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HomeMy WebLinkAbout25-161.00JewellExcavatingOn-CallRoadGraderforSnowRemovalContract No. 25-161 AGREEMENT FOR SERVICES Jewell Excavating On Call Road Graders for Snow Removal 2025-2026 Snow Season THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and <Jewell Excavating, hereinafter "Contractor," jointly referred to as "Parties." IN CONSIDERATION of the terms and conditions contained herein, the Parties agree as follows: 1. Work to Be Performed. Contractor shall provide all labor, services, and material to satisfactorily complete the Scope of Services, attached as Exhibit A. This is a non-exclusive contract, meaning the City reserves the right to, and intends to, contract with other entities for the same or similar work. By entering into this Agreement for on call snow removal on City streets, the City does not guarantee any work will be requested of Contractor, nor does the City guarantee any minimum amount of compensation to Contractor. Services will be requested on an as needed basis as determined in the sole discretion of the City. A. Administration. The City Manager or designee shall administer and be the primary contact for Contractor. Prior to commencement of work, Contractor 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, Contractor 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 Contractor in entering into this Agreement. By execution of this Agreement, Contractor 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. Contractor 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. Contractor shall be responsible for the technical accuracy of its services and documents resulting therefrom, and City shall not be responsible for discovering deficiencies therein. Contractor 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. Contractor shall exercise the degree of skill and diligence normally employed by professional contractors 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. Contractor will accept modifications when ordered in writing by the City Manager or designee, so long as the additional work is within the scope of Contractor's area of practice. Compensation for such modifications or changes shall be as mutually agreed between the Parties. Contractor 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. Jewell Excavating Page 1 of 8 Contract No. 25-161 2. Term of Contract. This Agreement shall be in full force and effect upon execution and shall remain in effect until April 30,2026, unless the time for performance is extended in writing by the Parties. 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 Contractor. In the event of termination without breach, City shall pay Contractor for all work previously authorized and satisfactorily performed prior to the termination date. 3. Compensation. City agrees to pay Contractor an agreed upon hourly rate up to a maximum amount of $120.000 as full compensation for everything done under this Agreement, as set forth in Exhibit B. Contractor 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. 4. Payment. Contractor 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 CONTRACTOR: Name: Jewell Excavating Phone:509-927-9600 Address: PO Box 280 Greenacres, WA 99016 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. Contractor warrants that its designs, construction documents, and services shall conform to all federal, state, and local statutes and regulations. 7. Certification Regarding Debarment, Suspension, and Other Responsibility Matters — Primary Covered Transactions. A. By executing this Agreement, the Contractor 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; 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, Jewell Excavating Page 2 of 8 Contract No. 25-161 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 Contractor 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 Contractor. Any and all employees who provide services to City under this Agreement shall be deemed employees solely of Contractor. The Contractor 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 Contractor 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 Contractor 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 Contractor shall have no liability for the use of Contractor'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 Contractor'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. Contractor 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 Contractor, its agents, representatives, employees, or subcontractors. A. Minimum Scope of Insurance. Contractor's required insurance shall be of the types and coverages described below: 1. Automobile liability insurance covering all owned, non -owned, hired, and leased vehicles. Coverage shall be at least as broad as Insurance Services Office (ISO) form CA 0001. Jewell Excavating Page 3 of 8 Contract No. 25-161 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 Contractor'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. B. Minimum Amounts of Insurance. Contractor 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. C. Other Insurance Provisions. The Contractor's policies are to contain, or be endorsed to contain, the following provisions for automobile liability and commercial general liability insurance: 1. Contractor'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 Contractor's insurance and shall not contribute with it. 2. Contractor 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 Contractor 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 Contractor, irrespective of whether such limits maintained by Contractor 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 Contractor. 4. Failure on the part of Contractor 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 Contractor 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 Contractor from the City. D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, Contractor 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. Jewell Excavating Page 4 of 8 Contract No. 25-161 12. Indemnification and Hold Harmless. Contractor 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 Contractor, Contractor'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 Contractor and the City, its officers, officials, employees, and volunteers, the Contractor's liability, including the duty and cost to defend, hereunder shall be only to the extent of the Contractor's negligence. It is further specifically and expressly understood that the indemnification provided herein constitutes the Contractor'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. Assianment and Delesation. Neither Party may 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, Contractor shall not enter into subcontracts for any of the work contemplated under this Agreement without obtaining prior written approval of City. 16. Confidentiality. Contractor may, from time -to -time, receive information which is deemed by City to be confidential. Contractor 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 Contractor shall be resolved in the Superior Court of the State of Washington in Spokane County. Notwithstanding the foregoing, Contractor 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 arise out of, or that are related to Contractor's services under this Agreement. Contractor further agrees that an arbitrator's decision therein shall be final and binding on Contractor and that judgment may be entered upon it in any court having jurisdiction thereof. 18. Cost and Attorney'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). Jewell Excavating Page 5 of 8 Contract No. 25-161 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. Assurance of Compliance with Applicable Federal Law. During the performance of this Agreement, the Contractor, for itself, its assignees, and successors in interest agrees as follows: A. Compliance with Regulations. Contractor 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. Contractor, 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. Contractor 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 Contractor 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 Contractor of Contractor'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. Contractor 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 Contractor is in the exclusive possession of another who fails or refuses to furnish the information, Contractor shall so certify to the City or the WSDOT, as appropriate, and shall set forth what efforts it has made to obtain the information. E. Sanctions for Noncompliance. In the event of a Contractor'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 Contractor under the Agreement until Contractor complies; and/or 2. Cancelling, terminating, or suspending the Agreement, in whole or in part. F. Incorporation of Provisions. Contractor shall include the provisions of Section 21 of this Agreement in every subcontract, including procurements of materials and leases of equipment, Jewell Excavating Page 6 of 8 Contract No. 25-161 unless exempt by the Acts, regulations and directives issued pursuant thereto. Contractor 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 Contractor becomes involved in, or is threatened with litigation by a subcontractor or supplier because of such direction, Contractor may request that the City enter into any litigation to protect the interests of the City. In addition, Contractor 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 Contractor 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 VI 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); 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 Jewell Excavating Page 7 of 8 Contract No. 25-161 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 el seq.). 22. Business Resistration. Prior to commencement of work under this Agreement, Contractor shall register with the City as a business if it has not already done so. 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. Equipment and Pricing C. Insurance Certificates The Parties have executed this Agreement this 77Wday of c =7-airy( , 202E— CITY OF SPOKANE VALLEY ohn Hohman, City Manager AP OVED S TPO R ethe City ttorney Jewell Excavating Page 8 of 8 Contractor: By: Its: Authorized Representative EXHIBIT A - SCOPE OF SERVICES SCOPE OF SERVICES The scope of Services will include, but is not limited to, the following: 1. The Contractor shall have a motor road grader 140G or equivalent with no larger than a 14' moldboard and be able to supply themselves tire chains and replacements. 2. The Contractor shall provide grader operators for 12-hour shifts. A full city residential plow takes approximately 48 hours to complete. 3. Road Graders must be able to work on city streets with lights and a flashing hazard (work light). Road Graders shall be able to work continuously until the snow emergency event ends and released by the City. 4. The Contractor shall plow the City Streets on routes/areas as directed by the City. 5. The Contractor shall perform all work in compliance with requirements of all applicable local, state, and federal laws, regulations, and standards, including without limitation those of governing agencies or authorities having jurisdiction and including provision for adequate protection to persons and property by means of insurance, bonding, traffic, etc. RESPONSE TIME EXPECTATIONS 1. The Contractor shall provide a 24-hour a day contact number, name, and be able to report with 12-hour advance notice. Contractor shall call back within 30 minutes after initial call is made from the City requesting their services. After 30 minutes, the next Contractor on the list will be contacted. The list of contractors is determined by scores of proposals based on the evaluation criteria. The highest-ranking contractor is first, and the lowest ranking contractor is last. 2. The Contractor shall have grader fully fueled and ready to work. Spokane ,,,,os Valley- ATTAC+fMEW "B" EQUIPMENT AND PRICING 2025-2026 SNOW SEASON ON -CALL ROAD GRADERS FOR SNOW REMOVAL Name: c It �Qi� �� U����i Gc?v ku 7o-1—T1c Signature: Date: q11 /-)-5 ROAD GRADER EQUIPMENT DESCRIPTION all equipment rates to include operator labor MODEL YEAR QUANTITY AVAILABLE RATE PER HOUR ANY OTHER CHARGES (if not included in above rates, such as travel time In 6,<O r� C -� JEWEEXC-02 TFULGARO ACORL7 F CERTIFICATE OF LIABILITY INSURANCE 1DATE (MM/DD(YYYV) 0/30/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Acrisure Northwest Partners Insurance Services, LLC PHONE FAX 19401 40th Ave W, Suite 440 1 (A/C, No, Ext): (800) 442-1281 ruc, No):(425) 291-5100 Lynnwood, WA 98036 IjEDoREss;____ INSURED Jewell Excavating and Construction, Inc. P.O. Box 280 Greenacres, WA 99016 C: INSURER E : INSURER F : Travelers Property Casualty Insurance l-/'1\/COArCC !`C�TICl/-A M u1111RAOCD. oGVICInm NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T TYPE OF INSURANCE-ADOL.SUBR FN D'' .POLICY POLICY NUMBER POLICY EFF POLICY EXP MM D _ LIMITS A X COMMERCIAL GENERAL LIABILITY ! EACH OCCURRENCE _ 1,000,000 CLAIMS -MADE X OCCUR I X !EPP 0048696 1111512124 11/15/2025 DAMAGE TO RENTED PREMISES Ea rren 500,000 $_, I MED EXP (Any oneperson) $ 10,000 _PERSONAL & ADV INJURY $__ 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑"' JECOT- 7LOC GENERAL AGGREGATE E 2,900,000 PRODUCTS - COMP/OP AGG _E2,000,000 OTHER: E A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea_a ent 1,000,000 E BODILY INJURY (Per person ANY AUTO i X .EPP 0048696 111/15/2024 11/15/2025 E _ BODILY INJURY Per accident E - - — - -- OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED �( NON -OWNED AUTOS ONLY - __. AUTOS ONLY i I PROPERTY DAMAGE A X UMBRELLA LIAR X OCCUR EACH OCCURRENCF E 2,000,000 EXCESS LIAB CLAIMS -MADE X EPP 0048696 11/15/2024 11/15/2025 AGGREGATE _ E -- DIED I X I RETENTION$ 0 Aggregate $ 2,000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERJEXECIriNE OFFICERWEMBER EXCLUDED? N/A (Mandatory in NH) EPP 0048696 11/15/2024 11/15/2025 X PER OTH- TA IT ER E.L. EACH ACCIDENT E 1,000,000 E.L. DISEASE - EA EMPLOYE E 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 E If yes, describe under DESCRIPTION OF OPERATIONS below B Equipment Floater i QT-660-626M1881-TIL-24 11/15/2024 11/15/2025 lRented Equipment 200,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Spokane Valley is included as an Additional Insured, as required by written contract or agreement, as per endorsement GA472 on the general liability and as per endorsement AA288 on the auto liability, as respects the operations of the named insured performed on their behalf. Coverage is primary 8 non-contributory. Umbrella is following form. City of Spokane Valley 10210 E Sprague Ave Spokane Valley, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 91988-2015 ACORD GUKF/UKA I Iurv. An rlgnis reserves. The ACORD name and logo are registered marks of ACORD Client#: 210087 JEWEEXCA DATE (MM/DD/YYYY) ACORD„. CERTIFICATE OF LIABILITY INSURANCE 11/26/2025 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lauren Bauman Propel Insurance PHONE A/C, No Ext : 800 499-0933 866 577-1326 A/C, No: _ 805 SW Broadway; Suite 2300 E-MAIL ADDRESS: lauren.bauman@propelinsurance.com P COM Construction INSURER(S) AFFORDING COVERAGE NAIC A Portland, OR 97205-3363 INSURER A: Middlesex Insurance Company 23434 INSURED INSURER B : Jewell Excavating and Construction Inc. INSURER C 3616 N Flora Rd. INSURER D : Spokane, WA 99216 INSURER E INSURER F : fall\/FRAhFf2 CFRTIFICATF NIIMRFR• RFVISION NLIMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR BI/PD Ded:1,000 A0294682004 11 /15/2025 11/15/2026 EACH OCCURRENCE $1,000,000 _ PREMISES EaEoccauErrrence $500,000 _ X MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY X JECT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG s2,000,000 WA Stop Gap $1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A0294682001 11 /14/2025 11/14/2026 COEaMBINED ccidentSINGLE LIMIT a $ 1, 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE A0294682006 11/15/2025 11/15/2026 EACH OCCURRENCE $2000000 AGGREGATE $2 000 000 DED X RETENTION $0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER I IOTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased & Rented A0294682003 1/15/2025 11/15/202 200,000/2,500 ded DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Spokane Valley Additional insured status is primary and non-contributory and waiver of subrogation applies per attached forms, when required by written contract. II�:La]R49� City f Spokane Valle SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y op y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10210 E Sprague Ave ACCORDANCE WITH THE POLICY PROVISIONS. Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S7702984/M7691875 MXR03 This page has been left blank intentionally. Sentry 0 POLICY NUMBER: A0294682004 ADDITIONAL INSURED - SUPPLEMENTAL DECLARATIONS The following persons or organizations are included as Additional Insureds, but only to the extent provided in the listed endorsement: Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage. The person or organization indicated above is included as an additional insured under the following endorsement(s): CG 20 37 12 19 Additional Insured - Owners, Lessees Or Contractors - Completed Operations Location and Description of Completed Operations: Jobsites and Operations as described in written contracts with the named insured. CG 20 10 12 19 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization Location of Covered Operations: Jobsites as described in written contracts with the named insured. Job Description: All Operations with written contract with the named insured. IL 70 07 08 16 Washington Notice Of Cancellation To Others Number of Days Notice 30 CG89051014 A0294682 Middlesex Insurance Company 1 b79a209-e597-4fd3-9d49-d953d68cdd9e Page 1 of 1 11 /17/2025 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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 organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 A0294682 Middlesex Insurance Company afdcb92d-35d4-4b1e-9a33-31258664e7b9 Page 1 of 2 11 /17/2025 C. 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 the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 A0294682 Middlesex Insurance Company afdcb92d-35d4-4b1 e-9a33-31258664e7b9 CG 20 10 12 19 11 /17/2025 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. B. 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 the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 A0294682 Middlesex Insurance Company 0f45158d-a59b-4e28-a8f1-d594c5566d3e Page 1 of 1 11 /17/2025 POLICY NUMBER: A0294682004 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG24041219 A0294682 Middlesex Insurance Company 1 00001 0000000000 25321 0 N © Insurance Services Office, Inc., 2018 1 bb264c7-93e9-433c-b704-040af338abd5 Page 1 of 1 11 /17/2025 COMMERCIAL GENERAL LIABILITY CG 71 18 06 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EACH CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Maximum Each Construction Project General Aggregate Limit: $10,000,000 Designated Construction Project(s): All construction projects away from premises owned by or rented to the Insured Information required to complete this Schedule if not shown above will be shown in the Declarations. A. For all sums which the insured becomes legally b. Claims made or "suits" brought; or obligated topay as damages caused by c. Persons or organizations making claims or occurrences, under Section I - Coverage A, bringing "suits". and for all medical expenses caused by accidents under Section I - Coverage C, which can be 4. Subject to Paragraph 2. above, any payments attributed only to ongoing operations at a single made under Coverage A for damages or designated construction project shown in the under Coverage C for medical expenses shall Schedule above: reduce the Each Construction Project General Aggregate Limit for that designated 1. Subject to Paragraph 2. below, a separate construction project. Such payments shall not Each Construction Project General reduce the General Aggregate Limit shown Aggregate Limit applies to each designated in the Declarations nor shall they reduce any construction project, and that limit is equal to other Each Construction Project General the amount of the General Aggregate Limit Aggregate Limit for any other designated shown in the Declarations. construction project shown in the Schedule 2. If shown in the Schedule, the Policy above. Maximum Each Construction Project 5. Subject to Paragraph 2. above, the limits General Aggregate Limit is the most we will shown in the Declarations for Each pay for the sum of all damages paid under all Occurrence, Damage To Premises Rented Each Construction Project General To You and Medical Expense continue to Aggregate Limits included in this policy. apply. However, instead of being subject to 3. Subject to Paragraph 2. above, the Each the General Aggregate Limit shown in the Construction Project General Aggregate Declarations, such limits will be subject to the Limit is the most we will pay for the sum of all applicable Each Construction Project damages under Coverage A, except damages General Aggregate Limit. because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; CG 71 18 06 20 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 A0294682 with its permission. 11/17/2025 Middlesex Insurance Company 8056a7f1-6750-4705-88ee-9a062a139ca0 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Each Construction Project General Aggregate Limit provided under this policy. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor any Each Construction Project General Aggregate Limit provided under this policy. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., CG 71 18 06 20 A0294682 with its permission. 11/17/2025 Middlesex Insurance Company 8056a7f1-6750-4705-88ee-9a062a139ca0 COMMERCIAL GENERAL LIABILITY CG 71 25 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BLANKET ADDITIONAL INSUREDS, PRIMARY & NONCONTRIBUTORY, WAIVER OF SUBROGATION This endorsement modifies the coverage provided under the following Coverage Form(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART E;11aCL 11DJ Coverage enhancements are listed below. For details of each coverage, please read the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds - Automatic Status for 13 Additional Insured Types A. Owners, Lessees Or Contractors - Automatic Status When Required In A Written Construction Agreement With You B. Owners, Lessees Or Contractors - Automatic Status When Required In Written Construction Agreement With You (Completed Operations) C. State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations D. Lessor of Leased Equipment E. Owners or Other Interests From Whom Land Has Been Leased F. Manager or Lessor of Premise G. Mortgagee, Assignee, or Receiver H. Controlling Interest 1. Co-owner Of Insured Premises J. Executors, Administrators, Trustees Or Beneficiaries K. State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises L. Vendors MI. Grantor of Franchise 2. Primary and Noncontributory - Other Insurance Condition 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Additional Insureds - Automatic Status for 13 Additional Insured Types Section II - Who Is An Insured is amended to include the following as additional insureds when you have agreed to add that person or organization as an Additional Insured on your policy in a written contract or written agreement with that person or organization, or because of a permit issued by a state or political subdivision; provided the injury or damage occurs subsequent to the execution of the contract or agreement or issuance of the permit and while the contract, agreement or permit remains in effect. A. Owners, Lessees Or Contractors - Automatic Status When Required In A Written Construction Agreement With You 1) A person or organization with respect to liability for "bodily injury", "property damage" or "personal 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 operations for the additional insured. CG 7125 06 22 Includes copyrighted material of Insurance Services Office, Inc., A0294682 with its permission. Middlesex Insurance Company 07da1 ab2-149d-4acc-ba21-5d42afbce5b6 Page 1 of 5 11 /17/2025 A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. 2) With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 any 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 the failure to render any professional architectural, engineering or surveying services. b. "Bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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 organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. B. Owners, Lessees Or Contractors - Automatic Status When Required In Written Construction Agreement With You (Completed Operations) 1) Any person(s) or organization(s) with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" performed for that additional insured and included in the "products -completed operations hazard", but only when that portion of the "products -completed operations hazard" is not excluded by endorsement. 2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any 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" involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C. State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, 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. 2) This insurance does not apply to: Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 71 25 06 22 A0294682 with its permission. 11/17/2025 Middlesex Insurance Company 07dalab2-149d4acc-ba21-5d42afbce5b6 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". D. Lessor of Leased Equipment 1) Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). 2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. E. Owners or Other Interests From Whom Land Has Been Leased 1) Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the land leased to you by the additional insured person(s) or organization(s). 2) With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to lease that land; b. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured person(s) or organization(s). F. Manager or Lessor of Premise Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you by the additional insured person(s) or organization(s), subject to the following additional exclusions: This insurance does not apply to: 1) Any "occurrence" which takes place after you cease to be a tenant in that premises. 2) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. G. Mortgagee, Assignee, or Receiver Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of a premises by you. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured person(s) or organization(s). H. Controlling Interest 1) Any person(s) or organization(s) with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. 2) This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. I. Co-owner Of Insured Premises Any person(s) or organization(s) with respect to their liability as co-owner of a premises co -owned by you and covered under this insurance. J. Executors, Administrators, Trustees Or Beneficiaries Any executor, administrator, trustee or beneficiary of your estate or living trust while acting within the scope of their duties as such. CG 71 25 06 22 Includes copyrighted material of Insurance Services Office, Inc., A0294682 with its permission. Middlesex Insurance Company 07dalab2-149d-4acc-ba21-5d42afbce5b6 Page 3 of 5 11 /17/2025 K. State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises Any state or governmental agency or subdivision or political subdivision, subject to the following additional provision: 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: 1) 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 2) The construction, erection or removal of elevators; or 3) The ownership, maintenance or use of any elevators covered by this insurance. L. Vendors 1) Any person(s) or organization(s) (referred to throughout this endorsement as vendor), but only with respect to liability for "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: (1) The exceptions contained in Subparagraphs d. or f.; or Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., A0294682 with its permission. Middlesex Insurance Company 07da1 ab2-149d4acc-ba21-5d42afbce5b6 CG 71 25 06 22 11 /17/2025 (2) 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. b. This insurance does not apply 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. M. Grantor of Franchise Any person(s) or organization(s) with respect to their liability as grantor of a franchise to you. However: 1. The insurance afforded to such additional insureds only applies to the extent permitted by law; and 2. 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. 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 the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. If there is any difference in coverage afforded to an additional insured in this endorsement and that provided under another additional insured endorsement attached to this policy, the broader coverage will apply to that additional insured. 2. Primary And Noncontributory Insurance The following is added to the Other Insurance Condition and supersedes any provision to the contrary: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional 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 the additional insured. 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 71 25 06 22 Includes copyrighted material of Insurance Services Office, Inc., A0294682 with its permission. Middlesex Insurance Company 07dalab2-149d-4acc-ba21-5d42afbce5b6 Page 5 of 5 11 /17/2025 POLICY NUMBER: A0294682001 Sentry13 ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS The following additional interests apply to this policy. Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage. 3616 N Flora Rd Spokane, WA 99216 CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage. 3616 N Flora Rd Spokane, WA 99216 CA 04 44 10 13 Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) First Interstate Bank AFR Service Center PO Box 863329 Plano, TX 75086-3329 CA89041014 A0294682 Middlesex Insurance Company fce4f237-b1d8-4015-970a-11648632cdf1 Page 1 of 1 11 /17/2025 POLICY NUMBER: COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Persons Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the "loss" under a contract with that person or organization. CA 04 4410 13 © Insurance Services Office, Inc., 2011 A0294682 Middlesex Insurance Company a5999467-c162-4780-bab4-18238785b686 Page 1 of 1 11 /17/2025 POLICY NUMBER: COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.I. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the "accident" 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 the person or organization. CA 76 01 06 15 Includes copyrighted material of Insurance Services Office, Inc., A0294682 with its permission. Middlesex Insurance Company 8cb94482-fa4d-4572-9d55-92536347c7ae Page 1 of 1 11 /17/2025 POLICY NUMBER: A0294682006 APPLICABLE FORMS AND ENDORSEMENTS Form/Endorsement Number and Edition Date EU 70 88 11 13 EU 70 89 05 14 EU 70 91 05 15 EU 70 98 07 18 EU 71 01 12 19 EU 71 04 03 18 EU 71 06 07 20 EU 71 26 V1 09 22 EU 71 39 09 22 EU 71 61 04 22 IL 80 04 07 16 Form/Endorsement Title Washington Changes - Defense Costs Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data Related Activity Amendment Of Other Insurance Condition Cannabis Exclusion Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) Non -Cumulation Of Limits Continuous Or Progressive Injury Or Damage Limitation Per- And Polyfluoroalkyl Substances (PFAS) Exclusion Washington Changes - Terrorism Abuse Or Molestation Exclusion Exclusion - Infectious Or Communicable Disease Basis of Premium is not subject to audit. PREMIUMS Annual Premium: $7,009.00 SCHEDULE OF UNDERLYING INSURANCE Policy, Insurer and Limits of Liability Commercial General Liability Middlesex Insurance Company A0294682004 Including Products/Completed Operations General Aggregate Limit $ 3,000,000 (Other Than Products/Completed Operations) Products/Completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Stop Gap (Employers Liability) Bodily Injury by Accident - Each Accident $ 1,000,000 Bodily Injury by Disease - Each Employee $ 1,000,000 Bodily Injury by Disease - Aggregate Limit $ 3,000,000 Commercial Auto Insurance Middlesex Insurance Company A0294682001 Each Accident Limit $ 1,000,000 OPTIONAL COVERAGE ENDORSEMENTS Exclusion - Designated Operations Covered By A Controlled (Wrap -Up) Insurance Program Description and Location(s) of Operation(s): All owner or contractor -controlled insurance programs in which you were enrolled or intended to enroll Page 2 of 3 EU 89 01 10 14 A0294682 11 /17/2025 Middlesex Insurance Company 19cd249e-eac1-4c0f-b10b-82bb1 a3a472b POLICY NUMBER: A0294682006 OPTIONAL COVERAGE ENDORSEMENTS Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) Name Of Person(s) Or Organization(s): Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage. EU 89 01 10 14 A0294682 Middlesex Insurance Company 19cd249e-eacl-4cOf-b10b-82bbl a3a472b Page 3 of 3 11 /17/2025 POLICY NUMBER: A0294682006 COMMERCIAL EXCESS / UMBRELLA EU 70 91 0515 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies the coverage provided under the following: COMMERCIAL EXCESS / UMBRELLA COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Person Or Organization: Any Additional Insured as required by written contract or written agreement executed prior to loss (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following is added to Paragraph H. Other Insurance of Section IV - Conditions: 1. This insurance is primary to and will not seek contribution from any other insurance available to the person or organization shown in the Schedule above, provided that such designated person or organization: a. Is identified as an additional insured in the "underlying insurance"; b. Is a Named Insured under such other insurance; and c. Has agreed with you in a written contract or agreement that: (1) Is signed and effective prior to an "occurrence" to which this insurance applies; (2) This insurance would be primary and would not seek contribution from such other insurance identified in Paragraphs 1.a. and 1.b. above; (3) Agrees to indemnify or defend the designated person or organization for liability and damages covered by the "underlying insurance"; and (4) Affords indemnification and/or defense of the designated person or organization to the extent permitted by law. 2. This condition does not apply to: a. Other insurance, not included in Paragraph 1. above, that may be available to the designated person or organization outside of your written contract or agreement; or b. Liability which: (1) May attach to the designated person or organization and is not assumed by your written contract or agreement; or (2) Is assumed by the designated person or organization under any other written contract assuming the obligations of another. EU 70 91 05 15 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0294682 with its permission. 11/17/2025 Middlesex Insurance Company d6cff2a0-flc1-412d-9646-9a0bOfcO7803 POLICY NUMBER: COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 71 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies the coverage provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not show above, will be shown in the Declarations. I The Transfer Of Rights Of Recovery Against Others To Us Condition under Section IV - Conditions is amended by the addition of the following: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. EU 71 01 12 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0294682 with its permission. 11/17/2025 Middlesex Insurance Company 8f81577d-4832-4af4-a7ee-49deaabfca6a This page has been left blank intentionally.