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10-083.00 MJM Grand: Broadway Ave ReconstructionContract THIS AGREEMENT, made and entered into this 1 day of , 2010, between the City of Spokane Valley under and by virtue of Title 35 RCW, as knended and MJM Grand, 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: Broadway Avenue Reconstruction Project SVPW Contract 10 -013 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. II. 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 60(0 -09`— 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 Jy , 2010. Date Printed Name Title ignature City of Spokane Valley te tJC�LIISOlsi Printed Name 442 - d P//' 14 2 COPY BIDDERS PACKET R ECE I VE D Broadway Avenue Reconstruction Project JUN 2 5 20 10 SVPW BID NO. 10 -013 CITY OF SPOKANE VALLEI� CITY CLERK II BID PROPOSAL CHECKLIST This Checklist and the documents listed below constitute a complete Bid Proposal. Failure to execute any of the following documents, or any addition, condition or limitation in writing to the form of the bid, not explicitly invited in the Bid Documents or Specifications may become cause for rejection of the bid as irregular. The BIDDER shall check each respective box indicating inclusion of each signed and dated item: Proposal Form Contractor's Administrative Information ]' Bidder Qualification Statement Subcontractor List Bid Deposit Form Bid Deposit Surety Bond Form (Use only if submitting Bond for Bid Deposit) Representations and Certifications The above forms have been inserted in a sealed envelope, properly identified and delivered at the place and time described in the Notice to Contractors form. Signature: Date: G � AD Title: Company: — )WJ W J�t4�— City of Spokane valley I Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No: 10.013 ' k PROPOSAL FORM SVPW BID NUMBER: 10-013 PROJECT TITLE: Broadway Avenue Reconstruction Project NAME OF FIRM SUBMITTING BID: 'T N\ &P-A of), 10 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 bird closing except under the conditions .explained in the Information to Bidders Section. RECEIPT OF ADDENDA: Bidder acknowledges receipt ofthe following addenda: Addendum No, Date Addendum No. Date Addendum No. Date Addendum No. Date 1 6 -1 3 it. - 1 G -zz 6-I© 4 Z ( -Z3 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 Fifty (50) working days from the date of commencement 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 price(s) to include all freight costs to the job site. SCHEDULES: All of the Base Bid schedules will be awarded, ifthe project is awarded. 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 Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No: 10 -013 Base Bid Schedule A » Road Work fTEM # ITEM DESCRIPTION UNITS QUANTITY PRICEIUNIT TOTAL 1 MOBILIZATION L.S. 1 L.S. S I 1 2 CONSTRUCTION SURVEYING L.S. 1 L.S. 20 RvO •v 3 PROJECT TEMPORARY TRAFFIC CONTROL L.S. 1 L.S. 31 1 q0 vd 4 STORM AND WATER TRENCH SAFETY SYSTEM L.S. 1 L.S. l ,� 5 EROSION CONTROL L.S. 1 L.S. L{, 000 00 6 CLEARING AND GRUBBING L.S. 1 L.S. 5 t 1 (0,00 7 LARGE TREE REMOVAL EACH 25 440100 C j 000 ; 8 REMOVE PCC CURB L.F. 90 7 6 g 331,20 9 REMOVE IRRIGATION PIPE L.F. 270 LA .52 I 10 ABANDON EXISTING DRYWELL EACH 1 59c) 00 5`0,00 11 REMOVE BOULDER, SPOIL PILE OR WALL L.S. 1 L.S. 5 1j>('0.00 12 REMOVE FENCE L.F. 490 1.10 53q.00 13 SAWCUT ACP PAVEMENT LF IN 5,150 �7 1, 6'f 8. 14 REMOVEACP S.Y. 8,500 j y5 tZ�325. 15 ROADWAY EXCAV. INCL, HAUL C.Y. 8,200 ; 5 gvI , 00 16 SELECT BORROW INCL. HAUL C.Y. 1,100 19,062- 17 EMBANKMENT COMPACTION METHOD C.Y. 1,100 ,.2,4 i 1 3 (.4,0 18 . CRUSHED SURFACING TOP COURSE, 2 IN. -DEPTtI S.Y. 500 Z.6$ 3`tO. 18 CRUSHED SURFACING TOP COURSE, 4 IN. S.Y. 3,900 DEPTH S. (t b 15,4 44.00 20 CRUSHED SURFACING TOP COURSE, 6 IN. S.Y.. 17,000 DEPTH S M &6 21 CRUSHED SURFACING TOP COURSE, 6 IN. S.Y. 220 -� DEPTH . S 1 I (,08;20 22 HMA. CL. 1/2" PG 70 -28, 0.42 FT. DEPTH S.Y. 15,200 1°7 • by . ZI;$, I zg' City of Spokane Valley 3 Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No: 10 -013 Race Rid CPhPdnlp A - Road Work Continued ITEM # ITEM DESCRIPTION UNITS QUANTITY PR10EIUNIT TOTAL 23 HMA. CL. 1/2" PG 70 -28 MICELLANOUS AREAS S.Y. 220 „L$`l 611-31 24 ANTI- STRIPPING ADDITIVE CALL 1 $1,000.00 $100.00 25 JOB MIX COMPLIANCE PRICE ADJUSTMENT CALC 1 $1.00 $1.00 28 COMPACTION PRICE ADJUSTMENT CALC 1 $1.00 $1.00 27 CEMENT CONCRETE PAVEMENT, 8 -IN. THICK, S Y. 264 1NCL. DOWELS �g ,lO — 7 1 840• 28 FURNISHING CONCRETE FOR CEMENT C.y. 60 CONCRETEPAVEMENT rtS,S(� ( 29 PORTLAND CEMENT CONCRETE COMPLIANCE CALC 1 $1.00 $1.00 ADJUSTMENT 30 REMOVAL AND REPLACEMENT OF C.Y. 500 UNSUITABLE MATERIAL I �t,33 1, i 65 • W 31 DUCTILE IRON STORM SEWER PIPE 10 IN, L.F. 540 'Z DIAM. 9 , �9 16,14 o.6o 32 DUCTILE IRON STORM SEWER PIPE 12 IN. L.F. 430 DIAM. 33 DUCTILE IRON STORM SEWER PIPE 18 IN. L.F. 65 DIAM. - 7 2, .89 4,1 31.US 34 SOLID WALL PVC STORM SEWER PIPE, 10 IN. L.F. 10 DIAM. '77.2-8 "1'7 2,$0 35 SOLID WALL PVC STORM SEWER PIPE, 12 IN. L F 1,54.0 DIAM. 0100 Lb,ZID.�so 36 SOLID WALL PVC STORM SEWER PIPE, 151N. L.F. 320 DIAM. 2l ,6�, 6 37 SOLID WALL PVC STORM SEWER PIPE, 181N. L.F. 230 DIAM. �q eo 4 I6185612.D 38 STORM DRAIN ENCASEMENT L.F. 240 %t 39 CURB INLET TYPE 2 EACH 1 40 CONCRETE INLET EACH 15 f546.11 Q-1694- 41 CATCHBASIN TYPE 1 EACH 13 g`I5, 38 i2 1 2M.14 42 CATCHBASIN TYPE 2,48 IN, DIAM. EACH 11 t 2, 20:1 Lt (8 ,9Z$,1+{ 43 PRECAST CONCRETE DRYWELL TYPE A EACH 3 1 - 7 5,B40.r City of Spokane Valley 4 Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPNY Bid No: 10 -013 Rase. Rid Schedule A - Load Work Continued ITEM # ITEM DESCRIPTION UNITS QUANTITY PRICEIUNIT TOTAL 44 PRECAST CONCRETE DRYWELL TYPE B EACH 2 2. 5, I y 0.06 45 EXISTING DRYWELL CONNECTION EACH 1 5 00 . CO S00. 00 46 MANHOLE FRAME AND GRATE INCL. EACH 2 ADJUSTMENT 315,00 ISO, 00 47 SEGMENTAL CONCRETE RETAINING WALL S.F. 280 2-1 -24 6 0 1 8-6 0 48 CONCRETE BLOCK RETAINING WALL S.F. 3,370 25,00 49 WATERLINE LOWERING, 6 IN. DIAM. EACH 9 - 2- j - 730,00 2 3 0 . 50 NEW WATER SERVICE 2 INCH DIAM L.F. 310 I o. ZZ 3,1652 51 EXTEND OR REPAIR EXISTING WATER L.F. 85 SERVICE 52 RELOCATE EXISTING WATER METER EACH 12 ASSEMBLY i�°1 Z,Ily.o`t 53 INSTALL NEW WATER METER ASSEMBLY 2 EACH 1 INCH '4,3(09.00 Z,us, 00 54 RELOCATE HYDRANT ASSEMBLY EACH 2 $SS.00 1 I().00 55 ADJUST VALVE BOX EACH 13 56 CEMENT CONCRETE CURB AND GUTTER L.F. 8,000 8- 57 DRIVEWAY APPROACH S.Y. 1020 1 .1 ,40 Zf - t ,168.co 58 ROUNDABOUT TRUCK APRON CEMENT L.F. 19© - CONCRETE CURB ZI. SA90.00 59 ROUNDABOUT CENTRAL ISLAND CEMENT L.F. 95 CONCRETE CURB 2[ , 0 0 0 15, 00 60 PEDESTRIAN CURB L.F. 270 iK,10 M O , 00 61 CEMENT CONCRETE'SIDEWALK S.Y. 2,750 - Lk' 00 5 1150.00 62 CONCRETE TRAFFIC ISLAND S.Y. 980 23,10 Li ,IS$'PO 63 CEMENT CONCRETE SIDEWALK RAMP TYPE 2 EACH 9 6� , sp 6,142,56 64 CEMENT CONCRETE SIDEWALK RAMP TYPE EACH 1 *7.2S 4A 61 1 6 l 7 , 7S City of Spokane Valley 5 Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No. 10 -013 Base Bid Schedule A - Road Work Continued ITEM # ITEM DESCRIPTION UNITS QUANTITY . PRICE/UNIT TOTAL 65 INSTALL DETECTABLE WARNING SURFACE S.F. 72 3L.`If, 2,6'Z5.I 66 QUARRY SPALLS S.Y. 14 53,5`1 - 1yg.98 67 MONUMENT CASE AND COVER EACH 1 Z.2.S,Dd 2ZS z W 68 BARK MULCH S.Y. 22 69 RIVER ROCK S.Y. 10 (b,�3 130 .vZ 70 TOPSOIL, TYPE B S.Y. 3,000 Z,2.o 6"C00.00 71 SOD INSTALLATION S.Y. 9860 ° - 1,1f;I .00 72 SEEDING, FERTILIZING AND MULCHING S.Y. 3540 . �fo 2,�36. 73 IRRIGATION SYSTEM REVISION EACH 42 3 85 - 0 0 y,bZO . vv 74 REMOVE AND RE- INSTALL VINYL FENCE L.F. 45 Lt5,65 I,OSy.rS 75 TEMPORARY FENCE L.F. 450 14,67 L,Z0n,So 76 PROPOSED FENCE CHAINLINK FENCE TYPE 4 L.F. 940 1 5,0 14 I1 Z© 77 DOUBLE 14 -FOOT CHAINLINK GATE EACH 3 67 11'&'7 4.40 78 DELINEATOR AND CORE HOLE EACH 10 Izo 117-8i.s© 79 BULLNOSE MARKER EACH 5 336 ,60 1,683. Do 80 PERMANENT SIGNING L.S. 1 L.S. q,070. ou 81 JUNCTION BOX, TYPE 2 EACH 2 82 CONDUIT PIPE, 3" DIAMETER L.F. 230 jo-lb 7 41640 83 TEMPORARY PAVEMENT MARKING L.F. 5055 17 1 961 •35 84 REMOVE PAVEMENT MARKING L.F. 6900 �I86.00 85 PLASTIC LINE L.F. 27,000 City of Spokane Valley 6 Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No: 10.013 Roast Rirl Rd-16PAudp A - Rand Wnrk Cantinned ITEM i# ITEM DESCRIPTION UNITS QUANTITY . PRICE/UNIT TOTAL 86 PLASTIC CROSSWALK LINE S.F. 432 &. Is 2 i 6. Qo 87 PLASTIC STOP LINE L.F. 30 10,403 31' lio 88 PLASTIC TRAFFIC ARROW EACH 32 1 83 ,'7 0 Z, ( - 7 8.40 89 PLASTIC BICYCLE SYMBOL EACH 5 I y g, S4 - 2 , SO 90 PLASTIC TRAFFIC LETTER EACH 12 4 - 7-97- S 7 S , O L i 91 MINOR CHANGE CALC 1 $5,000.00 $5,000.00 92' SPCC PLAN L.S. 1 L.S. 600. 93 NEW WATER SERVICE 1 IN DIAMETER LF 92 6,1 1 1 1 5'3 *J,32 94 INSTALL NEW WATER METER ASSEMBLY 1 IN EA 3 �l i0 'ESl Z�13Z�t 95 SWALE IRRIGATION SYSTEM EA 3 3 b32.So 11,491,50 96 PLANT SELECTION - UTAH SERVICEBERRY EA 9 43- 393 30 97 PLANT SELECTION —WOODS ROSE EA 23 4"S ,60 k 98 PLANT SELECTION —MOCK ORANGE EA 26 H 2.3 1 1 99 MAILBOX SUPPORT, TYPE 1 EA 15 ZI O,o 0 3, 15 o - 00 100 MAILBOX SUPPORT, TYPE 2 EA 13 L1vz_ 5, 2 ©.05 101 REMOVE PCC SIDEWALK! DRIVEWAY APPROACH SY 75 '-, �� Schedule A Total RaQP Riff Cf+hpd R _ Cnnitnry Re %ver Wnrk ITEM # ITEM DESCRIPTION UNITS QUANTITY PRICE/UNIT TOTAL 1 FIELD VERIFY EXISTING UTILITES EACH 1.0 ctzo,OO 9 ,00 2 MANHOLE TYPE 1 EACH 8.0 1 ,36 i .I Iv, e Ali x ' 3 MANHOLETEST EACH 2.0 Z75,0 5S6 4 REMOVAL AND REPLACEMENT OF UNSUIT. FOUNDATION MATERIAL G.Y. 70.0 6,5� t, l5`i ,90 5 REMOVAL AND REPLACEMENT OF UNSUIT. MATERIAL C.Y. 500.0 �'� y '�� O ' Oo 6 IMPORTED PIPE BEDDING L.F. 3,597.5 l ,Z8 4, 604.80 7 TRENCH EXCAVATION SAFETY SYSTEM L.F. 3,597.5 , 2. pool -3o 8 8" DIA. GRAVITY SEWER PIPE L.F. 539.0 5.1 g 9,5c6, 42 City of Spokane Valley 7 Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No: 10 -013 Race Rid fieherlifle R — Sanitnry Sewer Work Continued ITEM # ITEM DESCRIPTION UNITS QUANTITY PRICEIUNIT TOTAL 9 10" DIA. GRAVITY SEWER PIPE L.F. 1,627.0 2b,io 32 ,1S 10 12" DIA. GRAVITY SEWER PIPE L.F. 164.5 29, y i SS W , 33 11 EXTEND SIDE SEWER EACH 6.0 3 31 •6°7 I,9 W. 12 4" SIDE SEWER PIPE L.F. 717.0 12..x-15 g 1 q U".5 13 6" SIDE SEWER PIPE L.F. 550.0 ( 6 16 4 "A l 15 Z , oD 14 SIDE SEWER RISER 4 -INCH EACH 19.0 U 6 . Ss 2 Ii 15 , oZ 15 SIDE SEWER RISER 6 -INCH EACH 18.0 16 SIDE SEWER 8 "X 4" TEE EACH 4.0 17 SIDE SEWER 8 "X 6" TEE EACH 1.0 1 07 , 5 0 1 7 , S o 18 SIDE SEWER 10 "X 4" TEE EACH 13.0 135-38 1 1 - 7 61 .11 19 SIDE SEWER 10 11 X 6 TEE EACH 12.0 ( LA , 1'-1 l i $S'O.o `( 20 SIDE SEWER 12 "X 4" TEE EACH 2.0 8l < SO 3 63 ,00 21 12" SEWER CLEAN -OUT EACH 1.0 i 1 005 100 1 22 CONNECT DRY LINE EACH 12.0 C S, 00 Y H o , 00 23 DRY HOLE EACH 2.0 Li bd o0 C1 ZO , 00 Schedule B Total 1 O Z i g l. 5 5 Tax (8.7 %) Schedule B Total Incl. Tax Bid Summary Schedule Total Base Bid — Schedule A- Road Work (8(0,q4 i 3S Base Bid — Schedule B — Sanitary Sewer Work (incl. tax) i i t L5 Combined Total (� g g i 1 pCS, , So Person/Entity Name: 1 1 EZ LE Signature Of Bidder: Company: M.;S_M &a* i J C-- Date: City of Spokane Valley 8 Bid Proposal Documents Broadway Avenue Reconstruction Project Addendum 7 SVPW Bid No: 10 -013 CONTRACTOR'S ADNIINISTRATNE INFORMATION 1. PERSON/EN= a. Name as registered with the State of Washington: /�', �fl�"Ng b. Physical Address: /�� r LJ • A (� Aa -, 4 r 2►a µ y 144 GJ 4 1100 1 c. Mailing Address including zip code: P ly A4 9-,17 1 S f D " - ' 6 (" iq d. Remit To Address including zip code: 9 A.-� 0--0 e. Telephone number including area code: f. Fax number including area code: 5-0,9- g. E -mail address for business correspondence: /'K tM h. Washington State Contractors License Number: M J M i. Federal Tax Identification Number: , REDACTED j. Washington State UBI Number: k. State Industrial Account Identification Number: D to 1. City of Spokane Valley Business License Number: ��+77� U== mt mpfifi a L9-l`t 1 ft Bid, but mill be i� Pe—to Coattact= -di=) 2. INANCE `-'ON B . �; a. Name of company: t�iv� alli b. Mailing Address including zip code: g D / i c. Insurance Agent Name: - f v . d. Insurance Agent Telephone number including area code: e. Insurance Agent Fax number including area code: 3. BONDING COMPANY: �� ✓��,� a. Surety Name: b. Surety Mailing Address including zip - code t Name: c� � q - �.7 9 6�- � e. Bonding Agee 5,a� d. Bonding Agent Mailing Address including zip code: 1 V, all, 4 0 . e. Bonding Agent Telephone number including area code: 5 1 e & , f. Bonding Agent Fax number including area code: PersowEntity Name: J Sig Bidder. J� Company: 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 9 Bid Proposal Documents redacted or withheld documents pursuant to Spokane Valley SVPVJ Bid No: 10 -013 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) 2. The company has had experience comparable to that required under the proposed contract: a. As a prime contractor for years. b. As a subcontractor for Z 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 tQICK. VNNoEe.V&iLV Soy) Lf6 -66s4 ( l ,5 LL A DDISON V-6, GrRN'*2MF: aaiiNOs PAP—V— � '33 b ^ v 6�Q 5 K 1 e 'zoos S i N — Dpc�/CK MEIJC>E2 �So 1 � 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: Years of Name Title Experience L Q -rr+.) O o,J b'7 � s yt CA APIDb 40"0~gN Fo2c w�/�� 5. 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 fiunish a resume within 24 hours of notice by the City. 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. 0 h b. Claims or violations being filed by the Federal Government or the Washington State Departments of L & I, Employment Security or Revenue. K.) A- c. c. Liens being filed by suppliers or subcontractors. aJA Person/Entity Name Sol I��TZ l-G� Signature Of Bidder. Company: K &P - 6 00 , 1 N L Date: City of Spokane Valley 10 Bid Proposal Documents Broadway Avenue Reconstruction Project SVPW Bid No: 10 -013 ' Su b con tractor List IAP�sbtn n p 1P sora+osna a tvfdt RGYV�9:8QA6fl es ar�eriderl' a Bid Prn}�sal To Be Submit ed wim f ' _ d (� _ �o ,,� k vL N u �c ©� si ►� -�t-� Project NISMS - e eating, �rt and air wbo are proposed to perEorrn th work of t& as desctffied h' mapte 99. 8 ratture to 1{ at n ° teed in Chapter 9&106 FCl�tft and elec�toat diEtonit�, p� � "s one subcontractor to petkt the same word r t11E {tty p bid 6eit�9 non eoa ficw, or naming to void. . responsiv4 and'thdrefa t-'b 9, as ro osed to perforrA the work of bead n9, ver'iatior� mid air Eonci�t , p U1 BubOontrao") that are p p be L+-d below: 1�eixork described In draptet' 18.7 06 kOV4, and eleCt#tc ��natne. 'file requtremeiit td � tho p" o4n � er's to perfor+x►ed iq tq be wed below the sut�ca oni ro osed WAt3, phtmbMA, aand proposed WAC, p[ut thing pct eteofrtc* the p ma eeottirattt bidder , subt WO-ths btd to the pt�lio end aubgontt6ct0r? Who wi E°a� d'tr subc*nfia+ator If no subcont�m*r is ffsted betow, t#te bidder a*wMedt� t It does not tuna t use a* to perform those items of worst _ ttnft aciior• Name �loritinbe[?er€flrnr+ad All electrical: work associated with th project Bubc Subcn€radgr Name :- WA to be Perforated Subcon#rtctbr Nafhe WA to be Performed �ubco€rtfa�rl�g • .. ' Wdrk to be Perfflettaed W'DrX tP i?e PerNrM?d PVC OT metal condWt, j�tticgOn b e—% 80, or--- . Biddeea are noted #fiatic 06 apin#o13 of the eAftwm- entsflenc d ieot ca4 co *ac�,� even If the bst�ta0on Is f4t cottsid [ed e�ecttR eQ mg m id incest be Wt" by-# we aF eider cu 661 b e d duchy the pr-o� d {ire use aftd too wing ' rloF'rrx iha vYOrit. A aoensed eter�toa1 o4�`adcr must sae va bd to Pe DGT n5 a EF 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(l)(b), or 82.32.070(1)(b) 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: 14 J_K4 Person/entity submitting bid (pr nt) Signature: Title: Date: C City of Spokane Valley 14 Bid Proposal Documents Broadway Avenue Reconstruction Project SVPW Bid No: 10 -013 BID DEPOSIT FORM OF BID DEPOSIT - CHECK ONE: Please submit this sheet with the bid deposit. ,u,4 2 5 2010 CASK. Attach the deposit behind this sheet. CIT( OF gpOKANF- VA' -Le`f SURETY BOND - Attach bid bond behind this sheet. IT IS S?RONGLYREC0 t1EIENDED MAT YOU USE THE ATTACHED FORM. BID DEPOSIT REQUIRED. No bid may be considered for public work unless it's 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. If the City's Bid Surety Bond Form is not used, does not materially the bidder is qualify or warned to take special care in assuring 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 b 5 ��i Z L Signature Of Bidder: <7� Company: l✓1 P� C5'-I� lam' �J ! L Date: 12 Bid Proposal Documents City of Spokane Valley SVPW Bid No: 10 -013 Broadway Avenue Reconstruction Project CERTIFICATE OF LIABILITY INSURANCE OP ID CS DATE(MM/DD/YYYY) 07/1 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 po Icy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Inland Insurance Inc AIC No, Ext : (A/C, No): 9016 E Indiana Ave., Suite A ADDRESS: Spokane Valley WA 99212 CUSTOMER ID #: MJMGR -1 Phone:509- 456 -2648 Fax:509- 456 -3432 INSURER(S) AFFORDING COVERAGE NAIL# INSURED INSURERA: Continental Western MOM Grand Inc. Wes t Plains Leasing INSURER B: North Pacific 23892 Wes PO BOX 9277 INSURER C: RSUI Indemnity Co, 22314 Spokane WA 99209 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 ,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR 2435575 04/30/10 04/30/11 PREMISES (Ea occurrence) $250,000 MED EXP (Any one person) $5,000 X EMPLOYERS LIAB X X PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PR O LOC PRODUCTS - COMP /OP AGG s2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS C01 173829 04/30/10 04/30/11 COMBINED SINGLE LIMIT $ 1,000,000 X BODIL Y INJURY BODILY (Per person) $ SCHEDULED AUTOS X X BODILY INJURY (Per accident) $ X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS $ C UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X X NHA225887 04/30/10 04/30/11 EACH OCCURRENCE � Ii;2,000,000 $ 2,000, 0 0 0 AGGREGATE DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNERtEXECUTI OFFICERIMEMBER EXCLUDED? (Mandatory in NH) U yes, describe under DESCRIPTION under OPERATIONS below /A - 24 - 3 - 557 5 WASHINGTON STOP GAP 04/30/10 04/30/11 WC STA TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 T- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) RE: BROADWAY AVENUE PROJECT ADDITIONAL INSURED STATUS IS GRANTED TO THE CITY OF SPOKANE VALLEY, SPOKANE COUNTY STATE OF WASHINGTON AND VERA WATER AND POWER AS RESPECTS OPERATIONS OF THE NAMED INSURED AS REQUIRED BY CONTRACT 30 DAY WRITTEN NOTICE OF CANCELLATION APPLIES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SPOK147 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SPOKANE VALLEY 11707 E SPRAGUE, STE 106 SPOKANE VALLEY WA 99206 d..v-�, .rim Dinned President ©1988 -2009 ACORD CORPORATION. All rights resprvarl ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS (b) That is Fire, Lightning, Explosion or If SECTION I — COVERAGE C MEDICAL PAY- Sprinkler Leakage insurance for prem- MENTS is not otherwise excluded from this ises rented to you or temporarily occu- Coverage Part: pied by you with the permission of the owner; 1. The Medical Expense Limit provided by this 4. Paragraph 9.2. of SECTION V — DEFINI- policy, subject to the terms of SECTION III - TIONS is deleted and re laced b the follow - LIMITS OF INSURANCE, shall be the p y greater of: ing: a. $10,000; or b. The Medical Expense Limit shown in the ' Declarations of this Coverage Part. B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND SPRINKLER LEAKAGE DAMAGE TO PREM- ISES YOU RENT If damage to premises rented to you under Cov- erage A. is not otherwise excluded from this pol- icy, the following applies: 1. The last paragraph of SECTION I — COV- ERAGE A.2. Exclusions is deleted and re- placed by the following: Exclusions c, through n. do not apply to damage by fire; lightning, explosion or sprin- kler to premises while rented to your or temporarily occupied by'you with permis- sion of the owner. A separate limit of insur- ance applies to' this. cbV6r6be as described in SECTION III _ LIMITS OF INSURANCE. 2. Paragraph 6. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to 5. above, the greater of a. $300,000; or b. the Damage To Premises Rented To You Limit shown in the Declara- tions; Is the most we will pay under COVER - AGE'A for damages because of `prop - ei ly damage" to any one premises, while tented to you, or temporarily occupied by you with the permission of the owner arising out 'of anyone fire, lightning, ex- plosion or sprinkler leakage incident. 3. Paragraph 4.b.(1)(b) Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and re- placed by the following: CL CG 00 20 03 07 a. A contract for a tease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or sprinkler leakage,to premises while rented to you or temporarily occupied by you with permission of the owner is not an - in- sured contract "; C. NON -OWNED WATERCRAFT 1. Paragraph g.(21 of SECTION I — COVER- AGE A.2. , Exclusions is deleted and re- placed by the following: A- watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not.used to carry persons or property for a charge. D. SUPPLEMENTARY PAYMENTS SECTION .1 —.SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as fol- lows: 1. The limit of Insurance In paragraph I.P. is increased from $250 to $2,500; and 2. The limit ' of insurance in paragraph 1.d. is increased from $250 to $500. E. AUTOMATIC ADDITIONAL INSURED — SPEOFIEtYREtATIONSHIPS The following is added to. Paragr 2. of SEC- TION 11= WHO IS AN INSURED: e. Any person or organization described in paragraph f. below; whom you and such per- son or organization have agreed in writing in a •contract or agreement that such person or organization be added as an additional in- sured on your policy. Includes copyrighted material of Ins urance Services Otrce, Inc., with Its permission Page 1 of 6 Such person or organization is an insured provided: (1) The written or oral contract or agree- ment is: (a) Currently in effect or becomes effec- live during the policy period: and (b) Executed prior to an "occurrence" or offense to which this insurance would apply. (2) They are not specifically designated as an additional insured under any other provision of, or endorsement added lo, this policy. f. Only the following persons or organizations are additional insureds under this endorse- ment, and coverage provided to such addi- tional insureds is limited as provided herein: (1) The manager or lessor of a premise leased to You, but only with respect to li- ability arising from the ownership, main- tenance or use of that part of the prem- ises leased to you and subject to the fol- lowing additional exclusions: This insurance does not apply to: (a) Any "occurrence" which takes place after You cease to be a tenant of that premises. (b)_Structural . alterations, new construc- tion or 'demolition `operations per- formed by"or on behatf of the man- ager or lessor. (2) Any person 'or organiiation from whom you lease equipment, but only with re- spect to liability for "bodily injury", "prop- erty damage" or "personal and advertis- ing injury" caused, in whole or In part, by your maintenance, 'operation or use of equipri int' leased to you by such per- sons) tar orgarization(s). However, this insurance does not apply to any "occurrence" which takes place after the egyipmerit lease expires. (3) _Any'state of political subdivision, subject to the following additional provision: This insurance applies only with respect to the' following •hazards t'or ,which the state or political. subdivision has issiied a permit in connection With premises you 0v hr .rent or : control and to which this in- surance applies: (a) The.existence i ' maintenance, repair, ronstruction, erection or "removal of advertising signs, awnings, cano- Ai ceAar enhances., coal holes, driveways, r a' Moles, marquees, hoist ' away openings, sidewalk vaults, street banners, or decora- tions and similar exposures; or (b) The construction, erection, or re- moval of elevators; or (c) The ownership, mainlenance, or use of any elevators. F. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writ- ing in a contract or agreement that such per- son or organization be added as an addi- tional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and adver- tising injury" caused, in whole'.or in part, by. a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for the additional insured. A person's or organization's status as an ad- ditional insured under this policy ends when your operations for that additional 'insured are completed. 2. With respect . to the . insurance . afforded to these additional insureds, the following addi- tional exclusions apply: This insurance does apply to: •a. "Bodily injury', ".property ` damage" or 'personal and advertising injury" arising out of- the rendering of, oe tfhie failure to render, any professional architectural, engineenng or surveying services, in- cluding: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw- ings and specificatioris,'or (2) Supervisory, inspection, architec- tural or'engineering activities. b. "Bodily injury" or "property damage" occurring after. (1) All work, including materials, parts or equipment furnished in connec- tion with such work, 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 opera- tions has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been out to t intended use by Any person, or or other than another contractor or subcon- tractor engaged in performing op- erations for a principal as a part of the same project. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services page 2 of 6 Office, Inc., with its permission 3. The insurance provided by this endorsement is insurance c. We may pay any part or rll of the le- primary and we will not seek contribution under any insurance policy un- ductible amount to effect settlement of der which such additional insured is a insured, any claim or suit and, upon notification of the action taken; you shall promptly named if such policy was procured and paid for by such additional insured, reimburse us for such part of the de- or a parent or related entity of such additional in- ductible amount as we have paid, sured. H. BROADENED NAMED INSURED 4. With respect to the insurance afforded to Paragraph 3. of SECTION II - WHO IS AN IN- these additional insureds, SECTION III — SURED is deleted and replaced by the following: LIMITS OF INSURANCE is amended as fol- lows: Any organization, other than a joint venture, over which you maintain ownership or majority inter - The limits applicable to the additional in- est of more than 50% will be a Named Insured if sured are those specified in the written con- there is no other similar insurance available to tract or agreement or the limits stated in the that organization. However: Declarations, whichever is less. If no limits are specified in the written contract or agreement, a. Coverage under this provision is afforded only until the 180th day after you acquire the limits applicable to the addi- tional insured are those specified in the Dec- or form the organization or the end of the policy on. The limits of insurance are intro- period, whichever is earlier. save a sive of and not in addition to the limits of in- surance shown in the Declarations. b. COVERAGE A does;not apply to "bodil in- jury" " y or property damage" that occurred be- G. PROPERTY DAMAGE TO BORROWED fore you acquired or formed the organiza- tion: EQUIPMENT 1. Paragraph 2J of SECTION 1 - COVER- C. COVERAGE B does not apply to "personal and advertising injury' arising out of an of- AGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is fense committed before you acquired or formed the organization. amended as follows: Paragraphs (3) and (4) of this exclusion do 1. CONSTRUCTION PROJECT GENERAL AG- GREGATE LIMIT not apply to tools or equipment .loaned to you, provided they are not. being used to per- form operations at the time of loss. 1. For all sums 'which the insured becomes legally obligated to pay as damages caused 2. SECTION III - LIMITS OF INSURANCE is by.. "occurrences" under COVERAGE A (SECTION i) and for all medical expenses deleted and re'plaeed by the following: caused.. by accidents under COVERAGE C The most we will pay in an one "occur- • renee" for 'property dams borrowed (SECTION I), which can be attributed only to ongoing operations at a single construction a to equipment is $15,000. This limit of owed Project away. from premises owned by or rented to the insured: ante � is the most we will pay regardless of the number of. a. A Single. -Construction Project General a. Insureds; Aggregate , Limit applies to each con- struction r ect away from premises b. Claims made or "suits" brought; or owned by or rented to the insured; and c. Persons or organizations making claims "suits that limit is equal to. the amount of the General Aggregate Limit shown in the or bringing ". Declarations. 3. Deductible b. The Single Construction Project General a. Our obligation to Day damages on behalf Aggregate Limit is the most we wilt pay of the insured applies only to the amount for the sum of all damages under COW of damages in excess of $250 as appy- ERAGE A, except damages because of `bodily cable to property dama e" a' the result of any one "occurrence, regardless injurry�r or "property damage" in- eluded in tf�e 'products- completed op- of the number of persons or organizations erations hazard ", -and for medical ex- who sustain damages because of that perises under COVERAGE.0 regardless' "occurrence ". of life number of: b. The terms of this insurance, including ( Insureds; those with respect to our right and duty (2) Claims made or "suits" brought; or to defend the insured against any "suits" seeking those damages; and your duties (3) Persons or organizations making in the event of an "occurrence ", claim, or claims or bringing "suits ". "suit" apply irrespective of the application of the deductible amount. CL CG 00 20 03 07 Includes copyrighted material of Ins urance Services Page 3 of 6 Office, Inc., with its permission c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Ag- gregate Limit for that construction pro- ject away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construc- tion Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. 2. For, all sums which the insured becomes legally obligated to pay as damages caused by - occurrences" under COVERAGE A (SECTION 1), and for all medical expenses caused by. accidents under COVERAGE C (SECTION 1), which. cannot be attributed only to ongoing operations at'a single desig- nated construction project away from prem- ises owned by or rented to the Insured: J. KNOWLEDGE OF OCCURRE14CE The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. A report �of an "occurrence ", offense, claim or "suit" to: a. An y a ents made under, COVERAGE K. .p ym A for damages or tinder COVERAGE C for'medical expenses 'shall reduce the amount available _under the' General Ag- gregate Limit'o� tFie Products - Completed Operations Aggregate' Limit, whichever is applicable: and b. Such payments shall not reduce any Single Construction Project General Ag- gregate Limit. 3. When coverage for liability arising out of the `products - completed operations hazard" is provided, any payments for damages be- cause of `bodily injury" or,'property damage" included in the `products - completed opera- tions hazard" will reduce the Products - Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Single Construction Project General Ag- gregate Limit. 4. If the applicable construction project away from premises owned by.or rented to the in- sured has been abandoned, delayed, or abandoned and then restarted, or if the au- thorized. contracting parties° deviate from Plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. S. The provisions bf Limits Of Insurance (SECTION 111) not otherwise modified by this endorsement shall continue to apply as stipulated. L. (1) You, if you are an individual, (2) A partner, 9 you are a partnership, (3) An executive officer, if you are a corporation, or (4) A manager, if you are a limited liability company; is considered knowledge and requires you to notify us of the "occurrence ", offense, claim, or 'suit* as soon as practicable. f. We are considered' on ' notice of an `occurrence ", offense, claim or 'suit" that is reported to your Workers' Compensation insurer for an event which later develops into an 'occurrence ", offense, claim or `suit" for which there is coverage, under this policy. However, we will only be considered on notice if you notify us as soon as you know the claim should be addressed by this policy rather than your Workers' Compensation policy. UNINTENTIONAL OMISSIONS The following is added to paragraph 6. Repre- sentations . of SECTION . IV :- COMMERCIAL GENERAL LIABILITY CONDITIONS: d. If you unintentionally fail to disclose any ex- posures ;existing at the inception, date of your policy; we will not deny ;coverage under this Coverage,Part solely beeause'of such failure to disclose. However, this provision does not affect our right to collect additional pre- mium or exercise our right of cancellation or non - renewal. This provision does hot apply to any known injury or ' 8amaoe which is excluded under any other provision of this policy. MENTAL ANGUISH Paragraph 3. of SECTION V - DEFINITIONS is deleted and replaced by the following: 3. `Bodily injury", means bodily injury, sickness or disease: sustained by a person, including mental anguish or death resulting from any of these et any time. M. WAIVER OF TRANSFER OF RIGHTS OF RE- COVERY AGAINST OTHERS Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of SECTION IV - COM- MERCIAL GENERAL LIABILITY CONDITIONS is amended by the addition of the following: CL CG 00 20 03 07 Includes 'copyrighted material of Insurance Services Page 4 of 6 office, Ini., with its permission We waive any right of recovery we may have be- cause of payments we make for injury or dam- the premises, site or loca- tion in connection with such age arising out of your ongoing operations or operations by such insured, your work" done under a contract requiring such contractor or subcontractor, waiver with that person or organization and in- cluded in the "products- completed operations Subparagraph (b) does not hazard ", apply to "bodily injury" or However, our rights may only be waived prior to "occurrence" •'property damage" arising out of heat, smoke or fumes the giving rise to the injury or dam- from a "hostile fire ". age for which we make payment under this Cov- erage Part. The insured must do nothing after a (2) Any loss, cost or expense aris- loss to impair our rights. At our request, the in- ing out of any: sured will bring "suit" or transfer those rights to us and help us enforce those rights. (a) Request, demand, order or N. LIMITED JOB SITE POLLUTION statutory or regulatory re- quirement issued or made 1. Exclusion f. under Section I — Coverage A is replaced by the following: pursuant ..to any , environ- mental protection or envi- ronmental liability statutes or 2. Exclusions regulations that any insured This insurance does not apply lo: test for, monitor, clean up, remove, contain, treat, de- f. Pollution toxify or neutralize, or in any way respond to, or assess (1) "Bodily injury" or "property dam- the effects of, "pollutants "; age arising out of the actual, al- or leged or threatened discharge, dispersal, seepage, migration, n bee Claim or suit by or on (b) behalf release or escape of pollut- of a governmental authority ants ": for damages because o tes (a) Al or from any premises, for, monitoring, cleaning up, removing, con - site or location on which any taining, treating, detoxifying insured or any contractors or neutralizing or in anyway or subcontractors working responding to or assessing directly or indirectly on any the effects of, 'pollutants ". insured's behalf are per- forming operationsrf the However, this paragraph does operations are to test for, not apply to liability for those monitor, clean up, remove, sums the insured becomes le- contain, treat, detoxify gally obligated to pay as dam - neutralize, or in any way re- - ages because - of "property dam - or assess the ef- age" that the insured would seas of, , " ecis "pollutants`; or have in the absence of such re- quest, demand, order or statu- (b) Al or from a storage tank or tory or regulatory requirement, other container, ducts or or such claim or "suit" by or on piping which is below or par- behalf of a governmental author - tiaily below the surface of ity. the ground or water or which, at anytime, has been 2, With respect to "bodily injury" or "property buried under the surface of damage" arising out of the actual, alleged or the ground or water and threatened discharge, dispersal, seepage, then subsequently exposed migration, release or escape of "pollutants ": by erosion, excavation or a. The "Each Occurrence Limit" shown in any other means if the ac- the Declarations does not apply. tual, alleged or threatened discharge, dispersal, seep- b. Paragraph 7, of Limits Of Insurance age, migration, release or .(Section 111) does not appy. escape of "pollutants" arises at or from any premises, site c. Paragraph 1. of Section III — Limits Of or location which any in- Insurance is replaced by the following: sured or any contractors or The Limits Of Insurance shown in this subcontractors working di- endorsement, or in the Declarations and rectly or indirectly on any in- the rules below fix the most we will pay sured's behalf are perform- regardless of the number of: ing operations if the "pollut- ants" are brought on or to (1) Insureds; CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 5 of 6 Office, Inc., with its permission _ (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits ". d. The following are added to Section III -- Limits Of Insurance: 8. Subject to 2. or 3. above, whichever applies, the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Cover- age C because of "bodily injury' or "prop- erty damage" arising out of the ac- tual, alleged or threatened dis- charge, dispersal, seepage, migra- lion, release or escape of "pollut- ants" is $100,000. 9. Subject to 8. above, the Medical Expense Limit is the most we will pay under Coverage C for all medi- cal expenses because of "bodily in- jury" sustained by any one person arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or es- cape of "pollutants ". 0. OTHER INSURANCE If this policy includes a Coverage Form or an Endorsement which provides coverage for loss or damage covered by one or more of the Ex- tensions of this endorsement, the limit and the coverage provided by this endorsement are de- leted and .replaced by the limit and coverage provided by that Coverage Form oi: Endorse- ment. m CL CG 00 20 03 07 Includes copyrighted material of Ins urance Services Office, Inc., with Its permission Page 6 of 6 CONTRACTOR'S PERFORMANCE AND PAYMENT BOND TO DUAL OBLIGEES KNOW ALL MEN BY THESE PRESENTS, that MJM Grand, Inc. Travelers Casualty and Surety Company of America (Bonding Con penny), as Surety, acorporetion o f Connecticut _ whose principal office is located at 707 W. Main St., Suite 300, Spokane, WA 99201 . are firmly bound unto the State of Washington and the City of Spokane Valley, a political subdivision the Stave of Washington, as Obligees, to fulfill the obligations of the Principal and the Surety under the Contract to which reference is hereafter One Million - Two Hundred Ninety -Eight Thousand Three Hundred Twenty and 28/100 made, in the amount Of $ 1,298,320.28/100--------- - - - - -- (including Washington State sales tax) for paymeatt whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns jointly and sevesaily, fire ly by these presents. WHEREAS, principal has by , written proposal slated June 25, 2010 offered to enter into a contract with the City of Spokane Valley for Contact N o . SVWP10 -013 pursuant to the terns and conditions set forth in the GontradDocumnentadated July 13, 201 NOW, TEIE EMIRE, the condition of this obligation is such that if the Principal shall faithfully perturm all the provisions ofthe 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 any of 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 wank provided for in the Contract stmall have a direct right of ae ion under this bond, to the Went and in the manner set forth in RCW 39.48. The said Surety for value received hereby sVnlates and agrees that no change, extension of time, alteration or additiaa to the terms of the Contract or to the WORK to be performed thereunder or the SPBCIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such dmge, extesmsion oftime, alteration or addition to the terms of the Contract or to the WORK or to the SPECIFICATIONS, BOND NO: 105455720 (Contractor), as Principal, and No final settlement between the OWNER and the CONTRACTOR shall abridge the right of any bemteficimy hereunder, whose claim may be unsatisfied SIGNED AND3rwkUD TMS 13th DAY OF July YEAR 20 . Travelers C- Ssualtj and Surety Copqpany of America SURETY Slgrtature John reen lwedwalme Attorney -in -Fact Title (SEAL) MJM Grand, Inc /O ..r�� . . a •-T / Title 15 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. 221321 Certificate No. 003 708582 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 James P. Dinneen, John L. Green, Karen Fournier, and Jill Schilb of the City of Spokane , State of Wasbingtun , 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 acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 8th day of June 2010 Ay Farmington Casualty Company t „,_ _ St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance = Company r 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 GASU,/ qP••• F \ftE 6�b. `* N IN . +•' ,""�....q y Jp �tY 4ryQ yma.. RYI•._ <r CTV'��pgp� J � 'y"� 0. �......• 9 ..... ...... 9` g 8 ,� ^�Y �FY• .�•O j O V'F: R L P'. r - � '1 % Q' ' f s4:' '_ CP G Sa •t p� � A � ��DARORATED 9� eVc°q P°R4 >FS �e' 0.PORAT' p� � � ' y t 9 8 2 O SG 0 - ;i9� 1951 3 �` SE AL;os L,; o: W CONH. ° ;ttnR?Fg•AO e a 1896 � s S EAL • . D �y . �� d � ffin ��m1N�m E � Sv..,A..N• -'J 1S ....... �e� b1 �H • � '!/ �ttt`. State of Connecticut City of Hartford ss. By: Georg Thompson, enJ.— ce President On this the 8th day of June 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. G•T!7 n A , 1. �1 In Witness Whereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2011. � 'OUBU� Tk Mane C. Tetreault, Notary Public �s 58440 -4 -09 Printed in U.S.A. OF WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors 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, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kori M. Johanson, the undersigned, Assistant Secretary, 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 do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force'and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 13 th day of Kori M. Johans Assistant Secretary 20 M. G�SU,F � FIFE QNtlny * N IN$ • j INS�"w•. �FY AN w�� Y �1 J ® 0* SEALi E °F � i� ni,„o m dA� 1 $ N AFB f i f •....... •�a � bl I,N ♦ •� "' // �ttt To verify the authenticity of this Power of Attorney, call 1- 800 - 421 -3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the above -named individuals and the details of the bond to which the power is attached. nuuuumy euor �u o�u uem oo. w�ui mr aureame n Engineer's Estimate MJM Grand Inc. Eller Corporation Spokane Rock Products Red Diamond Constr. Inc. SCHEDULE $1878770.00 $1,106584.13 $1208,929.15 $1,271,603.87 $1293918.45 B - I r D 287722.94 $111756.16 $136100.58 $139633.98 $164770.33 MINNEW _ 2'+1�6 - - @ . . nuuuumy euor �u o�u uem oo. w�ui mr aureame n Rte CERTIFICATE OF LIABILITY INSURANCE OP ID CS DATE(MM /DD/YYYY) 07/06/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Inland Insurance Inc. 9016 E Indiana Ave., Suite A Spokane Valley WA 99212 Phone:509- 456 -2648 Fax:509- 456 -3432 NAME: PHONE :AX A/C, No, Ext : (A/C, No): ADDRESS: CUSTOMERID #: MJMGR - 1 INSURER(S) AFFORDING COVERAGE NAIC# INSURED MJM Grand, Inc. West Plains Leasing PO Box 9277 Spokane WA 99209 INSURERA: Continental Western GENERAL LIABILITY INSURER B: North Pacific 23892 INSURER C: RSUI Indemnity Co. 22314 INSURER D: EACH OCCURRENCE INSURER E: PREMISES(Eaoccurrence) INSURER F: A rnVFRAr:FA CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) (MM /DD/YYYY) LIMITS Jim DinneeN President GENERAL LIABILITY EACH OCCURRENCE $1,000,000 PREMISES(Eaoccurrence) $250,000 A X COMMERCIAL GENERAL LIABILITY 2435575 04/30/10 04/30/11 MED EXP (Any one person) $5, CLAIMS -MADE F_x1 OCCUR PERSONAL & ADV INJURY $1,000,000 X EMPLOYERS LIAR X GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG s2,000,000 $ POLICY X JE � LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1 000 000 r r B ANY AUTO C01 173829 04/30/10 04/30/11 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS X PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS X $ n C UMBRELLA LIAB X OCCUR NHA225887 04/30/10 04/30/11 EACH OCCURRENCE s2,000,0 AGGREGATE s2,000,000 EXCESS LIAB CLAIMS -MADE X DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVr[ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) / A TORY LIMITS ER _ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below F7 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: BROADWAY AVENUE PROJECT THE REQUIREDSBYKCONTRACT VALLEY AS RESPECTS OPERATIONS S TA T US I rFRTIFIreTF Wnl nFR CANCELLATION U l`JtStS-YUUy AI.VKU VVRf"V RAI IVrV. NII fIl�11W IC.7t:1YCU. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SPOK147 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SPOKANE VALLEY AUTHORIZED REPRESENTATIVE 11707 E SPRAGUE, STE 106 SPOKANE VALLEY WA 99206 Jim DinneeN President U l`JtStS-YUUy AI.VKU VVRf"V RAI IVrV. NII fIl�11W IC.7t:1YCU. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 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. x ACORD 25 (2001108) II4S025 (010$).08a Page 2 of 2 1 H15 tNDURStMtN I UIiANULb I Ht NULIC;Y. HLtAbt HEAD 11 UAKtI-ULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS (b) That is Fire, Lightning, Explosion or If SECTION I — COVERAGE C MEDICAL PAY- Sprinkler Leakage insurance for prem- MENTS is not otherwise excluded from this ices rented to you or temporarily occu- Coverage Part: pied by you with the permission of the owner; 1. The Medical Expense Limit provided by this q paragraph 9.a. of SECTION V — DEFINI- policy, subject to the terms of SECTION III - TIONS is deleted and replaced by the follow - LIMITS OF INSURANCE, shall be the greater of: ing: a. $10,000; or b. The Medical Expense Limit shown in the 'Declarations of this Coverage Part. B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND SPRINKLER LEAKAGE DAMAGE TO PREM- ISES YOU RENT If damage to premises rented to you under Cov- erage A: is not otherwise excluded from this pol- icy, the following applies: 1. The last paragraph of SECTION I — COV- ERAGE A.2. Exclusions is deleted and re- placed by the following: Exclusions c. through n.. do not apply to damage by fire; lightning, explosion or sprin- kler leakage to premises while rented to your or temporarily occupied by•you with permis- sion of the owner. A separate limit of insur- ance applies to this coverage as described in SECTION 1.11= LIMITS OF INSURANCE. 2. Paragraph. 6. of. SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to 5. above, the greater of a. $300,000; or b. the Damage To Premises Rented To You Limit shown in the Declara- tions', is the most -we will pay under COVER - AGE A for damages because of "prop - erry damage" to any one premises, while rented to you, or temporarily occupied by you with the permission of the owner arising out`of an 'one fire, lightning, ex- plosion or sprinkler leakage incident. 3. Paragraph 4.b.(1)(b) Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and re- placed by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "in- sured contract "; C. NON -OWNED WATERCRAFT 1. Paragraph g.(2). of SECTION I — COVER- AGE A.2.. Exclusions is deleted and re- placed 6y the' following: A uvatercraft you do not own that is: (a) Less than 51 feet long; and (b) Not.used to carry persons or property for a charge. D. SUPPLEMENTARY PAYMENTS SECTION_.1 — . SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as fol- lows: 1. The limit of insurance in paragraph I.P. is increased from $250 to $2,500; and 2. The limit'of insurance in paragraph 1.d. is increased from $250 to $500. E. AUTOMATIC ADDITIONAL INSURED - SPECIFIED: RELATIONSHIPS The following is added to Paragraph 2. of SEC- TION 11= WHO IS AN INSURED: e. Any person or organization described in paragraph f. below; whom you and such per- son or organization have agreed in writing in a contract or agreement that such person or organization be . added as an additional in- sured on your policy. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 1 of 6 Office, Inc., with Its permission z�>ucn peisun or oroanizauon is an insureo (c) I he ownership, maintenance, or use provided: of any elevators. (1) The written or oral contract or agree- F. ADDITIONAL INSURED - OWNERS, LESSEES ment is: OR CONTRACTORS - AUTOMATIC STATUS (a) Currently in effect or becomes effec- 1. SECTION II - WHO IS AN INSURED is live during the policy period; and amended to include as an additional insured (b) Executed prior to an "occurrence" or any person or organization for whom you are offense to which this insurance performing operations when you and such would apply. person or organization have agreed in writ- ing in a contract or agreement that such per - (2) They are not specifically designated as son or organization be added as an addi- an additional insured under any other tional insured on your policy. Such person or provision of, or endorsement added to, organization is an additional insured only this policy, with respect to liability for "bodily injury", Only the following persons or organizations "property damage" or "personal and adver- are additional insureds under this endorse- tisin-g injury" caused, in whote.or in part, by. ment, and coverage provided to such addi a. Your acts or omissions; or tional insureds is limited as provided herein: b. The acts or omissions of those acting on (1) The manager or lessor of a premise your behalf; leased to You, but only with respect to li- ability arising from the ownership, main- in the performance of your ongoing opera - tenance or use of that part of the prem- lions for the additional insured. 'ise's leased to you and subject to the fol- lowing additional exclusions: A person's or organizalion's status as an ad- ditional insured under this policy ends when This insurance does not apply to: your operations for that additional insured (a) Any "occurrence" which takes place are completed. after You cease to be a tenant of that 2. With respect to the insurance. afforded to premises. these additional insureds, the following addi- (b)�Structu ral. alterations, new construc- tional exclusions apply: Lion or .demolition 'operations per- This insurance_does apply to: formed by or on behalf of the man- ages or lessor. ,..: " a. Bodily injury ", .property damage or (2) Any person or organization from whom `personal and advertising ih1'ury" arising out of the rendering of, or tFie failure to you lease equipment, but only with re- render, any professional architectural, spect to liability for "bodily. injury", "prop= eity damage` or "personal and advertis- engineering or surveying services, in- dudi.ng ; Ing injury' caused; in whole or in part, by your. maintenance; operation . or use of ,.g 9. g 1 The re `. or failing O prep h , approv equipment leased to you by such per- sons) or organization(s): to.. prepare or approve, maps, shop drawings, opinions, reports, surveys, 'orders, However, this insurance does. not apply "occurrence` field change orders or draw- ings and 5peci lcatioris;'or to any which takes place after t#te equipment lease expires. (2) Supervisery, inspection, architec- (3) Any state or political subdivision, subject tural or engineering activities. to the following additional provision: b. "Bodily injury' or' "property damage" This insurance applies onl with respect to the' following : hazards for occurring. after: work. .'Which the (1). All including materials, parts state orpoliticat: subdivision has issued a or equipment furnished in connec- permit in connection with premises you tion with such work, , on the project own, -cent or and to which this in- (other than service,, maintenance or surance applies: repairs) to be performed by or on (a) The existence; maintenance, repair, behalf . of the additional insured(s) at 66nstruc(on, erection, or removal of the location of the covered opera- advertising signs, awnings, cano- lions has been completed; or pi s; cellar entrances, coal holes, (2) That portion of "your work" out of driveways, manholes, marquees, ' which the injury or damage arises hoist away openings, sidewalk has been out to. it intended use by vaults, street banners, or decora- any person. or organization other tions and similar exposures; or than another contractor or subcon- (b) The construction, erection, or re- tractor engaged in performing op- moval of elevators; or erations for a principal as a part of the same project. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 2 of 6 office, Inc., with its permission 3. The insurance provided by this endorsement c. We may pay any part or all of the de- is primary insurance and we will not seek -- contribution under any insurance policy un- ductible amount to effect settlement of der which such additional insured is a any claim or suit and, upon notification of the action taken; you shall promptly named insured, if such policy was procured reimburse us for such part of the de- and paid for by such additional insured, or a ductible amount as we have paid. parent or related entity of such additional in- sured. H. BROADENED NAMED INSURED 4. With respect to the insurance afforded to Paragraph 3. of SECTION II - WHO IS AN IN- these additional insureds, SECTION III — SURED is deleted and replaced by the following: LIMITS OF INSURANCE is amended as fol- lows: Any organization, other than a joint venture, over which you maintain ownership or majority inter - The limits applicable to the additional in- est of more than 50% will be a Named Insured if sured are those specified in the written con- there is no other similar insurance available to tract or agreement or the limits stated in the that organization. However: Declarations, whichever is less. If no limits a. Coverage under this provision is afforded are specified in the written contract or only until the 180th day after you acquire or agreement, the limits applicable to the addi- form the organization or the end of the policy tional insured are those specified in .the Dec - period, whichever is earlier. larations. The limits of insurance are inclu- sive of and not in addition to the limits of in- b. COVERAGE A does:not apply to "bodiy n- l i surance shown in the Declarations, " jury" or property damage" that occurred be- fore you acquired or formed the organiza- G. PROPERTY DAMAGE TO BORROWED lion: EQUIPMENT c. COVERAGE B does not apply to "personal 1. Paragraph 2 -L of SECTION I - COVER- and advertising injury' arising out of an of- AGES, COVERAGE A BODILY INJURY tense committed before you acquired or AND PROPERTY DAMAGE LIABILITY is formed the organization. amended as follows: I. CONSTRUCTION PROJECT GENERAL AG- Paragraphs (3) and (4) of this exclusion do GREGATE LIMIT not apply, to tools or equipment loaned to you, provided they are not, being used to per- Corm operations at the time of loss. 1. For all sums 'which the insured becomes legally obligated. to pay as damages caused by.. occurrences under COVERAGE A 2. SECTION III - LIMITS OF INSURANCE is (SECTION I) and for all medical expenses deleted and replaced by the following: caused.. by.accidents under COVERAGE C The most we will 'pay in any one 'occur- 'property (SECTION'[). which can -be attributed only to ongoing operations at a single construction rence" for damage , to borrowed Equipment is $1500. This limit of insur- project away. from premises owned by or rented to the insured: ance ; is the most we will pay regardless of the number of. a. A Single. Construction. Project General a. Insureds; Aggregate Limit applies to each Ion- struction project away from premises b. Claims made or "suits" brought; or owned by or rented to the insured; and that limit is equal to, the amount of the C. Persons or organizations making claims General Aggregate 'Limit shown in the or bringing 'suds ". Declarations. 3. Deductible b. The Construction Project General a. Our obligation.to.pay damages on behalf Aggregate Limit is the most we will pay of the insured applies only to the amount for.the sum of all damages under COV- of damages in excess of $250 as appy- ERAGE except damages because of `bodily cable to property damage" as the result injury" or "property damage" in- chided in the ine "occurrence", , regardless of of any one f persons or organizations the number o ' products- completed op- erations hazard "; and for medical` ex- who sustain damages because of that penses under COVERAGE .0 regardless ` occurrence.. of the number of: b. The terms of this insurance, including (1) Insureds; those with respect to our right and duty (2) Claims made or 'suits' brought; or to defend the insured against any "suits" seeking those damages; and your duties (3) Persons or organizations making in the event of an `occurrence ", claim, or claims or bringing `suits ". suit apply irrespective of the application Of the deductible amount. CL CG 00 20 03 07 Includes copyrighted material of Ins urance Services Page 3 of 6 Office. Inc., with its permission c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Ag- gregate Limit for that construction pro- ject away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construc- tion Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. 2. For, all sums which the insured becomes legally obligaled to pay as damages caused by 'occurrences" . under. COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which. cannot be attributed only to ongoing operations at 'a single desig- nated construction project away from prem- ises owned by or rented to the insured: a. Any payments made under. COVERAGE A.for damages'ot tinder .COVERAGE C for'medical expenses shalt reduce the amount available . under the :General Ag- gregate LimiCbr the Products-Completed Operations Aggregate' Limit, whichever is applicable; and b. Such payments shall not reduce any Single Construction Project General Ag- gregate Limit 3. When coverage for liability arising out of the 'products - completed operations hazard" is provided any payments for damages be- cause of 'bodily injury". or property damage" included in the 'products - completed opera- tions hazard" will reduce the' . Products - Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the, ingle Construction Project General Ag- gregate Limit. A. If the applicable construction project away from premises owned by.or rented to the in- sured has been abandoned, delayed, or abandoned and then restarted, or if the au- thorized. contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. J. KNOWLEDGE OF OCCURRENCE The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. A report of an 'occurrence ", offense, claim or "suit" to: (1) You, if you are an individual, (2) A partner, if you are a partnership, (3) An .executive officer, if you are a corporation, or (4) A manager, if you are a limited liability company; is considered knowledge and requires you to notify us of the "occurrence ", offense, claim, or 'suit' as soon as practicable. f. We are considered on ' notice of an `occurrence ", offense, claim or 'suit" that is reported to your Workers' Compensation insurer for an event .which later develops into an 'occurrence ", offense, claim or 'suit" for which there is coverage, under this policy. However, we will only be considered on notice if you notify us as soon as you know the claim should be addressed by this policy rather than your Workers' Compensation P olicy. K.. UNINTENTIONAL OMISSIONS The following is added to paragraph 6. Repre- sentations _ IA Y of SECTION , IV: - : COMMERCIAL GENERAL LBILIT CONDITIONS: d. If you, unintentionally fail to disclose any ex- pr ;existing at, the inception, date of your policy; we will not eny ,cverage under this Coverage,Part solely because of such failure to disclose. However, this provision does not affect our right to collect additional pre- mium or exercise our right'of cancellation or non - renewal. This provision does not apply to any known injury br dama .9e which is excluded under any other provision of this policy. L. MENTAL ANGUISH Paragraph 3. of SECTION V - DEFINITIONS is deleted'and replaced by the following: 3. `Bodily injury", means bodily injury, sickness or disease, . sustained by a person, including mental anguish or death resulting from any of these at. any time. M. WAIVER OF TRANSFER OF RIGHTS OF RE- COVERY AGAINST OTHERS Paragraph & Transfer Of Rights Of Recovery Against Others To Us of SECTION IV - COM- MERCIAL GENERAL LIABILITY CONDITIONS is amended by the addition of the following: CL CG 00 20 03 07 Includes copyrighted material of Insurance services Page 4 of 6 Office, Inc., with its permission We waive any right of recovery we may have be- cause of payments we make for injury or dam- age arising out of your ongoing operations or "your work" done under a contract requiring such waiver with that person or organization and in- cluded in the "products- completed operations hazard ". However, our rights may only be waived prior to the 'occurrence" giving rise to the injury or dam- age for which we make payment under this Cov- erage Part. The insured must do nothing after a loss to impair our rights. At our request, the in- sured will bring "suit" or transfer those rights to us and help us enforce those rights. N. LIMITED JOB SITE POLLUTION 1. Exclusion f. under Section I — Coverage A is replaced by the following: 2. Exclusions This insurance does not apply lo: f. Pollution (1) "Bodily injury" or "property dam- age" arising out of the actual, al- leged or threatened discharge, dispersal, seepage, migration, release or escape of "pollut- ants": (a) At or from any premises, site or location on which any insured or any contractors Or subcontractors working directly or indirectly on any insured's behalf are per - forming operations If the operations are to test for, ..monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way re- spond to, or assess the ef- fects of, "pollutants "; or (b) At or from a storage tank or other container, ducts or piping which is below or par- tially below the surface of the ground or water or which, at any time, has been buried under the surface of the ground or water and then subsequently exposed by erosion, excavation or any other means N the ac- tual, alleged or threatened discharge, dispersal, seep- age, migration, release or escape of "pollutants" arises at or from any premises, site or location which any in- sured or any contractors or subcontractors working di- rectly or indirectly on any in- sured's behalf are perform ing operations it the "pollut- ants" are brought on or to CL CIS 00 20 03 07 the premises, site or loca- tion in connection with such operations by such insured, contractor or subcontractor. Subparagraph (b) does not apply to "bodily injury" or "property damage " arising out of heat, smoke or fumes from a "hostile fire ". (2) Any loss, cost or expense aris- ing out of any: (a) Request, demand, order or statutory or regulatory re- quirement issued or made pursuant.. to any - environ- mental -protection or envi- ronmental liability statutes or regulations that any insured test for, monitor, clean up, remove, contain, treat, de- toxify or neutralize, or in any way respond to, or assess the effects of, "pollutants "; or (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning .up, removing, con- taining, treating, detoxifying or neutralizing or in any way responding to or assessing the effects of, "pollutants ". However, this paragraph does not apply to liability for those sums the insured becomes le- gally obligated to pay as dam- ages because of "property dam- age" that the insured would have in the absence of such re- quest, demand, order or statu- tory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental author- ity. 2. With respect to "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants ": a. The "Each Occurrence Limit" shown in the Declarations does not apply. b. Paragraph 7. of Limits Of Insurance ,(Section 111) does not appy. c. Paragraph 1. of Section III — Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; Includes copyrighted material of Insurance Services Office, Inc., with its permission . _ - ..- -- -..7 Page 5 of 6 (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits ". d. The following are added to Section III -- Limits Of Insurance: 8. Subject to 2. or 3. above, whichever applies, the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Cover- age C because of "bodily injury" or "prop- erty damage" arising out of the ac- tual, alleged or threatened dis- charge, dispersal, seepage, migra- tion, release or escape of "pollut- ants" is $100,000. CL CG 00 20 03 07 9. Subject to 8. above, the Medical Expense Limit is the most we will pay under Coverage C for all medi- cal expenses because of "bodily in- jury" sustained by any one person arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or es- cape of "pollutants O. OTHER INSURANCE If this policy includes a Coverage Form or an Endorsement which provides coverage for loss or damage covered by one or more of the Ex- tensions of this endorsement, the limit and the coverage provided by this endorsement are de- leted and .replaced by the limit and coverage provided by that Coverage Form of Endorse- ment. OP ID: CS �CQRO DATE (MM /DD /YYYY) �- CERTIFICATE OF LIABILITY INSURANCE 05/05/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 509 -456 -2648 NAME Inland Insurance Inc. PHONE FAX 9016 E Indiana Ave., Suite A 509 -456 -3432 A/C No Ext : A/c No) Spokane Valley, WA 99212 E -MAIL ADDRESS: James P Dinneen PRODUCER MJMGR -1 r:11RTnMFR Irl.. INSURED MJM GRAND, INC. P.O. BOX 2087 AIRWAY HEIGHTS, WA 99001 -2087 COVFRAGFS CFRTIFICATF NIlMRFR: INSURERS AFFORDING COVERAGE NAI INSURER A: Continental Western 10804 INSURER B: North Pacific 23922 INSURER C: Navigators Insurance Co. 42307 INSURER D : AllianZ INSURER E : REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISI ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IM UBR WVD POLICY NUMBER MM DD YYYY MM /DD /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X EMPLOYERS LIAB X 2435575 04/30/11 04/30/12 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 250,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY FX PRO LOC PRODUCTS - COMP /OPAGG $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X C01 173829 04/30111 04/30/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ $ $ $ X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) X X C X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE X SE11EXC7290251V 04130/11 04130112 EACH OCCURRENCE $ 2 ,000,000 AGGREGATE $ 2,000,00 DEDUCTIBLE RETENTION S $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 2435575 04130111 04130112 WASHINGTON STOP GAP WC STAT OTH- T RY LIMIT ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1 ,000,00( D LEASED /RENTED EQ MZI93006781 04/30/11 04/30/12 LIMIT 250,00 DIED 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THE CERTIFICATE HOLDER IS GRANTED ADDITIONAL INSURED STATUS AS RESPECTS �I, paL�( �1�/[� ��Y>S} ✓htG�u OPERATIONS OF THE NAMED INSURED AS REQUIRD BY CONTRACT (`FDTICIf ATF WnI IIFA r AMr'g:l I ATIr)N © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD � i G - oc,� j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SPOKANE VALLEY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 11707 E SPRAGUE, STE 106 ACCORDANCE WITH THE POLICY PROVISIONS. SPOKANE VALLEY, WA 99206 AUTHORIZED REPRESENTATIVE �� ,bm DinneeN President © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD � i G - oc,� j - MJMGR -1 PAGE 2 NOTEPAD INSUREDS NAME MJM GRAND, INC. OP ID: CS DATE 05/05/11 BLANKET ADDITIONAL INSURED WAIVER OF TRANSFER OF RIGHTS AND PER PROJECT AGGREGATE FORMS APPLY. CdVERAGE IS PRIMARY AND NON - CONTRIBUTORY ' POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization s : Location And Description Of Completed Operations Any person or organization whom you are required Any location or jobsite where this coverage is re- to name as an additional insured on this policy quired of the insured as part of a written contract. under a written contract or agreement. Such writ- ten contract or agreement must be executed prior to the "bodily injury" or "property damage ". No such person or organization is an insured with respect to any occurrence that takes place after expiration of the written contract or agreement between you and such person or organization. Information re wired to com fete this Schedule, if not shown above, will be shown in the Declarations. Section If — 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 dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". GG 20 3707 04 © ISO Properties, Inc_, 2004 Page 1 of 1 ❑ Lls X% ut IV 0.3 THIS ENDORS—ENT CHANGES THE POLICY. PLRASL READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGH'T`S 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: This endorsement applies to any entity for whom you perform work where this is required as part of a written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable 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 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 Copyright, Insurance Services office, Inc., 1992 CG 24 04 10 93 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE DESIGNATED CONSTRUCTION PROJECTS: AMENDMENT — AGGREGATE LIMITS OF INSURANCE PER PROJECT OVERALL POLICY GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Subject to an Overall Policy General Aggregate Limit of $5,000,000.the General Aggregate Limit under LIMITS OF INSURANCE (Section III) applies separately to each of your "projects" away from premises owned by or rented to you. For the purpose of this endorsement, "project' means the work for which the Named Insured is responsible as defined in an oral or written construction contract between the Named Insured as the contractor or sub- contractor, and an owner, developer or general or sub - contractor. All other terms and conditions remain unchanged. (If no entry appears above, information required to complete this endorsement will be shown in the Declaratinnc as appucaoie io inis enoorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard ", and for medi- cal expenses under COVERAGE C regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Ex- pense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Con- struction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which cannot be attributed only to ongoing operations at a sin- gle designated construction project shown in the Schedule above: CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Page 1 of 2 ❑ • 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical E. The provisions of Limits Of Insurance (SECTION expenses shall reduce the amount available Ill) not otherwise modified by this endorsement under the General Aggregate Limit or the shall continue to apply as stipulated. Products - Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the "products - completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard" will reduce the Products - Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Construction Pro- ject General Aggregate Limit. D. If the. applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 CG 25 03 03 97 13 ADVERTISEMENT FOR BIDS CITY OF SPOKANE PUBLIC WORKS DEPARTMENT BID # SVPW 10- 013,` BROADWAY AVENUE RECONSTRUCTION PROJECT Notice is hereby' given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Broadway Avenue Reconstruction Project. The project consists of sanitary sewer work, storm drain work, and road reconstruction including placement of crushed surfacing, and hot mix asphalt paving and curb and sidewalk installation. Copies of the bid packet including specifications and plans can be obtained at the office of :the City of Spokane Valley Public Works De- partment, at 11707 E. Sprague Avenue, Suite 304, Spokane -Val- ley, 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 com- pact disc at no charge. All bids must be accompanied by a bid deposit in the form of a sure- ty bond, postal money order, cash, cash ier's, check, or certified check _in an amount equal to five per- cent (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 Spokane Valley, 11707 E. Sprague.Avenue, Suite 106, Spokane Valley, Washington, 99206, and received not later than 10:00 a.m. PSOT, Friday, June 25, 2010. Bid open- ings will be held immediately thereafter and read aloud in the City Council Chambers, Suite 101. The City; of•.Spokane Valley re- serves the right to waive any irreg- ularities or informalities and to reject any or all bids. No bidder may withdraw his bid after the time announced for the bid open- ing, or before the award and exe- cution of the contract, unless the award is delayed for a period exceeding sixty (60) days. PUBLISH: Spokane June 4 and June 11, 2010 Christine, Bainbridge, CIVIC Spokane Valley City Clerk SR20926 *Federal Tax ID No. 68- 0617327 AFFIDAVIT OF PUBLICATION STATE OF WASHINGTON County of Spokane} ss Name: City of Spokane Valley Client ID PO No. SR20926 No. Lines: Ad No. 883142 Foreign No. Total Cost: $632.08 Order No 42365 74 1673564 183820 I, Joni L. Vincent 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 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 two time(s), the publication having been made once each time on the following dates: June 4 & 11. 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 published in the newspaper proper and not in a supplement. Subscribed and sworn to before me at the City of Spokane, this 15th day of June 2010. V I N CF S� EkJ` O 9 O p'(NRY m N I'UBO O O (P A s� Notary Public in and for the State of Washington, residing at Spokane County, Washington Notary Stamp NV'y Legal Affidavit Joni V.xls SUPERIOR COURT OF WASHINGTON FOR SPOKANE COUNTY In the Matter of: ADVERTISEMENT FOR BIDS No. City of Spokane Valley Public Works Dept. Bid # SVPW 10 -013 ' AFFIDAVIT OF PUBLISHING Broadway Avenue Reconstruction NOTICE Project STATE OF WASHINGTON ) )SS. County of Spokane ) MICHAEL HUFFMAN , being first duly sworn on oath deposes and says that he is the EDITOR , of The Spokane ValleyNewsHerald, a weeklynewspaper. Thatsaidnewspaper is a legalnewspaper and it is now and hasbeenfor 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 4th day of June, 2010, and ending the 11th day of Tune, 2010, all dates inclusive that such newspaper was regularly distributed to its subscribers during all of said period: ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID # SVPW 10 -013 BROADWAY AVENUE RECDNSTRUCTION PROJECT Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will ac- cept sealed bids for the Broadway Avenue Reconstruction Project. The project consists of sanitary sewer work, storm drain work, and road reconstruction including placement of crushed surfacing, and hot mix asphalt paving and curb and sidewalk installation. Copies of the bid packet including specifications and plans can be at the office of the City of Spokane Valley Public Works Department, at � 4 11707 E. Sprague Avenue, Suite 304, Spokane tssi'' Valley, WA 99206 -6124, Monday through Fridayp�` 7•,,(t� from 8:00 a.m. to 5:00 p.m. Anon- refundable +� amount of $50.00 is required. Copies of the bid r packet including specifications and plans may Co ? ©' qA be obtained in PDF format on a compact disc --j : ® m �` N at no charge. All bids must be accompanied by a bid deposit -k °. (jC in the form of a surety bond, postal money order, I� 4%' cash, cashier's check, or certified check in an amount equal to five percent (5%) of the amount �o� •., s, 2Q� ,•''.t of the bid proposed. Failure to furnish a bid bond in compliance with the City's bid deposit surety 4 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 laterthan 10:00 a.m. PSDT, Friday, June 25, 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.Christine Bainbridge, CMC Spokane Valley City Clerk 6/4,6/11 to before me State of Washington County of Spokane I certify that I know or have satisfactory evidence that Michael Huffman is the person who appeared before me, and said person acknowledged that he signed this instrument and acknowledged it to be his free and voluntary act for the uses and purposes men - kioned in the instrument. Jolene Rae ntz itle: Notary blic I " pointme t expires: 5 -16 -11 1oZ.uv V-) k6