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11-049.00 Spokane Rock Products: Indiana Ave Extension lICII - T11 APR 12 2011 By Contract THIS AGREEMENT, made and entered into this day of /4-p r1 ,2011, between the City of Spokane Valley under and by virtue of Title 35 RCW, as amended and Spokane Rock Products,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: Indiana Avenue Extension Project SVPW Contract 10-012 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. 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. City of Spokane Valley 15 Agreement for Construction Services Indiana Avenue Extension Project SVPW Bid No: 10-012 Co11— cL9 Executed by Contractor Ayr, I 7 , 2011. Date Printed Name dJ Title —"1111111 / � _ Signature _©i. City f Spokane Valley it e ✓a4-KSOh Printed Name --. .J a p.al e,'' itle 16011-11,_ - 1 7 City of Spokane Valley 16 Agreement for Construction Services Indiana Avenue Extension Project SVPW Bid No: 10-012 e udky. 105471013 BOND NO: CONTRACTOR'S PERFORMANCE AND PAYMENT BOND TO DUAL OBLIGEES KNOW ALL MEN BY THESE PRESENTS,that Spokane Rock Products, Inc. (Contractor),as Principal,and Travelers Casualty and Surety Company of America (Bonding Company),as Surety,a corporation of Hartford, Connecticut ,whose principal office is located at One Tower Square 3PB, Hartford, CT 06183 are firmly bound unto the State of Washington and the City of Spokane Valley,a political subdivision the State of Washington,as Obligees,to fulfill the obligations of the Principal and the Surety under the Contract to which reference is hereafter made,in the amount of$ l,049,282.20 (including Washington State sales tax)for payment (One Million Forty-Nine Thousand Two Hundred Eighty-Two and 20/100---Dollars) whereof Principal and Surety bind themselves,their heirs,executors,administrators,successors and assigns jointly and severally,firmly by these presents. March 11, 2011 WHEREAS,Principal has by written Proposal dated offered to enter into a Contract with the City of Spokane Valley for Contract No.10 012 pursuant to the terms and conditions set forth in the Contract Documents dated April 7, 2 011 NOW,THEREFORE,the condition of this 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 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. Al!persons who have fiunished labor,materials or supplies for use in and about the work provided for in the Contract shall have a direct right of action under this bond,to the extent and in the manner set forth in RCW 39.08. 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 WORK 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 claim may be unsatisfied. SIGNED AND SEALED THIS 7th DAY OF April YEAR 2011 Travelers Casualty and Surety Company of America Spokane Rock P Ell' PRI S�. �acure S ature J.,cqueline F. Hernandez y(ve c41 Typed Name Typed Nam Attorney-in-Fact Title Title (SEAL) City of Spokane Valley 17 Agreement for Construction Services Indiana Avenue Extension Project SVPW Bid No; 1 0-01 2 WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERSJ 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. 223257 Certificate No. 0 0 4 0 6 3 9 3 9 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 Pamela L.Thurman,Jacqueline F. Hernandez, JoHanna E.Zerb, Charles E. Hudon, Karen E.Alley,Jared Haff, and Sarah Scott of the City of Pasco ,State of Washington ,their true and lawful Attorney(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 1St day of February , 2011 • 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 Ghat/•, 1Y �' �41'�/. yoRE N••INSG `a+x IN3U4, pity 00. Na R Y _ep �T` 4�0 J�, n WCORPoRAIED C Z �fyOR PMR4>.h WipO f a 5 1982 O f RPORAT . i � 1977 g: !'^ as �_ .�- a HARTFORD, HARTFORD, � I 1951 i t �' o ; WWI CONM. Y N 1896 AF 51 - SE AI.ioJ ��.SSALia ,, o ,w 1s.........*Pa sdt aa�a r•.. 14*ANt^' fr*, State of Connecticut By: City of Hartford ss. Georg Thompson, ice President On this the 1St day of February 2011 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. In Witness Whereof,I hereunto set my hand and official seal. (TAR rt Ncf\.0304)1‘ u.A C • V�U1� My Commission expires the 30th day of June,2011. * oveoO * Marie C.Tetreault,Notary Public 49tEC f' 58440-4-09 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER 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 7th day ofApri1 ,2011 . Kori M.Johans Assistant Secretary '• pl.su pyn•• HRe°6'm.,, ysuq PITY AN° wa Fy1YA,y� p,(ygppp'`,J �o P Rr°R F ormr'�j C� �/ IRS a 5 (1 111��1-/It r Y �f W:O� e':= 1982 0 1977 �" ' . _� �[ o ` OONM. £ in lass S. s f 1951 - ,,. � SE A o id.SBAL.1 °d ,bey. P�+ ! �q -$ m sv4n NCEC .AN <g..:..* i Pa • /4y.,Awi 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. WARNING.THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER •1'o•: COADVER VSINSURANCE http://www.conoverinsurance.com April 13,2011 Ed Griner Spokane Rock Prdducts, Inc. P.O. Box 3808 Spokane, WA 99220 Re: Amended Certificate of Liability Insurance City of Spokane Valley Indiana Avenue Extension Project, Contract 10-012 Dear Ed: Thank you for forwarding the amended Certificate request from City of Spokane Valley regarding this project. As discussed,the 04/07/2011 Certificate originally issued for this project more than meets the project insurance limit requirements. The Excess Liability insurance policy of$9,000,000 limits as shown follows form with/is on top of the underlying General Liability and Business Auto insurance. So that this is made clearer, I issued an amended Certificate of Liability Insurance which specifically states-the Excess Liability insurance limits follow form with the underlying insurance. Please let me know if I can be of further assistance. Very sincerely, Jackie J- ernanc ez Jacqueline F. Hernandez,ACSR, CISR Account Manager Commercial Lines Team Lead—Tri-Cities, WA Attachment YAKIMA, TRI-CITIES KIRKLAND 125 N.50th Avenue 1804 W.Lewis,Pasco 11250 Kirkland Way P.O.Box 10088 P.O.Box 2528 P.O.Box 3299 Yakima,WA 98909 Tri-Cities,WA 99302 Kirkland,WA 98083-3299 509-965-2090 509-545-3800 425-822-3500 509-986-3454 FAX 509-547-7960 FAX 425-822-3510 , ACO D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) keee...-,i 4/13/2011 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 CONTACT NAME: �..(A X No):_ Conover Insurance, Inc. PHONE (509)545-3800 FA (509)547-7960 1804 W. Lewis St. ADDRESS: P.O. BOX 2828 PRODUCER CUSTOMERIP#: Tri-Cities WA 99302 INSURER(S)AFFORDING COVERAGE NAIC q INSURED INSURER A American States Insurance INSURER B:Insurance Co of the State of PA Spokane Rock Products, Inc. INSURER C: P.O. Box 3808 INSURER D: _. INSURER E: Spokane WA 99220 INSURER F: COVERAGES CERTIFICATE NUMBER:2010-2011 sRP REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH'POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IACCL'SUBRI � POLICY EFF i POLICY EXP TYPE OF INSURANCE LTR .INSR I WVD POLICY NUMBER (MM/DDIYYYY)I(MM/DD/YYYY)I LIMITS 1 O1CG68716470 EACH OCCURRENCE $ 1,000,000 GENERAL LIABILITY �O1/01/20111101/01/2012' � - ' DAMAGE TO RENTED X 1 COMMERCIAL GENERAL LIABILITY I PREMISES(Ea nrr,Irrence) $ 200,000 A 1 ' _ 'CLAIMS-MADE I X OCCUR j MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X ECT I LOC $ I AUTOMOBILE 24CC28988710 1/01/20110 A 1/ 01/2012 COMBINED SINGLE LIMIT $ 1,000,000 -- - (Ea accident) J ANY AUTO 1 BODILY INJURY(Per person) $ A X I ALL OWNED AUTOS BODILY INJURY(Per accident) $ X 1 SCHEDULED AUTOS PROPERTY DAMAGE $ • X�HIRED AUTOS 1 (Per accident) X NON-OWNED AUTOS I $ • . i I I UMBRELLA LIAB I X 1 OCCUR 8E876715B 01/01/2011�01/O1/2012[ EACH OCCURRENCE 1$ 9,000,000 I }{i EXCESSLIAR_ �—�CLAIMS-MADE: Follows Form W/Underlying AGGREGATE IS 9,000,000 DEDUCTIBLE I$ B I X RETENTION $ 10,000 : I 1 i $ A WORKERS COMPENSATION i01CG68716470 1/01/201101/01/2012 I WCSTATU- I Y 10TH-I AND EMPLOYERS'LIABILITY _;TORY:LIMIT., -_ R ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WASHINGTON STOP GAP ;EL EACH ACCIDENT l$ 1,000,000 OFFICER/MEMBER EXCLUDED? ,NIA (Mandatory in NH) E L DISEASE-EA EMPLOYEE$ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below , E L DISEASE-POLICY LIMIT I$ 1,000,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Re: Indiana Avenue Extension Project, Contract 10-012. City of Spokane Valley is additional insured. Additional Insured/Primary Additional Insured applies per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 0509. Business Auto additional insured per attached blanket Form #CA 71 10 03 07. Per-Project Aggregate Limit applies per CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E. Sprague, Suite 106 Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE Chuck Hudon/JACKS cc-%,X ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) r The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS blanket Form #CG 25 03 05 09. AMENDED: Cancels and replaces 04/07/2011 Certificate. Cancellation 30 Days Written Notice it OFREMARK COPYRIGHT 2000, AMS SERVICES INC. Safeco Insurance COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2.b. of the CANCELLATION Common SECTION II — LIABILITY COVERAGE -- A.1. WHO Policy Condition is replaced by the following: IS AN INSURED provision is amended by the addition of the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. e. Any person or organization for whom you are re- quired by an "insured contract" to provide insur- TEMPORARY SUBSTITUTE AUTO — PHYSICAL ance is an "insured", subject to the following DAMAGE COVERAGE additional provisions: (1) The "insured contract" must be In effect Under paragraph C. — CERTAIN TRAILERS, MO- during the policy period shown in the Decla- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rations, and must have been executed prior AUTOS of SECTION 1 - COVERED AUTOS, the to the "bodily injury" or "property damage". following is added: (2) This person or organization is an Insured" It Physical Damage coverage is provided by this Coy- only to the extent you are liable due to your erage Form, then you have coverage for: ongoing operations for that insured, whether the work is performed by you or for you, and Any "auto" you do not own while used with the per- only to the extent you are held liable for an mission of its owner as a temporary substitute for a "accident" occurring while a covered "auto" covered "auto" you own that is out of service be- is being driven by you or one of your em- cause of its breakdown, repair, servicing, "loss" or ployees. destruction. (3) There is no coverage provided to this person or organization for "bodily injury" to its em- BROAD FORM NAMED INSURED ployees, nor for "property damage" to its property. SECTION II — LIABILITY COVERAGE — A.1. WHO IS AN INSURED provision is amended by the addition (4) Coverage for this person or organization of the following; shall be limited to the extent of your negli- gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comparative negligence or fault. you during the policy period provided you own (5) The defense of any claim or "suit" must be 50% or more of the business entity and the business entity is not separately insured for tendered by this person or organization as Business Auto Coverage. Coverage is extended soon as practicable to all other insurers which potentially provide insurance for such up to a maximum of 180 days following acquisi claim or "suit". tion or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 SAleco and the Sateco logo ore rey'atered tredemw►A of SafoM Carprxa[ion CA 71 10 03 07 Page 1 of 6 EP C4J,19•rRe O1 crr•orUGa (6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION III -- PHYSICAL DAMAGE COVER- (a) The coverage and/or limits of this policy; AGE, A.4. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or limits required by c. personal Effects Coverage the "insured contract". For any Owned "auto" that is involved in a (7) A person's or organization's status as an covered "loss", we will pay up to $500 for "insured" under this subparagraph d ends "personal effects" that are lost or damaged when your operations for that "insured" are as a result of the covered 'loss", without completed. applying a deductible. EMPLOYEE AS INSURED EXTRA EXPENSE — BROADENED COVERAGE Under Paragraph A. of Section Il — LIABILITY COV- Paragraph A. — COVERAGE of SECTION 111 — ERAGE item f. is added as follows: PHYSICAL DAMAGE COVERAGE is amended to add: Your "employee" while using his owned "auto", or an "auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen in your business or your personal affairs,provided you covered "auto" to you. do not own, hire or borrow that "auto". This coverage is excess to any other collectible insurance coverage. AIRBAG COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B. — EXCLUSIONS of SECTION I11 — PHYSICAL DAMAGE COVERAGE,the following is Exclusion 5. FELLOW EMPLOYEE of SECTION II — added: LIABILITY COVERAGE — B. EXCLUSIONS is amended by the addition of the following: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. However, this exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you NEW VEHICLE REPLACEMENT COST own or hire, and provided that any coverage under this provision only applies in excess over any other Under Paragraph C — LIMIT OF INSURANCE of collectible insurance. Section III — PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: BLANKET WAIVER OF SUBROGATION 2. An adjustment for depreciation and physical con- We waive the right of recovery we may have for pay- dition will be made in determining actual cash ments made for "bodily injury" or "property damage" value in the event of a total loss. However, in the on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to "insureds" under Section II— LIABILITY COVERAGE which this coverage applies, as shown in the — A.1.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option: A.1.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- = PHYSICAL DAMAGE — ADDITIONAL TRANS eluding any insurance or warranties pur , PORTATION EXPENSE COVERAGE chased; The first sentence of paragraph A.4. of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make, model and follows: equipment, not including any furnishings, MOW parts or equipment not Installed by the We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership. 51.500 for temporary transportation expense incurred If the same model is not available pay the by you because of the total theft of a covered "auto" purchase price of the most similar model of the private passenger type. available; Mid Page 2of6 r.U).19.PP.Hfl a dYYrati r:a c. The market value'of your damaged vehicle, a. Actual cash value of the damaged or stolen not including any furnishings, parts or equip- property as of the time of the loss", less an merit not installed by the manufacturer or adjustment for depreciation and physical manufacturer's dealership. condition; or This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or of the private passenger, light truck or medium lease that the damaged covered "auto" is truck type (20,000 lbs or less gross vehicle subject to at the time of the loss", less any weight) and does not apply to initiation or set up one or all of the following adjustments: costs associated with loans or leases. (1) Overdue payment and financial penalties associated with those TWO OR MORE DEDUCTIBLES payments as of the date of the "loss". • Under SECTION III — PHYSICAL DAMAGE COV- ERAGE, if two or more `company" policies or cover- (2) Financial due to ti high mileage,under a age forms apply to the same accident, the following g g applies to paragraph D. Deductible: sive use or abnormal wear and tear, a. If the applicable Business Auto deduct- (3) Costs for extended warranties, Cre- ible is the smaller (or smallest) deduct- dit Life Insurance, Health, Accident ible it will be waived; or or Disability insurance purchased with the loan or lease, b. if the applicable Business Auto deduct- ible is not the smaller (or smallest) de- (4) Transfer or rollover balances from ductible it will be reduced by the amount previous loans or leases. of the smaller (or smallest) deductible; (5) Final payment due under a "Balloon or Loan". c. If the loss involves two or more Busi- (6) The dollar amount of any Hess Auto coverage forms or policies un-repaired damage that occurred the smaller (or smallest) deductible will prior to the "total loss" of a covered be waived. "auto". For the purpose of this endorsement (7) Security deposits not refunded by a "company" means: lessor. a, Safeco Insurance Company of America (8) All refunds payable or paid to you b. American States Insurance Company as a result of the early termination of a lease agreement or any war- e. General Insurance Company of America rarity or extended service agree- d. American Economy Insurance Company merit on a covered "auto", e. First National Insurance Company of (9) Any amount representing taxes. } America (10) Loan or lease termination fees 1. American States Insurance Company of Texas GLASS REPAIR — WAIVER OP DEDUCTIBLE g. American States Preferred Insurance Under paragraph D. -- DEDUCTIBLE of SECTION III Company — PHYSICAL DAMAGE COVERAGE,the following is h. Safeco Insurance Company of Illinois added: LOAN/LEASE GAP COVERAGE No deductible applies to glass damage if the glass is repaired rather than replaced. Under paragraph C — LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE, AMENDED ED DUTIES IN LOSS EVENT OF ACCi- the following is added: 4. The most we will pay for a total "loss" in any one The requirement in LOSS CONDITION 2.a. — "accident" is the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a $1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONDITIONS that you must notify us of an CA 71 10 03 07 Page 3 of 6 LR c,uo-1 o-Priarai-r,(0.oey "accident"applies only when the 'accident" is known deductible and excess provisions, we will provide to: coverage equal to the broadest coverage applicable to any covered "auto" you own. (1) You, if you are an individual; (2) A partner, if you are a partnership; or HIRED AUTO PHYSICAL DAMAGE COVERAGE — LOSS OF USE (3) An executive officer or insurance manager, if you are a corporation. SECTION III — PHYSICAL DAMAGE A.4.b. Form does not apply. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Subject to a maximum of $1,000 per accident, we will cover loss of use of a hired "auto" if it results from SECTION IV — BUSINESS AUTO CONDITIONS — an accident, you are legally liable and the lessor in- 8.2. is amended by the addition of the following: curs an actual financial loss. If you unintentionally fail to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE fisting at the inception date of your policy, we will not A. We will pay for rental reimbursement expenses deny coverage under this Coverage Form because of incurred by you for the rental of an "auto" be- such failure. However, this provision does not affect cause of a covered "loss" to a covered "auto". our right to collect additional premium or exercise our Payment applies in addition to the othorwlse ap right of cancellation or non-renewal. plicable amount of each coverage you have on a HIRED AUTO — LIMITED WORLD WIDE COVER- covered "auto". No deductibles apply to this coverage. AGE B. We will pay only for those expenses incurred Under Section IV — Business Conditions, Paragraph during the policy period beginning 24 hours atter B.7.b.e(1) is replaced by the following: the "loss" and ending, regardless of the policy's (1) The "accident" or "loss" results expiration, with the lesser of the following number from the use of an "auto" hired for of days: 30 days or less. 1. The number of days reasonably required to repair or replace the covered "auto". If RESULTANT MENTAL ANGUISH COVERAGE loss" is caused by theft, this number of days is added to the number of days it takes SECTION V — DEFINITIONS — C. is replaced by the to locate the covered `auto" and return it to following: you. "Bodily injury" means bodily injury, sickness or dis- 2. 30 days. ease sustained by a person including mental anguish C. Our payment is limited to the lesser of the fol or death resulting from any of these. lowing amounts: HIRED AUTO PHYSICAL-DAMAGE COVERAGE 1. Necessary and actual expenses incurred. If hired "autos" are covered "autos" for Liability coy- 2. $50 per day. erage and if Comprehensive, Specified Causes of D. This coverage does not apply while there are - Loss or Collision coverages are provided under this spare or reserve "autos" available to you for your Coverage Form for any "auto" you own, then the operations. Physical Damage Coverages provided are extended to "autos" you hire or borrow. E. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay The most we will pay for loss to any hired "auto" is under this coverage only that amount of your — S50,000 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which is riot al- whichever is smallest, minus a deductible. The de- ready provided for under the PHYSICAL DAM- - ductible will be equal to the largest deductible appli- AGE COVERAGE Coverage Extension, cable to any owned "auto" of the private passenger or light truck type for that coverage. Hired Auto Phy F. The Rental Reimbursement Coverage described UMW sical Damage coverage is excess over any other col- above does not apply to a covered "auto" that is lectible insurance. Subject to the above limit, described or designated as a covered "auto" on Page 4 of 6 C-14.10FFfllfaco-coozoc o•u Rental Reimbursement Coverage Form the manufacturer for the installation of a CA 99 23. radio. AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN- SURANCE provision of PHYSICAL DAMAGE A. Coverage COVERAGE is replaced by the following: 1. We will pay with respect to a covered "auto" 1. The most we will pay for loss" to audio, vi- for loss" to any electronic equipment that sual or data electronic equipment and any receives or transmits audio, visual or data accessories used with this equipment as a signals and that is not designed solely for the result of any one "accident" is the lesser ot: reproduction of sound. This coverage applies only if the equipment is permanently installed a. The actual cash value of the damaged in the covered "auto" at the time of the or stolen property as of the time of the loss" or the equipment is removable from a "loss"; or housing unit which is permanently installed b. The cost of repairing or replacing the in the covered "auto" at the time of the damaged or stolen property with other "loss", and such equipment is designed to property of like kind and quality. be solely operated by use of the power from the "auto's" electrical system, in or upon the c. $1,000. covered "auto". " 2. An adjustment for depreciation and physical 2. We will pay with respect to a covered "auto" condition will be made in determining actual for "loss" to any accessories used with the cash value at the time of the "loss". electronic equipment described in paragraph 3. If a repair or replacement results in better A.1. above. than like kind or quality, we will not pay for However, this does not include tapes, the amount of the betterment. records or discs. D. Deductible 3. If Audio, Visual and Data Electronic Equip- ment Coverage form CA 99 60 or CA 99 94 1. If "loss" to the audio, visual or data elec- is attached to this policy, then the Audio, Vi- ironic equipment or accessories used with suet and Data Electronic Equipment Cover- this equipment is the result of a loss" to the age described above does not apply. covered "auto" under the Business Auto Coverage Form's Comprehensive or Celli- . B. Exclusions sion Coverage, then for each covered "auto" The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, return or re- place damaged or stolen property will be re- AGE COVERAGE,except for the exclusion relat duced by the applicable deductible shown in ing to Audio, Visual and Data Electronic the Declarations. Any Comprehensive Cov- Equipment, also apply to this coverage. In addi- erage deductible shown in the Declarations tion, the following exclusions apply: does not apply to loss" to audio, visual or We will not pay for either any electronic equip- data electronic equipment caused by fire or ment or accessories used with such electronic lightning. equipment that is: 2. If "loss" to the audio, visual or data elec- f. Necessary for the normal operation of the tronic equipment or accessories used with covered "auto" for the monitoring of the this equipment is the result of a "loss" to the covered "auto's" operating system; or covered "auto" under the Business Auto Coverage Form's Specified Causes of Loss 2, Both: Coverage, then for each covered "auto" our a. an integral part of the same unit housing obligation to pay for, repair, return or replace any sound reproducing equipment de- damaged or stolen property will be reduced signed solely for the reproduction of by a $100 deductible. sound if the sound reproducing 3. If "loss" occurs solely to the audio, visual or equipment is permanently installed in data electronic equipment or accessories the covered "auto"; and used with this equipment, then for each cov- b. permanently installed in the opening of ered `auto" our obligation to pay for, repair, the dash or console normally used by CA71100307 Pago5016 EP c{'n-i 1.i'niareci•[xm•n091/41 return or replace damaged or stolen property SECTION V — DEFINITIONS is amended by adding will be reduced by a $100 deductible. the following: 4, In the event that there is more than one ap- Q. "Personal effects" means your tangible plicable deductible, only the highest deduct- property that is worn or carried by you, ex- ible will apply. In no event will more than one cept for tools, jewelry, money, or securities. deductible apply. R, "New vehicle" means any "auto" of which you are the original owner and the "auto" has not been previously titled and is less than 365 days past the purchase date. ii. eon MOM firer 0 ',mom ri Pacj a of 6 C.u11.1Y.PRIFY7L01.0 02 Q91A COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 POLICY NUMBER: 01-CG-687164-70 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: BLANKET Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to,Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of "your work" done under a contract with that person Section IV — Conditions: or organization and included in the We waive any right of recovery we may have against "Products completed operations hazard". This waiver the person or organization shown in the Schedule applies only to the person or organization shown in the Schedule above. above because of payments we make for injury or IP Insurance Services Office, Inc., 2008 Safeco and the Safeco logo are registered trademarks of Safeco Corporation CG 24 04 05 09 , EP COMMERCIAL GENERAL LIABILITY S. PCO insurance Ca 79 00 07 87 s THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1 . WHO IS AN INSURED - (SECTION 1) IS AMENDED TO INCLuJDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL ENSURED ON THIS COVERAGE PART, BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY" , "PROPERTY DAMAGE" OR "PERSONAL INJURY" ; AND B. IF AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS Olt OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "@.TRITTF,N CONTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES NOT QUALIFY AS Ail ADDITIONAL INSURED WITH RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. 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 IRED BY THE "WRITTEN CONTRACT REQUIRING INSURANCE", THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIIMITS OF LIABILITY REQUIRED BY THAT 'WRITTEN CONTRACT REQUIRING INSURANCE" THIS ENDORSE- , MENT SHALL NOT INCREASE THE LIMITS OF INSUR- ANCE DESCRIBED IN SECTION III - LIMIT_• S OF INSURANCE. B. THE INSURANCE PROVIDED TO TIIE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" , "PROPERTY DAMAGE" OR "PERSONAL INJURY' ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, ENGINEERING OR,SURVEYING SERVICES, INCLUDING: i . THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, Copyright, Insurance Services Office, Inc., 1983 Saco arvi he Sa:ecc logo are:90teeed rada'naces o!Sato C Yation Cr 79 00 07 87 Page 1 of 2 EF AFP-MEfA2-20-PRONro-4c57.3187-w . . Pe 2 0 2 S• COMMERCIAL GENERAL LIABILITY a#eco i- rr 1t" ' CG 78 QO 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POUCY CHANGES 1L 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, _JR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND i: _ SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODI LY INJURY" OR PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN TH Er "PRODUCTS-COMPLETED OPERA- TIONS '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 OCCURS BEFORE THE END OF THE PERIOD OF TIME 'FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3 . THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED 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-CONTRIBU- "'ORY BASIS, THIS INSURANCE IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL I NSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION 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 COLLECTI- BLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS ?AVM:LABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 :Act, aril ms Safeco logo are tegiiterad wardeirms el$i1* Ccteeseen c3 7a 81 ?age 1 a 2 EF AFF•'.ETA2.9tPP.NT661.486i•0itl4•W Pact ?o! 2 A.7P.V.:,742 i COMMERCIAL GENERAL LIABILITY : a#eC0 Ii al "t 't . CG 79 00 0787 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4 . AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii. 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 F CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADD]'I'TONAL INSURED, THE ADDITIONAL INSURED MUST: 1 . IMMEDIATELY RECORD THE SPECIFICS OF THE CLAIM OR "SUI'1 " 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 "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 OTHERWISE COMPLY WIH ALL E'OLICY CONDITIONS . C. THE ADDITIONAL INSURED MUST TENDER THE DEFENSE 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 NOT. AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER. INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc.. 1983 Van) ar,f Me Nowt Iola we rerietwe1 aaderlaka of Saferr C sceel,r. Cr) 79 00 07 87 Pogo 1 of 2 EP Page 2 of 2 42 r2w COMMERCIAL GENERAL LIABILITY �' 'CO insu;'a(�1(;e CO 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3 . ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS : "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN. CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE, "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS 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 III EFFECT; AND C. BEFORE THE END OF THE POLICY PERIOD. Copyright, Insurance Services Office, Inc., 1983 Soho and ete SOW 1090 ere re91slerea >aaemerks cl Salew Cu/prelim CGG 79 00 07 67 Page I of 2 EP AFP•14ETA2.20•PIINT001.1167.01 p0 W 2 nf 2 AFI,NEfA211f..krTiNT::::t4Erd2.11fvi-Vi COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 POLICY NUMBER: 01-CG-687164-70 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 Project(s): BLANKET Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section I — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I —Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit 2. The Designated Construction Project Gen shown in the Declarations, such limits will be subject to the applicable Designated Con- for Aggregate Limit is the most we will pay the sum of all damages under Coverage struction Project General Aggregate Limit. A, except damages because of `bodily B. For all sums which the insured becomes legally injury"or "property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section I — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section I — Coverage C, which a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available • damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and ® Insurance Services Office, Inc., 2008 Safeco and the Safeco logo are registered trademarks of Safeco Corporation CG 25 03 05 09 Page 1 of 2 EP ""REPRINTED FROM THE FORMS LIBRARY'''. 2. Such payments shall not reduce any Desig- Aggregate Limit nor the Designated Construction nated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned,delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, "bodily injury" or "propery damage" included in specifications or timetables, the project will still the "products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section III — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 Craig Aldworth From: Cary Driskell Sent: Thursday, April 14, 2011 11:54 AM To: Craig Aldworth Cc: Steve Worley Subject: RE: Spokane Rock Products Insurance for Indiana Ave Extension Project I asked WCIA in the past two months whether they were okay with such an umbrella to make up for a shortage on the CG and auto coverage,and they were fine with that. I think you are okay to move ahead. Cary P. Driskell Acting City Attorney City of Spokane Valley 11707 East Sprague Avenue Suite 103 Spokane Valley, WA 99206 Phone: (509) 720-5150 Fax: (509) 688-0299 Confidentiality Notice: The information contained in this email and any accompanying attachment(s) is intended only for the use of the intended recipient and may be confidential and/or privileged. If any reader of this communication is not the intended recipient,unauthorized use, disclosure or copying is strictly prohibited, and may be unlawful. If you have received this communication in error, please immediately notify the sender by return email, and delete the original message and all copies from your system. Thank you. From: Craig Aldworth Sent: Thursday, April 14, 2011 11:49 AM To: Cary Driskell Cc: Steve Worley Subject: Spokane Rock Products Insurance for Indiana Ave Extension Project Cary The Insurance Cert that Spokane Rock Products provided for the Indiana Avenue Extension project(CIP 0112)did not provide the exact coverage required by the Contract Documents. Insurance Type Required Spokane Rock Provided Commercial General Liability General Aggregate $3,000,000 $2,000,000 Automobile Liability Combined Single Limit $3,000,000 $1,000,000 Umbrella Liability each Occurrence $1,000,000 $9,000,000 Umbrella Liability each Occurrence $1,000,000 $9,000,000 I requested a new certificate providing at least the minimum for each of the insurance types. And they have responded with this email. The email includes a cover letter from the insurance provider; my marked up copy of the original insurance cert showing the deficiencies; a copy of the pertinent Contract specifications;the new amended insurance certificate. Please review. Does the extra Umbrella Liability make up for the deficiencies in the other coverages? Thanks, 1 1-07.18(4) Evidence of insurance The Contractor shall deliver to the Contracting Agency a Certificate(s) of Insurance and endorsements for each policy of Insurance meeting the requirements set forth herein when the Contractor delivers the signed Contract for the work. The certificate and endorsements must conform to the following requirements: 1. An ACORD certificate or a form determined by the Contracting Agency to be equivalent. 2. Copies of all endorsements naming Contracting Agency and all other entities listed In 1- 07,18(2) as Additional Insured(s), showing the policy number, The Contractor may submit a copy of any blanket additional insured clause from its policies Instead of a separate endorsement. A statement of additional insured status on an ACORD Certificate of Insurance shall not satisfy this requirement. 3. Any other amendatory endorsements to show the coverage required herein. 1-07.18(5) Coverages and Limits The insurance shall provide the minimum coverages and limits set forth below. Providing coverage in these stated minimum limits shall not be construed to relieve the Contractor from liability in excess of such limits. All deductibles and self-insured retentions must be disclosed and are subject to approval by the Contracting Agency. The cost of any claim payments falling within the deductible shall be the responsibility of the Contractor. 1-07.18(5)A Commercial General Liability A policy of Commercial General Liability Insurance, including: Per project aggregate endorsement on Form CG 2503 Premises/Operations Liability Products/Completed Operations —for a period of one year following final acceptance of the work. Personal/Advertising Injury Contractual Liability Independent Contractors Liability Stop Gap/ Employers' Liability Explosion, Collapse, or Underground Property Damage (XCU) Blasting (only required when the Contractor's work under this Contract includes exposures to which this specified coverage responds) Such policy must provide the following minimum limits: $1,000,000 Each Occurrence $3,000,000 General Aggregate $2,000,000 Products & Completed Operations Aggregate $1,000,000 Personal &Advertising Injury, each offence Stop Gap/Employers' Liability $1,000,000 Each Accident $1,000,000 Disease - Policy Limit $1,000,000 Disease - Each Employee 1-07.18(5)B Automobile Liability City of Spokane Valley 144 General Special Provisions Indiana Avenue Extension Project SVPW Bid No. 10-012 Commercial Automobile Liability: As specified by Insurance Services Office, form number CA 0001, Symbol 1 (any auto),with an MCS 90 endorsement and a CA 9948 endorsement attached if "pollutants" as defined in exclusion 11 of the commercial auto policy are to be transported..Such policy(ies)must provide the following minimum limit: Bodily Injury and Property Damage — $3,000,000 Combined Single Limit 1-07.18(5)C Workers' Compensation The Contractor shall comply with Workers' Compensation coverage as required by the Industrial Insurance laws of the state of Washington. 1-07.18(5)F Excess or Umbrella Liability (May 10, 2006 APWA GSP) The Contractor shall provide Excess or Umbrella Liability coverage at limits of 1 million per occurrence and annual aggregate. This excess or umbrella liability coverage shall apply, at a minimum, to both the Commercial General and Auto Insurance policy coverage. This requirement may be satisfied instead through the Contractor's primary Commercial General and Automobile Liability coverage, or any combination thereof. Contractor shall provide evidence of compliance with Worker's Compensation coverage, as required by the industrial insurance Laws of the State of Washington (RCW Title 51). If Contractor is qualified as a self-Insurer in accordance with RCW 51.14, Contractor shall so certify by letter signed by a corporate officer indicating that it is a qualified self insured, and setting forth the limits of any policy of excess insurance covering its employees. Builders Installation Floater: The Contractor shall purchase and maintain Builders Installation Floater Insurance covering loss by casualty of all or any part of the construction whether completed or not to indemnify itself from losses imposed by law or assumed under the Contract by the Contractor. Such Insurance shall include, but not be limited to, loss by fire, earthquake, landslide, flood, volcanic eruption, damage resulting from faulty =`! construction and vandalism. Such Builders' Installation Floater Insurance shall be equal to 50% of the total of all bid items for all pipe; manholes; tees and fittings; and, pipe bedding, Such Builders' Installation Floater Insurance shall be maintained in effect until final acceptance of the completed construction. 1-07.22 Use of Explosives (June 17, 2008 COSV GSP) Delete this section and replace with the following: Blasting is not allowed on City of Spokane Valley public works projects. Rock excavation . shall be accomplished by other methods. Construction Under Traffic Section 1-07.23(1) is supplemented with the following: City of Spokane Valley 145 General Special Provisions Indiana Avenue Extension Project SVPW Did No.10-012 . Washington State Department of «art. Employer Liability �`• '% Certificate Labor and Industries , Department of Labor and Industries Employer Liability Certificate Date: 04/13/2011 UBI #: 602 082 495 Legal Business Name: SPOKANE ROCK PRODUCTS INC Account#: 133,446-07 'Doing Business As'Name: SPOKANE ROCK PRODUCTS INC Estimated Workers Reported: Quarter 4 of Year 2010 "76 to 100 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? Yes License: SPOKARP990BH Expire Date: 2/1/2012 Account Representative: T8/DALE MCMASTER(360)902-5617 -Email: MCMS235 @lni.wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter.A single 480 hour position may be filled by one person,or several part time workers. Industrial Insurance,Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods,cancellation dates, limitations of coverage or waiver of subrogation(See RCW 51.12.050 and 51.16.190). a A ° DATE(MM/DD/Y CERTIFICATE OF LIABILITY INSURANCE 11/6/2012 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 CONTACT Jacqueline Hernandez, ACSR NAME: Conover Insurance PHONE (509)545-3800 I FAX (509)547-7960 Mir Flifl• 1804 West Lewis Street ADDR S : INSURER(S)AFFORDING COVERAGE NAIC# Pasco WA 99301 INSURERAAmerican Economy Ins Co INSURED INSURER B American States Ins Co Spokane Rock Products, Inc. INSURERC:Insurance Co of the ST of Penn P.O. Box 3808 INSURER D:Liberty N.W. Ins. Corp • INSURER E: _Spokane WA 99220 INSURERF: COVERAGES CERTIFICATE NUMBER:2012-2013 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE •DDL L.WU M/:R POLICY EFF POLICY EXP LIMITS LTR INSR VD POLICY NUMBER (MDD/YYYY) IMM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 •COMMERCIAL GENERAL LIABILITY • • • , • 200,000 CLAIMS-MADE © OCCUR •1CG68716480 I/1/2012 I/1/2013 • 10,000 Contractual • • 1,000,000 r X, C, U ••• ••• N'L AGGREGATE LIMIT APPLIES PER "•• • •'AGG $ 2,000,000 POLICY © PRO- ■ LOC $ AUTOMOBILE LIABILITY • • $ 1,000,000 F ANY AUTO BODILY accident $ ALL OWNED ■ SCHEDULED 11h1C1546365b0 '/1/2012 ./1/2013 BODILY INJURY(Per accident) AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS ■ AUTOS (Per accident) ■ Hired Auto Liabilit 113 UMBRELLA LIAB © OCCUR EACH OCCURRENCE $ 9,000,000 ■ EXCESS LIAB ■ CLAIMS-MADE ••• ••• DED © RETENTION$ 10,00. =E8767158 ./1/2012 ■/1/2013 STATU- I WORKERS COMPENSATION X TORY L IM OFR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? •1CG68716480 /1/2012 /1/2013 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE: $ 1,000,000 If yes,describe under A STOP GAP DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2 000 000 ill CONTRACTORS POLLUTION 1111CG68716480 ./1/2012 ./1/2013 LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Company D: ID/MT Workers Compensation, Policy #WC41NC011995011, 10/1/2011 to 10/1/2012, $1,000,000 Limit. Re: Indiana Avenue Extension Project, Contract 10-012. City of Spokane Valley is additional insured. Business Auto additional insured applies per attached blanket Form #CA 71 10 03 07. Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09.Per-Project Agg per Form #CG 25 03 05 09. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E. Sprague, Suite 106 Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE Chuck Hudon/JACKS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. Itd Cf19R,on,nnc%n, Tti„ wanon.............a r.-...-.-..........-a.......•.--.-.�., s wnnnn n f I/ , I A`oR ®O DATE(MM/D.VYY CERTIFICATE OF LIABILITY INSURANCE ( 1/6/2012 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 CONTACT Jacqueline Hernandez, ACSR NAME: Conover Insurance (A/C Nn PHONE (A/C. Feti' (509)545-3800 FAX Nol:(509)547-7960 1804 West Lewis Street E-MAIL ADDRFSS• - INSURER(S)AFFORDING COVERAGE NAIC# Pasco WA 99301 INsuRERA American Economy Ins Co INSURED INSURER B:American States Ins Co Spokane Rock Products, Inc. INsuRER c:Insurance Co of the ST of Penn P.O. Box 3808 INSURER D:Liberty N.W. Ins. Corp - INSURER E: Spokane WA 99220 INSURERF: COVERAGES CERTIFICATE NUMBER:2012-2013 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETE X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occur ence) $ 200,000 A I CLAIMS-MADE © OCCUR 01CG68716480 1/1/2012 1/1/2013 MED EXP(Any one person) $ 10,000 i X Contractual PERSONAL&ADV INJURY $ 1,000,000 X X, C, U GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —I POLICY I T I VT I]LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ (Ea accident) $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ —ALL OWNED SCHEDULED 01C154636510 1/1/2012 1/1/2013 BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS — AUTOS (Per accident) Hired Auto Liability $ X UMBRELLA LIAB X 9,000,000 OCCUR EACH OCCURRENCE $ C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 9,000,000 DED I X(RETENTION$ 10,000 BE8767158 1/1/2012 2/1/2013 $ A WORKERS COMPENSATION WC STATU- i 0TH- AND EMPLOYERS'LIABILITY X I TORY t IMITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N/A 1/1/2012 1/1/2013 (Mandatory in NH) 01CG68716480 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under P DESCRIPTION OF OPERATIONS below WA STOP GA .E.L.DISEASE-POLICY LIMIT $ 2,000,000 A CONTRACTORS POLLUTION 01CG68716480 1/1/2012 1/1/2013 LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Company D: ID/MT Workers Compensation, Policy #WC41NC011995011, 10/1/2011 to 10/1/2012, $1,000,000 Limit. Re: Indiana Avenue Extension Project, Contract 10-012. City of Spokane Valley is additional insured. Business Auto additional insured applies per attached blanket Form #CA 71 10 03 07. Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09.Per-Project Agg per Form #CG 25 03 05 09. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E. Sprague, Suite 106 Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE Chuck Hudon/JACKS „ _-... .0--,- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. inicrilc ion,nns n. LEI ! C. V ) afec #n ura ;,'-'' COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2.b. of the CANCELLATION Common SECTION 11 — LIABILITY COVERAGE — A.1. WHO Policy Condition is replaced by the following: IS AN INSURED provision is amended by the addition of the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. e. Any person or organization for whom you are re- quired by an Insured contract"to provide insur- TEMPORARY SUBSTITUTE AUTO -- PHYSICAL ance is an Insured", subject to the following DAMAGE COVERAGE additional provisions: Under paragraph C. — CERTAIN TRAILERS, MO (1) The "insured contract" must be in effect during the policy period shown in the Decla- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rations, and must have been executed prior AUTOS of SECTION 1 — COVERED AUTOS, the to the "bodily injury" or " following is added: Y "property damage". (2) This person or organization is an Insured" It Physical Damage coverage is provided by this Coy- only to the extent you are liable due to your erage Form,then you have coverage for: ongoing operations for that insured, whether the work is performed by you or for you,and Any "auto" you do not own while used with the per- only to the extent you are held liable for an mission of its owner as a temporary substitute for a "accident" occurring while a covered "auto" covered "auto" you own that is out of service be- is being driven by you or one of your em- cause of its breakdown, repair, servicing, loss" or ployees. destruction. (3) There is no coverage provided to this person BROAD FORM NAMED INSURED or organization for "bodily 'Noy" to its em- pioyees, nor for "property damage" to its o SECTION II — LIABILITY COVERAGE — A.1. WHO property. IS AN INSURED provision is amended by the addition (4) Coverage for this person or organization of the following: shall be limited to the extent of your negli- gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comparative negligence or fault, you during the policy period provided you own (5) The defense of any claim or "suit" must be 50% or more of the business entity and the business entity is not separately insured for tendered by this person or organization as soon as practicable to all other insurers Business Auto-Coverage. Coverage is extended which potentially provide insurance for such up to a maximum of 180 days following acquisi claim or "suit". tion or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, inc., 1997 Sateca and the Seines!Dir.are registere0 trademarks of Saieco Corporation GA 71 10 03 07 Page i of 6 EP GU6-19-PRINTt l-W12.fA3B&- (6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION ltd — PHYSICAL DAMAGE COVER- (a) The coverage and/or limits of this policy; AGE, k4. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or iimits required by c. Personal Effects Coverage the insured contract'. For any Owned "auto" that is involved in a (7) A person's or organization's status as an covered loss", we will pay up to $500 for `Insured" under this subparagraph d ends "personal effects" that are lost or damaged when your operations for that "insured" are as a result of the covered loss", without completed. applying a deductible. EMPLOYEE AS ENSURED EXTRA EXPENSE -- BROADENED COVERAGE Under Paragraph A. of Section II — LIABILITY COV- Paragraph A. — COVERAGE of SECTION III — ERAGE item 1. is added as follows: PHYSICAL DAMAGE COVERAGE is amended to add: Your "employee" while using his owned `auto", or an "auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen in your business or your personal affairs,provided you covered "auto" to you. do not own, hire or borrow that "auto".This coverage is excess to any other collectible insurance coverage. AIRBAG COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B. — EXCLUSIONS of SECTION III -- PHYSICAL DAMAGE COVERAGE,the following is Exclusion 5. FELLOW EMPLOYEE of SECTION II — added: LIABILITY COVERAGE — B. EXCLUSIONS is amended by the addition of the following: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. However, this exclusion does not apply if the "bodiy injury" results from the use of a covered "auto" you NEW VEHICLE REPLACEMENT COST own or hire, and provided that any coverage under this provision only applies in excess over any other Under Paragraph C — LIMiT OF INSURANCE of collectible insurance. Section IiI —PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: BLANKET WAIVER OF SUBROGATION 2. An adjustment for depreciation and physical con- We waive the right of recovery we may have for pay- dition will be made in determining actual cash melts made far "bodily injury" or "property damage" value in the event of a total loss. However, in the on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to $ "insureds" under Section II — LIABILITY COVERAGE which this coverage applies, as shown in the — A.1.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option: A.I.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- --- PHYSICAL DAMAGE — ADDITIONAL TRANS- Eluding any insurance or warranties pur- �, PORTATION EXPENSE COVERAGE chased; The first sentence of paragraph A.4, of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make, model and follows: equipment, not including any furnishings, MINN parts or equipment not installed by the We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership. $1,500 for temporary transportation expense incurred If the same model is not available pay the a — by you because of the total theft of a covered `auto" purchase p rice of the most similar model of the private passenger type. available; Page 2of6 '.110.04-PRtN'iffi5-01X12-OGS7 8 c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen not including any furnishings, parts or equip- property as of the time of the loss", less an rnent not installed by the manufacturer or adjustment for depreciation and physical manufacturer's dealership. condition; or This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or of the private passenger, light truck or medium lease that the damaged covered "auto" is truck type (20,000 lips or less gross vehicle subject to at the time of the "loss", less any weight) and does not apply to initiation or set up one or all of the following adjustments: costs associated with loans or leases. (1) Overdue payment and financial penalties associated with those TWO OR MORE DEDUCTIBLES payments as of the date of the loss". Under SECTION III — PHYSICAL DAMAGE COV- ERAGE, if two or more "company" policies or cover- (2) penalties P age forms apply to the same accident, the following lease due to high mileage, exces- applies to paragraph D. Deductible: sive use or abnormal wear and tear. a. If the applicable Business Auto deduct- (3) Costs for extended warranties, Cre- ible is the smaller (or smallest) deduct- dit Life Insurance, Health, Accident ible it will be waived; or or Disability Insurance purchased b. If the applicable Business Auto deduct- ible the loan or lease. ible is not the smaller (or smallest) de- (4) Transfer or rollover balances from ductible it will be reduced by the amount previous loans or leases. of the smaller (or smallest) deductible; (5) Final payment due under a "Balloon or Loan". c. If the loss involves two or more Busi- (S) The dollar amount of any ness Auto coverage forms or policies un-repaired damage that occurred the smaller (or smallest) deductible will prior to the "total loss" of a covered be waived. "auto". For the purpose of this endorsement (1) Security deposits not refunded by a "company" means: lessor. a. Safeco Insurance Company of America (8) All refunds payable or paid to you b. American States Insurance Company as a result of the early termination of a lease agreement or any war- e. General insurance Company of America rarity or extended service agree- d. American Economy Insurance Company merit on a covered "auto". e. First National insurance Company of (9) Any amount representing taxes. x America (10) Loan or lease termination fees f. American States Insurance Company of Texas GLASS REPAIR — WAIVER OF DEDUCTIBLE g. American States Preferred insurance Under paragraph D. — DEDUCTIBLE of SECTION Ill Company -- PHYSICAL DAMAGE COVERAGE,the following is h. Setaco Insurance Company of Illinois added: LOAN/LEASE GAP COVERAGE No deductible applies to glass damage if the glass is repaired rather than replaced. Under paragraph C -- LIMIT OF INSURANCE of SECTION Ill — PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI- the following is added: DENT, CLAIM, SUIT OR LOSS 4. The most we will pay for a total "loss" in any one The requirement in LOSS CONDITION 2.a. — "accident" is the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a $1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONDITIONS that you must notify us of an CA 71 10 03 07 Page 3of6 EP • "accident" applies only when the "accident" is known deductible and excess provisions, we will provide to: coverage equal to the broadest coverage applicable to any covered "auto" you own. (1) You, if you are an individual; HIRED AUTO PHYSICAL DAMAGE COVERAGE — (2) A partner, if you are a partnership; or LOSS OF USE (3) An executive officer or insurance manager, if you SECTION iIE -- PHYSICAL DAMAGE A.4.b. Form are a corporation. does not apply. UNINTENTIONAL FAILURE TO DISCLOSE Subject to a maximum of$1,000 per accident, we will HAZARDS Subject loss of use of a hired "auto" if it results from SECTION iV — BUSINESS AUTO CONDITIONS — an accident, you are legally liable and the lessor in- B.2. is amended by the addition of the following: curs an actual financial loss. if you unintentionally fail to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE fisting at the inception date of your policy, we will not We will pay for rental reimbursement expenses deny coverage under this Coverage Form because of incurred by you for the rental of an 'auto" be- such failure. However, this provision does not affect cause of a covered loss" to a covered "auto". our right to collect additional premium or exercise our Payment applies in addition to the otherwise ap- right of cancellation or non-renewal. plicable amount of each coverage you have on a covered "auto". No deductibles apply to this HIRED AUTO — LIMITED WORLD WIDE COVER- coverage. AGE B. We will pay only for those expenses incurred Under Section IV -- Business Conditions, Paragraph during the policy period beginning 24 hours after B.7.b.e(1) is replaced by the following: the "loss" and ending, regardless of the policy's (1) The "accident" or "loss" results expiration, with the lesser of the following number from the use of an "auto" hired for of days: • 30 days or less. 1, The number of days reasonably required to repair or replace the covered "auto". If RESULTANT MENTAL ANGUISH COVERAGE loss" is caused by theft, this number of days is added to the number of days k takes SECTION V — DEFINITIONS -- C. is replaced by the to locate the covered "auto" and return it to following: you. "Body injury" means bodily injury, sickness or dis- 2. 30 days. ease sustained by a person including mental anguish C Our payment is limited to the lesser of the fol- or death resulting from any of these. lowing amounts: HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses incurred. If hired "autos" are covered "autos" for Liability cov- 2. $50 per day. erage and if Comprehensive, Specified Causes of D. This coverage does not apply while there are .:— Loss or Collision coverages are provided under this spare or reserve "autos" available to you for your Coverage Form for any 'auto" you own, then the operations. Physical Damage Coverages provided are extended to "autos" you hire or borrow. E. If "loss" results from the total theft of a covered "= "auto" of the private passenger type, we will pay mom The most we will pay for loss to any hired `auto" is under this coverage only that amount of your swim $50,000 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which is not al- whichever is smallest, minus a deductible. The de- ready provided for under the PHYSICAL DAM- ductible will be equal to the largest deductible appli- AGE COVERAGE Coverage Extension. — cable to any owned "auto" of the private passenger F. The Rental Reimbursement Coverage described or light truck type for that coverage. Hired Auto Phy- mom sical Damage coverage is excess over any other col- above does not apply to a covered "auto" that is lectible insurance. Subject to the above limit, described or designated as a covered `auto" on Page 4 of 6 CAIMS.PAINTI -0302-1105'-B Rental Reimbursement Coverage Form the manufacturer for the installation of a CA 99 23. radio. AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN- SURANCE provision of PHYSICAL DAMAGE A. Coverage COVERAGE is replaced by the following: 1. We will pay with respect to a covered "auto" 1. The most we will pay for loss"to audio, vi- for loss" to any electronic equipment that sual or data electronic equipment and any receives or transmits audio, visual or data accessories used with this equipment as a signals and that is not designed solely for the result of any one "accident" is the lesser of: reproduction of sound. This coverage applies only if the equipment is permanently installed a. The actual cash value of the damaged in the covered "auto" at the time of the or stolen property as of the time of the loss" or the equipment is removable from a "loss"; or housing unit which is permanently installed b. The cost of repairing or replacing the in the covered "auto" at the time of the damaged or stolen property with other loss", and such equipment is designed to property of like kind and quality. be solely operated by use of the power from the "auto's" electrical system,in or upon the c. $1,000. covered "auto". 2. An adjustment for depreciation and physical 2. We will pay with respect to a covered "auto" condition will be made in determining actual for loss" to any accessories used with the cash value at the time of the loss". electronic equipment described in paragraph 3. if a repair or replacement results in better A.1. above. than like kind or quality, we will not pay for However, this does not include tapes, the amount of the betterment. records or discs, iD. Deductible 3. If Audio, Visual and Data Electronic Equip- ment Coverage form CA 99 60 or CA 99 94 1. If "loss" to the audio, visual or data elec- tronic equipment or accessories used with is attached to this policy, then the Audio, VI- sual and Data Electronic Equipment Cover- this equipment is the result of a loss" to the age described above does not apply. covered "auto" under the Business Auto Coverage Form's Comprehensive or Celli- Et. Exclusions sion Coverage, then for each covered "auto" The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, return or re- The damaged or stolen property will be re- AGE COVERAGE,except for the exclusion relat duced by the applicable deductible shown in ing to Audio, Visual and Data Electronic the Declarations. Any Comprehensive Cov- Equipment, also apply to this coverage. In add- erage erage deductible shown in the Declarations t"ion, the following exclusions apply: : does not apply to loss" to audio, visual or We will not pay for either any electronic equip- data electronic equipment caused by fire or meat or accessories used with such electronic lightning. equipment that is: 2. If loss" to the audio, visual or data elec- 1. Necessary for the normal operation of the tronic equipment or accessories used with covered *auto" for the monitoring of the this equipment is the result of a "loss" to the covered "auto's" operating system; or covered "auto" under the Business Auto 2. Both: Coverage Form's Specified Causes of Loss Coverage, then for each covered "auto" our a. an integral part of the same unit housing obligation to pay for, repair, return or replace any sound reproducing equipment de- damaged or stolen property will be reduced signed solely for the reproduction of by a$100 deductible. sound if the sound reproducing 3. If "loss" occurs solely to the audio, visual or equipment is permanently installed in data electronic equipment or accessories the covered "auto"; and used with this equipment, then for each coy- b. permanently installed in the opening of ered "auto" our obligation to pay for, repair, the dash or console normally used by CA71100307 Paga5ci6 EP c.itc-9-Pattran-0Etzoosez return or replace damaged or stolen property SECTION V — DEFINITIONS is amended by adding will be reduced by a$100 deductible. the-following: 4. In the event that there is more than one ap- O. "Personal effects" means your tangible plicable deductible, only the highest deduct- property that is worn or carried by you, ex- ibte will apply. In no event will more than one cept for toots,jewelry, money, or securities. deductible apply. R. "New vehicle" means any "auto" of which you are the original owner and the "auto" has not been previously titled and is less than 365 days past the purchase date. MOM wrorma S UMW MIME MOM MOM= NOM Pap 6 of 6 CAM 4PAINTIOana1 514 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 POLICY NUMBER: 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 Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section I — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I — Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit shown in the Declarations, such limits will be 2. The Designated Construction Project Gen subject to the applicable Designated Con- eral Aggregate Limit is the most we will pay struction Project General Aggregate Limit. for the sum of all damages under Coverage A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or "property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section I — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section I — Coverage C, which a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing "suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and © insurance Services Office. Inc., 2008 Saieco and the Sateco logo are registered trademarks of Sateco Corporation CG 25 03 05 09 Page 1 of 2 EP 2. Such payments shall not reduce any Desig- Aggregate Limit nor the Designated Construction nated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned,delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, "bodily injury" or "propery damage" included in specifications or timetables, the project will still the "products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section III — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 • COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 POLICY NUMBER: WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: BLANKET Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of `your work" done under a contract with that person Section IV — Conditions: or organization and included in the We waive any right of recovery we may have against "Products completed operations hazard". This waiver the person or organization shown in the Schedule applies only to the person or organization shown in above because of payments we make for injury or the Schedule above. ©Insurance Services Office, Inc., 2008 Sateco and the Sateco logo are registered trademarks of Sateco Corporation CG 24 04 05 09 EP COMMERCIAL GENERAL LIABILITY Insurance.. ...00 �n �.�i�'�c CG 79 fit) 07 87 tro THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 1201 /185 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABIUTY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED (SECTION 11 IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY", 'PROPERTY DAMAGE" OR "PERSONAL INJURY" ; AND B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS 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 ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. 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 INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- MENT SHALL NOT INCREASE THE LIMITS OF INSUR- ANCE DESCRIBED IN SECTION III - LIMITS OF INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" , "PROPERTY DAMAGE" OR "PERSONAL INJURY" ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, ENGINEERING OR SURVEYING SERVICES, INCLUDING: i. THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, Copyright, Insurance Services Office, Inc., 1983 Sate= and nor Saco mac am tepored ttalsmxts o!See• Corporator. CG 79 00 07 87 Page 1 of 2 EP AFP-MEfA2,2C PR4iJR' id'a57-01S7•w COMMERCIAL GENERAL LIABILITY :;CO t- Insurance CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POUCY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii. SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR . "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERA- TIONS 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 OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3 . THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED 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-CONTRIBU- TORY BASIS, THIS INSURANCE IS PRIMARY TO 'OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION 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 COLLECTI- BLE "OTHER INSURANCE", WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, insurance Services Office, Inc.., 1 Seim eAti Me Waco row) are registered trademarks d Satao Corot:tater. CG 00 07 87 Paga 1 01 2 EP AFPNETN2•Zr•PRINT001-4857-MW COMMERCIAL GENERAL LIABILITY CG fl r CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. POUCY CHANGES IL12011185 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLE 1 his OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4 . AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: 5,. HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii. 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. NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE RECEIVE WRITTEN 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 OTHERWISE COMPLY WIH ALL • POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE DEFENSE 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 NOT AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc., 1983 Salsas ant the Salsa logs are registered marks of Satarty Carpaera, CG 79 08 07 87 Pigs 1 of 2 EP A.FP4dIETA2-2C PP-INr6C1.4557-1191.1?` COMMERCIAL GENERAL LIABILITY a 0 insurance CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH w . ABOVE. 5 . THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN. CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND 'PROPERTY DAMAGE" OCCURS 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 END OF THE POLICY PERIOD. Copyright, insurance Services Office, Inc., 1983 Saiew and the Seim logo ace regkseced traoermics ct Salem Corpaalhn CO 79 00 07 07 Page t of 2 EP i co°� A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� ( 2/7/2012 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). i PRODUCER CONTACT Jacqueline Hernandez, ACSR NAME: Conover Insurance AHONN Fxtr (509)545-3800 I A C.No1: (509)547-7960 l 1804 West Lewis Street E-MAIL ADDRFSS: INSURER(S)AFFORDING COVERAGE NAIC# Pasco WA 99301 INSURERA:American Economy Ins Co INSURED INSURER B:American States Ins Company Spokane Rock Products Inc. INSURERC:Starr Indemnity & Liability Co. P.O. Box 3808 INsuRERD:Navigators Insurance Comapny INSURER E:Liberty Northwest Ins Corp. Spokane WA 99220 INSURER F: COVERAGES CERTIFICATE NUMBER:2012-2013 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 — DAMAGE TO RENTED 200 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ ' A I CLAIMS-MADE © OCCUR 01CG68716480 1/1/2012 1/1/2013 MED EXP(Any one person) $ 10,000 X Constructual PERSONAL&ADV INJURY $ 1,000,000 Includes X, C, U GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY[• I,,,,y, f i LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 _ (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 01CI54636510 1/1/2012 1/1/2013 AUTOS _ AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) — Hired Auto Liability $ 1,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAB CLAIMS-MADE SISIGCE50027812 AGGREGATE $ 4,000,000 DED ,I I RETENTION$ EXCESS AUTO LIABILITY 2/1/2012 1/1/2013 $ WC A WORKERS COMPENSATION I I ATU- 1 T IOER AND EMPLOYERS'LIABILITY ' ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A 1/1/2012 1/1/2013 (Mandatory in NH) 01CG68716480 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below *RA STOP GAP E.L.DISEASE-POLICY LIMIT I$ 2,000,000 A CONTRACTORS POLLUTION 01CG68716480 1/1/2012 1/1/2013 LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Company D: Excess Liability, Policy #SE12EXC7450301C, 2/1/2012 TO 1/1/2013, $9,000,000 Occurrence/Aggregate Limit. Company E: ID/MT Workers Compensation, Policy #WC41NCO11995011, 10/1/2011 to 10/1/2012, $1,000,000 Limit. Re: Indiana Avenue Extension Project, Contract 10-012. City of Spokane Valley is additional insured. Business Auto additional insured applies per attached blanket Form #CA 71 10 03 07. Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09.Per-Project Agg per Form #CG 25 03 05 09. Amended: Cancels & replaces certificate issued 1/06/12. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 11707 E. Sprague, Suite 106 Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE Chuck Hudon/KRISTI �__� �` � 't ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IMQA,c 1o11nnc,n, r�.., nnnon......... .....�r,.,.,..._-...,.....-a....,..1.........r,.. s nrnon C't...) —L)--i t � COMMENTS/REMARKS blanket Form #CG 25 03 05 09. AMENDED: Cancels and replaces 04/07/2011 Certificate. Cancellation 30 Days Written Notice OFREMARK COPYRIGHT 2000, AMS SERVICES INC. l ® YYY) ACORD DATE(MM/DD/Y CERTIFICATE OF LIABILITY INSURANCE 110/1/2013 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 CONTACT Jacqueline Hernandez, ACSR Conover Insurance AlC No F,,1. (509)545-3800 I(A/C Not (509)547-7960 1804 West Lewis Street ADDRIFSS• INSURER(S)AFFORDING COVERAGE NAIC# Pasco WA 99301 INSURER A:American Economy Ins Co. 19690 INSURED INSURER B:American States Ins Company 19704 Spokane_Rock Products Inca INSURERC:Starr Indemnity & Liability Co. 38318 P.O. Box 3808 INSURER D:Navigators Insurance Company 42307 INSURERE:Zurich American Insurance Co. 16535 Spokane WA 99220 INSURER F: COVERAGES CERTIFICATE NUMBER:2013-2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP W LIMITS LTR IN R VD POLICY NUMBER (MM/DD/YYYY1 (MM/DD/YYYY1 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 200 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A ICLAIMS-MADE © OCCUR 01CG6871649 1/1/2013 1/1/2014 MED EXP(Any one person) $ 10,000 X Contractual PERSONAL&ADV INJURY $ 1,000,000 X Includes X, C, U GENERALAGGREGATE _$ 2,000,000 GEN'L AGGREGATE LIMIT APPL IES PER PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY n FRO 17'LOC $ CMINED AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 01Ci5463652 1/1/2013 1/1/2014 BODILY INJURY(Per accident) $ AUTOS _ AUTOS — NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAB CLAIMS-MADE SISIGCE50027813 AGGREGATE $ 4,000,000 DED I (RETENTION$ EXCESS AUTO LIABILITY 1/1/2013 1/1/2014 $ A WORKERS COMPENSATION X I TOR S L M TS I 1°F-1 1R1- EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E .EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A 1/1/2013 1/1/2014 (Mandatory in NH) 01CG6871649 E .DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below WA STOP GAP E.L.DISEASE-POLICY LIMIT $ 2,000,000 A CONTRACTORS POLLUTION 01CG6871649 1/1/2013 1/1/2014 LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Company D: Excess Liability, Policy #SISIGCE50027813, 1/1/13 TO 1/1/2014, $9,000,000 Occurrence/Aggregate Limit. Company E: ID/MT Workers Compensation, Policy #WC-9327180-00 10/1/2013 to 1/1/2014, $1,000,000 Limit. Re:', Indiana Avenue Extension Project, Contract 10-0121 City of Spokane Valley is additional insured. Business Auto additional insured applies per attached blanket Form #CA 71 10 03 07. Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09.Per-Project Agg per Form #CG 25 03 05 09. AMENDED: Cancels and replaces 12/29/2012 Certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 11707 E. Sprague, Suite 106 Spokane Valley, WA 99206 AUTHORIZED REPRESENTATIVE J Hernandez, ACSR/JAC SlL2Qia-t '°`"w-v': ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IkItl'G,ten,nncxn, TL.. Af'f ..............1 r........�......—... III out Washington State Department of Employer Liability 7,Labor and Industries .r 4,,, Certificate a p I:4 ml Department of Labor and Industries Employer Liability Certificate Date: 10/01/2013 UBI #: 602 082 495 Legal Business Name: SPOKANE ROCK PRODUCTS INC Account#: 133,446-07 'Doing Business As'Name: SPOKANE ROCK PRODUCTS INC Estimated Workers Reported: Quarter 2 of Year 2013 "Greater than 100 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? Yes License: SPOKARP990BH Expire Date: 2/1/2014 Account Representative: T8 /DALE MCMASTER(360)902-5617 - Email: MCMS235 @lni.wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). S*.Liberty COMMERCIAL GENERAL LIABILITY ' Northwest. CG 79 00 07 87 Vrdvr [tn.nvnohla or THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED - (SECTION 1) IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY", "PROPERTY DAMAGE" OR "PERSONAL INJURY" ; AND B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS 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 ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. 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 INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- - MENT SHALL NOT INCREASE THE LIMITS OF INSUR- ANCE DESCRIBED IN SECTION III - LIMITS OF ME INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL FEE INSURED DOES NOT APPLY TO "BODILY INJURY" , Fag, "PROPERTY DAMAGE" OR "PERSONAL INJURY" ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, = ENGINEERING OR SURVEYING SERVICES, INCLUDING: .� i . THE PREPARING, APPROVING, OR FAILING TO = PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP c.nr ai.PR NT 1.l 4 •Y X Page 2 of 2 C-AG-31-PNINT0014904d092-Y 'z Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii . SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN THE "PRODUCTS—COMPLETED OPERA- TIONS 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 OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED 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—CONTRIBU- ..„I TORY BASIS, THIS INSURANCE IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL ERIE INSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION AS A NAMED INSURED FOR SUCH LOSS, AND BEE WE WILL NOT SHARE WITH THAT "OTHER INSURANCE" . BUT THE INSURANCE PROVIDED TO .ima THE ADDITIONAL INSURED BY THIS ENDORSEMENT — STILL IS EXCESS OVER ANY VALID AND COLLECTI- BLE "OTHER INSURANCE" , WHETHER PRIMARY, • = EXCESS, CONTINGENT OR ON ANY OTHER BASIS, EME THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP C-AG314,AIN!1X149I4O 93Y • Page 2 of 2 C-AG 31-P R I NTOO1.I 4.494•Y • Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: i . HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii. 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. NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE RECEIVE WRITTEN 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 OTHERWISE COMPLY WIH ALL POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE EEM DEFENSE AND INDEMNITY OF ANY CLAIM OR "SUIT" SE TO ANY PROVIDER OF "OTHER INSURANCE" WHICH =— WOULD COVER THE ADDITIONAL INSURED FOR A LOSS EEE WE COVER UNDER THIS ENDORSEMENT. HOWEVER, Mi THIS CONDITION DOES NOT AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, inc., 1983 CG 79 00 07 87 Page 1 of 2 EP CAG3'1-PRINT001-1904430 -V x Page 2 of 2 C•A G 31-PR I N T001-1904-0096-Y Liberty COMMERCIAL GENERAL LIABILITY � ' Northwest. CG 79 00 07 87 feet..d Lb.,WAaiia. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3. ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS 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 END OF THE POLICY PERIOD. r. ■ a ii. Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP C-AG-31-P1W1T001.19D6-0091-Y Page 2 of 2 C-AG-31•PRINT001.196<-0098-v COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2.b. of the CANCELLATION Common SECTION ft — LIABILITY COVERAGE — A.1. WHO Policy Condition is replaced by the following: IS AN INSURED provision is amended by the addition of the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. e. Any person or organization for whom you are re- quired by an Insured contract" to provide insur- TEMPORARY SUBSTITUTE AUTO — PHYSICAL ance is an Insured", subject to the following DAMAGE COVERAGE additional provisions: (1) The Insured contract" must be in effect Under paragraph C. — CERTAIN TRAILERS, MO- during the policy period shown in the Decla- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rations, and must have been executed prior AUTOS of SECTION 1 — COVERED AUTOS, the to the "bodily injury" or "property damage". following is added: (2) This person or organization is an Insured" If Physical Damage coverage is provided by this Cov- only to the extent you are liable due to your erage Form, then you have coverage for: ongoing operations for that insured, whether the work is performed by you or for you,and Any "auto" you do not own while used with the per- only to the extent you are held liable for an mission of its owner as a temporary substitute for a "accident" occurring while a covered "auto" covered "auto" you own that is out of service be- is being driven by you or one of your em- cause of its breakdown, repair, servicing, loss" or ployees. destruction. (3) There is no coverage provided to this person or organization for "bodily injury" to its em- BROAD FORM NAMED INSURED ployees, nor for "property damage" to its property. SECTION II — LIABILITY COVERAGE — A.1. WHO IS AN INSURED provision is amended by the addition (4) Coverage for this person or organization of the following: shall be limited to the extent of your negli- gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comparative negligence or fault. you during the policy period provided you own (5) The defense of any claim or "suit" must be 50% or more of the business entity and the tendered by this person or organization as business entity is not separately insured for soon as practicable to all other insurers Business Auto Coverage. Coverage is extended which potentially provide insurance for such up to a maximum of 180 days following acquisi- claim or "suit". tion or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 CA 71 10 03 07 Page 1 of 6 EP (6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION III — PHYSICAL DAMAGE COVER- (a) The coverage and/or limits of this policy; AGE, A.4. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or limits required by c. personal Effects Coverage the "insured contract". For any Owned "auto" that is involved in a (7) A person's or organization's status as an covered loss", we will pay up to $500 for "insured" under this subparagraph d ends "personal effects" that are lost or damaged when your operations for that "insured" are as a result of the covered "loss", without completed. applying a deductible. EMPLOYEE AS INSURED EXTRA EXPENSE — BROADENED COVERAGE Under Paragraph A. of Section II — LIABILITY COV- Paragraph A. — COVERAGE of SECTION III — ERAGE item f. is added as follows: PHYSICAL DAMAGE COVERAGE is amended to add: Your "employee"while using his owned "auto", or an "auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen in your business or your personal affairs,provided you covered "auto"to you. do not own, hire or borrow that "auto". This coverage is excess to any other collectible insurance coverage. AIRBAG COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B. — EXCLUSIONS of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is Exclusion 5. FELLOW EMPLOYEE of SECTION II — added: LIABILITY COVERAGE — B. EXCLUSIONS is amended by the addition of the following: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. However, this exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you NEW VEHICLE REPLACEMENT COST own or hire, and provided that any coverage under this provision only applies in excess over any other Under Paragraph C — LIMIT OF INSURANCE of collectible insurance. Section III —PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: BLANKET WAIVER OF SUBROGATION 2. An adjustment for depreciation and physical con- We waive the right of recovery we may have for pay- dition will be made in determining actual cash ments made for "bodily injury" or "property damage" value in the event of a total loss. However, in the on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to "insureds" under Section II —LIABILITY COVERAGE which this coverage applies, as shown in the — A.1.D. BROAD FORM NAMED INSURED and declarations,we will pay at your option: A.1.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- PHYSICAL DAMAGE — ADDITIONAL TRANS- cluding any insurance or warranties pur- PORTATION EXPENSE COVERAGE chased; The first sentence of paragraph A.4. of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make, model and follows: equipment, not including any furnishings, parts or equipment not installed by the We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership. $1,500 for temporary transportation expense incurred If the same model is not available pay the by you because of the total theft of a covered "auto" purchase price of the most similar model of the private passenger type. available; Page 2 of 6 c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen not including any furnishings, parts or equip- property as of the time of the loss", less an ment not installed by the manufacturer or adjustment for depreciation and physical manufacturer's dealership. condition; or This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or of the private passenger, light truck or medium lease that the damaged covered "auto" is truck type (20,000 Ibs or less gross vehicle subject to at the time of the "loss", less any weight) and does not apply to initiation or set up one or all of the following adjustments: costs associated with loans or leases. (1) Overdue payment and financial TWO OR MORE DEDUCTIBLES penalties associated with those payments as of the date of the "loss". Under SECTION III — PHYSICAL DAMAGE COV- ERAGE, if two or more "company" policies or cover- (2) Financial penalties imposed under a age forms apply to the same accident, the following lease due to high mileage, exces- applies to paragraph D. Deductible: sive use or abnormal wear and tear. a. If the applicable Business Auto deduct- (3) Costs for extended warranties, Cre- ible is the smaller (or smallest) deduct- dit Life Insurance, Health, Accident ible it will be waived; or or Disability Insurance purchased with the loan or lease b. If the applicable Business Auto deduct- ible is not the smaller (or smallest) de- (4) Transfer or rollover balances from ductible it will be reduced by the amount previous loans or leases. of the smaller (or smallest) deductible; (5) Final payment due under a `Balloon or Loan". c. If the loss involves two or more Busi- (g) The dollar amount of any ness Auto coverage forms or policies un-repaired damage that occurred the smaller (or smallest) deductible will prior to the "total loss"of a covered be waived. "auto". For the purpose of this endorsement (7) Security deposits not refunded by a "company" means: lessor. a. Safeco Insurance Company of America (8) All refunds payable or paid to you b. American States Insurance Company as a result of the early termination of a lease agreement or any war- e. General Insurance Company of America ranty or extended service agree- d. American Economy Insurance Company ment on a covered "auto". e. First National Insurance Company of (9) Any amount representing taxes. America (10) Loan or lease termination fees f. American States Insurance Company of Texas GLASS REPAIR —WAIVER OF DEDUCTIBLE g. American States Preferred Insurance Under paragraph D. — DEDUCTIBLE of SECTION III Company — PHYSICAL DAMAGE COVERAGE, the following is h. Safeco Insurance Company of Illinois added: LOAN/LEASE GAP COVERAGE No deductible applies to glass damage if the glass is repaired rather than replaced. Under paragraph C — LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI- the following is added: DENT, CLAIM, SUIT OR LOSS 4. The most we will pay for a total "loss" in any one The requirement in LOSS CONDITION 2.a. — "accident" is the greater of the following,subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a$1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONDITIONS that you must notify us of an CA 71 10 03 07 Page 3 of 6 EP "accident"applies only when the "accident" is known deductible and excess provisions, we will provide to: coverage equal to the broadest coverage applicable to any covered "auto"you own. (1) You, if you are an individual; (2) A partner, if you are a partnership; or HIRED AUTO PHYSICAL DAMAGE COVERAGE — LOSS OF USE (3) An executive officer or insurance manager,if you are a corporation. SECTION III — PHYSICAL DAMAGE A.4.b. Form does not apply. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Subject to a maximum of$1,000 per accident, we will cover loss of use of a hired "auto" if it results from SECTION IV — BUSINESS AUTO CONDITIONS — an accident, you are legally liable and the lessor in- B.2. is amended by the addition of the following: curs an actual financial loss. If you unintentionally fail to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE fisting at the inception date of your policy, we will not A. We will pay for rental reimbursement expenses deny coverage under this Coverage Form because of incurred by you for the rental of an "auto" be- such failure. However, this provision does not affect cause of a covered loss" to a covered "auto". our right to collect additional premium or exercise our Payment applies in addition to the otherwise ap right of cancellation or non-renewal. plicable amount of each coverage you have on a HIRED AUTO -- LIMITED WORLD WIDE COVER- covered "auto". No deductibles apply to this coverage. AGE B. We will pay only for those expenses incurred Under Section IV — Business Conditions, Paragraph during the policy period beginning 24 hours after B.7.b.e(1) is replaced by the following: the loss" and ending, regardless of the policy's (1) The "accident" or "loss" results expiration,with the lesser of the following number from the use of an "auto" hired for of days: 30 days or less. 1. The number of days reasonably required to repair or replace the covered "auto". If RESULTANT MENTAL ANGUISH COVERAGE loss" is caused by theft, this number of days is added to the number of days it takes SECTION V — DEFINITIONS —C. is replaced by the to locate the covered "auto" and return it to following: you. "Bodily injury" means bodily injury, sickness or dis- 2. 30 days. ease sustained by a person including mental anguish C. Our payment is limited to the lesser of the fol- or death resulting from any of these. lowing amounts: HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses incurred. 2. $50 per day. If hired "autos" are covered "autos" for Liability cov- erage and if Comprehensive, Specified Causes of D. This coverage does not apply while there are Loss or Collision coverages are provided under this spare or reserve "autos"available to you for your Coverage Form for any "auto" you own, then the operations. Physical Damage Coverages provided are extended to "autos"you hire or borrow. E. If loss" results from the total theft of a covered "auto" of the private passenger type, we will pay The most we will pay for loss to any hired "auto" is under this coverage only that amount of your $50,000 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which is not al- whichever is smallest, minus a deductible. The de- ready provided for under the PHYSICAL DAM- ductible will be equal to the largest deductible appli- AGE COVERAGE Coverage Extension. cable to any owned "auto" of the private passenger or light truck type for that coverage. Hired Auto Phy- F. The Rental Reimbursement Coverage described sical Damage coverage is excess over any other col—above does not apply to a covered "auto" that is lectible insurance. Subject to the above limit, described or designated as a covered "auto" on Page 4 of 6 Rental Reimbursement Coverage Form the manufacturer for the installation of a CA 99 23. radio. AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN- SURANCE provision of PHYSICAL DAMAGE A. Coverage COVERAGE is replaced by the following: 1. We will pay with respect to a covered "auto" 1. The most we will pay for "loss" to audio,vi- for loss" to any electronic equipment that sual or data electronic equipment and any receives or transmits audio, visual or data accessories used with this equipment as a signals and that is not designed solely for the result of any one "accident" is the lesser of: reproduction of sound.This coverage applies only if the equipment is permanently installed a. The actual cash value of the damaged in the covered "auto" at the time of the or stolen property as of the time of the "loss" or the equipment is removable from a "loss"; or housing unit which is permanently installed b. The cost of repairing or replacing the in the covered "auto" at the time of the damaged or stolen property with other loss", and such equipment is designed to property of like kind and quality. be solely operated by use of the power from the "auto's"electrical system, in or upon the c. $1,000. covered "auto". 2. An adjustment for depreciation and physical 2. We will pay with respect to a covered "auto" condition will be made in determining actual for "loss" to any accessories used with the cash value at the time of the loss". electronic equipment described in paragraph 3. If a repair or replacement results in better A.1. above. than like kind or quality, we will not pay for However, this does not include tapes, the amount of the betterment. records or discs. D. Deductible 3. If Audio, Visual and Data Electronic Equip- ment Coverage form CA 99 60 or CA 99 94 1. If "loss" to the audio, visual or data elec- is attached to this policy, then the Audio, VI- tronic equipment or accessories used with sual and Data Electronic Equipment Cover- this equipment is the result of a "loss" to the age described above does not apply. covered "auto" under the Business Auto Coverage Form's Comprehensive or Colli- B. Exclusions sion Coverage, then for each covered "auto" our obligation to pay for, repair, return or re- The exclusions that apply to PHYSICAL DAM- place damaged or stolen property will be re- AGE COVERAGE, except for the exclusion resat- duced by the applicable deductible shown in ing to Audio, Visual and Data Electronic the Declarations. Any Comprehensive Cov- Equipment, also apply to this coverage. In addi- erage deductible shown in the Declarations lion, the following exclusions apply: does not apply to "loss" to audio, visual or We will not pay for either any electronic equip- data electronic equipment caused by fire or ment or accessories used with such electronic lightning. equipment that is: 2. If loss" to the audio, visual or data elec- 1. Necessary for the normal operation of the Ironic equipment or accessories used with covered "auto" for the monitoring of the this equipment is the result of a "loss" to the covered "auto's" operating system; or covered "auto" under the Business Auto 2. Both: Coverage Form's Specified Causes of Loss Coverage, then for each covered "auto" our a. an integral part of the same unit housing obligation to pay for, repair, return or replace any sound reproducing equipment de- damaged or stolen property will be reduced signed solely for the reproduction of by a$100 deductible. sound if the sound reproducing 3. If "loss" occurs solely to the audio, visual or equipment is permanently installed in data electronic equipment or accessories the covered "auto"; and used with this equipment,then for each coy- b. permanently installed in the opening of Bred "auto" our obligation to pay for, repair, the dash or console normally used by CA 71 10 03 07 Page 5 of 6 EP return or replace damaged or stolen property SECTION V — DEFINITIONS is amended by adding will be reduced by a$100 deductible. the following: 4. In the event that there is more than one ap- Q. "Personal effects" means your tangible plicable deductible, only the highest deduct- property that is worn or carried by you, ex- ible will apply. In no event will more than one cept for tools,jewelry, money, or securities. deductible apply. R. "New vehicle" means any "auto" of which you are the original owner and the "auto" has not been previously titled and is less than 365 days past the purchase date. Page 6 of 6 1*. Liberty COMMERCIAL GENERAL LIABILITY �• ' Northwest. CG 25 03 05 09 POLICY NUMBER: O1—CG-687164-9 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 Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section I — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I —Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit 2. The Designated Construction Project Gen—shown in the Declarations, such limits will be eral Aggregate Limit is the most we will pay subject to the applicable Designated Con- - for the sum of all damages under Coverage struction Project General Aggregate Limit. A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or `property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section 1 .— Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section I — Coverage C, which a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing "suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and ®Insurance Services Office,Inc., 2008 Safeco and the Safeco logo are registered trademarks of Safeco Corporation CG 25 03 05 09 Page 1 of 2 EP C-AG-31-PNIN7001-t904- 75-Y 2. Such payments shall not reduce any Desig- Aggregate Limit nor the Designated Construction nated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned, delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, "bodily injury" or `propery damage" included in specifications or timetables, the project will still the "products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section III — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. x Page 2 of 2 C-AG31.PPINTl I.1 ax-co n-Y � - Liberty COMMERCIAL GENERAL LIABILITY f ' Northwest. CG 24 04 05 09 ..._.l rt..,,fmM. POLICY NUMBER: O1-CG-687164-9 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of "your work" done under a contract with that person Section IV — Conditions: or organization and included in the We waive any right of recovery we may have against "Products completed operations hazard". This waiver the person or organization shown in the Schedule applies only to the person or organization shown in above because of payments we make for injury or the Schedule above. MUM _ e Insurance Services Office, Inc.,2008 Salem and the Sateco logo are registered trademarks of SalecoCorporatlon CG24040509 EP C-AGJ1-PRlNTtXt-19040071-Y 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 -012 ) AFFIDAVIT OF PUBLISHING Indiana Avenue Extension Project NOTICE STATE OF WASHINGTON ) )SS. County of Spokane ) MICHAEL I UFFMAN , being first duly sworn on oath deposes and says that he is the EMOR , of The Spokane Valley Herald, a weeklynewspaper. Thatsaidnewspaperis a legal newspaper and it is now and hasbeenfor more thansix 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 18th day of February, 2011 and ending the 25th day, o a 1 all dates inclusive, and that such newspaper was regularly distributed to its subscribers during all of ' ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID # SVPW 10-012 INDIANA AVENUE EXTENSION PROJECT Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept seated bids for the Indiana Avenue Extension Project. The project consists of road construction including placement of crushed surfacing; hot mix asphalt paving; curb and sidewalk; storm drain piping and catchbasins; and associated work. Copies of the bid packet including specifications and can be obtained at the office of the City ?^ plans Department, of Spokane Valley Public Works at .# 11707 E. Sprague Avenue, Suite 304, Spokane r' C f7 - Valley, WA 99206 -6124, Monday through Friday �s ,�•,; ; , from 8:00 a.m. to 5:00 p.m. A non - refundable bid i amount of $50.00 is required. Copies of the packet including specifications and plans may be obtained in PDF format on a compact disc fi r ' ea tW at no charge. All bids must be accompanied by a bid deposit 10 in the form of asurety bond, postal money order,. cash, cashier's check, or certified check in an °. �'? �,,. ' °,`' amount equal to five percent (5 of the amount • '� " ' " of the bid proposed. Failure to furnish a bid bond �. ;� ; z•? �1 1 in compliance with the City's bid deposit surety bond form shall make the bid non - responsive and t ?• cause the bid to be reiected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spo- kane Valley, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received not later than 10:00 a.m. PSDT, Friday, March 11, 2011. 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. PUBLISH: Spokane February 18 and February 25, 2011 Christine Bainbridge, CMC Spokane Valley City Clerk 2/18,2/25 , SWORN to before me this 25th day of Februar 2011. 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- tioned in the Instrument. Jolene . ae Went r Title: tart' Public \' My appdi ,"ent expires: 5 -16 -11 P UUk-e� *Federal Tax ID No. 68- 0617327 CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID # SVPW 10 -012 INDIANA AVENUE EXTENSION PROJECT Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Indiana Avenue Extension Project. The project consists of road construction including placement of crushed surfacing; hot mix asphalt paving; curb and sidewalk; storm drain piping and catchbasins; and associated work. Copies of the bid packet including specifications and plans can be obtained at the office of the City of Spokane Valley Public Works Department, at 11707 E. Sprague Avenue, Suite 304, Spokane Valley, WA 99206 -6124, Monday through Friday from 8:00 a.m. to 5:00 p.m. A non - refundable amount of $50.00 is required. Copies of the bid packet including specifications and plans may be obtained in PDF format on a compact disc at no charge. All bids must be accompanied by a bid deposit in the form of a surety bond, postal money order, cash, cashier's check, or certified check in an amount equal to five percent (5 %) of the amount of the bid proposed. Failure to furnish a bid bond in compliance with the City's bid deposit surety bond form shall make the bid non- responsive and cause the bid to be rejected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spokane Valley, 11701 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received not later than 10:00 a.m. PSDT, Friday, March 11, 2011. Bid openings will be held immediately thereafter and read aloud in the City Council Chambers, Suite 101. The City of Spokane Valley reserves the right to waive any irregularities or informalities and to reject any or all bids. No bidder may withdraw his bid after the time announced for the bid opening, or before the award and execution of the contract, unless the award is delayed for a period exceeding sixty (60) days. PUBLISH: Spokane February 18 and February 25, 2011 Christine Bainbridge, MMC Spokane Valley City Clerk SR22329 AFFIDAVIT OF PUBLICATION STATE OF WASHINGTON County of Spokane} ss Name: City of Spokane Valley Client ID PO No. SR22329 Total Cost: $632 .08 I, Lori Nix do solemnly swear that I am the Principal Clerk of The Spokesman- Review, a newspaper established and regularly published, once each day in the English language, in and of general circulation in the City of Spokane 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: February 18 & 25, 2011 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 pr9P,er and not in a supplement. 42365 No. Lines: 74 Order No. 19856 Subscribed and sworn to before me at the City of Spokane, this 28th day of February 2011. A Notarj Public in and for the State of Washington, residing at Spokane County, Washington wV_ � L V/ NC �O !0 SSl ON F+ F2 A o NOTARY m v7� N P 13LIC N gER Notary Stamp Paper Affidavits