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12-003.00 Budinger & Associates: Indiana Ave ExtensionWOO State W'/ Deparhnent of Transportation Supplemental Agreement O rganization and Address Number 9- 0 53(5) Budinger & Associates 1101 N. Faucher Rd Spokane Valley, WA 99212 Original Agreement Number 10 -032 Phone: (509) 535 -8841 Project Number Execution Date Completion Date CIP 0112 10/2012009 6/30/2012 Project Title New Maximum Amount Payable Indiana Avenue Extension Project $ 52,211.46 Description of Work This supplemental agreement extends the material testing services Contract time through completion of the Indiana Avenue Extension Project The Local Agency of City of Spokane Valley desires to supplement the agreement entered into with Budinger and Associates and executed on 10120/2009 and identified as Agreement No. 9 -053 All provisions in the basic agreement remain in effect except as expressly modified by this supplement. The changes to the agreement are described as follows: Section 1, SCOPE OF WORK, is hereby changed to read: No change 11 Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: Tun e '3 1 201 2 111 Section V, PAYMENT, shall be amended as follows: n nhangc as set forth to the attached Exhibit A, and by this reference made a part of this supplement. If you concur with this supplement and agree to the changes as stated above, please sign in the appropriate spaces below and return to this office for final action. By: e n IL V Y\ rW-Qa v1 . Fri_ �n cTa By, Consultant Signature DOT Form 140 -063 EF Revised 912006 l L,— Date Approving ^uinumy 019na[ure Client#: 83101 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 12/ (MMIDD (MM/DD/YYYY) 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 Payne Financial Group Inc. Courtyard Office Center 827 W. First Avenue, Suite 225 CONTAC NAME: PHONE _ IFAX AIC No Ext : A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Spokane, WA 99201 INSURER A Continental Western GEN'L AGGREGATE LIMIT APPLIES PER: INSURED Budinger & Associates, Inc 1101 N Fancher Rd Spokane Valley, WA 99212 INSURER B: $ INSURER C AUTOMOBILE LIABILITY INSURER D INSURER E 8/06/2011 INSURER F: INED Ee accd."') SINGLE LIMIT 1,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN R TYPE OF INSURANCE D SUB POLICY NUMBER (POLICY EFF MM /DDY EXP LIMITS A GENERAL LIABILITY X X CWP277729325 8/06/2011 08/06/2012 E $1, 000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS -MADE 51 OCCUR MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PR M LOC $ • AUTOMOBILE LIABILITY X CWP277729325 8/06/2011 08/06/201 INED Ee accd."') SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED RETENTION $ $ • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) NIA CWP277729325 WA Stop Gap 8/06/2011 08/06/201 WC STLIMIT ETH- E.L. EACH ACCIDENT $1, 000,000 E.L. DISEASE - EA EMPLOYEE $1, 000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Installat Floater _r CWP277729325 08/06/2011 08/061201 $61,846 $1,000 deductible DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Testing Services - Indiana Avenue Extension Project City of Spokane Valley, their agents, officers and employees are additional insureds per policy forms. City of Spokane Valley THE SHO EXPIRATIION DATE V THEREOF, E NOTICE C BE C DELIVERED N BE Attn: Craig Aldworth PE ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave Ste 304 AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99206 ze: - , , --I " ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S715064/M676353 CRP1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS If SECTION I — COVERAGE C MEDICAL PAY- MENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit provided by this policy, subject to the terms of SECTION III - LIMITS OF INSURANCE, shall be the greater of: a. $10,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND SPRINKLER LEAKAGE DAMAGE TO PREM- ISES YOU RENT , ' Y " 'I V (b) That is Fire, Lightning, ( Explosion or Sprinkler Leakage; insurance for prem- ises rented to youti' orjtemporarily�occu- pied by you with the permission of the owner; A ' 4. Paragraph 9.a. of SECTION Vl'�- DEFINI- TIONS Is deleted and replaced by the fol- lowing: * a. A contract f6r of premises. However'; -athat portion of the contract for A �adease of that indemnifies any person or organization for damage by 1t:p fire, lightning, explosion or sprinkler y ' leakage to premises while rented to you or temporarily occupied by you with •; �; per islon of the owner is not an "in- If damage to premises rented to you under Cov- P sured contract "; erage A. Is not otherwise excluded from this poi C. NON -OWNED WATERCRAFT icy, the following applies: �A, 1. The last paragraph of SECTION I — COV- 1. tiParagraph g.(2) of SECTION I — COVER - ERAGE A.2. Exclusions is deleted.aand re�� '� �' placed y the following: Is deleted and re- placed by the following: " v Exclusions c. through n. do ,nor apply to A watercraft you do not own that is: damage by fire, lightning, explosion or sprin � (a) Less than 51 feet long; and kler leakage to premises ed to �> (b) Not used to carry persons or property your or temporarily occupied by j ou with for a charge. permission of the owner! A separate Ilm�it�& insurance applies to°�his egverage as, , de- D. SUPPLEMENTARY PAYMENTS scribed in SECTION'�II -, LIMITS OF IN- SECTION I — SUPPLEMENTARY PAYMENTS SURANCE. .111 COVERAGES A AND B is amended as fol- 2. Paragraph 6 o f SECTION'ill — CLIMITS OF INSURANCE is deleted and replaced by the following.: } ` 6. Subject Rot. above,�th`e greater of: J x$300,000; r "w bV .the Damage To Premises Rented i . To Y6u7Limit shown in the Declara- tions; ; i thelmost we will pay under COVER - AGE'A for damages because of "prop- erty damage" to any one premises, while rented to you, or temporarily oc- cupied by you with the permission of the owner arising out of any one fire, light- ning, explosion or sprinkler leakage in- cident. 3. Paragraph 4.b.(1)(b) Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and re- placed by the following: lows: 1. The limit of insurance in paragraph 1.b. is increased from $250 to $2,500; and 2. The limit of insurance in paragraph 1.d. is increased from $250 to $500. E. AUTOMATIC ADDITIONAL INSURED — SPECIFIED RELATIONSHIPS The following is added to Paragraph 2. of SEC- TION II - WHO IS AN INSURED: e. Any person or organization described in paragraph f. below, whom you and such person or organization have agreed in writ- ing in a contract or agreement that such per- son or organization be added as an addi- tional insured on your policy. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 1 of 8 Office, Inc., with its permission Such person or organization is an insured (c) The ownership, maintenance, or provided: use of any elevators. (1) The written or oral contract or agree- F. ADDITIONAL INSURED - OWNERS, LES- ment is: SEES OR CONTRACTORS - AUTOMATIC (a) Currently in effect or becomes effec- STATUS tive during the policy period; and 1. SECTION II - WHO IS AN INSURED is (b) Executed prior to an "occurrence" or amended to include as an additional insured any person or organization for whom you offense to which this insurance would apply. are performing operations when you and such person or organization have agreed in (2) They are not specifically designated as writing in a contract or agreement that such an additional insured under any other person or organization be addetl as an addi- provision of, or endorsement added to, tional insured on your policy. Such person or this policy. organization is an additional,rnsured only f. Only the following persons or organizations with respect to liability "ford `'injury", property damage [07. personal and adver- are additional insureds under this endorse- tising Injury caused, in whole or impart, by: ment, and coverage provided to such addi- tional insureds is limited herein: r. 11 0 Your & as provided a. acts omissions; ;ord (1) The manager or lessor of a premise b. Thefacts o ?komissions of those acting on leased to you, but only with respect to your behalf; A� liability arising from the ownership, maintenance or use of that part of the in the performance of your ongoing opera - premises leased to you and subject to tio�stfor.<the additional insured. the following additional exclusions: ylp�A person's or organization's status as an This insurance does not apply to: ,�. additional insured under this policy ends ,kwhen you operations for that additional in- a An "occurrence" which takes lace O Y p �lrsured,are completed. after you cease to be a tenant of that premises. 2. With respect to the insurance afforded to ,� �►' A N�these additional insureds, the following addi- (b) Structural alterations, new construc- ♦ tvonal exc apply: tion or demolition operations per- formed by or on behalf of the ffi an %. ,.� m - � insurance does not apply to: ager or lessor. i► • ::Bodily injury", V a. ""prop dams e" or 9„ (2) Any person or organization „from whom , p vp "personal and advertising Injury" arising you lease equipment, but with re- ��' out of the rendering of, or the failure to spect to liability for "bodlly'Inlury,,,.prop render, any professional architectural, erty damage' or personal and�advertis,, engineering or surveying services, in- Ing Injury caused, In whole or impart, by cluding: your malntenance� operation or Lase` equipment leased.to yoia�by such per_ (1) The preparing, approving, or failing son(s) or organizati8n(s). to prepare or approve, maps, shop 1 s However, this, insurance does not apply drawings, opinions, reports, sur- veys, field orders, change orders or to any ;occurrence" whichtfakes place drawings and specifications; or after,the equipment lease•expires. f subdivision, subject Any ate, or. olitica ( ) Y . p 1 (2) Supervisory, inspection, architec- tural or engineering activities. to the following additional provision: '" �� �P ti � This,-insurance fipplies only with respect b. "Bodily injury" or "property damage" occurring after: to the following hazards for which the state subdivision has issued (1) All work, including materials, parts avpermit in connection with premises or equipment furnished in connec- you own, rent, or control and to which tion with such work, on the project this Insurance applies: (other than service, maintenance or (arThe existence, maintenance, repair, repairs) to be performed by or on behalf of the additional insured(s) at construction, erection, or removal of the location of the covered opera - advertising signs, awnings, cano- pies, cellar entrances, coal holes, tions has been completed; or driveways, manholes, marquees, (2) That portion of "your work" out of hoist away openings, sidewalk which the injury or damage arises vaults, street banners, or decora- has been put to its intended use by tions and similar exposures; or any person or organization other (b) The construction, erection, or re- than another contractor or subcon- tractor engaged in performing op- moval of elevators; or CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 2 of 8 Office, Inc., with its permission erations for a principal as a part of the same project. r �r 1 �10 CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 3 of 8 Office, Inc., with its permission 3. The insurance provided by this endorsement is primary insurance and we will not seek contribution under any insurance policy un- der which such additional insured is a named insured, if such policy was procured and paid for by such additional insured, or a parent or related entity of such additional in- sured. 4. With respect to the insurance afforded to these additional insureds, SECTION III — LIMITS OF INSURANCE is amended as fol- lows: The limits applicable to the additional in- sured are those specified in the written con- tract or agreement or the limits stated in the Declarations, whichever is less. If no limits are specified in the written contract or agreement, the limits applicable to the addi- tional insured are those specified in the Dec- larations. The limits of insurance are inclu- sive of and not in addition to the limits of in- surance shown in the Declarations. G. PROPERTY DAMAGE TO BORROWED EQUIPMENT 1. Paragraph 2.j. of SECTION I - COVER- AGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows: c. We may pay any part or all of the de- ductible amount to effect settlement of any claim or suit and, upon notification of the action taken; you shall promptly reimburse us for such part of the de- ductible amount as we have paid. H. BROADENED NAMED INSURED Paragraph 3. of SECTION II - WHO IS AN IN- SURED is deleted and replaced by the follow- ing: Any organization, other than a joint = venture, over which you maintain ownership-or majority inter- est of more than 50% willb4a Named Insured if there is no other similar.lnsurance available to that organization. However: �, a. Coverage under this provislon,,is. afforded only until the 80th day after you acquire or form the organization or th.e)end of the pol- icy period whichever is earlier. b. COVERAGE A�does to "bodily in- jury" or "property damage" that occurred be- fore you cgtaired or formed the organiza- tion^ - c � COVERAGE B does not apply to "personal and advertising injury" arising out of an of- ,�fense committed before you acquired or ,4 formed,the organization. Paragraphs (3) and (4) of this exclusion do,, '� o� I GF not apply to tools or equipment loaned, to you, provided they are not being used Tto 1 perform operations at the time of lose '_X .4 'V 1 2. SECTION 111 — LIMITS OF INSURANCE is� 4 deleted and replaced by the following:,, The most we will pay in anVone,(occur- rence" for "property damage to�bsorrowed equipment is $15,000...,'Ois limit 1 6f, insur- ance is the most we`wlll pay regardlesslof the number of: t .►f o a. Insureds - , ^ b. Claims or "suits" brought; or C. Persons or organizations making claims or bringing4dits ". a 3. Deductible Our to pay damages on be- half�of & the- insured applies only to the 1' amount of damages in excess of $250 '9s applicable to "property damage" as the result of any one "occurrence ", re- gardless of the number of persons or organizations who sustain damages be- cause of that "occurrence ". PROJECT GENERAL AG- ?GATE LIMIT For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to the Insured: a. A Single Construction Project General Aggregate Limit applies to each con- struction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. b. The Single Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COV- ERAGE A, except damages because of "bodily injury" or "property damage" in- cluded in the "products- completed op- erations hazard ", and for medical ex- penses under COVERAGE C regard- less of the number of: b. The terms of this insurance, including (1) Insureds; those with respect to our right and duty to defend the insured against any "suits' (2) Claims made or "suits" brought; or seeking those damages; and your duties (3) Persons or organizations making in the event of an "occurrence ", claim, or claims or bringing "suits ". "suit" apply irrespective of the applica- tion of the deductible amount. CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 4 of 8 Office, Inc., with its permission c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Ag- gregate Limit for that construction pro- ject away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construc- tion Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the Insured. d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. J. KNOWLEDGE OF OCCURRENCE The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. A report of an "occurrence ", offense, claim or "suit" to: (1) You, if you are an individual, (2) A partner, if you are a partnership, (3) An executive officer, are a corporation, or (4) A manager, if you are a limited -lliability company; is considered knowledge an �-requ`ires you to notify us — of the "occurrence', offense, claim, or "suit "fas soon as Crractiicable. We are?' considered on! notice of an 'bccufrence", offense,,clalm or "suit" that is reported to:your`Workers' Compensation insurer for an event which later develops into an " occurrence", offense, claim or "suit" for which there is coverage under this policy. However, we will only be considered on t notice if`'you ° notify us as soon as you know he claim should be addressed by this policy rathercthan your Workers' Compensation 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE Add (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which cannot be attributed , p only to ongoing operations at a single des - ,A ignated construction project away from �r premises owned by or rented to the insurer" K. UNI a An payments made under COVERAGE A NTIONAL OMISSIONS A for damages or under COVERAGE CL, a` w v The following is added to paragraph 6. Repre- for medical expenses shall reduce the sentations of SECTION IV - COMMERCIAL amount available under the General Ag- a A- GENERAL LIABILITY CONDITIONS: gregate Limit or the y' Products- '� d Completed Operations Aggre , gate,Limit,j ; a - whichever is applicablend', - b X ti b. Such payments shall not reduce any Single Construction Project GenerallAg- gregate Limit. �, = ;' 0 3. When coverage - for liabilit rising out of the "products- completed operations? hazard" is provided, any payments for - damages be- cause of`F'6odily Injury" f or "pF perty damage" included in the r`products completed opera- tions hazar&�„ ill reduce the Products - Completed Operations` Aggregate Limit, and W t reduce the General Aggregate Limit nor the Single Construction Project General Ag- 4. If the applicable construction project away from premises owned by or rented to the in- sured rhas been abandoned, delayed, or abandoned and then restarted, or if the au- thorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. If you unintentionally fail to disclose any exposures existing at the inception date of your policy, we will not deny coverage under this Coverage Part solely because of such failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. This provision does not apply to any known injury or damage which is excluded under any other provision of this policy. L. MENTAL ANGUISH Paragraph 3. of SECTION V — DEFINITIONS is deleted and replaced by the following: 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, Including mental anguish or death resulting from any of these at any time. M. WAIVER OF TRANSFER OF RIGHTS OF RE- COVERY AGAINST OTHERS Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS is amended by the addition of the following: CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 5 of 8 Office, Inc., with its permission We waive any right of recovery we may have because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract requiring such waiver with that person or organization and included in the "products- completed operations hazard ". However, our rights may only be waived prior to the "occurrence' giving rise to the injury or dam- age for which we make payment under this Cov- erage Part. The insured must do nothing after a loss to impair our rights. At our request, the in- sured will bring "suit" or transfer those rights to us . and help us enforce those rights. N. LIMITED JOB SITE POLLUTION 1. Exclusion f. under Section I - Coverage A is replaced by the following: 2. Exclusions This insurance does not apply to: f. Pollution (1) "Bodily injury" or "property dam- age arising out of the actual, al- leged or threatened discharge, dispersal, seepage, migration, release or escape of "pollut- ants": P' b 17 1 1 (a) At or from any premises,o, V"- �h site or location on which any insured or any contractors ` or subcontractors working v ,�1 b- directly or indirectly,on anyXy7 insured's behalf, :area per- forming operations if the IPCP operations a re'�to tekt kfor, monitor, clean up,. remove, contain,,ctreat, detoxify orb neutralize, or In any'wayxg spond - to, o�assess th`e'•ef- fects of,"pollutants "; or (b) "At or fro m storage tank or , ti''other conta "finer," ducts or piping which is below or part 'ally „below the surface Q of the ground or water or y which,,„ at any time, has been%uried under the sur- face"of the ground or water and then subsequently ex- a ` posed by erosion, excava- tion or any other means if the actual, alleged or threatened discharge, dis- persal, seepage, migration, release or escape of "pol- lutants” arises at or from any premises, site or loca- tion which any insured or any contractors or subcon- tractors working directly or indirectly on any insured's behalf are performing op- erations if the "pollutants" are brought on or to CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 6 of 8 Office, Inc., with its permission the premises, site or loca- tion in connection with such operations by such insured, contractor or subcontractor. Subparagraph (b) does not apply to "bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire ". (2) Anv loss, cost or expense aris- 2. d.� k1 CC1WI %AUUIICIH.0 L11111L WIVVVII III 'the Declarations does not apply. b. Paragraph 7. of Limits Of Insurance (Section III) does not apply. c. Paragraph 1. of Section III — Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 7 of 8 Office, Inc., with its permission (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits ". d. The following are added to Section III — Limits Of Insurance: 8. Subject to 2. or 3. above, whichever applies, the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Cover- age C because of "bodily injury" or "prop- erty damage" arising out of the ac- tual, alleged or threatened dis- charge, dispersal, seepage, migra- tion, release or escape of "pollut- ants" is $100,000. 9. Subject to 8. above, the Medical Expense Limit is the most we will pay under Coverage C for all medi- cal expenses because of "bodily in- jury" sustained by any one person arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or es- cape of "pollutants ". O. OTHER INSURANCE If this policy includes a Coverage Form or an Endorsement which provides ccoverage for loss or damage covered by one "or more of the Ex- tensions of this endorsement, the and the coverage provided by this endorsement are de- leted and replaced byAhe limitgand coverage provided by that Coverage For ,Endorse- ment. ;V;� V qqu 4 by . CL CG 00 20 03 07 Includes copyrighted material of Insurance Services Page 8 of 8 Office, Inc., with its permission CWG I General Liability 101/01/07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CL CG 20 14 0107 ` ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to "bodily injury" and "property damage" caused, in whole or in part, by "your work" at locations specified in the written contract or agreement and included in the "products- completed operations hazard ". With respect to the insurance afforded to these additional insureds, this insurance does not apply tc "bodily injury" or "property damage" that occurs prior to the execution of, or subsequent to the expiration of, the contract or agreement in which you agreed that such person or organization be added as an additional insured on your policy. ©Continental Western Group ©2010 Vertafore, Inc. All Rights Reserved. ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/21 /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 Phone: (360) 598 -3700 Fax: (360) 598 -3703 MICHAEL J. HALL & COMPANY HALL & COMPANY 19660 10TH AVENUE N.E. POULSBO WA 98370 CONTACT MICHAEL J. HALL & COMPANY NAME: PHONE 360 598 -3700 FAX (360) 598 -3703 A/C No Edt : ( ) A/C No E -MAIL ADDRESS: PRODUCER 1854 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC p INSURED Budinger & Associates Inc 1101 N Fancher Rd INSURER BeaZley Insurance Company Inc 37540 INSURERS CLAIMS -MADE _]OCCUR [ P - OM MERCIALGENERALLIABILITY INSURERC Spokane Valley, WA 99212 -1275 DAMAGES Ea occurence TORENTED PREMISE INSURER D: MED. EXP (Any one person) INSURER E PERSONAL & ADV INJURY $ INSURER F COVERAGES CERTIFICATE NUMBER: 150557 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 LTR TYPE OF INSURANCE I ADD'L INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD POLICY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE _]OCCUR [ P - OM MERCIALGENERALLIABILITY DAMAGES Ea occurence TORENTED PREMISE $ MED. EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGRE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO _ BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE (Per accident) $ SCHEDULED AUTOS HIRED AUTOS $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE TO RY Y LIMITS OTH TO RY $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? I� (Mandatory in NH) NIA E.L. DISEASE POLICY LIMIT $ Ifyes, describe under DESCRIPTION OF OPERATIONS below A Professional LiabilityClaims Made Form V15QZD100501 02/28/11 02/28/12 $ 2,000,000 Per Claim Pollution Liability Extension Included $ 2,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: Indiana Avenue Extension Project / Project Number: CIP 0112 / Original Agreement Number: 10 -032 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of S pokane Valley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty p y ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave Ste 106 Spokane Valley, WA 99206 -6124 AUTHORIZED REPRESENTATIVE Attention: Craig Aldworth, P.E L. Copus� :ORD 25 (2009109) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACnRr1 name and Innn are rani mtorad marks of ACORD