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13-110.00 MDM Construction: Regional Decant Facility Ph 1
Contract THIS AGREEMENT, made and entered into this _ day of , 2013, between the City of Spokane Valley under and by virtue of Title 47 RCW4ds amended and MDM Construction, Inc. dba MDM Excavation 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: 1. The Contractor shall do all work and furnish all tools, materials, and equipment for: Phase 1— Spokane Valley Regional Decant Facility Project 0173, SVPW Contract 13 -033 In accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the 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. V. The project was awarded for the bid amount of $147,893.09 . City of Spokane Valley Phase 1— Spokane Valley Regional Decant Facility 13 SVPW Bid No 13 -033 0-10i3- tlo IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor '37w"- e- 12 , 2013. Date Mitch Swenson Printed Name President Title Signature City of S ok Valley City of Spokane Valley Phase I — Spokane Valley Regional Decant Facility 14 SVPW Bid No 13 -033 AOL crIY OF Spokane ,,;Oo *Va11eyR BOND NO: CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley, Washington 0176629 The City of Spokane Valley, Washington, in Spokane County, has awarded to MDM Construction, Inc. dba MDM Excavation (Contractor), as Principal, a contract for the construction of the project designated as PHASE 1 — SPOKANE VALLEY REGIONAL DECANT FACILITY, Proiect No 0173, SVPW Contract 13 -033 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to Tarnish a performance bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and Berkley Regional Insurance Company (Surety), a corporation, organized under the laws of Delaware and licensed to do business in the State of Washington as surety and named in the current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley, as Obligee, in the sum of $147,893.09 total Contract amount (including Washington State sales tax), subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified; shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract; and if such performance obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, and waiyes.notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL ON TR ACTOR) 6, -1 F -13 Principal Sigrr3hire Date Mitch Swenson Printed Name -.nres'ider;it: S TY `` ,, cc� .Wcy` 6 -18 -13 Surety Signature Date Shawn M. Wilson Printed Name Attorney -in -Fact Title W Title y. Name, address, And telephone of local office/agent of Surety Company is: eldest Insurance, Inc., 7903 E Broadway, Spokane Valley, WA 99212 / 509 - 789 -7431 City of Spokane Valley Phasc r — Spokane Valley Regional Decant Facility Is SVPW Bid No 13 -033 S "okane p Valley- ADDENDUM No. 1 TO BOND NO: 0176629 ADDENDUM TO CONTRACTOR'S NON - FEDERAL PAYMENT BOND to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to MDM Construction, Inc. dba MDM Excavation (Contractor), as Principal, a contract for the construction of the project designated as PRASE 1— SPOKANE VALLEY REGIONAL DECANT FACILITY, Project No. 0173, Contract 13- 033 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal and Surety have requested and the City has agreed that payment bond (Bond No. 0176629 shall be modified as provided in this Addenduun to Contractor's Non - Federal Payment Bond. The fourth paragraph of the payment bond is hereby modified as follows (with additions underlined): The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation, provided however, that any such increase shall not exceed 25% of the original amount of this payment bond without the consent of the Surety. The Principal shall provide notice to the Surety of any increase exceeding 25% of the original amount of thus payment bond. This Addendum shall not modify any other provisions of the payment bond and shall not otherwise affect the rights and responsibilities of the parties except as provided herein. This addendum may be executed in two (2) original counterparts, and shall be signed by the parties' duly authorized officers. This addendum will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL O CTOR) �9-/ 3 Principal g ignaaue Date Mitch Swenson Printed Name - presidamt Title SURETY k 6 -18 -13 Surety Signature Date Shawn M. Wilson Printed Name Attorney -in -Fact Title Name, address, and telephone of local office /agent of Surety Company is: PayneWest Insurance, Inc., 7903 E Broadway, Spokane Valley, WA 99212 / 509 - 789 -7431 City of Spokane Valley Phase 1— Spokane Valley Regional Decant Facility 16 SVPW Bid No 13 -033 No. 7801 e POWER OF ATTORNEY BERKLEY REGIONAL INSURANCE COMPANY WILMINGTON, DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY REGIONAL INSURANCE COMPANY (the "Company "), a Vcorporation duly organized and existing under the laws of the State of Delaware, having its principal office in Urbandale, Iowa, has made, constituted and appointed, and does by these presents make, constitute and appoint: Walter W. Wolf, James E. . Ma jeskey II, Judith C Kaiser - Smith, Judith A. Rapp, Shawn M. Wilson, Shelly Donovan, Nicholas W. Paget or Michael B. Cunningham of PayneWest Insurance, Inc. of Spokane Valley, WA its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing'that no single obligation shall exceed Fifty Million and 00 /100 U.S. Dollars c (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, o without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on August 21, 2000: "RESOLVED, that the proper officers of the Company are hereby authorized to execute powers of attorney authorizing and F. >U- qualifying the attorn ey -in -fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations Z °: on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; ° o and further 3 RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, a ' or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further F" RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney -in -fact named; and ° further RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any co o power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any 3 person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued." o ¢' b IN WITNESS WHEREOF, the Company has caused these presents to be signed and attested by its appropriate officers and its Y corporate seal hereunto affixed this Z.,day of `YaM►�.e�n.y , 2013. Attest: Berkley Regional Insurance Company O v (Seal) By By Ira S. Lederman Je after ti Senior Vice President & Secretary e c President -° o WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE " BERKLEY" SECURITY PAPER. o E STATE OF CONNECTICUT) Lz ) ss: n o COUNTY OF FAIRFIELD ) •N �° Sworn to before me, a Notary Public in the State of Connecticut, this dZ day of , 2013, by Jeffrey M. Halter and Ira S. Lederman who are sworn to me to be the Senior Vice President, and the Senior Vice President and Secretary, respectively, of Berkley Regional Insurance Company. EILEEN KILLEEN NOIAR Y PURUC. STATE OF CONNECTICUT Notary Public, State of Connecticut d o MY COMMISSION EXPIRES JUNE 30, 2017 CERTIFICATE I, the undersigned, Assistant Secretary of BERKLEY REGIONAL INSURANCE COMPANY, DO HEREBY CERTIFY that the z foregoing is a true, correct and complete copy of the original Power of Attorney; that said Power of Attorney has not been revoked or rescinded and that the authority of the Attorney -in -Fact set forth therein, who executed the bond or undertaking to which this 3 - Power of Attorney is attached, is in full force and effect as of this date. Given under my hand and seal of the Company, this 18th day of June 2013 (Seal) P"ew'I',t�u na CITY ors 40;0 alley BOND NO: 0176630 CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to MDM Construction, Inc. dba MDM Excavation ( "Contractor "), as Principal, a contract for the construction of the project designated as PHASE 1 — SPOKANE VALLEY REGIONAL DECANT FACILITY, Proiect No. 0173, SVPW Contract 13 -033 (the "Contract ") in Spokane Valley, Washington. The Principal, existing under and by virtue of the laws of the State of Washington and authorized to do business in the State of Washington, and Berkley Regional Insurance Company organized and existing under the laws of the State of Delaware and authorized to transact business in the State of Washington as Surety, are jointly and severally held and bound unto the City of Spokane Valley, hereinafter called Obligee, and are similarly held and bound unto the beneficiaries of the trust fund created by chapter 60.28 RCW, in the penal sum of 5% of the Contract, which is ** *Seven Thousand Three Hundred Ninety Four Dollars and Sixty Five Cents * ** dollars ($7,394.65*********************), plus 5% of any increases in the Contract amount that have occurred or may occur, due to change orders, increases in the quantities, or the addition of any new item of work. WHEREAS, on the 18th I I . day of _June , 2013 the said Principal and Obligee herein executed and entered into the Contract. WHEREAS, said Contract and chapter 60.28 RCW require the Obligee to withhold from the Principal the sum of 5% from monies earned by the Principal on estimates during the progress of the construction, hereinafter referred to as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under chapter 60.28 RCW. NOW THEREFORE, the condition of the obligation is such that the Principal and Surety are held and bound unto the beneficiaries of the trust fiend created by chapter 60.28 RCW in the aforesaid sum. This bond, including any proceeds therefrom, is subject to all claims and liens and in the same manner and priority as set forth for retained percentages in chapter 60.28 RCW. The condition of this obligation is also such that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund purposes of chapter 60.28 RCW to the Obligee, and indemnify and hold the Obligee harmless from any and all loss, costs, and damages that the Obligee may sustain by release of the earned retained funds to the Principal, then upon notification of such satisfaction and release of the Surety by the Obligee, this obligation shall be null and void. PROVIDED HOWEVER, that: City of Spokane Valley Phase I — Spokane Valley Regional Decant facility 17 SVPW Bid No 13 -033 1. The Surety shall be liable under this obligation as Principal. The Surety will not be discharged or released from liability for any act, omission or defenses of any kind or nature that would not also discharge Principal. 2. This obligation shall be binding upon and inure to the benefit of the Principal, the Surety, the Obligee, the beneficiaries of the trust fiord created by chapter 60.28 RCW and their respective heirs, executors, administrators, successors and assigns. 3. Any suit under this bond must be instituted within the time provided by applicable law. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL (C CTOR) Principaf Signature Date Mitch Swenson Printed Name President" Title SURETY Surety Signature Date Shawn M. Wilson Printed Name Attorney -in -Fact Title Name, address, and telephone of local office /agent of Surety Company is: PayneWest Insurance, Inc. 7903 E Broadway, Spokane Valley, WA 99212/ 509 - 789 -7431 Approved as to Office of of Spokane Valley /9-, Date City of Spokane Valley Phase 1— Spokane Valley Regional Decant Facility 18 SVPW Bid No 13 -033 No. 7801 e POWER OF ATTORNEY BERKLEY REGIONAL INSURANCE COMPANY WILMINGTON, DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY REGIONAL INSURANCE COMPANY (the "Company "), a corporation duly organized and existing under the laws of the State of Delaware, having its principal office in Urbandale, Iowa, has made, constituted and appointed, and does by these presents make, constitute and appoint: Walter W. Wolf, James E. Majeskey II, Judith C. Kaiser - Smith, Judith A. Rapp, Shawn M. Wilson, Shelly Donovan, Nicholas W. Paget or Michael B. Cunningham of PayneWest Insurance, Inc. of Spokane Valley, WA its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed Fifty Million and 00 /100 U.S. Dollars (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. . This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, o -2 without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following > 1� resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on August 21, 2000: "RESOLVED, that the proper officers of the Company are hereby authorized to execute powers of attorney authorizing and ° > qualifying the attorney -in -fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations CZ i CliPnt;g- RR777 MDMCONST ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/13/2013 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 Payne Financial Group, Inc. 7903 E Broadway Spokane, WA 99212 CONTACT NAME: PHONE - FAX A/C, No, Ext : A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 509 535 -9178 INSURER A Bituminous Fire and Marine 9101/2012 INSURED MDM Construction Inc. dba MDM Excavation INSURER B: Bituminous Casualty Company $1,000,000 INSURER C: Travelers Property Casualty of X COMMERCIAL GENERAL LIABILITY P O Box 2006 Hayden, ID 83835 INSURER D: PREMISES (ERENTED cc nte INSURER E MED EXP (Any one person) INSURER F: CLAIMS -MADE 51 OCCUR IX 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X X CLP3576026 9101/2012 09/01/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (ERENTED cc nte $100,000 MED EXP (Any one person) $10,000 CLAIMS -MADE 51 OCCUR IX PERSONAL & ADV INJURY $1,000,000 PD Ded:500 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 $ POLICY X PRO-- LOC A AUTOMOBILE LIABILITY CAP3576027 9101/2012 09/01/201 CMBIN Ea acccideDtSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X HIREDAUTOS X NON -OWNED AUTOS PerraccidentDAMAGE $ B X UMBRELLA LIAB X OCCUR CUP2800573 9/01/2012 09/01/201 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N/A CLP3576026 WA Stop Gap 9/0112012 09/01/201 TO STAZ OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEEI $1,000,000 E.L. DISEASE - POLICY LIMIT 1 $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Rent 8r Lease Eqpt CLP3576026 9/01/2012 09/01/201 $511,000/$2000 C Builders Risk QT6601189R920TIL 9/24/2012 09/241201 $2,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Please refer to attached form GL4665(01/11) Additional Insured - Completed Operations includes Primary and Non- Contributory. Form GL3088 (09/11) Includes Automatic Waiver of Subrogation and per Project. Re: Phase 1- Spokane Valley Regional Decant Facility City of Spokane Valley Project 0173, Bid #13 -033 City of Spokane Valle Public SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y p y' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Works ACCORDANCE WITH THE POLICY PROVISIONS. 11707 East Sprague Ave, Suite 106 AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99206 tri © 1988 -2010 ACORD CORPORATION. All ngnts reservea. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S926071/M900549 LAC1 This page has been left blank intentionally. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT LAND IMPROVEMENT CONTRACTORS EXTENDED LIABILITY COVERAGE This endorsement modifies insurance provided under the following: ' COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that the provisions listed below apply only upon the entry of an J in of such provision. A. 7X Partnership and Joint Venture Extension B, 0 Contractors Automatic Additionai Insured Coverage — Ongoing Operations C. jr-AY-71 Automatic Waiver of Subrogation D. I v Extended Notice of Cancellation, Nonrenewal E: 771 Unintentional Failure to Disclose Hazards F..� Broadened Mobile Equipment G. L_"J Personal and Advertising Injury - Contractual Coverage H. rX Nonemployment Discrimination 1. IF-711 Liquor Liability J. Ffl Broadened Conditions K. Cj Automatic Additional Insureds — Equipment Leases L. rj—Av-11 Insured Contract Extension - Railroad Property and Construction Contracts Y. the box next to the caption M. QX Construction Proje t General Aggregate Limits N. Fellow Employee Coverage O. XQ Property Damage ti the Named Insureds Worst P, l _XA11 Care, Custody or Control C. Q Electronic Data Liability Coverage R. 0 Consolidated Insurance Program Residual Liability Coverage S. 0 Automatic Additional Insureds — Managers or Lessors of Premises T. 7X Automatic Additional Insureds — State or Governmental Agency or Political Subdivisions — Permits or Authorizations U. Q Contractors Automatic Additional Insured Coverage -- Completed Operations V. OX Additional Insured Engineers, Architects or Surveyors ; A. PARTNERSHIP AND JOINT VENTURE EXTENSION The following provision is added to SECTION 11- WHO IS AN INSURED: The last full paragraph which reads as follows: No person or organization is an insured with respect to the conduct of any ci joint venture or limited liability company that is not shown as a Named Insu deleted and replaced with the following: ' ' it or past partnership, in the Declarations is With respect to the conduct of any past or present joint venture or partnership ` not shown as a Named Insured in the Declarations and of which you are or were a partner or member, you are an insured, but only with respect to liability arising out of "your work" on behalf of any partnership or joint venture not shown as a Named Insured in the- Declarations, provided no other similar liability Insurance is available to you for "your work" in connection with your interest in such partnership or joint venture. GL -3088 (09/11) -t- B. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE— ONGOING OPERATIONS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury", "property damage" or 'personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the project(s) designated In the written contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non - contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. C. AUTOMATIC WAIVER OF SUBROGATION Item 8. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted'and replaced with the following: 8. Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a. If the insured has rights to recover all or part of any payment we have' made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer'those rights to us and help us enforce them. b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of "your work" for that person or organization. D. EXTENDED NOTICE OF CANCELLATION, NONRENEWAL Item A.2.16. of the COMMON POLICY CONDITIONS, is deleted and replaced with the following: A.2b. 60 days before the effective date of the cancellation if we cancel for any other reason. Item 9. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 9. WHEN WE DO NOT RENEW GL -3088 (09/11) -2- ic a. If we choose to nonrenew this policy, we will mail or deliver to the first Named insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty(60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one time sixty day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a. above. E. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if 'nintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. F. BROADENED MOBILE EQUIPMENT Item 12.b. of SECTION V - DEFINITIONS, is deleted and replaced with the loll 12.b. Vehicles maintained for use solely on or next to premises, sites or occupy. G. PERSONAL AND ADVERTISING INJURY- CONTRACTUAL COVERAGE Exclusion 2.e. of SECTION 1, COVERAGE B is deleted. H. NONEMPLOYMENT DISCRIMINATION Unless "personal and advertising injury" is excluded from this policy: Item 14. of SECTION V - DEFINITIONS, is amended to include: "Personal and advertising injury" also means embarrassment or humiliati distress, physical illness, physical impairment, loss of earning capacity or caused by "discrimination." SECTION V - DEFINITIONS, is amended to include: "Discrimination" means the unlawful treatment of individuals based on race, gender or religion. Item 2. Exclusions of SECTION I, COVERAGE B, is amended to include: "Personal and advertising injury" arising out of "discrimination" directly or it employment, employment or prospective employment of any person or insured; 9 ns you own, rent or , mental or emotional onetary loss, which is r, ethnic origin, age, r related to the past of persons by any "Personal and advertising injury" arising out of "discrimination" by or at your, your agents or your "employees" direction or with your, your agents or your "employees" knowledge or consent; "Personal and advertising injury" arising out of "discrimination" directly or indiiectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub- lease.of any dwelling, permanent lodging or premises by or at the direction of any insured; or I Fines, penalties, specific performance or injunctions levied or imposed by i governmental entity, or governmental code, law, or statute because of "discrimination." GL -3088 (09/11) -3- 1. 'LIQUOR LIABILITY Exclusion 2.c. of SECTION I, COVERAGE A, is deleted. J. BROADENED CONDITIONS Items 2.a. and 2.b. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, are deleted and replaced with the following: 2. Duties In The Event; Of Occurrence, Offense, Claim Or Suit: a. You must see to it that we are notified of an "occurrence" or an offense which may result in a claim as soon as practicable after the "occurrence" has been reported to you, one of your officers or an "employee" designated to give notice to us. Notice should "include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) 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 any insured, you must: (1) Record the specifics of the claim or "suit" and the date received as soon as you, one of your officers, or an "employee" designated to record such information _is notified of it; and (2) Notify us in writing as soon as practicable after you, one of your officers, your legal department or an "employee" you designate to give us such notice learns of the claims or Item 2.e. is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: 2.e. If you report an "occurrence" to your workers compensation insurer which develops into a liability claim for which coverage is provided by the Coverage Form, failure to report such 'occurrence" to us at the time of "occurrence" shall not be deemed in violation of paragraphs 2.a., 2.b., and 2.c. However, you shall give written notice of this "occurrence" to us as soon as you are made aware of the fact that this "occurrence" may be a liability claim rather than a workers compensation claim. K. AUTOMATIC ADDITIONAL INSUREDS - EQUIPMENT LEASES SECTION 11 - WHO IS AN INSURED is amended to include any person or organization with whom you agree in a written equipment lease or rental agreement to name as an additional insured with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, at least in part, by your maintenance, operation, or use by you of the equipment leased to you by such person or organization, subject to the following additional exclusions. The insurance provided to the additional insured does not apply to: 1. "Bodily injury" or "property damage" occurring after you cease leasing the equipment. 2. "Bodily injury` or 'property damage" arising out of the sole negligence of the additional insured. 3. "Property damage" to: a. Property owned, used or occupied by or rented to the additional insured; or b. Property in the care, custody or control of the additional insured or over which the additional insured is for any purpose exercising physical control. GL -3088 (09/11) -4- This insurance is excess of all other insurance available to the additional insured,l whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution fri m such insurance if the written contract also requires that this insurance be non - contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or;additionIa] insured, this insurance will be excess. L. INSURED CONTRACT EXTENSION - RAILROAD PROPERTY AND CONSTRUCTION CONTRACTS Item 9. of SECTION V - DEFINITIONS, is deleted and replaced with the following 9. "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract "; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, i except in connection with work for a municipality; 8. An elevator maintenance agreement; If. That part of any .other contract or agreement pertaining :to your' business (including an indemnification of a municipality in connection with work performed (for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve,I maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or I (2) Under which the insured, it an architect, engineer or surveyor,! assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. M. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMffS This modifies SECTION III - LIMITS OF INSURANCE. A. For all sums which can be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an "occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I - COVERAGE C: GL -3088 (09/11) -5- 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard,° and for medical expenses under COVERAGE C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. 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 Construction Project General Aggregate Limit. B. For all sums which cannot be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an 'occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I - COVERAGE C: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products - Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. Payments for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard" will reduce the Products- Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If a construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION ill - LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to be applicable. N. FELLOW EMPLOYEE COVERAGE Exclusion 2.e. Employers Liability of SECTION 1, COVERAGE A, is deleted and replaced with the following: 2.e. "Bodily injury" to (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or GL -3096 (09/11) -6- rd (2) The spouse, child, parent, brother or sister of that "employee" paragraph (1) above. I This exclusion applies: (1) Whether the insured may be liable as an employer or in any other caps (2) To any obligation to share damages with or repay someone else because of the injury. This exclusion does not apply to: (1) Liability assumed by the insured under an "insured contract "; or (2) Liability arising from any action or omission of a co- "employee" wh either in the course of his or her employment or performing duties relal business. as a consequence of city; and ,vho must pay damages that co-"employee" is to the conduct of your Item 2.a. (1}(a) of SECTION 11- WHO IS AN INSURED, is deleted and replaced with the following: 2.a. (1)(a) To you, to your partners or members (if you are a partnership or (joint venture) or to your members (if you are a limited liability company), or to your "volunteer workers" while performing duties related to the conduct of your business. O. PROPERTY DAMAGE TO THE NAMED INSURED'S WORK Exclusion I of SECTION I, COVERAGE A. is deleted and replaced with the following: 1. Damage to Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products completed operation hazard." I This exclusion applies only to that portion of any loss in excess of $50,000 per occurrence if the damaged work and the work out of which the damage arises was performediby you. This exclusion does not apply if the damaged work or the work out bf wh performed on your behalf by a subcontractor. P. CARE, CUSTODY OR CONTROL Exclusion 2.1.4 of SECTION I, COVERAGE A. is deleted and replaced with the fol the damage arises was ,owing: 2.1.4 Personal property in the care, custody or control of the insured. However, (tor personal property in the care, custody or control of you or your "employees," this exclusion applies only to that portion of any loss in excess of $25,000 per occurrence, subject to the following terms and conditions: (a) The most that we will pay under this provision as an annual aggregate is $100,000, regardless of the number of occurrences. (b) This provision does not apply to "employee" owned property or any property that is missing where there is not physical evidence to-show what happened to the property. (c) The aggregate limit for this coverage provision is part of the General Aggregate Limit and SECTION 111 - LIMITS OF INSURANCE is changed accordingly. 1 (d) In the event of damage to or destruction of property covered by this lexception, you shall, if requested by us, replace the property or furnish the labor and material's necessary for repairs thereto, at actual cost to you, exclusive of prospective profit or overhead charges of any nature. GL -3088 (09111) -7- (e) $2,500 shall be deducted from the total amount of all sums you became obligated to pay as damages on account of damage to or destruction of all property of each person or organization, including the loss of use of that property, as a result of each "occurrence." Our limit of liability under the endorsement as being applicable to each "occurrence" shall be reduced by the amount of the deductible indicated above; however, our aggregate limit of liability under this provision shall not be reduced by the amount of such deductible. The conditions of the policy, including those with respect to duties in the event of "occurrence," claims or "suit" apply irrespective of the application of the deductible amount. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action laken, you shall promptly reimburse us for such part of the deductible amount,as has been paid by us, 0. ELECTRONIC DATA LIABILITY COVERAGE 1, Exclusion 2.p. Electronic Data of SECTION I, COVERAGE A, is deleted and replaced with the following; 2.p. Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. 2. The following definition is added to SECTION V — DEFINITIONS: "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD -ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 3. For the purposes of this coverage, the definition of "property damage" in SECTION V — DEFINITIONS is replaced by the following: "Property damage" means; a. Physical injury to tangible property, including all resulting loss of use of that property. Ail such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or C. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data ", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it_ For the purposes of this insurance, 'electronic data" is not tangible property. R. CONSOLIDATED INSURANCE PROGRAM RESIDUAL LIABILITY COVERAGE With respect to "bodily injury", "property damage ", or 'personal and advertising injury" arising out of your ongoing operations; or operations included within the "products- completed operations hazard ", the policy to which this coverage is attached shall apply as excess insurance over coverage available to "you" under a Consolidated Insurance Program (such as an Owner Controlled Insurance. Program or Contractors Controlled Insurance Program). Coverage afforded by this endorsement does not apply to any Consolidated Insurance Program involving a "residential project" or any deductible or insured retention, specified in the Consolidated Insurance Program. The following is added to Section V — Definitions GL -3088 (09/11) .8- "Residential project" means any project where 30% or more of the total square foot area of the structures on the project is used or is intended to be used for human residency. This includes but is not limited to single or multifamily housing, apartments, condominiums, townhouses, co-op IGratives or planned unit developments and appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). A "residential project" does not include military owned housing, college /university owned housing or dormitories, long term care facilities, hotels, motels, hospitals or prisons. All other terms, provisions, exclusions and iimitations of this policy apply. S. AUTOMATIC ADDITIONAL INSUREDS - MANAGERS OR LESSORS OR PREMISES SECTION iI — WHO IS AN INSURED is emended to include: Any person or organization with whom you agree in a written contract or written agreement to name as an additional insured but only with respect to liability arising cut of the ownership, maintenance or use of that part of the premises, designated in the written contract or written agreement, that is leased to you and subject to the following additional exclusions: I This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured listed in the written contract or written agreement. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non - contributory., But with respect to all'other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. T. AUTOMATIC ADDITIONAL INSUREDS — STATE OR GOVERNMENTAL AGENCY OR POLITICAL SUBDIVISIONS — PERMITS OR AUTHORIZATIONS SECTION 11 — WHO iS Arid INSURED is amended to include any state or governmental agency or subdivision or political subdivision with whom you are required by written contract, ordinance, law or building code to name as an additional insured subject to the following provisions: This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: 1. "Bodily injury", "property damage" or "persona( and advertising injury" arising out of operations performed for the Federal government, state or municipality; or 2. "Bodily injury" or "property damage" included within the "products - completed operations hazard". This insurance is excess of all other insurance available to the additional insured, Whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary, In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non - contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. U. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE— COMPLETED OPERATIONS GL -3088 (09/11) -9- SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed .operations, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the project designated in the contract, performed for that additional insured and included in.the "products - completed operations hazard ". This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non - contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance MI be excess. V. ADDR10NAt_ INSURED —ENGINEERS, ARCHITECTS OR SURVEYORS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any architect, engineer or surveyor who is required by written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations performed by you or on your behalf. This includes such architect, engineer or surveyor, who may not be engaged by you, but is contractually required to be added as an additional insured to your policy, With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or 2. Supervisory, inspection or engineering services. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non - contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-3088 (09 /11) -10- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who Is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed operations, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the project designated: in the contract, performed for that additional insured and included in the "products- completed operations hazard'. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non - contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL -4665 (41!11) Includes Copyrighted Material of Insurance Services Office With Its Permission This page has been left blank intentionally. Client #: 88777 MDMCONST ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD 6/13/2013 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 PayneWest Insurance, Inc. 7903 E Broadway Spokane, WA 99212 CONTACT NAME: PHONE _ FAX A/C No Ext : A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 509 535 -9178 INSURER A: Alaska National Insurance Compa INSURED MDM Construction Inc. dba MDM Excavation INSURER B: $ COMMERCIAL GENERAL LIABILITY P O Box 2006 INSURER C: Hayden,ID 83835 INSURER D: INSURER E INSURER F: 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. LTRR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM /DDY/YYYY MM/DID� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ $ POLICY D PRO LOC JECT AUTOMOBILE LIABILITY CO accMBINED SINGLE LIMIT Ea ident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � NIA 13D WS 8844 4/01/2013 04/01/201 X WC STATU- OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) E.L. DISEASE, POLICY LIMIT $11,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Phase 1- Spokane Valley Regional Decant Facility City of Spokane Valley Project 0173, Bid #13 -033 [tla:4112ly_\I=1: City of Spokane Valley, PUbIIC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y p y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Works ACCORDANCE WITH THE POLICY PROVISIONS. 11707 East Sprague Ave, Suite 106 AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99206 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S926068/M892328 LAC1 This page has been left blank intentionally. SUPERIOR COURT OF WASHINGTON FOR SPOKANE COUNTY In the Matter of: ADVERTISEMENT FOR BIDS No. City of Spokane Valley Public Works Department Bid # 13 -033 ) AFFIDAVIT OF PUBLISHING Phase 1- Spokane Valley Regional NOTICE Decant Facility STATE OF WASHINGTON ) )SS. County of Spokane ) MICHAEL HUFFMAN , being first duly sworn on oath deposes and says that he is the EDITOR of The Spokane Valley News Herald, a weeklynewspaper. Thatsaid newspaper is a legalnewspaper and itisnow and hasbeenfor more than six months prior to the date of the publication hereinafter referred to, published in the English language continually as a weekly newspaper in Spokane County, Washington, and it is now and during all of said time was printed in an office maintained at the aforesaid place of publication of said newspaper, which said newspaper had been approved as a legal 1 apex by order of the Sup or Court of the State of Washington in and for Spokane County. That the following is a true c of a u ' . n ' e as ' as lisped in regular issues commencing on the24th�ofMay ,2013andendingthe31stda a 21 smc 1v at ewspaper was regularly distributed to its subscribers during all of said period. ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT CRIBE WORN to before me BID SP tKA this 31st da of a 2013. PHASE 1 - SPOKANE VALLEY REGIONAL DECANT FACILITY 1911 Notice is hereby given that the City of Spow Abe il/ State Of Washm on kane Valley, Spokane County, Washington R% ®/ will accept sealed bids for the Spokane ®% t P+� W4 J'e County of Spokane Valley Regional Decant Facility, Phase e, „( • • .•... ` 1 Project. The project consists of storm V •0 J `•.• 0 drain and liquid decant process piping and •yep qFS., ® I certify that I know or have satisfactory evidence that underground structure work; hot mix asphalt 4(.,j ; •� patching; excavation and construction of a a $� Michael Huffman is the person who appeared before bio- infiltration Swale and sand filter, fence •: =me, and said person acknowledged that he signed repair and gate installation; and other rr =his instrument and acknowledged it to be his free related work. 7 �` + � g Copies of the bid packet including swift- ev� t f--- @.arid voluntary act for the uses and purposes men- cations and plans may be obtained in PDF a : (� •. format by downloatling from the Spokane ° _ tionec3�in the instrument. Valley FTP site. To obtain the FTP site , (s: • 1y ° Oa passwordandto submitabidforthisproJect, p 11), °•.�•• °5 -16.• ��`e0 Contractommusl ocntact Deven Nickerson,>B ......... _ Spokane Valley Public Works, at 7205008 B/ � ryry r �•�® orby email at dnickemon ®spokanevalley. ""'14' �0 Olenel�a ritZ org, Monday through. Friday from 8:00 POBB j 11I191a I a.m. to 5:00 p.m., excluding holidays. Title: Notary Public Contractors will then be placed on the City's Planholdees list. Any addenda tothis My appointment expires: 5 -16 -15 project will be sent only to those listed on the bids must b list. ( r� -1 All bids must be accompanied by a bid (//5 deposit in the.form of a surety bond, postal money order, cash, cashiers check, Drceni. fied check in an amount equal to five percent (5 %) of the amount of the bid proposed. (I✓ �l^-' Failure to furnish a bid bond in compliance with the City's bid deposit surety bond forms shall make the bid non- responsive and cause the bid to be rejected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spokane Valley, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received no later than 10:00 a.m. PSDT, Friday, June7, 2013. Bid open - ingswill 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 infor- malities and to reject any or all bids. No - bidder may withdraw his bid after the time announced forthe bid opening, or beforethe award and execution of the contract, unless the award is delayed fora period exceeding sixty (60) days. Came Koudelka, Deputy City Clerk Spokane Valley PUBLISH: May 24, and May 31, 2013 5/24,5/31 ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID A 13 -033 PHASE 1- SPOKANE VALLEY REGIONAL DECANT FACILITY Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Spokane Valley Regional Decant Facility, Phase 1 Project: The project consists of storm drain and liquid decant process piping and underground structure work; .hot mix asphalt patching; excavation and construction of a bio- infiltration swale and sand filter; fence repair and gate installation; and other related work. Copies of the bid packet including specifications and plans may be obtained in PDF format by downloading from the Spokane Valley FTP site. To obtain the FTP site password and to submit a bid for this project, Contractors must contact Deven Nickerson, Spokane Valley Public Works, at 720 -5008 or by email at do ickerson @spokaneval ley.grg, Monday through Friday from 8:00 a.m. to 5:00 p.m., excluding holidays. Contractors will then be placed on the City's Planholder's list. Any addenda to this project will be sent only to those listed on the Planholder's list. 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, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received no later than 10:00 a.m. PSDT, Friday, June 7, 2013. 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. Carrie Koudelka, Deputy City Clerk Spokane Valley PUBLISH: May 24, and May 31, 2013 SR26162 RECEIVED JUN 0 5 2013 *Federal Tax ID No. 68- 0617327 AFFIDAVIT OF PUBLICATION STATE OF WASHINGTON County of Spokane} ss Name: City of Spokane Valley Client ID PO No. SR26162 No. Lines Total Cost: $691.02 Order No. 42365 81 124956 I, Jean Robinson 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: May 24 & 31, 2013 That said notice was published in the regular and entire issue of every number of the paper during the period of time of publication, and that the notice was published in the newspaper proper and not in a supplement. Subscribed and sworn to before me at the City of Spokane, this 31 st day of May 2013. �\ �- VI C �O SI ON o NOTARY 9N �� ( %K1 PUBLIC err Nota Public in and for the State of Washington, ERA" residing at Spokane County, Washington OFWggH� Stamp P v_C Notary Paper Affidavits