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10-075.00 Acme Concrete Paving: Sprague Sullivan PCCP IntersectionContract 11 J THIS AGREEMENT, made and entered into this / day of ,2010, between the City of Spokane Valley under and by virtue of Title 35 R , as ended and Acme Concrete Paving, Inc. Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Sprague / Sullivan PCCP Intersection Project SVPW Contract 10 -015 In accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. H. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City of Spokane Valley by reason of entering onto this contract, except as provided herein. 13 O;D, 0 - 0�C3 IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor 6 1 1 so , 2010. Date Printed Name Title Signature City of Spokane Valley Printed Name Title Signature 14 Project: Sprague / Sullivan PCCP Intersection r�N . L "N ��an-e ,; o 0 Va U ey - BOND NO: 105422173 CONTRACTOR'S PERFORMANCE AND PAYMENT BOND TO DUAL OBLIGEES KNOW ALL MEN BY THESE PRESENTS, that ACME Concrete Paving, Inc. (Contractor), as Principal, and Travelers Casualty and Surety Company of America (Bonding Company), as Surety, a corporation Of Connecticut whose principal office is located at One Tower Square, Hartford, CT 06183 are firmly bound unto the State of Washington and the City of Spokane Valley, a political subdivision the State of Washington, as Obligees, to fulfill the obligations of the Principal and the Surety under the Contract to which reference is hereafter .made, in the amount of $ 835,000.00 (which includes taxes) (including Washington State sales tax) for payment Whereof Principal and Surety bind themselves their heirs, executors, administrators, successors and assigns jointly and severally firmly by these presents. WHEREAS, Principal has by written Proposal dated June 18, 2010 offered to enter into a Contract with the City of Spokane Valley for Contract No. 10-015 pursuant to the terms and conditions set forth in the Contract Documents dated NOW, THEREFORE, the condition of this obligation is such. that ifthe Principal. shall faithfully perform all the provisions of the Contract on its part, and pay all laborers, mechanics; subcontractors and material suppliers, and all persons who supply such person or persons or subcontractors with provisions and supplies for the carrying on of such work, and indemnify and hold harmless the Obligees from all loss, cost or damage which it may suffer by reason of the failure to do anyvf the foregoing, then this obligation shall be.null and void; otherwise it shall remain in full force and effect. All persons who have furnished labor, materials or supplies for use in and about the work provided for in the Contract shall have a direct right of action under this bond, to the extent and in the manner set forth in RCW 39.03. The said Surety for value received hereby stipulates and agrees that no change, extension oftitrt ,. alteration or addition to the teams of the Contract or to the WORK to he performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on, this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the WORK or to the SPECIFICATIONS. No final settlement between the OWNER and the CONTRACTOR shall abridge the right ofany beneficiary hereunder, whose claim may be unsatisfied. SIGNED AND SEALED THIS 30th DAY OF June Travelers Casualty and Surety of Ty Americ F �igiiatstre 1-- Judith C. Kaiser - Smith yped Name Attorney - in - Fact Title (SEAL) YEAR 20 ACME Concrg%e Paving, Inc. Signa l,e C t k— Typed N I a Title 15 PROPOSAL FORM copy SVPW BID NUMBER: 10 -015 PROJECT TITLE: Sprague / Sullivan PCCP Intersection Project NAME OF FIRM SUBMITTING BID: Each bid shall constitute an offer to the City of Spokane Valley as outlined herein and no bidder may withdraw his bid after the hour set for the .bid closing except under the conditions explained in the _ Information to Bidders Section. RECEIPT OF ADDENDA: Bidder acknowledges receipt of the following addenda: Addendum No. Date Addendum No. Date 1 06/06/2010 2 06/14/2010 3 06/15/10- 4 06/16/2010 REJECTION: The City reserves the right to reject any or all proposals, portions or parts thereof and to waive all minor irregularities in bidding. Special attention. will be directed to the qualifications of the bidders when considering awarding a contract. TIME TO COMPLETE: The contract shall be completed in Fifteen (15) working days from the date of commencemeint stipulated in a Notice to Proceed. BID IS NOT ELIGIBLE FOR CONTRACTOR'S BOND ELECTION to withhold 50% retainage in lieu of furnishing a Contractor's Bond (Performance and Payment Bond). FREIGHT: Bid prices) to include all freight costs to the job site. SCHEDULES: A Bidder must complete all Base Bid schedules or his bid will be rejected as non- responsive. The undersigned hereby certifies that (he/they) (has/have) personally examined the location and construction details of work as outlined on the plans and specifications for the above project and (has/have) read thoroughly and understands the plans, specifications, and contract governing the work embraced in this improvement and the method by which payment will be made for said work and hereby proposes to undertake and complete the work embraced in this improvement in accordance with said plans, specifications, and contract in accordance with the unit prices provided below. The Bidder, to be considered responsible, shall provide in legible figures (not words) hand written in ink or typed, a unit price (except Lump Sum items) and total for each of the items shown on the following schedules: City of Spokane Valley 2 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10 -015 Base Bid Schedule A ,= ITEM # ITEM DESCRIPTION UNITS QUANTITY PRICENNIT TOTAL 1 MOBILIZATION L.S. 1 LS Z ' 2 CONSTRUCTION SURVEYING L.S. 1 LS� od 3 SPCC PLAN L.S. 1 LS oa 4 EROSION CONTROL L.S. 1 LS 5 PROJECT TEMPORARY TRAFFIC CONTROL L.S. 1 LS D° 3 (.1 b1� 6 PEDESTRIAN CONTROL AND PROTECTION L.S. 1 LS 9t7a� 7 SAWCUT ACP PAVEMENT LF - IN 2700 0 8 REMOVE PCC MEDIAN CURB AND ISLAND S.Y. 340 /0 c ° 3 7d�0-6 9 REMOVE PCC CURB AND GUTTER L.F. 270 00 00 10 REMOVE PCC SW / DRIVEWAY APPROACH S.Y. 160 ' 00 , l ad 11 ABANDON EXISTING DRYWELL EACH 2 yQd d✓ 9�d 0 12 REMOVE/ ABANDON EXISTING CATCHBASIN EACH 4 -0 �3 _ 0 7yd �- 13 CONDUIT TRENCH EXCAVATION L.F. 240 a 14 BITUMINOUS PLANING, 2 INCH DEPTH S.Y. 1420 y 09 h oc) 15 ROADWAY EXCAVATION INCL. HAUL C.Y. 1850 16 UNSUITABLE FND EXCAVATION INCL. HAUL C.Y. 1670 �:f /0,370 7d 17 GRAVEL BASE C.Y. 1670 ! v ! 7 , a l07 0 18 CRUSHED SURFACING SALVAGE C.Y. 1000 49 6, 300 0 19 GEOGRID S.Y. 2260 3 a y7d 20 HMA CL. % IN. PG 70 -28 TN 11604, oo 710, 8' SC 21 HMA CL. '/ IN. PG 70-28,.17 FT DEPTH S.Y. 1420 a �0 : /4 do 22 HMA CL. % IN. PG 70-28, FT DEPTH S.Y. 60 5� 9 % b od Sc City of Spokane Valley 3 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10-015 ,= A 5 City of Spokane Valley 4 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10-015 ITEM 9 ITEM DESCRIPTION UNITS QUANTITY PRICElUNIT TOF t, v 23 COMMERCIAL HMA S.Y. 20 —� 24 ANTI - STRIPPING ADDITIVE CALC 1 $1000.00 $1,000.00 25 JOB MIX COMPLIANCE ADJUSTMENT CALC 1 $1.00 $1.00 26 COMPACTION PRICE ADJUSTMENT. CALC 1 $1.00 $1.00 27 CEMENT CONC. PAVEMENT 11 IN. THICK, S.Y. 4420 INCL. DOWELS a�. S Ag - boy 28 FURNISHING CONCRETE FOR CEMENT C.Y. 1360 0o Db CONCRETE PAVEMENT 29 PORTLAND CEMENT CONC. COMPLIANCE CALC 1 $1.00 $1.00 ADJUSTMENT 30 TRENCH EXCAVATION SAFETY SYSTEM L.S. 1 LS 31 . LE, CATCHBASIN ADJUST EXISTING MANHOLE, EACH 8 00 6 OR DRYWELL 32 ADJUST EXISTING VALVE BOX EACH 13 q0D 6a00 ° a 33 SOLID WALL PVC STORM SEWER PIPE 10 IN. L.F. 150 00 34' MANHOLE FRAME AND GRATE (INCL. ADJ.) EACH 2 g d°° Z d ° d S o d a 35 CATCH BASIN TYPE 1L EACH 4 3Da (. 366 36 CATCH BASIN TYPE 2 EACH 4 !960 7, (P00 37 SPILL CONTROL SEPARATOR EACH 4 a 16 SO 38 EXISTING DRYWELL CONNECTION EACH 2 5-/0 00 /1 ?Z)O 39 PRECAST CONCRETE DRYWELL, TYPE B EACH 2 a 3100 b 1 a00 o0 40 CONCRETE TRAFFIC ISLAND 24 IN. WIDE L.F. 840 3 � o 41 CEMENT CONC. TRAFFIC CURB AND GUTTER L.F. 270 19 60 of 42 CEMENT CONC. SIDEWALK S.Y. 160 A 9 43 CEMENT CONC. CURB RAMP, TYPE 2 EACH 3 7 00 44 CEMENT CONCRETE PEDESTRIAN CURB L.F. 90 630, 1 (70od 5 City of Spokane Valley 4 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10-015 ITEM $ ITEM DESCRIPTION UNITS QUANTITY PRICE/UNIT TOTAL 45 SOD INSTALLATION S.Y. 12 �9 0 3 y � o 46 BARK MULCH S.Y. 15 9 0 ° 00 47. CONDUIT PIPE 2 IN. DIAM. L.F. 1160 y a ° 48 CONDUIT PIPE 3 IN. DIAM. L.F. 740 q 7 D-V — 49 PULL BOX EACH 1 a'S D6 00 .2'sw 50 JUNCTION BOX, TYPE EACH 3 � /I RO #4 51 JUNCTION BOX, TYPE 8 EACH 4 y� d o0 00 52 INDUCTION LOOP TYPE 2 OR TYPE 3 . EACH 44 - ° 53 INDUCTION LOOP, PRE -FORMED BICYCLE. EACH 15 6-S-6 00 54 TRAFFIC SIGNAL SYSTEM MODIFICATIONS L.S. 1 A/, 0 00 °B . c9 4 000 55 GROOVED PLASTIC CROSSWALK LINE S.F. 900 56 PAINT LINE L.F. 1,910 o . 317 70670 57 PAINTED WIDE LINE L.F. 830 040 (,.6 58 PAINTED TRAFFIC ARROW EACH 15 0 y� - °° 73S 59 GROOVED PLASTIC STOP LINE L.F. 185 !a 00 a, ,'IoZOoo 60 SURVEY MONUMENT EACH 1 6 00 00 0d =' (a00 00 61 DELINEATOR AND CORE HOLE EACH 4 9800 S a ' a 7 62 BULLNOSE MARKER EACH 3 0 ° 'elDO /ao0 Base Bid Schedule A Total City of Spokane Valley Sprague / Sultivan PCCP Intersec 17 GRAVEL BASE C.Y. 2260 ! D 3 y .23, -1&& � 18 CRUSHED.SURFACING SALVAGE C.Y. 1400 19 GEOGRID S.Y. 3420 9 S � 1 -4 20 HMA CL. .% IN. PG 70 -28 TN 1580 21 HMA CL. % IN. PG 70 FT DEPTH S.Y. 740 `7` �, , 141.0 3. wav 22 HMA CL. % IN. PG 70-28,.58 FT DEPTH S.Y. 26 '1` w al sC. City of Spokane Valley 6 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10 -015 rTEM# I ITEM DESCRIPTION U UNITS Q QUANTITY PRICENNIT T TOTAL 1 M MOBILIZATION L L.S. 1 1 L LS 2 C CONSTRUCTION SURVEYING L L.S. 1 1 L LS 4 45 SO ou 3 S SPCC PLAN L L.S. 1 1 L LS S SSD 4 E EROSION CONTROL L L.S. 1 1 L LS ° ° 5 P PROJECT TEMPORARY TRAFFIC CONTROL L L.S. 1 1 L LS 3 3(1000 o. 6 P PEDESTRIAN CONTROL AND PROTECTION L L.S. 1 1 L LS ° ° y o_ 9r / 7 S SAWC UTACP PAVEMENT L LF -IN 2 2450 0 0 Vp 1 1,940 °d 8 R REMOVE PCC MEDIAN CURB AND ISLAND S S.Y. 4 440 / /0 4 4l, 1)06 00 9 R REMOVE PCC CURB AND GUTTER L L. F. 2 280 y y p� ! !a you 10 R REMOVE PCC SW/ DRIVEWAY APPROACH. S S.Y. 1 170 0 00 0 0 0 11 A ABANDON EXISTING DRYWELL E EACH 4 4 A A1 90 T 9 96 6 do 12 R REMOVE /ABANDON EXISTING CATCHBASIN E EACH 3 3 y y35 1 1, 3 13 C CONDUIT TRENCH EXCAVATION L L.F. 1 115 3 3f 1 1 'Ll9s06 14 B BITUMINOUS PLANING, 2 INCH DEPTH S S.Y. 7 740 5 5 - - g 15 R ROADWAY EXCAVATION INCL. HAUL C C.Y. 2 2400 Q Q- I. e e, I, w 16 U UNSUITABLE JFND EXCAVATION INCL, HAUL C C.Y. 2 2260 e e ql pay '1` w al sC. City of Spokane Valley 6 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10 -015 csac�aaaaw asaaa v..a.v..s.... +. fTEM # ITEM DESCRIPTION UNITS QUANTITY PRICE/UNIT TOTAL 23 COMMERCIAL HMA .. ' 6 } �� ' S.Y. 20 -# = -bb&.- ` i30.o0 24 ANTI - STRIPPING ADDITIVE CALC 1 $1000.00 $1,000.00 25. JOB MIX COMPLIANCE ADJUSTMENT CALC 1 $1.00 $1.00 26 COMPACTION PRICE ADJUSTMENT CALC 1 $1.00 $1.00 27 CEMENT CONC. PAVEMENT 11 IN, THICK, S.Y. 5600 oa INCL. DOWELS ay 28 FURNISHING CONCRETE FOR CEMENT C.Y. .1720 00 0 1 0 (05 /a CONCRETE PAVEMENT I 29 PORTLAND.CEMENT CONC. COMPLIANCE CALC 1 $1.00 $1.00 ADJUSTMENT 0 30 TRENCH EXCAVATION SAFETY SYSTEM L.S. 1 LS /� f $1 ADJUST EXISTING MANHOLE, CATCHBASIN EACH 9 c c�l� ( � OR DRYWELL 32 ADJUST EXISTING VALVE BOX EACH 15 1/p7p 33 SOLID WALL PVC STORM SEWER PIPE 10 IN. L.F. 190 �3 °° 8, I7Ddo DIAM: 34 D.I. STORM SEWER PIPE, 101N DIAM. L.F. 10 00 q7 - 9 o0 35 MANHOLE FRAME AND GRATE (INCL. ADJ.) EACH 2 b oo I l ��oo 36 CONCRETE INLET EACH 1 11 300 o° 1, add od 37 CATCH BASIN TYPE 1L EACH 5 re 7, 875 OC 38 CATCH BASIN TYPE 2 EACH 6 A ggpoa 11, 3oo 39 SPILL CONTROL SEPARATOR EACH 6 a / g - 6 ,308 w 40 EXISTING DRYWELL CONNECTION EACH 2 67/4,092 00 41 PRECAST CONCRETE DRYWELL, TYPE B EACH 4 3, tSOd la �� 00 42 CONCRETE TRAFFIC ISLAND 24 IN. WIDE L.F. 980 13 ia, 7ya pD 43 CEMENT CONC. TRAFFIC CURB AND GUTTER L.F. 280 1 ou 5, 3;20 ° 44 CEMENT CONC. SIDEWALK I S.Y. 170 i a 9 oa ° yr 8 93 City of Spokane Valley 7 ma rroposm voaumr -a- Sprague / Sullivan PCCP Intersection Project SVPW Bid No: 10 -015 curcauaaw ITEM E "Aa a..uv...s....+ ITEM DESCRIPTION UNITS QUANTITY PRICE/UNIT TOTAL 45 CEMENT CONCRETE CURB RAMP, TYPE 2 EACH 3 7 v p ° a `' a 1 00 46 CEMENT CONCRETE PEDESTRIAN CURB L.F. 90 ° l3 ee 1, l'ia 47 SOD INSTALLATION S.Y. 13 o° �9 ... fl 3�� 48 BARK MULCH S.Y. 17 .29 0-°• X93 49 CONDUIT PIPE 2 IN. DIAM. L:F. 1160 ° 50 CONDUIT PIPE 3 IN. DIAM. L.F. 740 �! sv 7 D30. 51 PULL BOX EACH 1 !P06 02 °D 52 JUNCTION BOX, TYPE 2 EACH 3 (000 t-0 00 eo .g b o 53 JUNCTION BOX, TYPE 8 EACH 4 t app LO S, bA0` 0 54 INDUCTION LOOP TYPE 2 OR TYPE 3 EACH 44 S ao I yo 'o° 55 INDUCTION LOOP, PRE - FORMED BICYCLE EACH 15 SSb b ° $ aSa q1.q- 56 TRAFFIC SIGNAL SYSTEM MODIFICATIONS L.S. 1 x/000_ 57 GROOVED PLASTIC CROSSWALK LINE S.F. 900 9 �S Sbs� 58 PAINT LINE L.F. 2,510 G•3� 02& Z 59 PAINTED WIDE LINE L.R 940 © -"M 60 PAINTED TRAFFIC ARROW EACH 15 S 735 o 61 GROOVED PLASTIC STOP LINE L.F. 185 00 2aat, 62 SURVEY MONUMENT EACH 1 (ppa o (001) 00 63 DELINEATOR AND CORE HOLE EACH 4 a g ° 3 q-2 64 BULLNOSE MARKER EACH 4 �0OQ°. a do pd ° Alternate Bid Schedule B Total 3-5 toed City of Spokane valley Sprague / Sullivan PCCP Intersection Project Schedule ,�� Total 9 g Base Bid Schedule A Alternate Bid Schedule B Person/EntityName: Steve Clark Signature Of Bidder•v/ Company: Acme Concrete Paving, Inc. Date: June 16.2010 City of Spokanc Sprague / Sulliv CONTRACTOR'S ADNIlNBTR4TIVE INFORMATION 1. PERSON/ENTITY a. Name as registered with the State of Washington: Acme Concrete Paving, Inc. b. Physical Address: 4124 East Broadway, Spokane, WA 99202 e. Mailing Address including zip code: 4124 East Broadway, Spokane, WA 99202 d. Remit To Address including zip code: 4124 East Broadway, Spokane, WA 99202 e. Telephone number including area code: i; q- au -a -t a g f. Fax number including area code: 509- 242 -1232 g. E -mail address for business correspondence: sclark @acmeconcretepaving.com h. Washington State Contractors License Number: ACMECP1986C! i. Federal Tax Identification Number: REDACTED j. Washington State UBI Number: 602170 211 k. State Industrial Account Identification Number: 399,615-01 1. City of Spokane Valley Business License Number: 02519 (Business Licersa not required for Bid, but will be required prior to Con= W=tion) 2. INSURANCE COMPANY: a. Name of company: CNA b. Mailing Address including zip code: CNA Plaza, Chicago, Illinois 60685 c. Insurance Agent Name: Bill Dineen d. Insurance Agent Telephone number including area code: 509- 358 -3800 e. Insurance Agent Fax number including area code: 509 -358 -3812 3. BONDING COMPANY: Travelers Casualty and Surety Company of America a. Surety Name: 707 West Main Avenue, Ste 300, Spokane, WA 99201 b. Surety Mailing Address including zip code: c. Bonding Agent Name: Wolf- Majewsky -Rapp d. Bonding Agent Mailing Address including zip code: PO Box 2984 Spokane, WA 99220 e. Bonding Agent Telephone number including area code: 509- 535 -9178 f Bonding Agent Fax number including area code: 509- 534 -8134 Person/Entity Name: Steve Clark Signature Of Bidder: Company: Acme Concrete Paving, Inc. Date: June 16, 2010 This document contains confidential tax information and has been redacted pursuant to RCW 82.32.330. You may petition for a review of our findings pertaining to any Bid Proposal Documents SVPW Bid No: 10 -015 redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. BIDDER QUALIFICATION STATEMENT The following statements of experience, personnel, equipment, and general qualifications of the Bidder are submitted with the assurance that the owner can rely on its accuracy and truthfulness. If more space is required for your answers please attach a continuation sheet(s) to the corresponding bid response page referencing the item number. 1. The company has been in business continuously from (month and year) 12/2001 2. The company has had experience comparable to that required under the proposed contract: a. As a prime contractor far. 9 years. b. As a subcontractor for 9 years- 3 `The following is a partial list of work completed that was on an order of magnitude equal to or greater in scope and complexity to that required under the proposed contract. Year Owner & Person to contact Phone No. Location Contract Value See Attached 4. A list of supervisory personnel currently employed by- the.Bidder and available for work on the project (Construction Manager, principal foreman, superintendents and engineers) is as follows: Name Steve Clark Darin Cornwell Years of Title Experience Project Manager 21 Superintendent 21 S Please attach a resume of the qualifications, previous employers, and experience of the project manager who is proposed to be assigned to the project. If a resume is not included in the bid documents the bidder agrees to furnish a resume within 24 hours of notice by the City. See Attached 6. Following is a listing of all projects the company has undertaken in the last five years, which have resulted in: a. Arbitration or litigation. None b. Claims or violations being filed by the Federal Government or the Washington State Departments of L & I, Employment Security or Revenue. None c. Liens being filed by suppliers or subcontractors. None Person/EntityName: Steve Clark Signature Of Bidder: Company: Acme Concrete Paving. Inc. Date: June 16, 2010 City of Spokane Valley 11 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Pmject SVPW Bid No: 10 -015 subcontractor List Mkfnu on M T a f tnGP'QrW1ofi prepared CO MOSPOD WO as Mail To Be Submitted w1th the Bid Pitiposal Project Name BROADWAY/SULLIVAN PCCP,INTERSECTION PROJECT 10-01% frag . ur4 to Hot subodntraitars'4 W PiOPmOd to P the work of FiVAC (h9atIng, V.OlatHiLdOlt 4nd Jdr Corl ditl6 n i ng ), p*M6f a described [ dhapier 18•.908 FM and electrtaaf as described 10 MaPtOr 1 4- 28 KOW, or nambIg lbor6tftn one subcontractor to Parf:OM the 82MG WOrkWgrowlt Ili Your bld being nqn- respQnAV4 and tharefore voIdL bdWO nft, 0 9 Gt Suboontraotb4s) that grip proposqd to paribrm- the WWR of h -ver&116ft dfid sk ' co - 116 Work I Od h onaptor 10.28 p D�W be listed bd6w- T described 6 oh-apter 1.8.'i06 ROW, iknd elecftigl as crasWM - to ba polibma4d Is t4 bo Opted beloW the suboontmOtOr( vid I o p me. Th6 Wukemii fd g tvffi o th 6 dQ.ntraQk blddeei propoAd HYAC, plumbing arid afeptrjosl ;uboontMotors applies only to proposed WAD, PIUMMM9, and eltdtdcal . o ot d1rooly vA& -e p sub9ontro0orp Who will D Mrs the prima vol*4QJ bidder subm4t[rip the Width .090 Orft If no subcontractor Is listed below, the bidder aakwMedges that It dads not fatend to use any suboonhator to perform- those Items OtWork. Aztech Electric, Inc., 5204 E Broadway, Spokane,, WA 99211.;0795 AZ-TE-CE-13.20KW Suboqntra$prN=e Work to be Fatformed associated with the project ---- Work to be PefforideA .................... Subootftutbrfthe Wo*•o'be Performed euboonft*rNamd Writ 16 g P-61for M-dd Subconirdict-of KWO Work tp bp PA*rcnpd n. I sien(W PM or MW 6011 dult, JUM90m boxes, eta. am StddsOa iva ftiffled #W In the C0 11110 0 Of fm OWM oonq149 red elpott - of eqdp Men, W1 4 i b by-i Wood *19*-W cor*201 "On It the b W 181lon 18 A Roartsed eteq1doO agnkp6lor MUM be law 0 090ft th& Ort IaQT ;%14pr EF BID DEPOSIT FORM OF BID DEPOSIT - CHECK ONE: Please submit this sheet with the bid deposit. CASH. Attach the deposit behind this sheet. X SURETY -BOND - Attach bid bond behind this sheet. ITHMONGLFRECOMMEIVDED THAT YOU USE THEATTACBM FORM. BID DEPOSIT REQUIRED. No bid may be considered for public work unless it is accompanied by a bid deposit in the form of a surety bond, postal money order, cash, cashier's check, or certified check in an amount equal to five percent (5 %) of the amount of the bid proposed. if the bidder to whom the contract is awarded fails to enter into the contract and furnish the contractor's bond as required within ten days after notice of the award, exclusive of the day of notice, the amount of the bid deposit shall be forfeited to the City and the contract awarded to the next lowest and best bidder. if the deposit is "cash" and is in the form of a postal money order, cashier's check, or certified check, the checks are to be made payable to the City of Spokane Valley. Cash bid deposits are to be accompanied by this form. Cash bid deposits of all unsuccessful bidders shall be returned after the contract is awarded and the required contractor's bond and proof of insurance given by the successful bidder is accepted by the City of Spokane Valley. If the bid deposit is in the form of a surety bond it must be of a corporate surety licensed to do business in the State of Washington. The City strongly recommends the use of the attached City Bid Deposit Surety Bond Form. It the City's Bid Deposit Surety Bond Form is not used, the bidder is warned to take special care in assuring that the form used does not materially alter, qualify or conflict with the terms and conditions set forth in the City's Bid Deposit Surety Bond Form. The failure to furnish a bid bond in compliance with the City's Bid Deposit Surety Bond Form shall make the bid non - responsive and shall cause the bid to be rejected by the City. Person/Entity Name: Steve Clark Signature Of Bidder: Company: Acme Concrete Paving, Inc. Date June 16.2010 City of Spokane Valley 13 Bid Proposal Documents Sprague / Sullivan PCCP Intersection Project SVPW laid No: 10 -015 BOND NO * * *bid bond * ** BID DEPOSIT SURETY BOND FORM NAME OF PROJECT: Sprague / Sullivan PCCP Intersection Project SVPW BID NUMBER: 10 -015 NAME-OF FIRM: .ACME Concrete Paving, Inc. Travelers Casualty and Surety We, ACME Concrete Paving, Inc. as Principal, and Company - of America as Surety, are held and firmly bound unto the CITY OF SPOKANE VALLEY, a Washington State Municipality, in the penal sum of FIVE PERCENT .(5 %) OF THE TOTAL AMOUNT BID, for the payment of which we jointly and severally bind ourselves, and our legal representatives and successors. THE CONDITIONS OF THE OBLIGATION are that if the City of Spokane Valley shall make timely award to the Principal according to the terms of the bid documents; and the Principal shall, within ten (10) days after notice of the award, exclusive of the day of notice, enter into the contract with the City of Spokane Valley and furnishes the contractor's bond (performance and ,payment bond) with Surety - satisfactory to the City of Spokane Valley in an amount equal to one hundred percent (100%) of the amount of the bid proposed including Washington State Sales Tax then this obligation shall be null and void; otherwise if the Principal fails to enter into the contract and furnish the contractor's bond within ten (10) days after notice of the award, exclusive of the day of notice, the amount of the bid deposit shall be forfeited to the City; but in no event will the Surety's liability exceed this bond's face amount. SIGNED AND SEALED THIS 18 th DAY OF June YEAR 2e 10 Travelers Casualty and Surety Company of America ACME Concrete Paving, Inc. S Y PRINCIPAL gnature Signatmo Judith C. Kaiser —Smith Typed Name Attorney —in —Fact Title Typed Name S � C_ �Z�- 'T -✓/J Title (SEAL) City of Spokane Valley Sprague / Sullivan PCCP Intersection Project 14 Bid Proposal Documents SVPW Bid No: 10-015 WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERS Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No 219685 Certificate No. 003477182 KNOW ALL MEN BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies "), and that the Companies do hereby make, constitute and appoint Judith A. Rapp, James E. Majeskey II, and Judith C. Kaiser -Smith of the City of S pokane , State of 3WARhina , their true and lawful Attomey(s) -in -Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and ackn any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business o�f.guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required o�� ed chons or4rroceedings allowed by law. �, IN WITNESS WHEREOF, the Companies have caused this ins etit to be signedland theirr,co�o ate seals to be hereto affixed, this 3rd day of February 2010 ,�'�): 9' *� T q� , Farmington Casualty Cotfipany � Fidelity and Guaranty�nsurancb Company, pany, Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company O5 �� f1 � "`�^�NWtED H Z �I��p PORA�f n W:'GORP�RAT� � a O9i MARROW � �O �'�e S a � � 1951 �'. S E A L��o" � ?s �d CCttN. �o �• �� N � d., • FFFJ � P° �S`SANGEGO �d S., y AL L J • 'C� ,,Q State of Connecticut City of Hartford ss. By: / Georgqg Thompson, nior ice President On this the 3rd day of February 2010 , before me personally appeared George W. Thompson, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. 3 0.1 � In Witness Whereof, I hereunto set my hand and official seal. ?AA My Commission expires the 30th day of June, 2011. � QMJ� C • V Marie C. Tetreault, Notary Public 58440 -4 -09 Printed in U.S.A. Failure to return this Declaration as part of the bid proposal package will make the bid nonresponsive and ineligible for award. NON - COLLUSION DECLARATION I, by signing the proposal, hereby declare, under penalty of perjury under the laws of the United States that the following statements are true and correct: 1. That the undersigned person(s), firm, association or corporation has (have) not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the project for which this proposal is submitted. 2. That by signing the signature page of this proposal, I am deemed to have signed and to have agreed to the provisions of this declaration. NOTICE TO ALL BIDDERS To report rigging activities call: 1 -800 -424 -9071 The U.S. Department of Transportation ( USDOT) operates the above toll -free "hotline" Monday through Friday, 8:00 a.m. to 5:00 p.m., eastern time. Anyone with knowledge of possible bid rigging, bidder collusion, or other fraudulent activities'should use the "hotline" to report such activities. The "hotline" is part of USDOT's continuing effort to identify and investigate highway construction contract fraud and abuse and is operated under the direction of the USDOT Inspector General. All informationwill be treated confidentially and caller anonymity will be respected. DOT Forth 272 -036H EF Revised 5/06 City of Spokane Valley 16 Bid Proposal Documents Sprague/ Sullivan PCCP Intersection Project SVPW Bid No: 10 -015 REPRESENTATIONS AND CERTIFICATIONS ANTI - KICKBACK No officer or employee of the City of Spokane Valley, having the power or duty to perform an official act or action related to this submittal, shall have or acquire any interest in this submittal, or have solicited, accepted or granted a present or future gift, favor, service, or other thing of value from or to any person involved in this submittal. REPRESENTATION: In submitting this bid we represent that the bid documents have been read and understood, that the site has been visited and or that we have familiarized ourselves with the - local conditions under which the work is to be performed, that by signature of this proposal we acknowledge all requirements and that we have signed.all certificates contained herein. REPRESENTATION: In submitting this bid we acknowledge the requirements and conditions applicable to bid deposits in the form of a cash bid deposit or surety bond bid deposit. NON - COLLUSION: That the undersigned person(s), firm, association or corporation has (have) not either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the project for which this bid is submitted. I CERTIFY that no final determination of violation of RCW 50.12.070(1)(b), 50.16.070(1)(b), or 82.32.070(1)(6) has been made by the Washington State Departments of Employment Security, Labor And Industries or Revenue respectively dated within two years of the date of the closing of this bid. I understand further that no bid may be submitted, considered or contract awarded for a public work to any person or entity that has -a determination of violation of the above referenced statutes within two years from the date that a violation is finally determined and the date of this bid closing. I CERTIFY that to the best of my knowledge the information contained in this proposal is accurate and complete and that I have the legal authority to commit this Firm to a contractual agreement. I realize the final funding for any service is based upon budget levels and the approval of the City of Spokane Valley. I CERTIFY that by signing the signature page of this bid, I am deemed to have signed and have agreed to the. provisions of this declaration. Name: SteveClark / Acme. Concrete Paving Inc. Person/entity sub g bid (print) Signature: Title: Secretary Date: June 16,201n City of Spokane Valley 15 Bid Proposal Documents SVPYV Bid No: 10 -015 Sprague / Sullivan PCCP Intersection Project Certification for Federal -Aid Contracts The prospective participant certifies by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds hme been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to 'Influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan or cooperative agreement (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer.or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. This certification is material representation of the fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Tile 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. DOT Revised 112000 F City of Spokane Valley 17 Bid Proposal Documents Sprague/ Sullivan PCCP Intersection Project SVPW Bid No: 10 -015 Aft w i ton Disadvantaged Business TAP Department pt'iramporMllan Enterprise Utilization Certification To be eligible foreword of this contract the biddermust fill out and submit, as part of Its bid proposal, the following Dtaadvantaged Business Enterprise Utilization Certification relating to Disadvantaged Business Enterprise (DBE) requirements. The Contracting Agency shall consider as non - responsive and shall reject any bid proposal thatdoes not contain a DBE Certilloatlon which properly demonstrates that the bidder will meet the DBE participation requirements In one of the manners provided for to the proposed contract. If the bidder is relying on the good faith effort method to meet the DBE assigned contraotgoal, documentation in addition to the certificate must be submitted with the bid proposal as support for such errorts. The successful bidder's DBE Certification shaft be deemed a part of the resulting contract. Information on cert#led. firms Is available from OMWSE, telephone 360- 753.9693, ACME CONCRETE PAVING, INC. certifies that the Disadvantaged Business Enterprise Name of etdder (DBE) Firms Rated below have been contacted regarding participation on this project. If this bidder is successful on this project and Is awarded the Contract; It shall assure that subcontracts or supply agreements are executed with those firms where an "Amount to be AooiledTowards Goal• . s listed. (itnecessarv. use addifionat sheet.) Name of DBE Certificate Number project Role * (prime, subcontractor, Manufacturer, Regular Dealer) description of Work Amount to ** be Applied Towards.Goal t, Simplex Construction Supplies, Inc. Regular Dealer Dowel Bars and Dowel Bar Asses ories $13,534.00 D2F8719396 2, North Star Enterprises, Inc. Subcontractor Traffic Markings, Earthwork r' D2 7218231 3. Items, Partial $32,540.00 4. 5. 6. 7 . 8 . 8. t0. Disadvantaged Business Enterprise Subcontracting Goat; 4% DBE Total $ $46,074.00 + Regular Dealer statue mustbe approved pdorto bW subm#t0by the Office of Equal Opportunely, Weah. Stele Dept. or Transportation, on each contract. 'k Seethe seotton'Counting DBE Participatlon Toward Meeting the Gosr in the Contract Document. + "• The Conlracilnp Agency vl uWse this amount to determine whether ornot the bidder has mat the goal. In the event of on arithmetic difference between thla toles and the sum of rha individual amounts listed above, then Me sum of the amounts fisted slap prove# and the total vAlt be reAsed 00T Fonn T/2 -Qaa EP evtae4 7/07 ACM40709 ACORD ,,., CERTIFICATE OF LIABILI"T"Y INSURANCE DAT 7/112 DIYYYY) 7n12o10 PRODUCER Co mmercial Lines - (509) 358 -3800 Wells Fargo Insurance Services USA, Inc. - CA Lic #: OD08408 601 West Main Street, Suite 1400 Spokane, WA 99201 -0635 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Acme Concrete Paving, Inc. 4124 E. Broadway Spokane, WA 99202 INSURER A: National Fire Ins. of Hartford -A CNA Co. 20478 INSURER B: American Casualty Company of Reading 20427 INSURER c: Great American Insurance Company 16691 INSURER 0: NIED EXP (Arty one person) S 10.000 INSURER E: PERSONAL S AOV INJURY 5 1,000,000 • ^ ^ 1C0A1-_ec 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD* - POLICY EFFECTIVE POLICY EXPIRATION LTR I NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MWDO LIMITS A GENERAL LIABILITY 2091645862 -2 12/31109 12/31/10 EACH OCCURRENCE $ 1.000,000 DAMAGE TO RENTED 300,000 tJERCIAL GENERAL LIABILITY P E 1 - rice S CLAIIAS MADE OCCUR 470111 NIED EXP (Arty one person) S 10.000 PERSONAL S AOV INJURY 5 1,000,000 • GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 2,000,000 POLICY X 7,eg?- LOC B AUTOMOBILE LIABILITY 2091645912 - 2 12/31/09 12/31/10 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY S (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 OTHER THAN EA FC C _ S ANY AUTO S AUTOONLY: AGG C EXCESSIUMBRELLA LIABILITY TUE5955928 -7 12/31109 12/31110 EACH OCCURRENCE S 15,000.000 AGGREGATE S 15,000,000 0 X OCCUR CLAIMS MADE $ DEDUCTIBLE S X RETENTION S iokoo WC STATU OTH• A WORKERS COMPENSATION AND 2091645862_2 12/31/09 12/31110 .'83 FR -� - E.L. EACH ACCIDENT — S 1.000.000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP ONLY OFFICERIMEMBER EXCLUDED? E.L. DISEASE -'EA EMPLOYEE $ 1.000,000 Et. DISEASE - POLICY LIMIT S 1,000,000 If yes. describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS RE: SPRAGUE/SULLIVAN PCCP INTERSECTION PROJECT SPOKANE VALLEY CAPITAL IMPROVEMENT PROJECT NO. 0065 SVPWBIDNO: 10 -015; CONTRACT AMOUNT $835,000. PRIMARY AND NON - CONTRIBUTORY ADDITIONAL INSURED STATUS IS GIVEN TO THE CITY OF SPOKANE VALLEY AND ANY OTHER ENTITY REQUIRED IN THE MAIN CONTRACT AS GRANTED BY THE ENDORSEMENT ATTACHED. A WAIVER OF SUBROGATION AND PER PROJECT AGGREGATE DO APPLY PER THE ENDORSEMENT ATTACHED. CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT 11707 E SPRAGUE AVENUE SUITE 106 SPOKANE VALLEY, WA 99206 nr-nRn 7s r7nMlnA% 4 —4: 157671 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF. THE ISSUING INSURER WILL I?NbUM1 10 DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, $DCF.I4XXX»a;H><ID)O'13aAf AUTHORIZED o ACORD CORPORATION 1988 V V A M (This certificate replaces certificate# 1576703 issued on 71112010) IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 -S (2001/08) 2 of 2 #S915260/M915043 CNA G-1 7957-G (Ed. 01/01) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SNIT. SEE PARAGRAPH C.1. OF THIS ENDORSEMENT FOR THESE DUTIES. ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL LIABILITY COVERAGE WITH RESPECTS -C THE "BODILY OPERATIONSR "PROPERTY HAZARD ". SEE DA ARAGRAPH O F 3. OF THIS "PRODUCTS-COMPLETED ENDORSEMENT FOR THIS COVERAGE CHANGE. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH LIMITED PRODUCTS- COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Designated Project: AS REQUIRED BY THE CONSTRUCTION CONTRACT (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) o A. WHO IS AN INSURED (Section lI) is amended to 2. The Limits of Insurance applicable to the insured are those specified in the o include as an insured any person or organization, including any person or organization shown in the additional written contract or written agreement or in the schedule above, (called additional insured) whom you Declarations of this policy, whichever is Less. These Limits of insurance are inclusive of, and not N are required to add as an additional insured on this N under a written contract or written agreement; in addition to, the Limits of Insurance shown in the policy but the writt en contract or written agreement must be: Declarations. 1. Currently in effect or becoming effective during the 3. The coverage provided to the additional insured f. of —_ term of this policy; and by this endorsement and paragraph the definition of "insured contract" under r– 2. Executed prior to the "bodily injury," "property DEFINITIONS (Section V) do not apply to "bodily — damage," or "personal and advertising injury". injury" or "property damage" arising out of the B. The insurance provided to the additional insured is "products - completed operations hazard" unless required by the written contract or written '"– limited as follows: agreement. When coverage does apply to "bodily 1. That person or organization is an additional injury" or "property damage" arising out of the insured solely for liability due to your negligence "products- completed operations hazard" such ,�. .. specifically resulting from "your work" for the coverage will not apply beyond: additional insured which is the subject of the No a. The period of time required by the written written contract or written agreement. applies to liability resulting from the sole contract or written agreement; or coverage negligence of the additional insured. Page i of 2 G- 17957 -G (Ed. OV01) b. 5 years from the completion of "your work" on the project which is the subject of the written contract or written agreement, whichever is less. 4. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional 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; and to. Supervisory, or inspection activities performed as part of any related architectural or engineering activities: C. As respects the coverage provided under this endorsement, SECTION N — COMMERCIAL GENERAL LIABILITY CONDITIONS are amended as follows: 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (3) Agree to make insurance which has for a loss Coverage Part. available any other the additional insured we cover under this f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a Written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. ( - 17957 -G Page 2 of 2 G- 18652 -H (Ed. 01106) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' GENERA!. LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. m s b "s s 0 n s 0 1. MISCELLANEOUS ADDITIONAL INSUREDS WHO IS AN INSURED (Section 11) is amended to include as an insured any person or organization (called additional insured) described in paragraphs 2.a. through 2.g. below whom you are required to add as an additional Insured on this policy under a written contract or agreement but the written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the 'bodily injury," 'property damage' or 'personal injury and advertising injury,' but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. State or Political Subdivisions A state or political subdivision subject to the following provisions: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit 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, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (2) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. This insurance does not apply to "bodily injury," "property damage' or "personal and advertising injury" arising out of operations performed for the state or municipality. b. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. c. Managers or Lessors of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and 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; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. d. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only 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 or demolition operations performed by or for such additional insured. Page 1 of 7 G- 18652 -Fi (Ed. 01106) e. Owners /Other Interests — Land is Leased An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any - occurrence" which takes place after you cease to lease that land; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. f. Co -owner of insured Premises A co -owner of a premises co -owned by you and covered under this insurance but only with respect to the co- owners liability as co -owner of such premises. g. Lessor of Equipment Any person or organization from whom you lease equipment. Such person or organization are insureds only with respect to their liability arising out of the maintenance, operation or use by you of equipment leased to you by such person or organization. A person's or organization's status as an insured under this endorsement ends when their written contract or agreement with you for such leased equipment ends. With respect to the insurance afforded these additional insureds, the following additional exclusions apply: This insurance does not apply: (1) To any 'occurrence" which takes place after the equipment lease expires; or (2) To 'bodily injury', 'property damage', or 'personal and advertising injury' arising out of the sole negligence of such additional insured. Any insurance provided to an additional insured designated under paragraphs a. through g. above does not apply to `bodily injury' or 'property damage' included within the 'products- completed operations hazard'. As respects the coverage provided under this endorsement, Paragraph 4.b. SECTION iV — COMMERCiAL GENERAL LIABILITY G- 1 8652 -H CON€}ITiONS is deleted and replaced with the following: 4. other Insurance b. Excess Insurance This insurance is excess over: Any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or agreement specifically requires that this insurance be either primary or primary and noncontributing. Where required by written contract or agreement, we will consider any other insurance maintained by the additional insured for injury or damage covered by this endorsement to be excess and noncontributing with this insurance. 2. EMPLOYEES AS INSUREDS — HEALTH CARE SERVICES Paragraph 2.a.(1)(d) of Section II — Who Is An Insured its deleted. 3. JOINT 'DENTURES f PARTNERSHIP I LIMITED LIABILITY COMPANY COVERAGE A. The following is added to Section II — Who is An Insured: 4. You are an insured when you had an interest in a joint venture, partnership or limited liability company which terminated or ended prior,to or during this policy period but only to the extent of your interest in such joint venture, partnership or limited liability company. This coverage does not apply: a. Prior to the termination date of any joint venture, partnership or limited liability company; or b. If there is other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company. c. To a joint venture, partnership or limited liability company which is or was insured under a 'consolidated (wrap -up) insurance program'. 'Consolidated (wrap -up) insurance program' means a construction, erection or demolition project for which the prime contractor /project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, otherwise referred to as an Owner Controlled Page 2 of 7 G- 18652 -H (Ed. 01106) 0 ° o 0 a i; 0 0 0 N Insurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.I.P.). B. The last paragraph of Section 11 — Who Is An Insured is deleted and replaced by the following: Except as provided in 4. above, no person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. 4. EXPANDED PERSONAL AND ADVERTISING INJURY A. The following is added to Section V — Definitions, the definition of "Personal and advertising injury°: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any °executive officer ", director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any insured. B. Exclusions of Section .1— Coverage B — Personal and Advertising Injury Liability is amended to include the following: p. Discrimination Relating To Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. q. Fines Or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. C. This provision 4. (EXPANDED PERSONAL AND ADVERTISING INJURY COVERAGE) does not apply to discrimination or humiliation committed in the states of New York or Ohio. Also, EXPANDED PERSONAL AND ADVERTISING INJURY COVERAGE does not apply b policies issued in the states of New York or Ohio. D. This provision 4. (EXPANDED PERSONAL AND ADVERTISING INJURY COVERAGE) does not apply if Section I — Coverage B — Personal And Advertising Injury Liability is excluded either by the provisions of the Coverage Part or by endorsement. 5. MEDICAL PAYMENTS A. Paragraph 7. Medical Expense Limit, of Section III — Limits of Insurance is deleted and replaced by the following: 7. Subject to S. above (the Each Occurrence Limit), the Medical Expense Limit is the most we will pay under Section — I — Coverage C for all medical expenses because of *bodily injury' sustained by any one person. The Medical Expense Limit is the greater of: (1) $15,000; or (2) The amount shown in the Declarations for Medical Expense Limit. B. This provision 5. (Medical Payments) does not apply if Section I — Coverage C Medical Payments is excluded either by the provisions of the Coverage Part or by endorsement. C. Paragraph 1.a.(3)(2) of Section I — Coverage C — Medical Payments, Is replaced by the following: The expenses are incurred and reported to us within three years of the date of the accident; and 6. LEGAL LIABILITY AND BORROWED EQUIPMENT A. Under Section I — Coverage A — Bodily Injury and Property Damage 2. Exclusions, Exclusion j. is replaced by the following. 'Property damage" to: (1) Property you own, rent, or occupy; (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 Page 3 of 7 G- 18652 -N (Ed. 01106) (6) That particular part of any property that must be restored, repaired or replaced because 'your work' was incorrectly performed on it. 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 (1), (3) and (4) of this exclusion do not apply to: (i) "property damage' to tools or equipment loaned to you it the tools or equipment are D. not being used to perform operations at the time of loss, or (ii) "property damage' (other than damage by fire) to premises rented to you or temporarily occupied by you with the permission of the owner, or to the contents of premises rented to you for a period of 7 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. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to 'property damage' included in the 'products - completed operations hazard'. B. Under Section I - Coverage A - Bodily Injury and Property Damage the last paragraph of 2. !Exclusions is deleted and replaced by the following. Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance. C. Paragraph 6. Damage To Premises Rented To You Limit of Section III - Limits Of Insurance is replaced by the following: 6. Subject to S. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most we will pay under Section - I - Coverage A for damages because of "property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days. The Damage To Premises Ranted To You Limit is the greater of: a. $200,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations. Paragraph 4.b.(1)(b) of Section IV - Commercial General Liability Conditions is deleted and replaced by the following: (b) That is property insurance for premises rented to you or temporarily occupied by you with the permission of the owner, or E. This provision 6. (LEGAL LIABILITY AND BORROWED EQUIPMENT) does not apply if Damage To Premises Rented To You Liability under Section I - Coverage A is excluded either by the provisions of the Coverage Part or by endorsement. 7. NON -OWNED WATERCRAFT Under Section I - Coverage A, Exclusion 2.g., subparagraph (2) is deleted and replaced by the following. (2) A watercraft you do not own that is: (a) Less than 55 feet long; and (b) Not being used to carry persons or property for a charge. 8. NON -OWNED AIRCRAFT Exclusion 2.g. of Section I - Coverage A - Bodily Injury and Property Damage, does not apply to an aircraft you do not own, provided that: 1. The pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. It is rented with a trained, paid crew; and 3. It does not transport persons or cargo for a charge. 9. CONTRACTUAL LIABILITY FOR PERSONAL AND ADVERTISING INJURY Exclusion e. Contractual Liability of Section I - Coverage B is deleted. G-11 8652-H Page 4 of 7 GA 8652 -H (Ed. 01/06) 10. SUPPLEMENTARY PAYMENTS when the "occurrence ", offense, claim or "suit" is A. Under Section I - Supplementary Payments - known to: Coverages A and B, Paragraph 1.b., the limit of (1) You, if you are an individual; $250 shown for the cost of bail bonds is replaced (2) A partner, if you are a partnership; by $2,500: B. In Paragraph i.d., the limit of $250 shown for daily (3) An executive officer or the employee designated by you to give such loss of earnings is replaced by $1,000. notice, if you are a corporation; or 11. LIQUOR LIABILITY (4) A manager, if you are a limited Exclusion c. of Section I - Coverage A is deleted. liability company. 12. NEWLY FORMED OR ACQUIRED 17. AGGREGATE LIMITS PER PROJECT ORGANIZATIONS A. For all sums which the insured becomes legally Paragraph 3.a. of Section ti - Who Is An Insured is obligated to pay as damages caused by deleted and replaced by the following "occurrences' under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents Coverage under this provision is afforded only until the under COVERAGE C (SECTION 1), Which can be end of the policy period or the next anniversary of this attributed only to ongoing operations at a single policy's effective date after you acquire or form the construction project away from premises owned organization, whichever Is earlier. by or rented to the insured: 13. LIBERALIZATION CLAUSE 1. A separate Single Construction Project If we adopt a change in our forms or rules which would General Aggregate Limit applies to each broaden coverage for contractors without an additional construction project away from premises premium charge, your policy will automatically provide owned by or rented to the insured, and that the additional coverages as of the date the revision is limit is equal to the amount of the General effective in your state. Aggregate Limit shown in the Declarations. 14. UNINTENTIONAL FAILURE -TO DISCLOSE 2. The Single Construction Project General Aggregate Limit is the most we will pay for the HAZARDS sum of all damages under COVERAGE A, Based on our reliance on your representations as to except damages because of "bodily injury" or existing hazards, if unintentionally you should fail to property damage' included in the 'products - disclose all such hazards at the inception date of your completed operations hazard', and for policy, we will not deny coverage under this Coverage medical expenses under COVERAGE C n Part because of such failure. regardless of the number of: b s 15. OCCURRENCE NOTICE OF OCC a. Insureds; The following is added to paragraph 2. of Section IV - b. Claims made or "suits' brought; or 4 Commercial General Liability Conditions - Duties In The Event of Occurrence, Offense, Claim or Suit: c. Persons or organizations making claims 'suits'. or bringing Your rights under this Coverage Part will not be fail to us notice of an 3. An payments made under COVERAGE A for y p Y prejudiced if you give "occurrence ", offense, claim, or 'suit` and that failure is damages or under COVERAGE C for medical — solely due to your reasonable belief that the "bodily expenses shall reduce the Single Construction Project General Aggregate Limit injury" or 'property damage' is not covered under this Coverage Part. However, you shall give written notice for that construction project away from of this "occurrence', offense, claim or 'suit" to us as premises owned by or rented to the insured. Such payments shall not reduce the General .... soon as you are aware that this insurance may apply *suit*. Aggregate Limit shown in this Declarations to such "occurrence`, offense claim or nor shall they reduce any other Single = 16. BROAD KNOWLEDGE OF OCCURRENCE Construction Project General Aggregate Limit —' The following is added to paragraph 2. of Section IV - for any other separate construction project away from premises owned by or rented to commercial General Liability Conditions - Duties the insured. .a in The Event of Occurrence, Offense, Claim or Suit: = .�., You must give us or our authorized representative 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical _ notice of an "occurrence', offense, claim, or 'suit' only Expense continue to apply. However, instead G- 18652 -H Page 5 of 7 G- 18652 -H (Ed. 01/06) of being subject to the General Aggregate of the insured. This exclusion does not 'bodily 'property Limit shown in the Declarations, such limits apply to injury' or will be subject to the applicable Single damage' resulting from the use of Construction Project General Aggregate Limit. reasonable force to protect persons or property. B. For all sums which the insured becomes legally obligated to pay as damages caused by 2o. OWNER CONTROLLED INSURANCE PROGRAM, 'occurrences° under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents CONTRACTOR CONTROLLED INSURANCE PROGRAM OR CONSOLIDATED (WRAP -UP) under COVERAGE C (SECTION 1), which cannot INSURANCE PROGRAMS be attributed only to ongoing operations at a single The endorsement EXCLUSION — CONSTRUCTION construction project away from premises owned WRAP -UP PROGRAM which is attached to this policy by or rented to the insured: is amended as follows: 1. Any payments made under COVERAGE A for A. This exclusion does not apply to: damages or under COVERAGE C for medical expenses shall reduce the amount available 1. Coverage available to you under this policy under the General Aggregate Limit or' the Products - Completed Operations Aggregate which is broader in scope than coverage provided to you under a "consolidated (wrap - Limit, whichever is applicable; and up) insurance program' for a construction project in which you are involved; 2. Such payments shall not reduce any. Single Construction Project General Aggregate Limit. 2. Coverage for your interest only for ongoing operations in excess of all coverage available C. When coverage for liability arising out of the to you under a 'consolidated (wrap -up) `products - completed operations hazard' is insurance program` for a construction project provided, any payments for damages because of in which you are involved; and "bodily injury' or "property damage' included in the `products - completed operations hazard' will 3. Coverage for your interest only for operations reduce the Products - Completed Operations included within the `products - completed Aggregate Limit, and not reduce the General the Single Construction operations hazard' in excess of all coverage available to you under a 'consolidated (wrap - Aggregate Limit nor Project General Aggregate Limit. up) insurance program' for a construction project in which you are or have been D. If a single construction project away from involved. premises owned by or rented to the 'inured has been abandoned and then restarted, or if' the Paragraphs A.1., A.2. and A.3. above do not authorized contracting parties deviate from plans, apply to any portion of a 'consolidated (wrap -up) 'residential blueprints,. designs, specifications or timetables, insurance program ° involving a the project will still be deemed to be the same structure.' construction project. B. The following is added immediately after the first E. The provisions of Limits of insurance (SECTION paragraph of provision b. Excess Insurance of 111) not otherwise modified by this endorsement Section IV — Commercial General Liability shall continue to apply as stipulated. Conditions —Other Insurance: . 16. EXPANDED BODILY INJURY This insurance is excess, over any of the other insurance whether primary, excess, contingent or ° Section V — Definitions, the definition of bodly any other basis that is insurance available to you injury' is changed to read: as a result of your being a participant in a 'Bodily injury' means bodily injury, sickness or disease 'consolidated (wrap -up) insurance program', but only as respects your involvement in that sustained by a person, including death, humiliation, `consolidated (wrap -up) insurance program`. shock, mental anguish or mental injury by th at person at any time which results as a consequence of the C. The following is added to Section V — bodily injury, sickness or disease. Definitions: 19. EXPECTED OR INTENDED INJURY 'Consolidated (wrap -up) insurance program' Exclusion a. of Section I — Coverage A — Bodily by means a construction, erection or demolition for which the prime contractor /project Injury and Property Damage Liability is replaced project manager or owner of the construction project has the following: secured general liability insurance covering some a. `Bodily injury' or "property damage' or ail of the contractors or subcontractors involved expected or intended from the standpoint in the project, otherwise referred to as an Owner Page 6 of 7 G- 18652 -H G- 18652 -H (Ed. 01106) s 9 0 0 N O N Controlled Insurance Program (O.C.I.P.) or d. An obligation, as required by ordinance, Contractor Controlled Insurance Program to indemnify a municipality, except in (C C I P) connection with work for a municipality; "Residential structure° means any structure e. An elevator maintenance agreement; where 30 or more of the square foot area is f. That part of any other contract or used or is intended to be used for human agreement pertaining to your business residency including but not limited to single or (including an indemnification of a multifamily housing, apartments, condominiums, municipality in connection with work townhouses, co- operatives or planned unit performed for a municipality) under which developments and also includes their common you assume the tort liability of another areas andlor appurtenant structures (including party to pay for "bodily injury" or 'property pools, hot tubs, detached garages, guest houses damage° to a third person or organization. or any similar structures). When there is no Tort liability means a liability that would individual ownership of units, residential structure be imposed by law in the absence of any does not include military housing, contract or agreement. collegeluniversity housing or dormitories, long term care facilities, hotels, or motels. Residential Paragraph f. does not include that part of structure also does not include hospitals or any contract or agreement: prisons. (1) That indemnities an architect, 21. CONTRACTUAL LIABILITY — RAILROADS engineer or surveyor for injury or damage arising out of: With respect to operations performed within 50 feet of railroad property and for which a Railroad Protective (a) Preparing, approving or failing to Liability policy in the name of the railroad has been prepare or approve maps, shop provided, the definition of °insured contract" In the drawings, opinions, reports, SECTION V — DEFINITIONS is replaced by the surveys, field orders, change following: orders or drawings and specifications; or °Insured Contract" means: (6} Giving directions or instructions, a. A contract for a (ease of premises. or failing to give them, if that is However, that portion of the contract for a the primary cause of the injury or lease of premises that indemnifies any damage; person or organization for damage by fire to premises while rented to you or (2) Under which the insured, if an temporarily occupied by you with architect, engineer or surveyor, permission of the owner is not an "insured assumes liability for an injury or contract "; damage arising out of the insureds rendering or failure to render b. A sidetrack agreement; professional services, including those c. Any easement or license agreement; listed in paragraph (1) above and supervisory, inspection, architectural or engineering activities. G-1 8652-H Page 7 of 7 POLICY NUMBER: 2091645909 -1 CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: AS REQUIRED BY THE CONSTRUCTION CONTRACT (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as aDDlicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV -COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above 0 r~ m N S h O O C o l O N O O O O O O N O O N because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard." This waiver applies only to the person or organization shown in the Schedule above. ,, I — 1nciir2nrd RcrviPo_Q nffirr_a. Inc... 1992 ADVERTISEMENT FOR CITY OF SPOKANEVALLEY,:'' PUBLIC WORKS DEPARTMENT BID # SVPW 10 -015 SPRAGUE/ SULLIVAN PCCP INTERSECTION PROJECT Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Sprague/Sullivan PCCP Intersec- tion Project. The project consists of road reconstruction and storm drain construction work including placement of crushed surfacing, installation of Portland Cement Concrete pavement (PCCP) and hot mix asphalt paving. Copies of the bid packet including specifications and plans can be' ob- tained at the office of the City of Spo- kane Valley Public Works Department, at 11707 E. Sprague Avenue, Suite 304, Spokane Valley, WA 99206 -6124, Monday through Friday from 8:00 a.m. to 5:00 p.m. A non- refundable amount of $50.00 is required. Copies of the bid packet including specifications and plans may be obtained in PDF format on a compact disc at no charge. All bids must be accompanied by a bid deposit in the form of a surety bond, postal money order, cash, cash- ier's check, or certified check in an amount equal to five percent (5 %) of the amount of the bid proposed. Fail - iure to furnish a bid bond in compli- :ance with the City's bid deposit surety bond form shall make the bid non- responsive and cause the bid to be re- jected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spokane Valley, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and re- 'ceived not later than 10:00 a.m. PSOT, Friday, June 18,, 2010. Bid openings will be held immediately thereafter and read aloud in the City Council Chambers, Suite 101. The City of Spokane Valley reserves the right to waive any irregularities 'or informalities and to reject any or all bids. No bidder may "withdraw his bid after the time announced for the bid ,opening, or before- the award and execution of the contract, unless the award is delayed for a period exceed- ing sixty (60) days. The City of Spokane Valley, in ac- cordance witn Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 20004 to 2000 -4 and Title 49, Code of Federal Regulations, Depart ment of Transportation, subtitle A, Office of the Secretary, Part 21, non- discrimination in Federally assisted programs of the Department of Trans- portation issued pursuant to such,Act, hereby notifies all bidders that it will affirmatively insure that in any contract entered into pursuant to this advertisement, minority business enterprises will not be discriminated against on the grounds of race, color or national origin in consideration for an award. PUBLISH: May 28 and June 4, 2010 Christine Bainbridge, CMC Spokane Valley City Clerk SR20871 "Federal Tax ID No. 68- 0617327 AFFIDAVIT OF PUBLICATION STATE OF WASHINGTON County of Spokane, ss. Name: City of Spokane Valley Acct: 42365 P.O. No.: No. Lines: 79 Total Cost: $ 337.09 Log No: SR20871 I, Lori Nix do solemnly swear that I am the Principal Clerk of the SPOKESMAN - REVIEW, a newspaper established and regularly published, once each day in the English language, in and of general circulation in the City of Spokane, Spokane County, Washington; and in the City of Coeur d'Alene, Kootenai County, Idaho; that said newspaper has been so established and regularly published and has had said general circulation continuously for more than six (6) months prior to the 23rd day of July, 1941; that said newspaper is printed in an office maintained at its place of publication in the City of Spokane, Washington; that said newspaper was approved and designated as a legal newspaper by order of the Superior Court of the State of Washington for Spokane County on the 23rd day of July, 1941, and that said order has not been revoked and is in full force and effect; that the notice attached hereto and which is a part of the proof of publication, was published in said newspaper, one time(s), the publication having been made once each time on the following dates: June 4, 2010 That said notice was published in the regular and entire issue of every number of the paper during the period of time of publication, and that the notice was publish in the newspaper proper and not in a supplement. . Subscribed and sworn to before In6 at the City of Spokane, this 4th day of June, 2010 A Notafy ublic in ana fdr the State of Washir r iding in Spokane County, Washingto VI N A �� C) �401'AfO/ 0 N N� J'L'131 -1C o Z A �1 jx, 11B EF \'A `�1� ° F Wash`` SUPERIOR COURT OF WASHINGTON FOR SPOKANE COUNTY In the Matter of: ADVERTISEMENT FOR BIDS City of Spokane Valley Public Works Dept. Bid # SVPW 10 -015 Sprague /Sullivan PCCP Intersection STATE OF WASHINGTON ) )SS. County of Spokane ) 1_\rel AFFIDAVIT OF PUBLISHING NOTICE MICHAEL HUFFMAN , being first duly sworn on oath deposes and says that he is the EDITOR , of The Spokane Valley News Herald, a weekly newspaper. That said newspaper is a legal newspaper and it is now and has been for more than six months prior to the date of the publication hereinafter referred to, published in the English language continually as a weekly newspaper in Spokane County, Washington, and it is now and during all of said time was printed in an office maintained at the aforesaid place of publication of said newspaper, which said newspaper had been approved as a legal newspaper by order of the Superior Court of the State of Washington in and for Spokane County. That the following is a true copy of a public notice as it was published in regular issues commencing on the 28th day of May, 2010, and ending the 4th day of June, 2010, allAates inclusive, an such newspaper was regularly distributed to its subscribers during all of said period: �� ox ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID # SVPW 10-015 SPRAGUE/ SULLIVAN PCCP INTERSECTION PROJECT Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Sprague /Sullivan PCCP Intersection Project. The project consists of road reconstruction and storm drain construction work including placement of crushed surfacing, instal- lation of Portland Cement Concrete pavement (PCCP) and hot mix asphalt paving. Copies of the bid packet including specifications and plans can be obtained at the office of the City of Spokane Valley Public Works Department, at 11707 E. Sprague Avenue, Suite 304, Spokane Valley, WA 99206 -6124, Monday through Friday from 8:00 a.m. to 5:00 p.m. A non - refundable amount of $50.00 is required. Copies of the bid packet including specifications and plans may be obtained in PDF format on a compact disc at no charge. All bids must be accompanied by a bid deposit in the form of a surety bond, postal money order, cash, cashier's check, or certified check in an amount equal to five percent (5%) of the amount of the bid proposed. Failure to furnish a bid bond in compliance with the City's bid deposit surety bond form shall make the bid non - responsive and cause the bid to be rejected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spo- kane Valley, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received not later than 10:00 a.m. PSDT, Friday, June 18, 2010. Bid openings will be held im- mediately thereafter and read aloud in the City Council Chambers, Suite 101. The City of Spokane Valley reserves the right to waive any irregularities or informalities and to reject any or all bids. No bidder may withdraw his bid after the time announced for the bid opening, or before the award and execution of the contract, unless the award is delayed for a period exceeding sixty (60) days. The City of Spokane Valley, in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 2000d to 2000 -4 and Title 49, Code of Federal Regulations, Department of Transportation, subtitle A, Office of the Secretary, Part 21, non - discrimination in Federally assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively insure that in any contract entered into pursuant to this advertisement, minority business enterprises will not be discriminated against on the grounds of race, color or national origin in consideration for an award. Christine Bainbridge, CMC Spokane Valley City Clerk 5/28 & 6/4 ED to before me State of Washington County of Spokane I certify that I know or have satisfactory evidence that ;A Michael Huffman is the pperson whoappeared before me, and said acknowledged he signed �lE ........... ... person this instrument and acknowledged it to be his free �;�mfssp�' bd- N" and voluntary act for the uses and purposes men- ;' � tioned in the ' strument. ?y � p� ••'.ys Jolene Rae Werttz 201 ..•;t0 g Title: Notary Public S H 1 1 - 0 2 ' My appointment expires: 5 -16 -11 ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID # SVPW 10 -015. SPRAGUE / SULLIVAN PCCP INTERSECTION PROJECT Notice is hereby given that the City of Spokane Valley; Spokane County, Washington will accept sealed bids for the Sprague /Sullivan PCCP Intersec- tion Project. The project consists of road reconstruction and storm drain construction work including placement of crushed surfacing, installation of Portland Cement Concrete pavement (PCCP) and hot mix asphalt paving. Copies of the bid packet including specifications and plans can be ob- tained at the office of the City of Spo- kane Valley Public Works Department, at 11707 E. Sprague Avenue, Suite 304, Spokane Valley, WA 99206 - 6124, Monday through Friday,from 8:00 a.m. *Federal Tax ID No. 68 0617327 to 5:00 p.m. A non - refundable amount of $50.00 is required. Copies of the bid AFFIDAVIT OF PUBLICATION packet including specifications and plans may be obtained in PDF format on a compact disc at no charge. STATE OF WASHINGTON All bids must be accompanied by a County of Spokane, ss. bid deposit in the form of a surety bond, postal money order, cash, cash- ier's check, or certified check in an Name: City of Spokane Valley Acct: 42365 amount equal to five percent (5 %) of the amount of the bid proposed. Fail- P.O. No.: No. Lines: 79 ure to furnish a bid bond in compli- ance with the City's bid deposit surety bond form shall make the bid non Total Cost: $ 337.09 Log No: SR20871 responsive and cause the bid to be re- jected. Bids must be submitted in sealed I, Lori Nix envelopes addressed to the City Clerk do solemnly swear that I am the Principal Clerk of the SPOKESMAN - of the City of Spokane Valley, 11707 E. REVIEW, a newspaper established and regularly published, once Sprague Avenue, Suite 106, Spokane each day in the English language, in and of general circulation in the Valley, Washington, 0:0 06, and re- ceived not later than 10:00 a.m. PSDT, Ci of S pokane, Spokane Count Washington; and in the City of Y P Y� 9 Friday, June 18, 2010. Bid openings Coeur d'Alene, Kootenai County, Idaho; that said newspaper has will be held immediately thereafter been so established and regularly published and has had said general and read aloud in the City Council circulation continuously for more than six (6) months prior to the 23rd Chambers, Suite 101. The City of Spokane Valley reserves d of Ju that said newspaper is Y Y� p rinted in an office P the right to'waive any irregularities or maintained at its place of publication in the City of Spokane, informalities and. to reject any or all Washington; that said newspaper was approved and designated as a bids. No bidder may withdraw his bid after the time announced for the bid legal newspaper by order of the Superior Court of the State of opening, or before the award and Washington for Spokane County on the 23rd day of July, 1941, and execution of the contract, unless the that said order has not been revoked and is in full force and effect; award is delayed for a period exceed- that the notice attached hereto and which is a part of the proof of ing sixty (60) days. The City of Spokane Valley, in ac- p blii blihd i id p O° the p ublication, was p ublished said newspaper, one times cordance with Title. VI of the Civil publication having been made once each time on the following dates: Rights Act of 1964, 78 Stat'. 252,42 U.S.C. 20004 to 2000 -4 and Title 49, May 28, 2010 Code of Federal Regulations, Depart- ment of Transportation, subtitle A, Office of the Secretary, Part 21, non- That said notice was published in the regular and entire issue of every discrimination in Federally assisted number of the paper during the period of time of publication, and that programs of the Department of Trans- portation issued pursuant to such Act, the notice was publishe in he newspaper proper and not in a hereby notifies all bidders that it will supplement. affirmatively insure that , in any XAMV contract entered into pursuant to this Subscribed and sworn to b me City of Spokane,. this 28th . advertisement, minority business enterprises will not be discriminated d of Ma 2010 y y against on the grounds of race, color ` or national origin in consideration for 44 7 an award. PUBLISH: May 28 and June 4, 2010 P tary Public in and for the State of Washington, g or in Spokane County, Washington Fko� Christine Bainbridge, CMC residing O �• , Spokane Valley City Clerk SR20871 o`� �AO'VARY 9 �N I'U'131 \ o - 1 �O 9� �MBE? �C? cc �F WAS��