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10-133.00 Wm. Winkler Co: Park Rd Grade Crossing Safety ImprovementContract THIS AGREEMENT, made and entered into this 18th day of September 2010, between the STATE OF WASHINGTON, acting through the City of Spokane Valley under and by virtue of Title 35 RCW, as amended and IAJ m ultnkle -Co. 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: The Contractor shall do all work and furnish all tools, materials, and equipment for: Park Road Grade Crossing Safety Improvement Project Spokane Valley Public Works Contract # 10 -031 In accordance with and as described in the attached 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 attached plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the attached 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. C.ofo --C33 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 9 -18 , 2010. Date Sterling Christler Printed Name Project Manager Title Signatur City of pok /Valley l i� Printed Nake �# o ? ,,; BOND NO: 6668740 CONTRACTOR'S PERFORKANCE AND PAYMENT BOND TO DUAL OBLIGEES KNOW ALL MEN BY THESE PRESENTS, that WM• Winkler Company (Contractor), as Principal, and First National Insurance Company of Ameri onding Company) as Surety, a corporation of Washington whose principal oft is located at Liberty Lake, Washington ,are firmly bound unto the State of Washington and the City of Spokane Valley, a political subdivision the State of Washington, as Obligees, to fulfill the obligations of the Principal and the Surety under the Contract to which reference is hereafter made, in the amount ofS 24,305..00 (including Washington State sales tax) for payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents. WHEREAS, Principal has by written Proposal dated 8 -2 7 —2 010 offered to enter into a Contract with the City of Spokane Valley for Contract No. 10 -031 pursuant to the terms and conditions set forth in the Contract Documents dated 9- 18 -201Q NOW, THEREFORE, the condition ofthis obligation is such that if the Principal shall faithfully perform all the provisions of the Contract on its part, and pay all laborers, mechanics, subcontractors and material suppliers, and all persons who supply such person or persons or subcontractors with provisions and supplies for the carrying on of such work, and indemnify and hold harmless the Obligees from all loss, cost or damage which it may suff r 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 work provided for in the Contract shall have a direct right of actior under this bond, to the extent and in the manner set forth in RCW 39.05. The said Surety for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract or to the WOP.K to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the WORK or to the SPECIFICATIONS. No final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose cla' Irance unsatisfied. SIGNED SEDTHIS 18 th DAYOF September YEAR20 10 . First National Company WM. Winkl PRINCIP Sie�nna Signature 6dil H. Davis Brian .7 Wink er Tv�pg_d Typed Name K. orney in Fact Presi r3Pnt Title Title (SEAL) _ Liberty POWER First National Insurance Company of America 1001 4th Avenue MUtLI OF ATTORNEY Suite 1700 Seattle, WA 98154 KNOW ALL BY THESE PRESENTS: No. 2195 That FIRST NATIONAL INSURANCE COMPANY OF AMERICA, a Washington corporation, does hereby appoint * * * * * * * * * * * * * * * * * ** *THOMAS V. A. DAVIS; WILLIAM H. DAVIS; Spokane, Washington * * * * * * * * * * * * * * * * * * * * * * * **** its true and lawful attomey(s) -in -fact, with full authority to execute on behalf of the company fidelity and surety bonds or undertakings and other documents of a similar character issued by the company in the course of its business, and to bind FIRST NATIONAL INSURANCE COMPANY OF AMERICA thereby as fully as if such instruments had been duly executed by its regularly elected officers at its home office. IN WITNESS WHEREOF, FIRST NATIONAL INSURANCE COMPANY OF AMERICA has executed and attested these presents this 2 1 st day of March , 2009 Dexter R. Legg, Secretary Timothy A. Mikolajewski, Vice President CERTIFICATE Extract from the By -Laws of FIRST NATIONAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys -in -fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of FIRST NATIONAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of- attorney appointment, executed pursuant thereto, and (iii) Certifying that said power -of- attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, Dexter R. Legg , Secretary of FIRST NATIONAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of this corporation, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this 18th day of September 2 SEAL ._1928 S- 1049/DF 3/09 -4" a 0 P, X* arkj 1 Dexter R. Legg, Secretary WEB PDF BIDDERS PACKET Park Road Grade Crossing Safety Improvement Project BID NO. 10 -031 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 C] 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: Title: President Company: Wm. Winkler Company CITY OF SPOKANE VALLEY 5 PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT Date: 9 -3 -10 BID PROPOSAL DOCUMENTS BID NO: 10 -031 PROPOSALFORM PROJECT NUMBER: 10 -031 PROJECT TITLE: Park Road Grade Crossing Safety Improvement Project NAME OF FIRM SUBMITTING BID: wm. Winkler Company Each bid shall constitute an offer to the City of Spokane Valley as outlined herein and no bidder may withdraw his bid after the hour set for the bid closing except under the conditions explained in the Information to Bidders Section. RECEIPT OF ADDENDA: Bidder acknowledges receipt of the following addenda: Addendum No. Date Addendum No. Date Wone 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 ten (10) working days from the date of commencement stipulated in a Notice to Proceed. The Notice to Proceed is generally issued between 11 and 15 days after award. 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. 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: Person /Entity Name: Wm Winkler Company 13rr5 J. Winkler Signature Of Bidder: CITY OF SPOKANE VALLEY 6 BID PROPOSAL DOCUMENTS PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT BID NO: 10 -031 Person /Entity Name: Wm. Winkler Company Signature Of Bidder: �R2k��,��-7 - Brian J. Winkler Company: Wm. Winkler Company Date: 9 -3 -10 CITY OF SPOKANE VALLEY 7 BID PROPOSAL DOCUMENTS PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT BID NO: 10-031 ITEM DESCRIPTION UNIT QUANTITY PRICE ! UNIT AMOUNT 1 MOBILIZATION L.S. 1 >< 5,800.00 2 CEMENT CONC. MEDIAN CURB L.F. 245 29.00 . 7, 05.00 3 DELINEATOR AND CORE HOLE EACH 30 1 50 .00 4,500.00 4 BULLNOSE MARKER EACH 8 4 00 .0 0 3,200.00 5 PROJECT TEMPORARY TRAFFIC CONTROL L.S. 1 3,200.00 6 MINOR CHANGE DOLLAR 500.00 500.00 CONTRACT TOTAL 24,305.00 Person /Entity Name: Wm. Winkler Company Signature Of Bidder: �R2k��,��-7 - Brian J. Winkler Company: Wm. Winkler Company Date: 9 -3 -10 CITY OF SPOKANE VALLEY 7 BID PROPOSAL DOCUMENTS PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT BID NO: 10-031 CONTRACTOR'S ADMINISTRATIVE INFORMATION 1. PERSON /ENTITY a. Name as registered with the State of Washington: Wm. Winkler Company b. Physical Address: 1822 E Fairview Ave Spokane, WA 99207 c. Mailing Address including zip code: 1 822 E Fairview Ave Spokane, w A 99207 d. Remit To Address including zip code: 1822 E. Fairview Ave. Spokane, WA 9920 e. Telephone number including area code: 509-489-6100 f. Fax number including area code: 509 - 484 -0646 g. E -mail address for business correspondence: 13rian(awmwinkler. cam h. Washington State Contractors License NumberW *935 I. Federal Tax Identification Number: _ _ REDAC TED j. Washington State UBI Number: k. State Industrial Account Identification Number: 39,956 -01 1. City of Spokane Valley Business License Number: 602 703 784 2. INSURANCE COMPANY: a. Name of company: Western states Insurance b. Mailing Address including zip code: 501 N Riverpoint Blvd. Ste 403 Spokane, WA 99202 -1649 c. Insurance Agent Name: Bill Davi s d. Insurance Agent Telephone number including area code: 509 -838 -3501 e. Insurance Agent Fax number including area code: 509 -534 -0318 3. BONDING COMPANY: a. Surety Name: First National Insurance Company of America b. Surety Mailing Address including zip code: 1001 4th Amen c �o M E w M C M X N M M 41 N 00 4 5 Cv W C „ o r V M L M 3 r a C u v Y v� E E a, C O v CD Ln s �o H L c v 3 � = v o j v Wv_ C C = -1 .V f6 O - 0 L Q ' 0 - o. io 41 4.1 C *: - 0 O O � O � L C i :3 (0 Z3 Q O 4- 4- 00 O o E r � u N p O L� 2 r) L -0 U 6 � 0 2 Ln O N > N C � 3 0 v u O Q O 4 2 ro +� cTO 0 • n c E U •� (0 C o o Z } Q c. Bonding Agent Name: W t - . - , f- -Prn gi Seattle, WA 98154 Tnaivrnn r-,m Rill Dalz i c d. Bonding Agent Mailing Address including zip code: 501 N. Riverpoint Blvd. Ste 4 03 S pokane, WA 99202 - 1649 e. Bonding Agent Telephone number including area code. 509-818-3501 f. Bonding Agent Fax number including area code: 509 - 534 -0318 Person /Entity Name: Wm. Winkler Compan )pignature Of Bidder: Brian J. Winkler Company: wm wi nkl ar Co pa Date: g- i -1 n 602 703 784 CITY OF SPOKANE VALLEY 8 BID PROPOSAL DOCUMENTS PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT BID NO: 10 -031 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) 1919 2. The company has had experience comparable to that required under the proposed contract: a. As a prime contractor for 91 years. b. As a subcontractor for 91 years. 3. The following is a partial list of work completed that was on an order of magnitude equal to or greater in scope and complexity to that required under the proposed contract. Year Owner & Person to contact Phone No. Location Contract Value See Attached 4. A list of supervisory personnel currently employed by the Bidder and available for work on the project (Construction Manager, principal foreman, superintendents and engineers) is as follows: Years of Name Title Experience See Attached 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 furnish a resume within 24 hours of notice by the City. Resume Furnished Upon Request 6. Following is a listing of all projects the company has undertaken in the last five years, which have resulted in: a. Arbitration or litigation. None b. Claims or violations being filed by the Federal Government or the Washington State Departments of L & I, Employment Security or Revenue. None c. Liens being filed by suppliers or subcontractors. None Person /Entity Name: Winkler Company Signature Of Bidder: Brian J. Winkler Company: Wm. Winkler Company Date: 9 -3 -10 CITY OF SPOKANE VALLEY 9 BID PROPOSAL DOCUMENTS PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT BID NO: 10-031 City of Spokane Valley Park Road Grade Crossing Safety Improvement Project Bid Proposal Documents Bid No: 10 -031 Bidder Qualification Statement Pg 9 Question 3: Year Owner & Person to contact Phone No. Location Contract Value 2009 Spokane International Airport 509 - 455 -6413 Spokane Airport General Contractor 2009 2009 2008 2008 Matt Brene Terminal Ramp Construction Phase 1 City of Spokane 509- 625 -6700 Spokane, WA General Contractor John Thompson 2009 Community City of Spokane Department of Engineering 509- 625 -7722 (Perry M. Taylor P.E.) Development $434,600 Idaho Transportation Department Joe Schacher City of Spokane Valley Shane Arit LHC Incorporated Jay Additional projects available upon request Question 4: Name Title Brian J. Winkler President Sterling Christler Construction Manager Chris J. Winkler, P.E. Project Engineer Joe McConnell Foreman 208 -799 -4233 Moscow, ID Subcontractor to ML Albright & Sons, Inc. A St. - Rodeo $277,500 509 - 688 -0043 City of Spokane Subcontractor to Valley Knife River Appleway Ave. Reconstruction $511,000 406 - 758 -6400 Kalispell, MT Subcontractor to LHC Incorporated Reserve Loop $1,033,000 Years Experience 26 16 27 32 REPRESENTATIONS AND CERTIFICATIONS ANTI - KICKBACK: No officer or employee of the City of Spokane Valley, having the power or duty to perform an official act or action related to this submittal, shall have or acquire any interest in this submittal, or have solicited, accepted or granted a present or future gift, favor, service, or other thing of value from or to any person involved in this submittal. REPRESENTATION: In submitting this bid we represent that the bid documents have been read and understood, that the site has been visited and or that we have familiarized ourselves with the local conditions under which the work is to be performed, that by signature of this proposal we acknowledge all requirements and that we have signed all certificates contained herein. REPRESENTATION: In submitting this bid we acknowledge the requirements and conditions applicable to bid deposits in the form of a cash bid deposit or surety bond bid deposit. NON - COLLUSION: That the undersigned person(s), firm, association or corporation has (have) not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the project for which this bid is submitted. I CERTIFY that no final determination of violation of RCW 50.12.070(1)(b), 50.16.070(1)(b), or 82.32.070(1)(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. 1 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: Wm. Winkler Company / Brian J. Winkler Person /entit submitting bid rint) Signature: Title: P dent Date: 9 -3 - CITY OF SPOKANE VALLEY 10 BID PROPOSAL DOCUMENTS PARK ROAD GRADE CROSSING SAFETY IMPROVEMENT PROJECT BID NO: 10 -031 OP ID: 2.1 AC_ "M" INSURANCE BIN ©ER 11111a.� DATE (MM/DD/YYYY) 1 DEDUCTIBLE 09/21/2010 THIS BINDER. IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. AGENCY COMPANY BINDER# 10726 Western States Ins. - Spokane Travelers Indemnity of America 501 N Riverpoint Blvd, Ste 403 EFFECTIVE EXPIRATION Spokane, WA 99202 -1649 DATE TIME DATE TIME DAMAGE TO RENTED PREMISES $ AM MED EXP (Any one person) X 12:01 AM Tom and Bill Davis $ GENERAL AGGREGATE 09/18/10 12:01 PM 10/18/10 NOON A/ C N No Ext : 5Q9- 838 -3501 F AX No): 5O9- 838 -3511 LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY #:SPS- 5082P2941ND CODE: SUB CODE: AGENCY WMWIN -1 CUSTOMER ID: DESCRIPTION OF OPERATIONSNEHICLES /PROPERTY (Including Location) Park Road Grade Crossing Safety Improvement INSURED BNSF Railway Company 2454 Occidental Ave So. BIdg1A Project Spokane Valley Public Works Seattle WA 98134 Contract #10 -031 COVERAGES _ _ _LIMITS TYPE OF INSURANCE COVERAGEIFORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC FI BROAD 71 SPEC GENERAL LIABILITY OMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR Protective RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ 2,000,00 DAMAGE TO RENTED PREMISES $ J XRailroad MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 6,000,00 PRODUCTS - COMP /OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ MEDICAL PAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ I s AUTO PHYSICAL DAMAGE DEDUCTIBLE COLLISION: OTHER THAN COL: ALL VEHICLES Li SCHEDULED VEHICLES ACTUAL CASH VALUE $ STATED AMOUNT OTHER GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE 1 $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ AGGREGATE $ SELF - INSURED RETENTION $ WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY WC STATUTORY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL OTTHER ONS! COVERAGES FEES $ TAXES $ ESTIMATED TOTAL PREMIUM $ MORTGAGEE ADDITIONAL INSURED LOSS PAYEE X Contractor LOAN # WM Winkler Company 1822 E Fairview Avenue Spokane WA 99207 ACORD 76 (2004/09) AUTHORIZED REPRESENTATIVE NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE © ACORD CORPORATION 1993 -2004 WMWIN -1 OP ID: 2J CONDITIONS This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in -the amount of one million dollars ($1,000,000) or more,_ the title of the form is changed from "Insurance Binder" to "Cover Note Applicable in Colorado With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home owners, the insurer has thirty (30) business days, commencing from the effective date of coverage, to evaluate the issuance of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company. Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. ACORD 75 (2004/09) -AeOW CERTIFICATE OF LIABILITY INSURANCE OP ID 23 DATE(MMIDDIYYYY) WMWIN -1 09/21/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins. - Spokane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 501 N Riverpoint Blvd, Ste 403 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spokane WA 99202 -1649 Phone: 509- 838 -3501 Fax: 509 -838 -3511 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Charter Oak Fire Insurance Co INSURER B: Travelers Indemnity of America W.M. Winkler Company INSURER C: Travelers Property Casualty Co 1822 E. Fairview INSURER D: Spokane WA 99207 I I INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN K LTR Do INSRa TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I DATE MM /DD/YYYY POLICY EXPIRATION DATE MM /DD/YYYY LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X] OCCUR X Employer L1ab DTC08020P992COF10 04 /01/10 04/01/11 EACH OCCURRENCE $1,000,000 PREMISES (Ea occurence) 1$300,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $1,000,000 iSPOKANE GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X 1 P R O F LO PRODUCTS - COMP /OP AGG s2,000,000 J EMP Liab 1,000 000 B X AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS DT8108020P992TIA10 04/01/10 04/10/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY H ANY AUTO I AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG I $ $ C EXCESS / UMBRELLA LIABILITY X OCCUR FI CLAIMSMADE DEDUCTIBLE X RETENTION $ 1000 DTSMCUP8020P992TIL10 04/01/10 04/01/11 EACH OCCURRENCE s3,000,000 AGGREGATE $ 3,000,000 $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIV4 OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Spokane Valley is added as additional insured per attached form as respects to: Park Road Grade Crossing Safety Improvement Project Spokane Valley Public Works Contract #10 -031 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2009101) U 1 VUt5 -ZUUy AUUKU GUKt'UKA I IUN. All rlgnts reservea. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYOFV DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR CITY OF SPOKANE VALLEY REPRESENTATIVES. TH IZEREPRESENTATVE AU D 11707 E SPRAGUE #106 iSPOKANE VALLEY WA 99206 ACORD 25 (2009101) U 1 VUt5 -ZUUy AUUKU GUKt'UKA I IUN. All rlgnts reservea. 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 This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, . extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) CWMERCIAL GENERIAL LIABILITY TIME ENDORSEMENT allANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following_ COMM =RCIAL G_NEP,A_ LIABILITY 010\F—RAG PART 't. WHO IS AN INSUPED — (Section 11) is amended c) The insurance provided to the additional in- to include any person or Organization that you sured does not apply to "bodily injury" or agree in a 'iwritten contract requiring insurance" "property damage" caused by "your "work" to include as an additional insured on this Cover- and included in the "products- completed op- age Part, but; erations hazard" unless the "written contra aj Only with respect to liability for "bodily iniury", requiring insurance" specifically requires you to provide such coverage for that additional 'property damage" or "personal injury'; and insured, acid then the insurance provided tb bi If, ' and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or' omissions of "bodily injury" or "property damage" that Dc- you or you, subcontractor in the performance. curs before the end of the period of time :for flf "your work" to which the "written contract which the "wriitien -contract requiring insur - requiring insurance" applies. The parson or ance" requires you to provide such coverage organization does not qualify as are additionsl or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. „ o. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid a nd by this endorsement is limited as follows, collectible "other insuranoe", whether primary, aj in the event that the Limits of insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss vue LYCeed the limits of liability required by the cover under this endorsement However, if the "written contraet requiring insurance ", the in- "written contract requiring insurance" specifically sljranCe DrOVlded to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability ra- basis or a primary and non- contributory basis, quired by that "written contract requiring in- this insurance is primary to 'other insurance" surance ". This endorsement shall not in- available to the additional insured which rovers crease the limits of insurance described in that person or organization as a named insured Section ill — Limits Of insurance. for such loss, and we willf not share with that "other insurance ". But the insurance provided to bi The insurance prbvidad to the additional in- the additional insured by this endorsement still is the sured does not apply to "bodily injury", "prop- over any valid and collectible "other in- arty damage" or "personal injure" arising out surance ", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- proiessional architectural, engineering or sur- bona] insured when that person or organization is veying services. including: an additional insured under such "other insur 1. The preparing, approving, or failing to ante ". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, a) The additional insured must give us written approving, or failing to prepare or ap- prove, drawings and specifications; and notics as soon as practicable of an '°occur- rence" or an offLns8 wJJch may result in a ii. Supervisory, inspection, architectural or claim. To the erterr possible, such notice engineering activities. should include: CG D2 46 08 05 © 20D5 The St. Paul Travelers Companies, Inc. Page 1 of 2 A 4 F= �r G� t� r� is G� r;= C G� C� t� 1 1 COMMER31AL GENERAL LIABILITY i. How, when and where the 'occurrence" Or Offense took place; U. The names and addresses of any injured persons and witnesses, and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim Is made or "suit" is brought against the additional insured, the additional insured must; i. immediately record the specifics of the claim or "suit" and the date received, and ii. N otify U s as soon as practicablE. The additional insures must see to it that we receive wri itten notice of the claim or "suit" as . soon as practicable, c) The additional insured must, immediately send us copies of all legal papers received in connection with the claim or "suit ", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and othervAse comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does riot. affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 2. above. 3. The following definition is added to SECTION V, — DEFINITIONS: "Written contract requiring insurance" means that part of any written contras or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage "_ or. curs and the "personal injury" is caused by an offense committed: a. Afiterthe signing and execution Of the contract or agreement by you; b. While that part of the contract car agreement is in effect; and c, Before the end of the policy pet iod. Page 2 of 2 © 2005 The St_ Paul Travelers Companies, Inc. CG D2 46 D8 05 006345 Ac(:>RDr CERTIFICATE OF LIABILITY INSURANCE OP ID 2J WMWIN -1 09/21/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins. - Spokane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 501 N Riverpoint Blvd, Ste 403 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOVk! Spokane WA 99202 -1649 Phone: 509- 838 -3501 Fax: 509- 838 -3511 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Charter Oak Fire Insurance Co INSURER B: Travelers Indemnity of America W.M. Winkler Company INSURER C: Travelers Property Casualty Co 1822 E. Fairview I INSURER D: Spokane WA 99207 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /DD/YYYY POLICY EXPIRATION DATE (MM LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR X Employer Liab DTC08020P992COF10 04/01/10 04/01/11 I EACH OCCURRENCE 1 $1,000,000 t� I LA PREMISES(Ea $ 300, 000 MED EXP (Any one person) 1 $5,000 PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $2,0 �7 'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS - COMP /OP AGG I $ 2 , 000 , 00 0 Emp L1ab I 1 , 000 f 000 B X AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS DT810802OP992TIA10 04/01/10 04/10/11 COMBINED SINGLE LIMIT (Ea accident) $1 ,000, 000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT I $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ C EXCESS I UMBRELLA LIABILITY X OCCUR F] CLAIMSMADE DEDUCTIBLE X RETENTION $ 10000 DTSMCUP8020P992TIL10 04/01/10 04/01/11 EACH OCCURRENCE $ 3,000,000 AGGREGATE s3,000,000 $ $ I s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below OTH TORY LIMITS I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Burlington Northern Santa Fe Railway is added as additional insured per attached form as respects to: Park Road Grade Crossing Safety Improvement Project Spokane Valley Public Works Contract #10 -031. Coverage is Primary and non - contributory. Waiver of Subrogation applies. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2009/01) (0 19SS - 2UU9 AGURL) GORPORATIUN. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BNSFRAI DATE THEREOF, THE ISSUING INSURER WILLTRUERCDR" MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, L Burlington Northern Santa Fe 1111pes BIL OF ANY KIND UPON THE IN , Railway INSURANCE COMPLIANCE AUTH RED REPRESENTAT VE P O BOX 12010 -BN EMET CA 92546 -8010 ACORD 25 (2009/01) (0 19SS - 2UU9 AGURL) GORPORATIUN. All rights reserved. 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 This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE DEAD IT CAREFULLY BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMME=RCIAL GENERAL LIABILITY COVERASE PART 1. WHO IS AN INSURED — (Section 11) is amended to include any person or Prganization that you agree in a "written contract requiring Insurance" to include as an additional insured on this Cover- age Part, but; a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) lf,' and drily to the extent that, the injury or damage is caused by ects or' omissions of you or your subcontractor in the performance. of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent ads or omissions of such person or organization. Z. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the in- surance provided to the additional insured shall be limited to the limits of liability re- quire¢ by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section 111— Limits Of Insurance. b) The insurance provided to the additional In- sured does not apply to "bodily injury", "prop - erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury's or "property damage" caused by "your 'work" and included in the "products- completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time - for which the "written -contract requiring insur- ance" requires you to provide such overage or the end of the policy period, whichever is earlier. r 3. The insurance provided to the additional irisured by this endorsement is excess over any valid and collectible "other Insurance ", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement_ However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to "other insurance" available to the additional Insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance ". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible: "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4, As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur. rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46138 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 c 1 4 COMMERCIAL GENERAL LIABILITY ^ i. How, when and where the "occurrence" or offense took place; ii. The names and addresses oil any injured persons and witnesses; and Iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. F o� C 4� O� t � r -1. �I b) If a claim is made or "suit" is brought against the additional insured, the additional insured must, i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "salt" as soon as practicable, c) The additional insured must immediately send us oopies of -all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all }policy conditions. d) The additional insured must tender the de- fense and Indemnity of any claim or "suit" to any proviger of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named Insured as described in paragraph 3. above. . 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contractL requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the 'bodily injury" and "property damage" acr curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the and of the policy period. Page 2 of 2 © 2005 The SL Paul Travelers Companies, Inc. CG D2 4618 05 006343 Verify Workers' Comp Premium Status - Account Information Washington State Department of Labor & Industries Verify Workers' Comp Premium Status: Account Information Did you know ... ...that under Washington State law', you may be liable for the unpaid workers' compensation (industrial insurance) premiums of any business you hire or contract with? ( "See RCW 51.12.070) In the construction industry, you can protect yourself from liability for your subcontractors unpaid premiums. Click here to see what you have to do. L&I will track a contractor for you and tell you if their status changes. Page 1 of 2 If this is a contractor whose premiums and license are current, a "Submit Contractor Tracking Request" link will appear in the certificate below. Click it to fill out a Tracking Request. If the contractor fails to pay workers' comp premiums or renew their contractor registration or if their electrical contractor license is suspended or revoked within one year of the start-date on your tracking request, L&I will send you a notification letter. Department of Labor and Industries Employer Liability Certificate Date: 09/29/2010 UBI #: 602 703 784 -- Check for active Department of Revenue tax account. Legal Business Name: WINKLER BROTHERS INC Account #: 039,956 -01 'Doing Business As' Name: WM WINKLER COMPANY Estimated Workers Reported: Quarter 2 of Year 2010 "31 to 50 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? License: Yes -- Get contractor's license history. Expire Date: � 3/23/2011 Submit Contractor Tracking Request here to be notified if this contractors premium or license status changes during the next year. Risk Classification: Get risk classification information. Experience Factor: Get experience factor history. Account Representative: T2 / GARY HONC (360)902 -4825 - Email: HONC235@lni.wa.gov https:H fortress. wa. gov/ lni lcrpsilAectInfo.aspx ?AccountId= 03995601 &BusinessId= 602703... 9/29/2010 lb DATE (MM /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE O IN l 03/31/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins. - Spokane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 501 N Riverpoint Blvd, Ste 403 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW DATE MMIDD TION LIMITS Spokane WA 99202 -1649 Phone: 509 - 838 -3501 Fax: 509 - 838 -3511 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Fire Ins of Hartford EACH OCCURRENCE INSURER B: Valley Forge Insurance Co. PREMISESEaoccurence) $100,000 INSURER C: Transportation Insurance Co. X Wm. Winkler Company INSURER D: 04/01/11 1822 E. Fairview Spokane WA 99207 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATECMM /DD CTIVE DATE MMIDD TION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISESEaoccurence) $100,000 A X X COMMERCIAL GENERAL LIABILITY 4027027552 04/01/11 04/01/12 CLAIMS MADE X] OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 X Stop Gap GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG s2,000,000 POLICY X P LOC Stop Gap 1,000,000 B X AUTOMOBILE X LIABILITY ANY AUTO 4027027583 04/01/11 04/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIREDAUTOS NON- OWNEDAUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 4,000,000 C X OCCUR F_ICLAIMSMADE 4027027566 04/01/11 04/01/12 AGGREGATE $4,000,000 $ $ H DEDUCTIBLE $ X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE---I OFFICER/MEMBER EXCLUDED? TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Spokane Valley is added as additional insured per attached form G140331C 1010 Blanket Additional Insured (Contractors)as respects to: Park -Road -Grade Crossing Safety Improvement Project Spokane Valley Public Works r _Contact _ #1'0_031: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION C ITYOFV DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR CITY OF SPOKANE VALLEY REPRESENTATIVES. 11707 E SPRAGUE #106 AUTH IZEDREPRESSENTAT E SPOKANE VALLEY WA 99206 K A� The ACORD name and logo are registered marks of ACORD C'.olo-133 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 This Certificate of Insurance 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. AGORD 25 (2009101) - G140331C 1010 [Z11 =1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS - COMPLETED OPERATIONS • -' This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf in the performance of your ongoing operations specified in the "written contract; or c. "Your work" that is specified in the "written contract' but only for "bodily injury" or "property damage" included in the "products- completed operations hazard," and only if: (1) The "written contract' requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. We will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. Required by the "written contract'; b. Described in B.I. above; or c. Afforded to you under this policy. 3. This insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the "written contract," this insurance will be primary and non - contributory relative to insurance on which the additional insured is a Named Insured. 4. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying http://fon 3/30/2011 G140331C 1010 Page 2 of 2 services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit' under this insurance, and of any claim or "suit' that does result; (2) Except as provided in Paragraph B.3 of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit' to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract' requires this insurance to be primary and non - contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." 2. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph 4.a. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance a. Primary Insurance This insurance is primary and non - contributory except when rendered excess by endorsement G- 140331-C, or when Paragraph b. below applies. D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury" or "property damage "; or b The offense that caused the "personal and advertising injury" for which the additional insured seeks coverage under this Coverage Part. http: / /formnet- ci.cna.com /glhtm/cna9027.htm 3/30/2011