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13-152.00 Cameron Reilly: Wellesley Ave & Adams Rd SidewalksContract THIS AGREEMENT, made and entered into this day , 2013, between the City of Spokane Valley under and by rtue of Title 35 R , as amended and Cameron - Reilly, LLC Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: The Contractor shall do all work and furnish all tools, materials, and equipment for: Wellesley Avenue Sidewalk and Adams Road Sidewalk Project #0168 SVPW Contract 13 -022 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City of Spokane Valley by reason of entering onto this contract, except as provided herein. io1� -152- V. The project was awarded for the bid amount of 54$ 2,200• 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 — 2-6— ) 3 , 2013. Date Printed Name Citi, Spokane ,,;ooV;Valley- BOND NO: 023017831 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Cameron — Reilly, LLC (Contractor), as Principal, a contract for the construction of the project designated as Wellesley Avenue Sidewalk and Adams Road Sidewalk Project, Project No. 0168, in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and The Ohio Casualty Insurance Company (Surety), a corporation, organized under the laws of New Hampshire 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 S 542,200 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 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. 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. PRINC]P ( �TRACTOR) P I al Signature Date -J,✓K Printed Name ^ " Title SURETY i� %f� 8 -27 -2013 urety Signature Date Judith C Kaiser —Smith Printed Name Attorney —in —Fact Title Name, address, and telephone of local office /agent of Surety Company is: Nicholas W. Paget, Agent 509- 363 -4024 PayneWest Insurance, Inc. 7903 E. Broadway Ave. Spokane Valley, WA 99212 Revised 1. 14.13 Spokane ,,,;0o*Va11ey- BOND NO: 023017831 CONTRACTOR'S PAYMENT BOND (NON- FEDERALLY FUNDED PROJECT) to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Cameron — Reilly, LLC (Contractor), as Principal, a contract for the construction of the project designated as Wellesley Avenue Sidewalk and Adams Road Sidewalk Proieet, Project No. 0168, 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 The Ohio Casualty Insurance Company (Surety), a corporation organized under the laws New Hampshire 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 $542,200 total Contract amount (including Washington State sales tax), subject to the provisions herein. This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with chapters 39.08 and 39.12 RCW, including all workers, laborers, mechanics, subcontractors, and materialmen, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work; and shall indemnify and hold harmless the Obligee from all loss, cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments; and if such payment 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, 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. 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 NTRACTOR) I 6r2-9-1 3 Prifilial Signature Date Printed Name AA-b, — Title SURETY _8 -27 -2013 =Surety Signature Date Judith C. Kaiser —Smith Printed Name Attorney —in —Fact Title Name, address, and telephone of local office /agent of Surety Company is: Nicholas W. Paget, Agent 509 - 363 -4024 PayneWest Insurance, Inc. 7903 E. Broadway Ave. Spokane Valley, WA 99212 Revised 1.14.13 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 6070293 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and WestAmerican Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collective[ called the "Companies "), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, James E. Maleskey, II; Judith A. Rapp; Judith C. Kaiser - Smith; Nicholas•W. Paget; Shawn M. Wilson; Shelly Donovan; Walter W. Wolf all of the city of Spokane valley , state of WA each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 8th day of April 12013 D =As, American Fire and Casualty Company `, �« k .f o° r:::4, F SAO -,,; r ^ <; :3• • The Ohio Casualty Insurance Company `~ $ Lam• Liberty Mutual Insurance Company `I 1 919 n >i 9i2 w., West American Insurance Company ie J By: STATE OF WASHINGTON ss Gregory W. Davenport, Assistant Secretary COUNTY OF KING On this 8th day of April , 2013 , before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, and West Amencan Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle, Washington, on the day and year first above written. KD Riley, Not Public :�y Tf 1 Yaa cv This Power of Attorney is made and executed pursuant to and by authority of the following By -laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and WestAmerican Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS — Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attomey, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts — SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attomey, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attomeys -in -fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile'or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attomey issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2 % thday of AuguS t 20 13. LMS_12873_092012 19i2 a 1941 i 6, �'L• W f.a i- ri � yq' By: David M. Carey,'Assistant Secretary 44 of 150 u S P ',SVfMey- BOND NO: CONTRACTOR'S RETAINAGE BOND to City of Spokane Valley, Washington 023017832 The City of Spokane Valley, Washington, in Spokane County, has awarded to Cameron — Reilly, LLC ( "Contractor "), as Principal, a contract for the construction of the project designated as Wellesley Avenue Sidewalk and Adams Road Sidewalk Proiect, Project No. 0168, (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 The Ohio Casualty Insurance Company organized and existing under the laws of the State of New Hampshire 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 * *Twenty Seven Thousand (one Hundred TPn & N J M0'd *llars ($ 27, 110.00 ), 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 4th day of September , 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 fund 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: 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 fund 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 CONTRACTOR) &/j P ' i j- pal Signature Date Printed Name ffi,(O� Title SURETY zZ, 9 -4 -2013 Surety Signature Date Judith C. Kaiser —Smith Printed Name Attorney —in —Fact Title Name, address, and telephone of local office /agent of Surety Company is: Nicholas W. Paget. Agent 509- 363 -4024 PayneWest Insurance, Inc. 7903 E. Broadway Ave., Spokane Valley, WA 99212 Revised 1. 14.13 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 6070297 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and WestAmerican Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies "), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, James E. Mafeskey, 11; Judith A. Rapp; Judith C. Kaiser- Smith; Nicholas W. Paget;,Shawn M. Wilson; Shelly Donovan; Walter W. Wolf all of the city of Spokane Valley , state of WA each individually if there be more than one named, its true and lawful attomey -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 8th day of April —12013 ' VC" N-u _„ �i^._ , American Fire and Casualty Company E� .W The Ohio Casualty Insurance Company >, cj Y t - Liberty Y Mutual Insurance Company Y 190 -n=g 1:91 WestAmerican Insurance Company By: STATE OF WASHINGTON ss Gregory W. Davenport, Assistant Secretary COUNTY OF KING On this 8th day of April 1 2013 , before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle, Washington, on the day and year first above written. NOTARY By: u KD Riley, Notd4 Public This Power ofAttorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV– OFFICERS – Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII – Execution of Contracts – SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation – The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attomeys -in -fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization – By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power ofAttorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 4th day of Sep teMber20 13 LMS_12873_092012 By: David M. Carey; Assistant Secretary 48 of 150 Client #: 81651 CAMERONR ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) TYPE OF INSURANCE 08/(MM/DD 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PayneWest Insurance, Inc. PHONE FAX Courtyard Office Center - A/C, No, Ext : A/C, No): E -MAIL 827 W. First Avenue, Suite 225 ADDRESS: MED EXP (Any one person) $10,000 PERSONAL 6 ADV INJURY INSURER(S) AFFORDING COVERAGE NAIC # Spokane, WA 99201 INSURER A: Cincinnati Insurance Company $2,000,000 INSURED INSURER 8: $2,000,000 Cameron - Reilly, LLC. $ • 309 N Park Rd INSURER C X ENP0056339 12/31/2012 Spokane Valley, WA 99212 INSURER D: $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) INSURER E PROPERTY DAMAGE Per accident 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM /DO/YYYY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE l OCCUR X PD Ded:1,000 X X ENP0056339 12/31/2012 12/31/2013 EACH OCCURRENCE $110001000 DAMAGEToRENTED nte $500000 MED EXP (Any one person) $10,000 PERSONAL 6 ADV INJURY $1,000,000 x Primary Wording GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: POLICY JECOT- LOC PRODUCTS - COMP/OP AGG $2,000,000 $ • AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X X ENP0056339 12/31/2012 12/31/2013 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X ENP0056339 12131/2012 12/31/2013 EACH OCCURRENCE s4,000,000 AGGREGATE s4,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEL OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ENP0056339 WA Stop Gap 12/31/2012 12/31/201 WC STATU- OTH- IER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Wellesley Avenue Sidewalk and Adams Road Sidewalk Project #0168 /SVPW Contract 13 -022 The City of Spokane Valley, the contracting agent and its officers, elected officials, employees, agents and volunteers are listed as additional insured per policy form GA233 with primary and non - contributory wording. Waiver of subrogation applies. VAN City of Spokane Valle SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y p y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 11707 E Sprague ACCORDANCE WITH THE POLICY PROVISIONS. Spokane, WA 99206 AUTHORIZED REPRESENTATIVE 1006;. e ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S957732/M957729 J GH 1 This page has been left blank intentionally. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage: Begins on Pape: 1. Employee Benefit Liability Coverage ................................................................... ............................... 2 2. Unintentional Failure to Disclose Hazards ........................................................... ............................... 7 3. Damage to Premises Rented to You .................................................................... ............................... 8 4. Supplementary Payments .................................................................................... ............................... 9 5. Medical Payments. .......... .............. ... .... ................... ....... ............................... . ... .. ... ...... .. . 9 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control LiabilityCoverage (Coverage b.) ......................................................................................................... 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations ..................... .............................10 8. Waiver of Subrogation ....... ... .. ........................................ .............................10 9. Automatic Additional Insured - Specified Relationships: ......... 4 ...................................................... 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions - Permits Relating to Premises; • State or Political Subdivisions - Permits; and • Contractors' Operations 10. Broadened Contractual Liability - Work Within 50' of Railroad Property ............ .............................14 11. Property Damage to Borrowed Equipment ..........................................:............... .............................14 12. Employees as Insureds - Specified Health Care Services: ............................................................ 14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence ......................................................................... .............................14 B. Limits of insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 1 of 15 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $9,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of a. The following is added to SECTION I (b) Payroll $5,000) $5,000) Liability Coverage. Gross Sales (1) Insuring Agreement ity to pay sums or perform acts or services is covered (a) We will pay those sums that �c) d) Units the insured becomes legally under Supplementary Pay - obligated to pay as dam- e) Other ages caused by any act, er- (b) This insurance applies to b. Care, Custody damages only if the act, er- sured, or of any other per- son for whose acts the in- $ or Control gently committed in the "administration" of your which this Insurance ap- plies. We will have the right "employee benefit pro - "; TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the ap- plicable limit of insur- 1. Employee Benefit Liability Coverage ance in the payment of a. The following is added to SECTION I judgments or settle- ments. - COVERAGES: Employee Benefit Liability Coverage. No other obligation or liabil- (1) Insuring Agreement ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay - obligated to pay as dam- ments. ages caused by any act, er- (b) This insurance applies to ror or omission of the in- damages only if the act, er- sured, or of any other per- son for whose acts the in- ror or omission, is negli- sured is legally liable, to gently committed in the "administration" of your which this Insurance ap- plies. We will have the right "employee benefit pro - "; and duty to defend the in- gram and sured against any "suit" 1) Occurs during the pol- seeking those damages, icy period; or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our a) You did not have discretion, investigate any knowledge of a report of an act, error or omission and settle any claim or "suit" on �� claim or suit that may re- or before the ef- fective date of this sult. But: endorsement. 1) The amount we will pay You will be for damages is limited deemed to have as described In SEC- TION []I - LIMITS OF INSURANCE; and claim or "suit" when any 2) Our right and duty to "authorized repre- defend ends when we sentative "; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 2 of 15 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 3 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or omission to us 3) Advice given to any or an other person with respect to insurer that persons decision ' to participate or not to ii) Receives a participate in any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram ". ages because of the act, er- (f) Workers' Compensation ror or omis- and Similar Laws sion; and Any claim arising out of b) There is no other your failure to comply with applicable insur- the mandatory provisions of ance. any workers compensation, unemployment compensa- (2) Exclusions tion insurance, social secu- rity or disability benefits law apply or any similar law. to: (5) ERISA (a) Bodily Injury, Property Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of liability imposed on a fiduci- "Bodil injury", "property Y t ry ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by any similar federal, state or Criminal or Malicious Act local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits committed by any insured, are available, with reason - including the willful or reck- able effort and cooperation less violation of any statute. of the insured, from the ap- (c) Failure to Perform a Con- plicable funds accrued or other collectible insurance. tract Damages arising out of fail- (I) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations under (j) Employment - Related any plan included in the Practices "employee benefit pro- Any liability arising out of gram ". any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any claim based upon: (3) Coercion, demotion, evaluation, reassign- 1 Failure of an invest- } Y ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- tion or other employ- formation on past per- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 3 of 15 ment - related practices, acts or omissions; or (4) Consequential liability as a result of (1), (2) or (3) above. This exclusion applies whether the insured may be held liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. (3) Supplementary Payments SECTION I - COVERAGES, SUPPLEMENTARY PAY- MENTS - COVERAGES A AND B also apply to this Coverage. b. Who is an Insured As respects Employee Benefit Liabil- ity Coverage, SECTION II - WHO IS AN INSURED is deleted in Its en- tirety and replaced by the following: (1) If you are designated in the Declarations as: GA 233 02 07 (a) An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. (b) A partnership or joint ven- ture, you are an insured. Your members, your part- ners, and their spouses are also insureds but only with respect to the conduct of your business. (c) A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are in- sureds, but only with re- spect to their duties as your managers. (d) An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and di- rectors are insureds, but only with respect to their duties as your officers or di- rectors. Your stockholders are also insureds, but only with respect to their liability as stockholders. (e) A trust, you are an insured. Your trustees are also in- sureds, but only with re- spect to their duties as trustees. (2) Each of the following is also an insured: (a) Each of your "employees" who is or was authorized to administer your "employee benefit program ". (b) Any persons, organizations or "employees" having proper temporary authori- zation to administer your "employee benefit program" if you die, but only until your legal representative is ap- pointed. (c) Your legal representative if you die, but only with re- spect to duties as such. That representative will have all your rights and du- ties under this Coverage Park (3) Any organization you newly ac- quire or form, other than a part- nership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization. However, cover- age under this provision: (a) Is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and (b) Does not apply to any act, error or omission that was committed before you ac- quired or formed the or- ganization. c. Limits of Insurance As respects Employee Benefit Liabil- ity Coverage, SECTION III - LIMITS OF INSURANCE Is deleted in its en- tirety and replaced by the following: (1) The Limits of Insurance shown In Section B. Limits of Insur- ance, 1. Employee Benefit Li- ability Coverage and the rules below fix the most we will pay regardless of the number of: (a) Insureds; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 15 (b) Claims made or "suits" brought; (c) Persons or organizations making claims or bringing "suits "; (d) Acts, errors or omissions; or (e) Benefits included in your "employee benefit pro- gram". (2) The Aggregate Limit shown in Section B. Limits of Insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages because of acts, er- rors or omissions negligently committed in the "administra- tion" of your "employee benefit program ". (3) Subject to the limit described in (2) above, the Each Employee Limit shown in Section B. Limits of Insurance, 1. Employee Benefit Liability Coverage of this endorsement is the most we will pay for all damages sus- tained by any one "employee ", including damages sustained by such "employee's" dependents and beneficiaries, as a result of. (a) An act, error or omission; or (b) A series of related acts, er- rors or omissions, regard- less of the amount of time that lapses between such acts, errors or omissions, negligently committed in the "administration" of your "em- ployee benefit program ". However, the amount paid un- der this endorsement shall not exceed, and will be subject to the limits and restrictions that apply to the payment of benefits in any plan included in the "em- ployee benefit program ". (4) Deductible Amount (a) Our obligation to pay dam- ages on behalf of the in- sured applies only to the amount of damages in ex- cess of the deductible amount stated in the Decla- rations as applicable to Each Employee. The limits of insurance shall not be reduced by the amount of this deductible. (b) The deductible amount stated in the Declarations applies to all damages sustained by any one "em- ployee", including such "employee's" dependents and beneficiaries, because of all acts, errors or omis- sions to which this insur- ance applies. (c) The terms of this insurance, including those with respect to: 1) Our right and duty to defend the insured against any "suits" seeking those dam- ages; and 2) Your duties, and the duties of any other In- volved insured, in the event of an act, error or omission, or claim, apply irrespective of the application of the deductible amount. (d) 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 taken, you shall promptly reimburse us for such part of the deductible amount as we have paid. d. Additional Conditions As respects Employee Benefit Li- ability Coverage, SECTION IV - COMMERCIAL GENERAL LIABIL- ITY CONDITIONS is amended as follows: (1) Item 2. Duties in the Event of Occurrence, Offense, Claim or Suit is deleted in its entirety and replaced by the following: 2. Duties in the Event of an Act, Error or Omission, or Claim or Suit a. You must see to it that we are noti- fied as soon as practicable of an act, error or omission which may result in a claim. To the extent possible, no- tice should include: (1) What the act, error or omission was and when it occurred; and (2) The names and addresses of anyone who may suffer dam- ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 5 of 15 b. If a claim is made or "suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the claim or "suit" and the tion by equal shares, date received; and we will follow this (2) Authorize us to obtain records method also. Under (2) Notify us as soon as practicable. this approach each in- You must see to it that we receive surer contributes equal amounts until it has written notice of the claim or "suit" as surance to the total ap- soon as practicable. of nsuranceliornlone oaf c. You and any other involved insured the loss remains, must: whichever comes first (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per - monses or legal papers re- ceived in connection with the mit contribution by equal shares, we will claim or "suit'; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its applicable limit of in- Cooperate with us in the investi- (3 ) p surance to the total ap- gation or settlement of the claim "; plicable limits of insur- or defense against the "suit ance of all insurers. and (4) Assist us, upon our request, In c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is insured because of an act, error entitled to recovery un- or omission to which this insur- der any other insur- ance may also apply. ance in force. previous d. No insured will, except at that in- to the effective date of this Coverage Part. sured's own cost, voluntarily make a payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added: If other valid and collectible 1. "Administration" means: Insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees ", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee benefit programs "; This insurance is pri- mary except when c, b. Interpreting the "em- below applies. If this ployee benefit pro - insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro - will share with all that grams "; or other insurance by the d. Effecting, continuing or method described in b. terminating any "em- below. ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 6 of 15 GA 233 02 07 in any benefit included benefits, workers' com- in the "employee bene- pensation and disability fit program ". benefits; and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- a. Handling payroll grams; leave of ab- sence programs, in- ductions; or eluding military, mater - b. The failure to effect or nity, family, and civil leave; tuition assis- maintain any insurance or adequate limits of tance plans; transpor- coverage of insurance, tation and health club including but not limited subsidies. to unemployment in- (2) The following definitions are surance, social security deleted in their entirety and re- benefits, workers' com- placed by the following; pensation and disability benefits. 21. "Suit" means a civil pro- 2. "Cafeteria P ceeding in which money damages because of an plan authorized by applica- act, error or omission to ble taw to allow "employ- which this insurance applies ees" to elect to pay for cer- are alleged. "Suit" includes: tain benefits with pre -tax dollars. a. An arbitration pro - ceeding in which such 3. "Employee benefit P ro- damages are claimed grams" means a program and to which the in- providing some or all of the sured must submit or following benefits to "em- does submit with our ployees ", whether provided consent• ' through a "cafeteria plan" or otherwise: b. Any other alternative dispute resolution pro - a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- tal, vision and hearing sured submits with our plans; and flexible consent; or spending accounts; provided that no one c. An appeal of a civil other than an "em- proceeding. ployee" may subscribe to such benefits and 8. "Employee" means aper- such benefits are made son actively employed, for - generally available to merly employed, on leave those "employees" who of absence or disabled, or satisfy the plan's eligi- retired. "Employee" in- bility requirements; eludes a "leased worker". "Employee" does not in- b. Profit sharing plans, elude a "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock subscription plans, SECTION IV - COMMERCIAL GENERAL provided that no one LIABILITY CONDITIONS, 7. Represen- other than an "em- tations is hereby amended by the addi- ployee" may subscribe tion of the following: to such benefits and Based on our dependence upon your such benefits are made representations as to existing hazards, if generally available to unintentionally you should fail to disclose all "employees" who all such hazards at the inception date of are eligible under the your policy, we will not reject coverage plan for such benefits; under this Coverage Part based solely on c. Unemployment insur- such failure. ance, social security Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 15 3, Damage to Premises Rented to You e) Settling, cracking, shrinking or ex- a. The last Subparagraph of Paragraph pansion; or 2. SECTION I - COVERAGES, COVERAGE A. - BODILY INJURY f) Nesting or infesta- AND PROPERTY DAMAGE, 2. LI- tion, or discharge ABILITY Exclusions Is hereby de- or release of leted and replaced by the following: waste products or secretions, by in- Exclusions c. through q. do not apply sects, birds, ro- to damage by fire, explosion, light- dents or other ning, smoke or soot to premises animals. while rented to you or temporarily occupied by you with permission of (b) Loss caused directly or indi- the owner. rectly by any of the follow- b. The insurance provided under SEC- ing: TION I - COVERAGES, COVERAGE 1) Earthquake, volcanic A. BODILY INJURY AND PROP- eruption, landslide or ERTY DAMAGE LIABILITY applies any other earth move - to "property damage" arising out of ment; water damage to premises that are 2) Water that backs up or both rented to and occupied by you. overflows from a (1) As respects Water Damage Le- sewer, drain or sump; gal Liability, as provided in 3) Water under the Paragraph 3.b. above: ground surface press - The exclusions under SECTION ing on, or flowing or - COVERAGES, COVERAGE seeping through: A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- a) Foundations, ITY, 2. Exclusions, other than I. walls, floors or paved surfaces; War and the Nuclear Energy Liability Exclusion, are deleted b) Basements, and the following are added: whether paved or This insurance does not apply not; or to: c) Doors, windows or (a) "Property damage ": other openings. 1) Assumed in any con- (c) Loss caused by or resulting from water that leaks or tract; or flows from plumbing, heat - 2) Loss caused by or re- ing, air conditioning, or fire sulting from any of the protection systems caused following: by or resulting from freez- ing, unless: a) Wear and tear; 1) You did your best to b) Rust, corrosion, maintain heat in the fungus, decay, building or structure; or deterioration, hid- den or latent de- 2) You drained the fect or any quality equipment and shut off in property that the water supply if the causes it to dam- heat was not main - age or destroy it- tained. self; (d) Loss to or damage to: C) Smog; 1) Plumbing, heating, air d) Mechanical conditioning, fire pro - breakdown in- tection systems, or cluding rupture or other equipment or ap- bursting caused pliances; or by centrifugal force; 2) The interior of any building or structure, or to personal property in the building or structure Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 8 of 15 caused by or resulting from rain, snow, sleet or ice, whether driven by wind or not. c. Limit of Insurance The Damage to Premises Rented to You Limit as shown in the Declara- tions is amended as follows: (2) Paragraph 6. of SECTION M- LIMITS OF INSURANCE is hereby deleted and replaced by the following: 6. Subject to 5, above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, for damages because of "property damage" to premises while rented to you or temporarily occupied by you with permission of the owner, arising out of any one "occurrence" to which this insurance ap- plies, (3) The amount we will pay is lim- ited as described in Section B. Limits of Insurance, 3. Dam- age to Premises Rented to You of this endorsement. 4. Supplementary Payments Under SECTION I - COVERAGE, SUP- PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. Paragraph 2. is replaced by the fol- lowing: Up to the limit shown in Section B. Limits of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", Including actual loss of earnings up to the limit shown in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- dorsement per day because of time off from work. 5. Medical Payments The Medical Expense Limit of Any One Person as stated in the Declarations is amended to the limit shown in Section B. Limits of Insurance, 5. Medical Pay- ments of this endorsement. 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage a. Voluntary Property Damage Cov- erage We will pay for "property damage" to property of others arising out of op- erations incidental to the insured's business when: (1) Damage is caused by the in- sured; or (2) Damage occurs while in the in- sured's possession. With your consent, we will make these payments regardless of fault. b. Care, Custody or Control Liability Coverage SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, j. Damage to Property, Subparagraphs (3), (4) and (5) do not apply to "property damage" to the property of others described therein. With respect to the insurance provided by this section of the endorsement, the fol- lowing additional provisions apply: a. The Limits of Insurance shown in the Declarations are replaced by the lim- its designated in Section B. Limits of Insurance, 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage of this endorsement with respect to cover- age provided by this endorsement. These limits are inclusive of and not in addition to the limits being re- placed. The Limits of Insurance shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam - age and Care, Custody or Control Liability Coverage of this endorse- ment fix the most we will pay in any one "occurrence" regardless of the number of: (1) Insureds; (2) Claims made or "suits" brought; or (3) Persons or organizations mak- ing claims or bringing "suits ". Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with Its permission. Page 9 of 15 b. Deductible Clause (1) Our obligation to pay damages on your behalf applies only to the amount of damages for each "occurrence" which are In ex- cess of the. deductible amount stated in Section B. Limits of insurance, 6. Voluntary Prop- erty Damage and Care, Cus- tody or Control Liability Cov- erage of this endorsement. The limits of insurance will not be re- duced by the application of such deductible amount. (2) Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit, applies to each claim or "suit" irrespective of the amount. (3) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit' and, upon notification of the ac- tion taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 7. 180 Day Coverage for Newly Formed or Acquired Organizations SECTION II - WHO IS AN INSURED is amended as follows: Subparagraph a, of Paragraph 4. is hereby deleted and replaced by the fol- lowing: a. Insurance under this provision is af- forded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; 8. Waiver of Subrogation SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 9. Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following: We waive any right of recovery we may have because of payments we make for injury or damage arising out of your on- going operations or "your work" done un- der a written 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 "occur- rence" giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce those rights. 9. Automatic Additional Insured - Speci- fied Relationships a. The following is hereby added to SECTION it - WHO IS AN INSURED: (1) Any person or organization de- scribed in Paragraph 9.a.(2) below (hereinafter referred to as additional insured) whom you are required to add as an addi- tional insured under this Cover- age Part by reason of. (a) A written contract or agreement; or (b) An oral agreement or con - tract where a certificate of insurance showing that per- son or organization as an additional insured has been issued, is an insured, provided: (a) The written or oral contract or agreement is: 1) Currently in effect or becomes effective during the policy pe- riod; and 2) Executed prior to an "occurrence" or offense to which this insurance would apply; and (b) They are not specifically named as an additional in- sured under any other pro- vision of, or endorsement added to, this Coverage Part (2) Only the following persons or organizations are additional in- sureds under this endorsement, and insurance coverage pro- vided to such additional in- sureds is limited as provided herein: (a) The manager or lessor of a premises leased to you with whom you have agreed per Paragraph 9.a.(1) above to provide insurance, but only with respect to liability aris- ing out of the ownership, maintenance or use of that part of a premises leased to you, subject to the following additional exclusions: This insurance does not apply to: 1) Any "occurrence" which takes place after Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 10 of 15 you cease to be a ten- c) Any physical or ant In that premises. chemical change in the product 2) Structural alterations, made intentionally new construction or by the vendor; demolition operations performed by or on be- d) Repackaging, un- half of such additional less unpacked insured. solely for the pur- pose of inspection, An person or organization {) Y P 9 demonstration, from which you lease testing, or the equipment with whom you substitution of have agreed per Paragraph parts under in- 9.a.(1) above to provide in- structions from the surance. Such person(s) or manufacturer, and organization(s) are insureds then repackaged solely with respect to their in the original liability arising out of the container; maintenance, operation or use by you of equipment e) Any failure to leased to you by such per- make such in- son(s) or organizations (s). spections, adjust - However, this insurance ments, tests or does not apply to any "oc- servicing as the currence" which takes place vendor has after the equipment lease agreed to make or expires. under- alto takes n make (c) Any person or organization the usual course (referred to below as ven- of business, in do r) with whom you have connection with agreed per Paragraph the distribution or 9.a.(1) above to provide in- sale of the prod - surance, but only with re- ucts; spect to "bodily injury" or "property damage" arising f) Demonstration, in- out of "your products" which stallation, servic- are distributed or sold in the ing or repair op- regular course of the ven- erations, except dor's business, subject to such operations the following additional ex- performed at the clusions: vendor's premises in connection with 1 The insurance afforded the sale of the the vendor does not product; apply to: g) Products which, a "Bodily in'u or Y 7 rY after distribution or "property damage" sale by you, have for which the ven- been labeled or dor is obligated to relabeled or used pay damages by as a container, reason of the as- part or ingredient sumption of liabil- of any other thing ity in a contract or or substance by or agreement. This for the vendor. exclusion does not apply to liability for 2) This insurance does damages that the not apply to any in- vendor would sured person or or- have in the ab- ganization: sence of the con- tract or agree- a) From whom you ment; have acquired such products, or b) Any express war- any ingredient, ranty unauthorized part or container, by you; entering into, ac- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 11 of 15 corm an in g or containing such 2) This insurance does not apply to "bodily in- products; or jury", "property dam- age" or "personal and b) When liability in- advertising injury" aris- cluded within the ing out of operations "products- performed for the state completed opera- or political subdivision. tions hazard" has been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1) spect to such above to provide insurance, products. but only with respect to li- ability arising out of "your (d) Any state or political subdi- work" performed for that vision with which you have additional insured by you or agreed per Paragraph on your behalf. A person or 9.a.(1) above to provide in- organization's status as an surance, subject to the fol- insured under this provision lowing additional provision: of this endorsement contin- This Insurance applies only ues for only the period of time required by the written with respect to the following contract or agreement, but hazards for which the state no event beyond the ex- or political subdivision has or Cover- pration date of this Cover- p issued a permit in connec- age Part If there is no tion with premises you own, rent or control and to which written contract or agree - ment, or if no period of time this insurance applies: is required by the written 1) The existence, mainte- contract or agreement, a nance, repair, con- struction, erection, or person or organization's status as an insured under removal of advertising this endorsement ends signs, awnings, cano- pies, cellar entrances, when your operations for that Insured are completed. coal holes, driveways, manholes, marquees, (3) Any insurance provided to an additional insured designated hoist away openings, sidewalk vaults, street under Paragraph 9.a.(2): banners, or decora- (a) Subparagraphs (e) and (f) tions and similar expo- does not apply to "bodily sures; or injury" or "property damage" 2) The construction, erec- included within the "prod - ucts- completed operations tion, or removal of ele- hazard"; vators; or 3) The ownership, main- (b) Subparagraphs (a), (b), (d), (e) and (f) does not apply to or use any "bodily injury", "property elevators covered elevat by damage" or "personal and this insurance. advertising injury" arising (e) Any state or political subdi- out of the sole negligence vision with which you have or willful misconduct of the agreed per Paragraph additional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily Injury", "per erations performed by "property damage" or - you or on your behalf sonal and advertising injury" for which the state or arising out of: political subdivision has 1) Defects in design fur - issued a permit, nished by or on behalf Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 12 of 15 of the additional in- spects any other insurance sured; or policy issued to the addi- tional insured, and such tional The rendering f 9 , or other insurance policy shall failure to render, any be excess and / or noncon- professional architec- tributing, whichever applies, tural, engineering or with this insurance. surveying services, in- cluding: (b) Any insurance provided by this endorsement shall be a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, S. Other and specifications; Insurance, b. Excess and Insurance; or b) Supervisory, in- 2) For any other valid and spection, archi- collectible insurance tectural or engi- available to the addi- neering activities. tional insured as an additional insured by 3 "Your work" for which a attachment of an en- consolidated (wrap -up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor- project basis. In such case, manager or owner of the coverage provided the construction project under this endorse - in which you are in- ment shall also be ex- volved. cess. b. Only with regard to Insurance pro- (2) Condition 11. Conformance to vided to an additional insured desig- Specific Written Contract or nated under Paragraph 9.a.(2) Sub- Agreement is hereby added: paragraph (f) above, SECTION III - LIMITS OF INSURANCE is amended 11. Conformance to Specific to include: Written Contract or Agreement The limits applicable to the additional insured are those specified in the With respect to additional written contract or agreement or in insureds described in Para - the Declarations of this Coverage graph 9.a,(2)(f) above only: Part, whichever are less. If no limits If a written contract or are specified in the written contract or agreement, or if there is no written agreement between you contract or agreement, the limits ap- and the additional insured plicable to the additional insured are specifies that coverage for those specified in the Declarations of the additional insured: this Coverage Part The limits of in- a. Be provided by the In- surance are inclusive of and not in surance Services Of- addition to the limits of Insurance fice additional insured shown in the Declarations. form number CG 20 10 c. SECTION IV - COMMERCIAL GEN- or CG 20 37 (where edition specified); or ERAL LIABILITY CONDITIONS is hereby amended as follows: b. Include coverage for (1) Condition 5. Other Insurance is completed operations; amended to include: or (a) Where required by a written c. Include coverage for "; contract or agreement, this "your work insurance is primary and / and where the limits or cov- or noncontributory as re- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 13 of 15 tional insured is more re- strictive than was specifi- cally required in that written contract or agreement, the terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. above, or any combination thereof, shall be interpreted as providing the limits or coverage required by the terms of the written contract or agreement, but only to the extent that such limits or coverage is included within the terms of the Coverage Part to which this endorse- ment is attached. If, how- ever, the written contract or agreement specifies the In- surance Services Office additional insured form number CG 20 10 but does not specify which edition, or specifies an edition that does not exist, Paragraphs 9.a.(3)(a) and 9.a.(3)(b) of this endorsement shall not apply and Paragraph 9.b. of this endorsement shall ap- ply. 10. Broadened Contractual Liability - Work Within 50' of Railroad Property It is hereby agreed that Paragraph f.(1) of Definition 12. "Insured contract" (SEC- TION V - DEFINITIONS) is deleted. 11. Property Damage to Borrowed Equip- ment a. The following is hereby added to Ex- clusion j. Damage to Property of Paragraph 2., Exclusions of SEC- TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform opera- tions at the time of loss. b. With respect to the Insurance pro- vided by this section of the en- dorsement, the following additional provisions apply: (1) The Limits of insurance shown in the Declarations are replaced by the limits designated in Sec- tion B. Limits of Insurance, 11. of this endorsement with respect to coverage provided by this endorsement. These limits are inclusive of and not in addition to the limits being replaced. The Limits of Insurance shown in Section B. Limits of Insurance, 11. of this endorsement fix the most we will pay in any one "oc- currence" regardless of the number of. (a) Insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bring "suits ". (2) Deductible Clause (a) Our obligation to pay dam- ages on your behalf applies only to the amount of dam- ages for each "occurrence" which are in excess of the Deductible amount stated in Section B. Limits of Insur- ance, 11. of this endorse- ment. The limits of insur- ance will not be reduced by the application of such De- ductible amount. (b) Condition 2. Duties in the Event of Occurrence, Of- fense, Claim or Suit, ap- plies to each claim or "suit" irrespective of the amount. (c) 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 taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 12. Employees as Insureds - Specified Health Care Services It is hereby agreed that Paragraph 2.a.(1)(d) of SECTION II - WHO IS AN INSURED, does not apply to your "em- ployees" who provide professional health care services on your behalf as duly li- censed: a. Nurses; b. Emergency Medical Technicians; or c. Paramedics, in the jurisdiction where an "occurrence" or offense to which this insurance applies takes place. 13. Broadened Notice of Occurrence Paragraph a. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 TIONS) is hereby deleted and replaced by the following: a. You must see to it that we are noti- fied as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "oc- currence" or offense took place; (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. This requirement applies only when the "occurrence" or offense is known to an "authorized representative ". Includes copyrighted material of Insurance GA 233 02 07 Services Offlce, Inc., with its permission. Page 15 of 15 This page has been left blank intentionally. CAMELLC-03 SSTROH 4 R'Cr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Spokane-Downtown Office PHONE 509 455-6767 FAX PayneWest Insurance,Inc. (A/C,No,Ext):( (A/C,No): 827 West 1st Avenue Suite 225 ADDRESS: Spokane,WA 99201 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Companies 10677 INSURED INSURER B: Cameron-Reilly,LLC INSURER C: 309 N Park Rd INSURER D: Spokane Valley,WA 99212 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR 111/VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X ENP0056339 12/31/2013 12/31/2014 DAMAGE 70 IZENTED 500 000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X PD Deductible: 1000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 —I POLICY X PM: LOC WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 000 (Ea accident) A X ANY AUTO ENP0056339 12/31/2013 12/31/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X AU OSWNED Per a cidentDAMAGE X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE ENP0056339 12/31/2013 12/31/2014 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY �,/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E .EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ A Installation Floater ENP0056339 12/31/2013 12/31/2014 Per Location 5,000 A Rented/leased equip ENP0056339 12/31/2013 12/31/2014 $1000 Deductible 130,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:Wellesley Avenue Sidewalk and Adams Road Sidewalk Project#0168/SVPW Contract 13-022 The City of Spokane Valley,the contracting agent and its officers,elected officials,employees,agents and volunteers are listed as additional insured per policy form GA233 with primary and non-contributory wording.Waiver of subrogation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spokane Valley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY P y ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Spokane,WA 99206 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CCI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disdose Hazards 7 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments 9 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.) 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured -Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions-Permits Relating to Premises; • State or Political Subdivisions-Permits; and • Contractors' Operations 10. Broadened Contractual Liability-Work Within 50' of Railroad Property 14 11. Property Damage to Borrowed Equipment 14 12. Employees as Insureds-Specified Health Care Services: 14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence ....14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 ' ' 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM a Area (For Limits in Excess of (For Limits in Excess of b Payroll $5,000) $5,000) c Gross Sales d Units e Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION I judgments or settle- - COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- ror or omission of the in- (b) This insurance applies to sured, or of any other per- damages only if the act, er- son for whose acts the in- ror or omission, is negli- sured is legally liable, to gently committed in the which this insurance ap- administration' of your plies. We will have the right "employee benefit pro- and duty to defend the in- gram"; and sured against any "suit' 1) Occurs during the pol- seeking those damages. icy period;or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE; and claim or suit' when any "author- 2) Our right and duty to ized representa- defend ends when we tive"; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or omission to us 3) Advice given to any or any other person with respect to insurer; that person's decision to participate or not to ii) Receives a participate in any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or orris- and Similar Laws sion; and Any daim arising out of your b) There is no other failure to comply with the applicable insur- mandatory provisions of any ance. workers' compensation, un- employment compensation (2) Exclusions insurance, social security or This apply disability benefits law or any his insurance does not a PP y similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fidud- "Bodily injury", "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail-(i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any usurer. including those imposed (d) under the Internal Revenue d) Insufficiency of Funds Code or any similar state or Damages arising out of an local law. insufficiency of funds to (j) Employment-Related meet any obligations under Practices any plan included in the "employee benefit pro- Any liability arising out of gram". any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any daim based upon: (3) Coercion, demotion, 1 Failure of any invest- evaluation, reassign- 1) Y ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per- tion or other employ- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 3 of 15 ment-related practices, (e) A trust, you are an insured. acts or omissions; or Your trustees are also in- sureds,Consequential liability sureds, but only with re- (4) q ty spect to their duties as trus- as a result of(1), (2) or tees. (3)above. This exdusion applies (2) Each of the following is also an Pp insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having proper temporary authoriza- (3) Supplementary Payments tion to administer your "em- ployee I - COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS - COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage Part. (1) If you are designated in the Dec- (3) Any organization you newly ac- larations as: quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over only with respect to the con- which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- lar insurance applies to that or- (b) A partnership or joint yen- ganization. However, coverage ture, you are an insured. under this provision: Your members, your part- ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, whichever is earlier; and (c) A limited liability company, you are an insured. Your (b) Does not apply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation. eds, but only with respect to c. Limits of Insurance their duties as your manag- ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, tirety and replaced by the following: you are an insured. Your (1) The Limits of Insurance shown "executive officers" and di- in Section B. Limits of Insur- rectors are insureds, but ance, 1. Employee Benefit Li- only with respect to their du- ability Coverage and the rules ties as your officers or direc- below fix the most we will pay tors. Your stockholders are regardless of the number of: also insureds, but only with respect to their liability as (a) Insureds; stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 4 of 15 (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations applies to all damages sus- (c) Persons or organizations tamed by any one "em- making daims or bringing ployee", including such "em- "suits"; ployee's" dependents and (d) Acts,errors or omissions; or beneficiaries, because of all acts, errors or omissions to (e) Benefits induded in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability Coverage of this endorsement 1) Our right and duty to is the most we will pay for all defend the insured damages because of acts, errors against any suits' or omissions negligently commit- seeking those dam- ted in the "administration" of ages; and your "employee benefit pro- 2) Your duties, and the gram". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission,or daim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of pfication of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of claim or"suit"and, upon no- tification An act, error or omission; or tification of the action taken, (a) you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, As respects Employee Benefit Li- negligently committed in the ability Coverage, SECTION IV - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan induded in the "employee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission, or Claim or Suit a Our obligation to pay dam- a. You must see to it that we are noti- (a) 9 P Y fled as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a daim. To the extent possible, no- amount of damages in ex- tice should indude: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred;and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may suffer dam- deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 5 of 15 b. If a daim is made or"suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the daim or "suit" and the tion by equal shares, date received; and we will follow this (2) Notify us as soon as eradicable. method also. each in- ( ) fY P this approach each in- You must see to it that we receive surer contributes equal written notice of the claim or"suit"as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its in- (3) Cooperate with us in the investi- applicable limit of ip- gation or settlement of the daim pliable limits the total u - or defense against the "suit"; plicable 1 ns re of insur- or ance of all insurers. (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en- insured because of an act, error titled to recovery under or omission to which this insur- any other insurance in ance may also apply. force previous to the ef- fective d. No insured will, except at that in- date of this Cover sured's own cost, voluntarily make a Coverage Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added: If other valid and collectible 1. "Administration" means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- benefit programs"; mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro- will share with all that grams"; or other insurance by the method described in b. d. Effecting, continuing or below. terminating any "em- ployee's' participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15 in any benefit included benefits, workers' corn- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, indud- does not include: ing buy and sell pro- grams;deduc- leave of ab- s. Handling payroll sence programs, in- bons; or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans; transporta- coverage of insurance, tion and health dub including but not limited subsidies. to unemployment in- (2) The following definitions are de- surance, social security leted in their entirety and re- benefits, workers' corn- placed by the following: pensation and disability benefits. 21. "Suit" means a civil pro- ceeding means ceeding in which money 2. "Cafeteria P damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit" includes: tain benefits with pre-tax dollars. a. An arbitration proceed- ing in which such darn- 3. "Employee benefit pro- ages are daimed and grams" means a program to which the insured providing some or all of the must submit or does following benefits to "em- submit with our con- ployees", whether provided sent; through a "cafeteria plan"or otherwise: b. Any other alternative dispute resolution pro- a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- tal, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil pro- other than an "em- ceeding. ployee" may subscribe to such benefits and 8. "Employee means a per- such benefits are made son actively employed, for- generally available to merly employed, on leave of those "employees"who absence disabled, r re- satisfy the plan's eligi- tired. Y includes bility requirements; a "leased worker". "Em- ployee" does not include a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV-COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep- benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disdose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such c. Unemployment insur- failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 . 3. Damage to Premises Rented to You f) Nesting or infesta- tion,of Paragraph o or discharge a. The last Subparagraph or release of 2. SECTION I - COVERAGES, waste products or COVERAGE A. - BODILY INJURY secretions, by in- AND PROPERTY DAMAGE, 2. LI- sects, birds, ro- ABILITY Exclusions is hereby de- dents or other leted and replaced by the following: animals. Exclusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or b. The insurance provided under SEC- any other earth move- ment;I -COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in through: Paragraph 3.b.above: a) Foundations, The exclusions under SECTION walls, floors or I - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY, 2. Exclusions, other than i. whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract;or by or resulting from freez- 2) Loss caused by or re- ing, unless: sulting from any of the 1) You did your best to following: maintain heat in the a) Wear and tear; building or structure;or b) Rust, corrosion, 2) You drained the equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main- or latent defect or tained. any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self conditioning, fire pro- tection systems, or c) Smog; other equipment or ap- d) Mechanical break- pliances; or down including 2) The interior of any rupture or bursting building or structure, or caused by cen- to personal property in trifugal force; the building or structure Settling, cracking, by or resulting e) g g, from rain, snow, sleet shrinking or ex- or ice, whether driven pansion;or by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 c. Limit of Insurance Limits of Insurance, 5. Medical Pay- ments of this endorsement. The Damage to Premises Rented to You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for "property damage"to property of others arising out of op- 6. Subject to 5. above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured; or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of "prop- erty damage" to premises With your consent, we will make while rented to you or tern- these payments regardless of fault. porarily occupied by you with permission of the b. Care, Custody or Control Liability owner, arising out of any Coverage one "occurrence" to which SECTION I - COVERAGES, COV- this insurance applies. ERAGE A. BODILY INJURY AND (3) The amount we will pay is lim- PROPERTY DAMAGE LIABILITY, ited as described in Section B. 2. Exclusions, j. Damage to Prop- Limits of Insurance, 3. Dam- erty, Subparagraphs (3), (4) and (5) age to Premises Rented to do not apply to "property damage"to You of this endorsement. the property of others described therein. 4. Supplementary Payments With respect to the insurance provided by Under SECTION I - COVERAGE, SUP- this section of the endorsement, the fol- PLEMENTARY PAYMENTS - COVER- lowing additional provisions apply: AGES A AND B: a. The Limits of Insurance shown in the a. Paragraph 2. is replaced by the fol- Declarations are replaced by the lowing: its designated in Section B. Limits of Up to the limit shown in Section B. Insurance, 6. Voluntary Property Limits of Insurance, 4.a. Bail Bonds Damage and Care, Custody or of this of Insurance,for cost Bonds bail Control Liability Coverage of this i endorsement with respect to cover- bonds required because of accidents or traffic law violations arising out of age provided by this endorsement. the use of any vehicle which the These limits are indusive of and not Bodily Injury Liability Coverage ap- in addition to the limits Insurance re- Bodily We do not have to furnish placed. The Limits of Insurance these bonds. shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam- b. Paragraph 4. is replaced by the fol- age and Care, Custody or Control lowing: Liability Coverage of this endorse- ment fix the most we will pay in any All reasonable expenses incurred by one "occurrence" regardless of the the insured at our request to assist number of: us in the investigation or defense of the claim or "suit", induding actual (1) Insureds; loss of earnings up to the limit shown (2) Claims made or "suits" brought; in Section B. Limits of Insurance, or 4.b. Loss of Earnings of this en- dorsement per day because of time (3) Persons or organizations making off from work. claims or bringing"suits". 5. Medical Payments b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 9 of 15 cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) be- Insurance, 6. Voluntary Prop- low (hereinafter referred to as erty Damage and Care, Cus- additional insured) whom you tody or Control Liability Coy- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con- Claim or Suit, applies to each tract where a certificate of claim or"suit" irrespective of the insurance showing that per- amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- (a) The written or oral contract tion taken, you shall promptly re- or agreement is: imburse us for such part of the or agreement is: deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- ing 180 Day Coverage for Newly Formed or the policy period; Acquired Organizations 2) Executed prior to an SECTION II - WHO IS AN INSURED is "occurrence" or offense amended as follows: to which this insurance Subparagraph a. of Paragraph 4. is would apply;and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in- a. Insurance under this provision is af- sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV-COMMERCIAL GENERAL and insurance coverage pro- LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or "your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that cluded in the "products-completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Cov- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our 1) Any"occurrence" which request, the insured will bring "suit" or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Speci- 2) Structural alterations, fied Relationships new construction or a. The following is hereby added to demolition operations SECTION II-WHO IS AN INSURED: performed by or on be- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 half of such additional solely for the pur- insured. pose of inspection, (b) Any person or organization demonstration, ( ) Y P 9 testing, or the from which you lease substitution of equipment with whom you parts under in- have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and surance. Such person(s) or then repackaged organization(s) are insureds in the original con- solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s). tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence" which takes place normally under- after the equipment lease takes to make in expires. the usual course person or organization of business, in (c) Any P 9 connection with (referred to below as ven- the distribution or dor) with whom you have sale of the prod- agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op- out of"your products" which erations, except are distributed or sold in the such operations regular course of the ven- performed at the dor's business, subject to vendor's premises the following additional ex- in connection with clusions: the sale of the product; 1) The insurance afforded the vendor does not g) Products which, apply to: after distribution or "Bodily injury" or sale by you, have a Y 1 rY been labeled or re- "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub- reason of the as- stance by or for sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exdusion does not not apply to any in- apply to liability for sured person or organi- damages that the zation: vendor would have in the absence of a) From whom you the contract or have acquired agreement; such products, or any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or containing such c) Any physical or products; or chemical change in the product b) When liability in- made intentionally cluded within the by the vendor; "products- completed Repackaging, completed opera- d) Re P 9 g, tions hazard" has unless unpacked Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 11 of 15 been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1)above sped to such to provide insurance, but products. only with respect to liability (d) Any state or political subdi- arising out of "your work" ( ) Y P performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re- with respect to the following quired by the written con- hazards for which the state trail or agreement, but in no or political subdivision has event beyond the expiration issued a permit in connec- date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe- this insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair, construc- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op- signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, hoist away openings, additional insured designated sidewalk vaults; street under Paragraph 9.a.(2): banners, or decorations (a) Subparagraphs (e) and (f) and similar exposures; does not apply to "bodily in- or jury" or "property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- ucts-completed operations vators;or hazard"; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f)does not apply to elevators covered by bodily injury", "property this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad- agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by "property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of political subdivision has issued a permit. 1) Defects in design fur- nished by or on behalf 2) This insurance does of the additional in- not apply to "bodily in- sured; or jury", "property dam- age" or "personal and 2) The rendering of, or advertising injury" aris- failure to render, any ing out of operations professional architec- performed for the state tural, engineering or or political subdivision. surveying services, in- cluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 12 of 15 a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, 5. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tural or engineer- available to the addi- ing activities. tional insured as an additional insured by 3) "Your work" for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Conformance to b. Only with regard to insurance pro- Specific Written Contract or vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- paragraph 11. Conformance to Specific (f) above, SECTION III - Conformance Contract or LIMITS OF INSURANCE is amended to include: Agreement The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para- written contract or agreement or in graph 9.a.(2)(f)above only: the Dedarations of this Coverage If a written contract or Part, whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for contract or agreement, the limits ap- the additional insured: plicable to the additional insured are those specified in the Dedarations of a. Be provided by the In- this Coverage Part. The limits of in- surance Services Office surance are inclusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- c. SECTION IV - COMMERCIAL GEN- tion specified); or ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5. Other Insurance is or amended to include: c. Include coverage for (a) Where required by a written "your work"; contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and / or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted (b) Any insurance provided by as providing the limits or this endorsement shall be coverage required by the terms of the written contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 13 of 15 or agreement, but only to (c) Persons or organizations the extent that such limits or making claims or bring coverage is induded within "suits". the terms of the Coverage Part to which this endorse- (2) Deductible Clause ment is attached. If, how- (a) Our obligation to pay dam- ever, the written contract or ages on your behalf applies agreement specifies the In- only to the amount of dam- surance Services Office ad- ages for each "occurrence" ditional insured form num- which are in excess of the ber CG 20 10 but does not Deductible amount stated in specify which edition, or Section B. Limits of Insur- specifies an edition that ance, 11. of this endorse- does not exist, Paragraphs ment. The limits of insur- 9.a.(3)(a) and 9.a.(3)(b) of ance will not be reduced by this endorsement shall not the application of such De- apply and Paragraph 9.b. of ductible amount. this endorsement shall ap- ply. (b) Condition 2. Duties in the Event of Occurrence, Of- 10. Broadened Contractual Liability-Work fense, Claim or Suit, ap- Within 50' of Railroad Property plies to each daim or "suit" It is hereby agreed that Paragraph f.(1)of irrespective of the amount. Definition 12. "Insured contract" (SEC- (c) We may pay any part or all TION V-DEFINITIONS) is deleted. of the deductible amount to 11. Property Damage to Borrowed Equip- effect settlement of any ment claim or"suit and, upon no- tification of the action taken, a. The following is hereby added to Ex- you shall promptly reim- clusion j. Damage to Property of burse us for such part of the Paragraph 2., Exclusions of SEC- deductible amount as has TION I -COVERAGES, COVERAGE been paid by us. • A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 12. Employees as Insureds - Specified Health Care Services Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- It is hereby agreed that Paragraph ment loaned to you, provided they 2.a.(1)(d) of SECTION II - WHO IS AN are not being used to perform opera- INSURED, does not apply to your "em- tions at the time of loss. ployees" who provide professional health care services on your behalf as duly li- b. With respect to the insurance pro- censed: vided by this section of the endorse- ment, the following additional provi- a. Nurses; sions apply: b. Emergency Medical Technicians; or (1) The Limits of insurance shown in c. Paramedics, the Declarations are replaced by the limits designated in Section in the jurisdiction where an "occurrence" B. Limits of Insurance, 11. of or offense to which this insurance applies this endorsement with respect to takes place. coverage provided by this en- dorsement. These limits are in- 13. Broadened Notice of Occurrence clusive of and not in addition to Paragraph a. of Condition 2. Duties in the limits being replaced. The the Event of Occurrence, Offense, Limits of Insurance shown in Claim or Suit (SECTION IV-COMMER- Section B. Limits of Insurance, CIAL GENERAL LIABILITY CONDI- 11. of this endorsement fix the TIONS) is hereby deleted and replaced most we will pay in any one "oc by the following: currence" regardless of the number of: a. You must see to it that we are noti- fied Insureds; fed as soon as practicable of an "oc- currence" or an offense which may (b) Claims made or "suits" result in a claim. To the extent pos- brought;or sible, notice should include: (1) How, when and where the "oc- currence" or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 (2) The names and addresses of This requirement applies only when any injured persons and wit- the "occurrence" or offense is known nesses; and to an"authorized representative". (3) The nature and location of any injury or damage arising out of the"occurrence" or offense. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 /"1 CAMELLC-03 SSTROH ' AC-OREY DATE(MM/DDNYYY) A CERTIFICATE OF LIABILITY INSURANCE 12/31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Spokane-Downtown Office PHONE 509 455-6767 FAX PayneWest Insurance,Inc. /C.No,Est): (NC,No): 827 West 1st Avenue Suite 225 ADDRESS: Spokane,WA 99201 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Companies 10677 INSURED INSURER B: Cameron-Reilly,LLC I INSURER C: 309 N Park Rd INSURER D: Spokane Valley,WA 99212 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSR SWVD POLICY NUMBER (MM/DDY/YYYY)j(MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,001 A X COMMERCIAL GENERAL LIABILITY X ENP0056339 12/31/2013 12/31/2014 DAMAGE TO RENTED 500,001 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,001 X PD Deductible: 1000 PERSONAL&ADV INJURY $ 1,000,00• GENERAL AGGREGATE $ 2,000,001 GE 'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 t POLICY X jET LOC WA STOP GAP $ 1,000,001 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 I (Ea accident) $ A X ANY AUTO ENP0056339 12/31/2013 12/31/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE- $ 4,000,00 t A EXCESS LIAB CLAIMS-MADE ENP0056339 12/31/2013 12/31/2014 AGGREGATE $ 4,000,001 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured forms GA233 and AA4171;Wellesley Avenue Sidewalk and Adams Road Sidewalk Project#0168 SVPW Contract 13-022 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Spokane,WA 99206 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 0)0 t - /52_ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disclose Hazards 7 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments .... 9 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.) 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured -Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions-Permits Relating to Premises; • State or Political Subdivisions-Permits; and • Contractors' Operations 10. Broadened Contractual Liability-Work Within 50'of Railroad Property 14 11. Property Damage to Borrowed Equipment 14 12. Employees as Insureds-Specified Health Care Services: 14 • Nurses; • Emergency Medical Technicians;and • Paramedics 13. Broadened Notice of Occurrence ....14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 • 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM a Area (For Limits in Excess of (For Limits in Excess of b Payroll $5,000) $5,000) c Gross Sales d Units e Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION I judgments or settle- - COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- (b) This insurance applies to ror or omission of the in- damages only if the act, er- sured, or of any other per- ror or omission, is , e - son for whose acts the in- , sured is legally liable, to gently committed in the which this insurance ap- administration' of your plies. We will have the right "employee benefit pro- and duty to defend the in- gram"; and sured against any "suit' 1) Occurs during the pol- seeking those damages. icy period;or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE; and claim or "suit" when any "author- 2) Our right and duty to ized representa- defend ends when we tive"; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or omission to us 3) Advice given to any or any other person with respect to insurer; that person's decision to participate or not to ii) Receives a participate in any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or orris- and Similar Laws sion; and Any daim arising out of your b) There is no other failure to comply with the applicable insur- mandatory provisions of any ance. workers' compensation, un- employment compensation (2) Exclusions insurance, social security or This apply disability benefits law or any his insurance does not a PP y similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fidud- "Bodily injury", "property ary by the Employee Re- damage' or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any nsurer. including those imposed (d) under the Internal Revenue d) Insufficiency of Funds Code or any similar state or Damages arising out of an local law. insufficiency of funds to (j) Employment-Related meet any obligations under Practices any plan included in the "employee benefit pro- Any liability arising out of gram". any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any daim based upon: (3) Coercion, demotion, 1 Failure of any invest- evaluation, reassign- 1) Y ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per- tion or other employ- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 3 of 15 ' ment-related practices, (e) A trust, you are an insured. acts or omissions; or Your trustees are also in- sureds,Consequential liability sureds, but only with re- (4) q ty spect to their duties as trus- as a result of(1), (2) or tees. (3)above. This exdusion applies (2) Each of the following is also an PP insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having proper temporary authoriza- (3) Supplementary Payments tion to administer your "em- SECTION I - COVERAGES, SUPPLEMENTARY PAY- ployee fi "you die, but bene only t program until your if ap- MENTS -COVERAGES A AND legal representative is ap- pointed. B also apply to this Coverage. (c) if b. Who is an Insured you Your representative die, but only wi �with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage Part. (1) If you are designated in the Dec- (3) Any organization you newly ac- larations as: quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over only with respect to the con- which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- lar insurance applies to that or- (b) A partnership or joint ven- ganization. However, coverage ture, you are an insured. under this provision: Your members, your part- ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, whichever is earlier; and (c) A limited liability company, you are an insured. Your (b) Does not apply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation. eds, but only with respect to c. Limits of Insurance their duties as your manag- ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, tirety and replaced by the following: you are an insured. Your (1) The Limits of Insurance shown "executive officers" and di- in Section B. Limits of Insur- rectors are insureds, but ance, 1. Employee Benefit Li- only with respect to their du- ability Coverage and the rules ties as your officers or direc- below fix the most we will pay tors. Your stockholders are regardless of the number of: also insureds, but only with respect to their liability as (a) Insureds; stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 4 of 15 ` (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations applies to all damages sus- (c) Persons or organizations tained by any one "em- making daims or bringing ployee", induding such "em- "suits"; ployee's" dependents and (d) Acts,errors or omissions; or beneficiaries, because of all acts, errors or omissions to (e) Benefits induded in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement defend the insured is the most we will pay for all damages because of acts, errors against any "suits" or omissions negligently commit- seeking those dam- ted in the "administration" of ages; and your "employee benefit pro- 2) Your duties, and the gram". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission,or claim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of plication of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of , claim or"suit"and, upon no- tification of the action taken, (a) An act, error or omission; or you shall promptly reim- (b) A series of related acts, er- burse us for such part of the deductible amount as we rors or omissions, regard- less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, As respects Employee Benefit Li- negligently committed in the ability Coverage, SECTION IV - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However, the amount paid under IOC' this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan induded in the "employee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission, or Claim or Suit a. You must see to it that we are noti- (a) Our obligation to pay dam- fled as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a daim. To the extent possible, no- amount of damages in ex- tice should indude: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred;and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may suffer dam- deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 • b. If a daim is made or"suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the daim or "suit" and the tion by equal shares, date received; and we will follow this (2) Notify us as soon as practicable. method also. each in- ( ) fY P this approach each in- You must see to it that we receive surer contributes equal written notice of the claim or"suit"as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its (3) Cooperate with us in the investi- applicable limit of in- surance or settlement of the daim surance to the total ap- gation defense against the "suit"; p limits insur- ns urree rs. and ance ce of all 1 insurers. (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en- insured because of an act, error titled to recovery under or omission to which this insur- any other insurance in ance may also apply. force previous to the ef- d. No insured will, except at that in- ve date of this Co sured's own cost, voluntarily make a Coverr age Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added: If other valid and collectible 1. "Administration" means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- benefit programs"; mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro- will share with all that grams"; or other insurance by the method described in b. d. Effecting, continuing or terminating any "em- below. ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15 in any benefit induded benefits, workers' corn- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, indud- does not include: ing buy and sell pro- grams; leave of ab- a. Handling payroll deduc- sence programs, in- tons; or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans; transporta- coverage of insurance, tion and health dub induding but not limited subsidies. to unemployment in- (2) The following definitions are de- surance, social security leted in their entirety and re- benefits, workers' corn- placed by the following: pensation and disability benefits. 21. "Suit" means a civil pro- ceeding means ceeding in which money 2. "Cafeteria P damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit" includes: tain benefits with pre-tax dollars. a. An arbitration proceed- ing in which such dam- 3. "Employee benefit pro- ages are daimed and grams" means a program to which the insured providing some or all of the must submit or does following benefits to "em- submit with our con- ployees", whether provided sent; through a "cafeteria plan"or otherwise: b. Any other alternative dispute resolution pro- a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the In- tel, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil pro- other than an "em- ceeding. ployee" may subscribe to such benefits and 8. "Employee" means a per- such benefits are made son actively employed, for- generally available to mercy employed, on leave of those "employees" who absence or disabled, or re- satisfy the plan's eligi- tired. "Employee" includes bility requirements; a "leased worker". "Em- ployee" does not include a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV-COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep- benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disclose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such c. Unemployment insur- failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 3. Damage to Premises Rented to You f) Nesting or infesta- tion, or discharge a. The last Subparagraph of Paragraph or release of 2. SECTION I - COVERAGES, waste products or COVERAGE A. - BODILY INJURY secretions, by in- AND PROPERTY DAMAGE, 2. LI- sects, birds, ro- ABILITY Exclusions is hereby de- dents or other Ieted and replaced by the following: animals. Exclusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or b. The insurance provided under SEC- ment;other earth move- TION I -COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in through: Paragraph 3.b.above: a) Foundations, The exdusions under SECTION walls, floors or I - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY, 2. Exclusions, other than I. whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract;or by or resulting from freez- ing, unless: 2) Loss caused by or re- sulting from any of the 1) You did your best to following: maintain heat in the a) Wear and tear; building or structure;or b) Rust, corrosion, 2) You drained the equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main- or latent defect or tained. any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self conditioning, fire pro- tection systems, or c) Smog; other equipment or ap- d) Mechanical break- pliances; or down including 2) The interior of any rupture or bursting building or structure, or caused by cen- to personal property in trifugal force; the building or structure caused by or resulting e) Settling, cracking, from rain, snow, sleet shrinking or ex- or ice, whether driven pansion; or by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 • c. Limit of Insurance Limits of Insurance, 5. Medical Pay- ments of this endorsement. The Damage to Premises Rented to You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for "property damage"to property of others arising out of op- 6. Subject to 5. above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured; or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of "prop- erty damage" to premises With your consent, we will make while rented to you or tern- these payments regardless of fault. porarily occupied by you with permission of the b. Care, Custody or Control Liability owner, arising out of any Coverage one "occurrence" to which SECTION I - COVERAGES, COV- this insurance applies. ERAGE A. BODILY INJURY AND (3) The amount we will pay is lim- PROPERTY DAMAGE LIABILITY, ited as described in Section B. 2. Exclusions, j. Damage to Prop- Limits of Insurance, 3. Dam- erty, Subparagraphs (3), (4) and (5) age to Premises Rented to do not apply to "property damage"to You of this endorsement. the property of others described therein. 4. Supplementary Payments With respect to the insurance provided by Under SECTION I - COVERAGE, SUP- this section of the endorsement, the fol- PLEMENTARY PAYMENTS - COVER- lowing additional provisions apply: AGES AAND B: a. The Limits of Insurance shown in the a. Paragraph 2. is replaced by the fol- Declarations are replaced by the lim- lowing: its designated in Section B. Limits of Up to the limit shown in Section B. Insurance, 6. Voluntary Property Limits of Insurance, 4.a.Bail Bonds Comaoe and Care, Custody or of this endorsement for cost of bail Control Liability Coverrage age of f this required because of accidents endorsement with respect to cover- bonds re q age provided by this endorsement. or traffic law violations arising out of These limits are indusive of and not the use of any vehicle to which the in addition to the limits being re- Bodily Injury Liability Coverage ap- placed. The Limits of Insurance plies. We do not have to furnish shown in Section B. Limits of Insur- these bonds. ance, 6. Voluntary Property Dam- b. Paragraph 4. is replaced by the fol- age and Care, Custody or Control lowing: Liability Coverage of this endorse- ment fix the most we will pay in any All reasonable expenses incurred by one "occurrence" regardless of the the insured at our request to assist number of: us in the investigation or defense of the daim or "suit", including actual (1) Insureds; loss of earnings up to the limit shown (2) Claims made or "suits" brought; in Section B. Limits of Insurance, or 4.b. Loss of Earnings of this en- dorsement per day because of time (3) Persons or organizations making off from work. claims or bringing"suits". 5. Medical Payments b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 9 of 15 ' cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) be- Insurance, 6. Voluntary Prop- low (hereinafter referred to as erty Damage and Care, Cus- additional insured) whom you tody or Control Liability Cov- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con- Claim or Suit, applies to each tract where a certificate of claim or"suit" irrespective of the insurance showing that per- amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect settlement of any daim or "suit" is an insured, provided: and, upon notification of the ac- (a) The written or oral contract tion taken, you shall promptly re- or agreement is: imburse us for such part of the deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- ing 180 Day Coverage for Newly Formed or the policy period; Acquired Organizations 2) Executed prior to an SECTION II - WHO IS AN INSURED is "occurrence" or offense amended as follows: to which this insurance Subparagraph a. of Paragraph 4. is would apply;and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in- a. Insurance under this provision is af- sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV-COMMERCIAL GENERAL and insurance coverage pro- LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or "your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that cluded in the "products-completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Coy- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our 1) Any"occurrence" which request, the insured will bring "suit" or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Sped- 2) Structural alterations, fied Relationships new construction or a. The following is hereby added to demolition operations SECTION II-WHO IS AN INSURED: performed by or on be- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 ' half of such additional solely for the pur- insured. pose of inspection, (b) Any person or organization demonstration, ( ) Y P 9 testing, or the from which you lease substitution of equipment with whom you parts under in- have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and surance. Such person(s) or then repackaged organization(s) are insureds in the original con- solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s). tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence" which takes place normally under- after the equipment lease takes to make in expires. the usual course of business, in (c) Any person or organization connection with (referred to below as ven- the distribution or dor) with whom you have sale of the prod- agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op- out of"your products" which erations, except are distributed or sold in the such operations regular course of the ven- performed at the dor's business, subject to vendor's premises the following additional ex- in connection with clusions: the sale of the 1) The insurance afforded product; the vendor does not g) Products which, apply to: after distribution or sale by you, have a) "Bodily injury" or been labeled or re- "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub- reason of the as- stance by or for sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exdusion does not not apply to any in- apply to liability for sured person or organi- damages that the zation: vendor would have in the absence of a) From whom you the contract or have acquired agreement; such products, or any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or containing such c) Any physical or products; or chemical change in the product b) When liability in- made intentionally cluded within the by the vendor; "products- Repackaging, completed opera- d) tions hazard" has unless unpacked Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1)above spect to such to provide insurance, but products. only with respect to liability (d) Any state or political subdi- arising out of "your work" ( ) Y P performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re- with respect to the following quired by the written con- hazards for which the state tract or agreement, but in no or political subdivision has event beyond the expiration issued a permit in connec- date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe- this insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair, construc- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op- signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, additional insured designated hoist away openings, under Paragraph 9.a.(2): sidewalk vaults, street banners, or decorations (a) Subparagraphs (e) and (f) and similar exposures; does not apply to "bodily in- or jury" or "property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- ucts-completed operations vators; or hazard ; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f) does not apply to elevators covered by 'bodily injury", "property this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad- agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by "property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of political subdivision has issued a permit. 1) Defects in design fur- nished by or on behalf 2) This insurance does of the additional in- not apply to "bodily in- sured; or jury", "property dam- 2) The rendering of, or age" or "personal and advertising injury" aris- failure to render, any ing out of operations professional architec- performed for the state tural, engineering or or political subdivision. surveying services, in- cluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 12 of 15 ' a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, 5. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tural or engineer- available to the addl- ing activities. tional insured as an additional insured by 3) "Your work" for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Conformance to b. Only with regard to insurance pro- Specific Written Contract or vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- paragraph 11. Conformance to Specific (f) above, SECTION III - Conformance Contract or LIMITS OF INSURANCE is amended to include: Agreement The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para- written contract or agreement or in graph 9.a.(2)(f)above only: the Declarations of this Coverage If a written contract or Part, whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for contract or agreement, the limits ap- the additional insured: plicable to the additional insured are those specified in the Dedarations of a. Be provided by the In- this Coverage Part. The limits of in- surance Services Office surance are inclusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- c. SECTION IV - COMMERCIAL GEN- tion specified); or ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5. Other Insurance is or amended to include: c. Include coverage for (a) Where required by a written "your work"; contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and / or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted (b) Any insurance provided by as providing the limits or this endorsement shall be coverage required by the terms of the written contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 13 of 15 or agreement, but only to (c) Persons or organizations the extent that such limits or making claims or bring coverage is included within "suits". the terms of the Coverage Part to which this endorse- (2) Deductible Clause ment is attached. If, how- (a) Our obligation to pay dam- ever, the written contract or ages on your behalf applies agreement specifies the In- only to the amount of dam- surance Services Office ad- ages for each "occurrence" ditional insured form num- which are in excess of the ber CG 20 10 but does not Deductible amount stated in specify which edition, or Section B. Limits of Insur- specifies an edition that ance, 11. of this endorse- does not exist, Paragraphs ment. The limits of insur- 9.a.(3)(a) and 9.a.(3)(b) of ance will not be reduced by this endorsement shall not the application of such De- apply and Paragraph 9.b. of ductible amount. this endorsement shall ap- ply. (b) Condition 2. Duties in the 10. Broadened Contractual Liability Work Event of Occurrence, Of - fense, Claim or Suit, ap- Within 50' of Railroad Property plies to each claim or "suit" It is hereby agreed that Paragraph f.(1)of irrespective of the amount. Definition 12. "Insured contract" (SEC- (c) We may pay any part or all TION V-DEFINITIONS) is deleted. of the deductible amount to 11. Property Damage to Borrowed Equip- effect settlement of any ment claim or"suit"and, upon no- tification of the action taken, a. The following is hereby added to Ex- you shall promptly reim- clusion j. Damage to Property of burse us for such part of the Paragraph 2., Exclusions of SEC- deductible amount as has TION I -COVERAGES, COVERAGE been paid by us. A. BODILY INJURY AND PROP- 12. Employees as Insureds - Specified ERTY DAMAGE LIABILITY: Health Care Services Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- It is hereby agreed that Paragraph ment loaned to you, provided they 2.a.(1)(d) of SECTION II - WHO IS AN are not being used to perform opera- INSURED, does not apply to your "em- tions at the time of loss. ployees" who provide professional health care services on your behalf as duly li- b. With respect to the insurance pro- censed: vided by this section of the endorse- ment, the following additional provi- a. Nurses; sions apply: b. Emergency Medical Technicians; or (1) The Limits of insurance shown in c. Paramedics, - the Declarations are replaced by the limits designated in Section in the jurisdiction where an "occurrence" B. Limits of Insurance, 11. of or offense to which this insurance applies this endorsement with respect to takes place. coverage provided by this en- dorsement. These limits are in- 13. Broadened Notice of Occurrence clusive of and not in addition to Paragraph a. of Condition 2. Duties in the limits being replaced. The the Event of Occurrence, Offense, Limits of Insurance shown in Claim or Suit (SECTION IV-COMMER- Section B. Limits of Insurance, CIAL GENERAL LIABILITY CONDI- 11. of this endorsement fix the TIONS) is hereby deleted and replaced most we will pay in any one "oc- by the following: currence" regardless of the number of: a. You must see to it that we are noti- fied Insureds; fed as soon as practicable of an "oc- currence" or an offense which may (b) Claims made or "suits" result in a claim. To the extent pos- brought;or sible, notice should include: (1) How, when and where the "oc- currence" or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 • (2) The names and addresses of This requirement applies only when any injured persons and wit- the "occurrence" or offense is known nesses; and to an"authorized representative". (3) The nature and location of any injury or damage arising out of the"occurrence" or offense. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 SUPERIOR COURT OF WASHINGTON FOR SPOKANE COUNTY In the Matter of: ADVERTISEMENT FOR BIDS No. City of Spokane Valley Public Works Department Bid #13 -022 AFFIDAVIT OF PUBLISHING Wellesley Avenue Sidewalk and Adams NOTICE Road Sidewalk Project STATE OF WASHINGTON ) )ss. County of Spokane ) MICHAEL HIJUMAN . being first duly sworn on oath deposes and says that he is the EDITOR , of The Spokane Valley N ews Herald, a weeklynewspaper. That said newspaper is a legalnewspaper and itisnow and has beenfor more than six months prior to the date of the publication hereinafter referred to, published in the English language continually as a weekly newspaper in Spokane County, Washington, and it is now and during all of said time was printed in an office maintained at the aforesaid place of publication of said newspaper, which said newspaper had been approved as a legal newspaper by order of the Sup e ' r Court of the State of Washington in and for Spokane County. That the following is a true copy of 10 'as 'had in regular issues commencing on the 2nd day of August. 2013 and ending the 9th day of 20 t ve, and that such newspaper was regularly distributed to its subscribers during all of said period:'— CITY ADVERTISEMENT OF POKANE VALLEY BED and S ORN to before me CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT WELLESLEY BIDNUE SIDEWALK 2 this 9th day of August, 2013. NAoticeishereby given than SIDEWALK ofSpo I E'W nf�rJ�'a State of Washington Kane Valley, Spokane County, Washington �O( ' V m, COUrif,, Of Spokane will accept sealed bids for the Wellesley V .'ON�EXp� rr t p Avenue Sidewalk and Adams Road • Sidewalk Project. The project consists It . �5 .�I certify that I know or have satisfactory evidence that installation n sidewalk and curb, asphalt' patching, and storm drainage improve- . J? ZZ P4�►, . Z 1vlichaelHuffman is the pperson who appeared before ments. 0:0 NQ� \ d m11e and said person acknowled ed that he signed Copies of the bid packet including specifi- cations and plans may be obtained in PDF • ` ®� 1iS instrument and acknowledged it to be his free format by downloading from the Spokane , : (li : d voluntary act for the uses and purposes men - Valley FTP site Contact Darla Arnold, Spa. . , y p p kane Valley Public Works, at 509 -720 -5003 w .n • 0� or by email at darnatd�.spokanevalle)LOrg / (P • 6• \ `'�tlOri d lri the 1riStrLlrilP.rit. Monday through Friday frwn 8:00 am, to °�j �� • .,�50 �. ' •G 5:00 p.m. for instructions and to be added 40 0 4,' to the Planholder's list If a potential bidder ���LLL --- --- is unable to reproduce the packet from the �0 O �� F!P site, a hard copy with half-size plans X1111 1 11110 Io ne Rae Wentz may be obtained from the City for anon- Title: Notary Public refundable fee of $50. Any addenda to this project will be sent only to those on the Planhclders list. My appointment expires: 5 -16 -15 All bids must be accompanied by a bid deposit in the form of surety bond, postal I C money order, cash, cashiers check, or rti- fied check in an amount equal to five percent (5 %) of the amount of the bid proposed. Failure to furnish a bid bond in compliance withthe City's bid deposit surety bond form shall make the bid non - responsive and cause the bid to be rejected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spokane Valley, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received not laterthan 11;00 a.m—PST Edd?y, AU9u t 16,2013. Bid openings will be held immediately thereafter and read aloud in the CRY Council Cham- bers, 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 peforethe award and execution of the contract, unless the award is delayed for a period exceeding sixty (60) days. The City of Spokane Valley, in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 2000d to 2000.4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, non -dis- s - crimination in Federally assisted program of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively insure that in any contract entered into pursuant to this advertisement, d isadvantaged business enterprises as tlefined at 49 CFR Part 26 will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color or national origin, or sex In consideration for an award. PUBLISH: 812 and 8/9, 2013 Christine Bainbridge, MMC Spokane Valley City Clerk 812, 8/9 ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID #13 -022 WELLESLEY AVENUE SIDEWALK AND ADAMS ROAD SIDEWALK PROJECT Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Wellesley Avenue Sidewalk and Adams Road Sidewalk Project. The project consists of installation of sidewalk and curb, asphalt patching, and storm drainage improvements. Copies of the bid packet including specifications and plans may be obtained in PDF format by downloading from the Spokane Valley FTP site. Contact Darla Arnold, Spokane Valley Public Works, at 509 - 720 -5003 or by email at darnold @sookanevaIlev.org Monday through Friday from 8:00 a.m. to 5:00 p.m. for instructions and to be added to the Planholder's list. If a potential bidder is unable to reproduce the packet from the FTP site, a hard copy with half -size plans may be obtained from the City for a non- refundable fee of $50. Any addenda to this project will be sent only to those 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 not later than 11:00 a.m. PST. Friday, August 16, 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. The City of Spokane Valley, in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 20004 to 2000 -4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, non- discrimination in Federally assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively insure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises as defined at 49 CFR Part 26 will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color or national origin, or sex in consideration for an award. PUBLISH: 8/2 and 8/9, 2013 Christine Bainbridge, MMC Spokane Valley City Clerk SR26499 *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. SR26499 No. Lines: Total Cost: $909.94 Order No. 42365 107 132276 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: 2 & 9, 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 9th day of August , 2013. ,NL VINO 44q)l 7O% \551 O N�FXA — s — L, i � N YUViL1C v Nb ry Public in and for the State of Washington, N�j�iBER residing at Spokane County, Washington OF WASH Notary Stamp Paper Affidavits