) Which you are liable to a third
olation of law with your actual knowl-
party by reason of a claim or
edge or the actual knowledge of any of
"suit" against you by that third
your "executive officers".
party to recover the damages
f. Termination, Coercion Or Discrimination
claimed against such third party
Damages arising out of coercion, criti-
as a result of injury to your
"employee";
cism, demotion, evaluation, reassign -
ment, discipline, defamation, harass-
(b) Care and loss of services; and
ment, humiliation, discrimination
(c) Consequential "bodily injury by
against or termination of any "employ -
accident" or "bodily injury by
ee", or arising out of other employment
disease" to a spouse, child, par-
or personnel decisions concerning the
ent, brother or sister of the in-
insured.
jured "employee";
g. Failure To Comply With "Workers Com-
provided that these damages are
pensation Law"
the direct consequence of "bodily
"Bodily injury by accident" or "bodily
injury by accident" or "bodily injury
injury by disease" to an "employee"
by disease" that arises out of and
when you are:
in the course of the injured "em-
ployee's" employment by you; and
(1) Deprived of common law defenses;
(2) Because of "bodily injury by acci-
"bodily
or
(2) Otherwise subject to penalty;
dent" or injury by disease"
to your "employee" that arises out
because of your failure to secure your
of and in the course of employ-
obligations or other failure to comply
ment, claimed against you in a
with any "workers compensation law".
capacity other than as employer.
h. Violation Of Age Laws Or Employment
2. Exclusions
Of Minors
This insurance does not apply to:
"Bodily injury by accident" or "bodily
a. Intentional Injury
injury by disease" suffered or caused
by any person:
"Bodily injury by accident" or "bodily
(1) Knowingly employed by you in vio-
injury by disease" intentionally caused
"bodily
lation of any law as to age; or
or aggravated y you, or injury
by accident" or "bodily injury by dis-
(2) Under the age of 14 years, regard -
ease" resulting from an act which is
less of any such law.
determined to have been committed by
i. Federal Laws
you if it was reasonable to believe that
an injury is substantially certain to oc-
Any premium, assessment, penalty,
fine, benefit, liability or other obligation
cur.
imposed by or granted pursuant to:
b. Fines Or Penalties
(1) The Federal Employer's Liability Act
Any assessment, penalty, or fine levied
(45 USC Section 51-60);
by any regulatory inspection agency or
authority.
(2) The Non -appropriated Fund Instru-
mentalities Act (5 USC Sections
c. Statutory Obligations
8171-8173);
Any obligation of the insured under a
(3) The Longshore and Harbor Work -
workers' compensation, disability bene-
ers' Compensation Act (33 USC
fits or unemployment compensation
Sections 910-950);
law or any similar law.
(4) The Outer Continental Shelf Lands
d. Contractual Liability
Act (43 USC Section 1331-1356);
Liability assumed by you under any
(5) The Defense Base Act (42 USC
contract or agreement.
Sections 1651-1654);
Page 2 of 4 Copyright, ISO Properties, Inc., 2003 CG 04 42 11 03
(6) The Federal Coal Mine Health and
Safety Act of 1969 (30 USC Sec-
tions 901-942);
(7) The Migrant and Seasonal Agricul-
tural Worker Protection Act (29
USC Sections 1801-1872);
(8) Any other workers compensation,
unemployment compensation or
disability laws or any similar law; or
(9) Any subsequent amendments to
the laws listed above.
j. Punitive Damages
Multiple, exemplary or punitive dam-
ages.
k. Crew Members
D. For the purposes of this endorsement, Section
III - Limits Of Insurance, is replaced by the fol-
lowing:
1. The Limits of Insurance shown in the
Schedule of this endorsement and the rules
below fix the most we will pay regardless
of the number of:
"Bodily injury by accident" or "bodily
injury by disease" to a master or mem-
ber of the crew of any vessel or any
member of the flying crew of an air-
craft.
B. The Supplementary Payments provisions apply
to Coverage - Stop Gap Employers Liability as
well as to Coverages A and B.
C. For the purposes of this endorsement, Section
II - Who Is An Insured, is replaced by the fol-
lowing:
If you are designated in the Declarations as:
1. An individual, you and your spouse are in-
sureds, but only with respect to the con-
duct of a business of which you are the
sole owner.
2. A partnership or joint venture, you are an
insured. Your members, your partners, and
their spouses are also insureds, but only
with respect to the conduct of your busi-
ness.
3. A limited liability company, you are an in-
sured. Your members are also insureds, but
only with respect to the conduct of your E.
business. Your managers are insureds, but
only with respect to their duties as your
managers.
4. An organization other than a partnership,
joint venture or limited liability company,
you are an insured. Your "executive of-
ficers" and directors are insureds, but only
with respect to their duties as your officers
or directors. Your stockholders are also in-
sureds, but only with respect to their lia-
bility as stockholders.
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims
or bringing "suits".
2. The "Bodily Injury By Accident" - Each Ac-
cident Limit shown in the Schedule of this
endorsement is the most we will pay for all
damages covered by this insurance be-
cause of "bodily injury by accident" to one
or more "employees" in any one accident.
3. The "Bodily Injury By Disease" - Aggregate
Limit shown in the Schedule of this en-
dorsement is the most we will pay for all
damages covered by this insurance and
arising out of "bodily injury by disease", re-
gardless of the number of "employees"
who sustain "bodily injury by disease".
4. Subject to Paragraph D.3. of this endorse-
ment, the "Bodily Injury By Disease" - Each
"Employee" Limit shown in the Schedule of
this endorsement is the most we will pay
for all damages because of "bodily injury
by disease" to any one "employee".
The limits of the coverage apply separately to
each consecutive annual period and to any re-
maining period of less than 12 months, starting
with the beginning of the policy period shown
in the Declarations, unless the policy period is
extended after issuance for an additional period
of less than 12 months. In that case, the addi-
tional period will be deemed part of the last
preceding period for purposes of determining
the Limits of Insurance.
For the purposes of this endorsement, Con-
dition 2. - Duties In The Event Of Occurrence,
Claim Or Suit of the Conditions Section IV is
deleted and replaced by the following:
2. Duties In The Event Of Injury, Claim Or Suit
a. You must see to it that we or our agent
are notified as soon as practicable of a
"bodily injury by accident" or "bodily
injury by disease" which may result in a
claim. To the extent possible, notice
should include:
No person or organization is an insured (1) How, when and where the "bodily
with respect to the conduct of any current injury by accident" or "bodily injury
or past partnership, joint venture or limited by disease" took place;
liability company that is not shown as a (2) The names and addresses of any in -
Named Insured in the Declarations. jured persons and witnesses; and
CG 04 42 11 03 Copyright, ISO Properties, Inc., 2003 Page 3 of 4
(3) The nature and location of any in-
jury.
b. If a claim is made or "suit" is brought
against any insured, you must:
(1) Immediately record the specifics of
the claim or "suit" and the date re-
ceived; and
(2) Notify us as soon as practicable.
You must see to it that we receive writ-
ten notice of the claim or "suit" 'as
soon as practicable.
c. You and any other involved insured
must:
(1) Immediately send us copies of any
demands, notices, summonses or
legal papers received in connection
with the injury, claim, proceeding
or "suit";
(2) Authorize us to obtain records and
other information;
(3) Cooperate with us and assist us, as
we may request, in the investiga-
tion or settlement of the claim or
defense against the "suit";
(4) Assist us, upon our request, in the
enforcement of any right against
any person or organization which
may be liable to the insured be-
cause of injury to which this insur-
ance may also apply; and
(5) Do nothing after an injury occurs
that would interfere with our right
to recover from others.
d. No insured will, except at that insured's
own cost, voluntarily make a payment,
assume any obligation, or incur any ex-
pense, other than for first aid, without
our consent.
F. For the purposes of this endorsement, Para-
graph 4. of the Definitions Section is replaced
by the following:
4. "Coverage territory" means:
a. The United States of America (including
its territories and possessions), Puerto
Rico and Canada;
b. International waters or airspace, but
only if the injury or damage occurs in
the course of travel or transportation
between any places included in a.
above; or
c. All other parts of the world if the injury
or damage arises out of the activities of
a person whose home is in the territory
described in a. above, but who is away
for a short time on your business;
provided the insured's responsibility to pay
damages is determined in the United States
(including its territories and possessions),
Puerto Rico, or Canada, in a suit on the
merits according to the substantive law in
such territory, or in a settlement we agree
to.
G. The following are added to the Definitions Sec-
tion:
1. "Workers Compensation Law" means the
Workers Compensation Law and any Occu-
pational Disease Law of Washington. This
does not include provisions of any law pro-
viding non -occupational disability benefits.
2. "Bodily injury by accident" means bodily in-
jury, sickness or disease sustained by a
person, including death, resulting from an
accident. A disease is not "bodily injury by
accident" unless it results directly from
"bodily injury by accident".
3. "Bodily injury by disease" means a disease
sustained by a person, including death.
"Bodily injury by disease" does not include
a disease that results directly from an acci-
dent.
H. For the purposes of this endorsement, the defi-
nition of "bodily injury" does not apply.
Page 4 of 4 Copyright, ISO Properties, Inc., 2003 CG 04 42 11 03
A CU p 1 0
C40 CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/09/2025
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 Nicole Goodman
NAME:
PHONE 541-371-2812 FAX No
Graybeal Group, Inc.
ADDRESS: nicole@graybealgroup.com
4206 W 24th Ave, Suite A104
INSURERS AFFORDING COVERAGE
NAIC N
INSURER A: Western National Mutual Insurance Company
15377
Kennewick WA 99338
INSURED
INSURER B : Pacific Insurance Company, Ltd.
INSURERC:
Waltek II Inc
INSURERD:
dba Intermountain Materials Testing
INSURER E :
PO BOX 2801
INSURER F
Pasco WA 99302
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
LT
OF INSURANCE
ADDLTYPE
I=
SUER
POLICY NUMBER
MPOLICY
NYYY
MM/DD YY
LIMITS
X
COMMERCIAL GENERALLIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIM&MADE � OCCUR
DAMAGE TO R
EaEocw ence
$ 100,000
X
-PREMISES
MED EXP (Any one person)
$ 5,000
WA Stop -Gap
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
Y
CPP 1338250 01
4/1/2025
4/1/2026
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY JECTPRO- LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER
AUTOMOBILE
LIABILITY
COMB NE S NGLE L M T
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED X �/ SCHEDULED
AUTOS ONLY AUTOS
Y
Y
CPP 1337311 01 4/1/2025
4/1/2026
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Par accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
X
UMBRELLALWB
OCCUR
EACH OCCURRENCE
$ 4,000,000
AGGREGATE
$ 4,000,000
A
EXCESS UAS
CLAIMS -MADE
Y
Y
UMB 105631701
4/1/2025
4/1/2026
DED X I RETENTION $ 10,000
$
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑
N/A
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
B
Professional lity Claims Made
Retro Date Liabiiabi009
010H0663825-24
06/24/2024
06/24/2025
Each
Aggregate
$ 1,000,000
$ 2,000,000
Deductible
30 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Spokane Valley are additional insured as respects to general and auto liability when required by written contract per blanket additional insured forms WN
GL 139 06 18 and WN CA 80 06 19 included. Waiver of subrogation applies as respects to both general liability and auto liability. Primary and Non -Contributory
applies per general liability form WN GL 139 06 18 and auto liability form WN CA 80 06 19.
taK I IHUA 1 It HULUtK
City of Spokane Valley
10210 East Sprague Avenue
Spokane Valley
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
I AUTHORIZED REPRESENTATIVE
WA 99206
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD