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13-157.00 Spokane Rock Products: Carnahan, Indiana & Sprague PreservationContract THIS AGREEMENT, made and entered into this day of 2013, between the City of Spokane Valley under and by virtue of Title 35 RC , as amended and Spokane Rock Products, Inc. Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Carnahan, Indiana & Sprague Street Preservation Project #0180 Phase 3 — 2013 Street Preservation Program SVPW Contract 13 -035 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. a013 -t57 V. The project was awarded for the bid amount of $999,134.45. 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 A-u� 26 , 2013. ' { — Date Printed Name 1 Title Signature City of Spokane a%l�ley 1 "J4 C� Printed Name V t! CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley, Washington BOND NO: 105957894 The City of Spokane Valley, Washington, in Spokane County, has awarded to Spokane Rock Products, Inc. (Contractor), as Principal, a contract for the construction of the project designated as Carnahan, Indiana & Sprague Ave Street Preservation Project, Project No. 0180 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 Travelers Casualty and Surety Company of America (Surety), a corporation, organized under the laws of Connecticut 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 $ 9 9 9.13 4.4 5 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 surer 31 Signature Printed Name Title T Date SURETY Travelers C sualty and ety Company of America .0 8/26/2013 Sure igna a Date ed Haff Printed Name Attorney -In -Fact Title Name, address, and telephone of local office /agent of Surety Company is: Conover Insurance Services, LLC 1804 W. Lewis Street Pasco WA 99301 Revised 1.11 13 EY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERSJ� Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 226761 Certificate No. 005522944 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies "), and that the Companies do hereby make, constitute and appoint Pamela L. Thurman, Jacqueline F. Hernandez, JoHanna E. Zerb, Charles E. Hudon, Karen E. Alley, Jared Haff, Sarah Scott, and Ashley Stevens of the City of Pasco , State of Washington , their true and lawful Attomey(s) -in -Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this day of June 2013 State of Connecticut City of Hartford ss. Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company 7th St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company GI,SU,� 08 ;T\ O Sls R� N EP :._O..AI•.R . i N.;�. aSL., >G Fq i � om 'i i 1i)fW�d.1.P . .......... �.. . p' .,�.a..:,a:'w ;t''"° a° dHi A �OR�OTY � FN AON/Ry. � D+ �, G a c y i o 6:1�Kl 6"", 000A SEAL o 4�F 18y 9 8 X7'1 ANt� By: 4,c.�d Robert L. Raney, enior Vice President On this the 7th day of June 2013 before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. p,TET In Witness Whereof, I hereunto set my hand and official seal. Tai W wk 0, • t�� My Commission expires the 30th day of June, 2016. �IBU�, * Marie C. Tetreault, Notary Public 58440 -8 -12 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full forcerand'effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2 6th day of Augu S t 20 Kevin E. Hughes, Assistant SecrYtary °I,SU.��1 Qys••• J F \RE 4 � (1��N I NS•G9 J+� +' ,�� 4,,,� gJP�(Y q�y�s ��10 Yyy��, �., RY "�J � 1 9 8 2 O � 1 F; —•_ . o i a NANTFORD, < tlAiirF6Rq Ti � 1977 ii t Ji. S o CONN. n \ GONN. f? N 1896 2 1951 � �.SEAL,+o", ot SEAL:'3 m \ •••_• •,,,f/// � %�a �%,�, 2 ° �y.. a'tir o :'•. 'a" 'r n!gil ,gyp ra of few ra �d11 AHtdM To verify the authenticity of this Power of Attorney, call 1- 800 - 421 -3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the above -named individuals and the details of the bond to which the power is attached. c�J�l N r :v � ,,;oo `Wle'- BOND NO: 105957894 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 Spokane Rock Products, Inc. (Contractor), as Principal, a contract for the construction of the project designated as Carnahan. Indiana & Sprague Ave Street Preservation Project, Project No. 0180 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 Travelers Casualty and Surety Company of America (Surety), a corporation organized under the laws Connecticut 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 $ 999 ,134.45 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 (CONTRACTOR) Spokane Rock Products, Inc. 8/26/2013 P ' cipal Sign a Date Print I � C Title SURETY Travelers C sualty and Su y Company of America 14 8_/26/2013 Surety Sigr AaW Date J ed Haff Printed Name Title Name, address, and telephone of local office/agent of Surety Company is: Conover Insurance Services, LLC Attornev -In -Fact 1804 W. Lewis Street Pasco. WA 99301 Re0sed 1 14.13 THIS POWER OF ATTORNEY THE RED BORDER ' Y Q POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 226761 Certificate No. 005522942 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies "), and that the Companies do hereby make, constitute and appoint Pamela L. Thurman, Jacqueline F. Hernandez, JoHanna E. Zerb, Charles E. Hudon, Karen E. Alley, Jared Haff, Sarah Scott, and Ashley Stevens of the City of Pasco , State of Washington , their true and lawful Attomey(s) -in -Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 7th day of June 2013 State of Connecticut City of Hartford ss. Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company. St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company °ASU,� F \0.E 4 \'W INgG '11N SUq `y. P\.TY ANA 06-zw,;� �¢YAryp ' QQ... � r�� - 9 rt00. POR.I TFi I z� �! ,•, m � gD' S y� 1,; o7 o 1896 '`•SEALio; zo;S8AL:3 gyp-. �ads ��RS! LF r 1 PP Atlt mnm hswA..+� hww • By: '44a� Robert L. Raney, enior Vice President On this the 7th day of June 2013 , before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G•Ter In Witness Whereof, I hereunto set my hand and official seal. w Marie r `' • My Commission expires the 30th day of June, 2016. Marie C. Tetreault, Notary Public �s 58440 -8 -12 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United'States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force and'effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2 6 t h day of August 20 13 Kevin E. Hughes, Assistant Seciftary GASU,��T J f \0.E 4 O�*µ..lMSG9 JP��� v� eJP TY nNp a` ,cµ�"wntry� �\p413�Y4A'D h 5 D (1 �e x,� N m j�EOP FORS >f',m Q�OpPPORAJt: �t^f 9� n ; m HARTFORD, +HAftIPogD, T! < 1�"� SEALaO1 a To verify the authenticity of this Power of Attorney, call 1- 800 - 421 -3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the above -named individuals and the details of the bond to which the power is attached. A� ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 1 8/26/2013 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 Conover Insurance 1804 West Lewis Street Pasco WA 99301 NAMEACT Jacqueline Hernandez , ACSR PHONE . (509) 545 -3800 FAX o . (509) 547 -7960 IAIC. ADDIL INSURER(S) AFFORDING COVERAGE NAIC # INSURER A'American Economy Ins Co. LIMITS INSURED Spokane Rock Products Inc. P.O. Box 3808 S okane WA 99220 114SURERB:AlAerican States Ins Company Spokane Valley, WA 99206 INSURERC:Starr IndemnitV & Liabilit Co. INSURER D:Nav1 ators Insurance Com an INSURER E:LibertV Northwest Ins Co $ 1,000,000 INSURER F: $ 200 , 000 n�ae- nwn_oc f%= RTICIrtATIX IIJI IM13ER•2013 -2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR LTR TYPE OF INSURANCE AD S 8 POLICY NUMBER MM DD/YYYY MM /DDIYYYY LIMITS Suite 106 GENERAL LIABILITY Spokane Valley, WA 99206 K Schrader /KRISTI EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 200 , 000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 A I CLAIMS -MADE X OCCUR 01CG6871649 /1/2013 /1/2014 PERSONAL & ADV INJURY $ 1,000,000 • Contractual • Includes X, C, U GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 $ PRO- POLICY X LOC .T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X B ANY AUTO ALL OWNED SCHEDULED 01CI5463652 /1/2013 /1/2014 BODILY INJURY (Per accident) $ AUTOS NON OWNED PROPERTY t DAMAGE idenI Per acc $ HIRED AUTOS AUTOS I $ UMBRELLA LIAB X OCCUR EAC_H OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 C EXCESS LIAB CLAIMS -MADE SISIGCE50027813 — RED RETENTION$ $ EXCESS AUTO LIABILITY /1/2013 /1/2014 A WORKERS COMPENSATION X ORY LATU- O FIR E L. EACH ACCIDENT $ 1 000 000 AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN E.L DISEASE - EA EMPLOYE $ 1,000,000 OFFICER /MEMBER EXCLUDED, (Mandatory in NH) NIA 1CG6871649 /1/2013 /1/2014 E.L DISEASE= - POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below NA STOP GAP A CONTRACTORS POLLUTION 1CG687i649 1/1/2013 /1/2014 LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Company D: Excess Liability, Policy #SEI3EXC7450301V, 1/1/2013 - 1/1/2014, $9,000,000 Occurrence /Aggregate Limit. Company E: ID /MT Workers Compensation, Policy #WC4 iNC011995012, 10/1/2012 to 10/1/2013, $1,000,000 Limit. Re: Carnahan, Indiana & Sprague Street Preservation Project #0180 Phase 3 - 2013 Street Preservation Program SVPiff Contract 13 -035. City of Spokane Valley is additional insured. Business Auto additional insured applies per attached blanket Form #CA 71 10 03 07. Additonal Insured /Primary Additional Insured. apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09.Per- Project Agg per Form *CG 25 03 05 09. ACORD 25 (2010/05) V TSfKB -LUTU A%IU?[Li %'%Jrcrvr%M I IU1n. —1 11y11w .� „1 •`• INS025 (201005).01 The ACORD name and logo are registered marks of ACORD �..�. -- (509) 921 -1008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 11707 E. Sprague Ave AUTHORIZED REPRESENTATIVE Suite 106 Spokane Valley, WA 99206 K Schrader /KRISTI ACORD 25 (2010/05) V TSfKB -LUTU A%IU?[Li %'%Jrcrvr%M I IU1n. —1 11y11w .� „1 •`• INS025 (201005).01 The ACORD name and logo are registered marks of ACORD TA Pirr y fvorth�vest. !h�MrdllmJf! el.Wq� POLICY NUMBER: 01 -CG- 687154 -9 COMMERCIAL GENERAL LIABILITY CG 24 04 06 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART PROIJUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION FOR +wWOM YOU AaE REQUIRED BY WRITTEN COM'IRACT, AGRZEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. Information required to complete this Schedule, it not shown above, will be shown in the Declarations. The following is added to Paragraph 0. Transfer Of Rights Of Recovery Againsa Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or nrganizztion shown In the Schedule above because of payments 1ve rrakke for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. #) Insurance Services Office, Inc., 2008 Safeea and the Safcco logo are reglsten CO 24 04 05 09 %p "'ten y"... �Y,S..dtl..ry Nmvl eam? POLICY NUMBER: 01- CG- 687164- °9 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Constmclion Proj(x,(4) -: ALL PROJECTS OF THE NAMED INSURED 'UNLESS SPECIFICALL'.Y E1:C1JUDED Information required to complete this Schedule, it not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated N) pay as damages caused by ',occurrences" under Section I -- Coverage A, and for all medical expenses caused by acci- dents under Section I — Coverage C, which can be attributed only to ongoing operations at a sin- gle de; ic,nsa i)d construction F ~ci.'oct shown in the Schedule above: 1. A separate D.)signatej Cr 1,,Jruction Prcjuct General Aggregate Limit i!polies to each desigmilad construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. Tlio Dc.; ;ignated Constructior Project Gen- eral Aggregate Limit is the most we. will Palo for the Earn oli all damagn-c u-ider Coverage A, c{rt.ept darnages htocause of "bodily injury' -r "property damage" included in the "�ro��,c:t:: con taleted ope,,- "ions hazard ", and for medical expenses under Coverage C regardless of the numbar 1: n. (m;i trc:ds; b. Claims made or "suits." brought; or Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense con- tinue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Con- struction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I •- Coverage A and fo; ali medical expenses caused by acci- dents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: c. l,`;,. -.sons air organizatkirs making claims 1. Any payments made under Coverage A for or bringing "suits ". damages or, under Coverage C for medical 3. Ari p,;.,; -rient - made :. ride'r Coverage A for expenses shall reduce the amount available darvlzyers or c,nder Co vn,rago C for med ir*! under the General Aggregate Limit or the shall reduc,� 11-a Dosignsr.''ad Products- completed Operations Aggregate Limit, wnichever is applicable; and @ Insurance Services Office, Inc., 2008 Sateco and ^.hs. Saf u'o I -iflo are vegi,temd trademarks of Safeeo COrporatlon CG 25 03 05 09 Page 1 of 2 EP C- AG31 - PRINTOM - 1904.00MY 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the °products- carnpleted operations hazard" is pro- vided, any payments for damages because of 'bodily injuryl or "propery darnage" included in the "products-completed operations hazard" will reduce thc, Products - completed Operations Aggregate limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 C -AG-M •PNINT001- 1904-00MY x ,'=Y 1Yorthtivesp. COMMERCIAL GENERAL LIABILITY CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12011165 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE POLLUTION LIABILITY COVERAGE PART PRODUCTStCOMPLETEID OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYW ;C:A_NS, :i aRGEON3 AND DENTISTS PROFESSIONAL LIABILITY BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED - (SECTION 1) IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU ,ArREE IN A "WfRT.TTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL; INSURED ON THIS COVERAGE PART, BUT: A. ONLY TPXTH RESPEcr Tc8 LIABILITY FOR "BODILY INJURY", "PROPS -IT'Y DAMAGE" OR "PERSONA1", INJURRY" S AND B. IF, AI'+n OF'LY TO ".'F.3 EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS OR OMISSIONS OF YOU OR 'gUU1i SUBC014TIlACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "WRITTEN CQKTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES NOT QUALIFY AS AN ADD: TI*ON"�1L INSURED WITH RESPECT TO 11HE T.NDEPEN'DENT ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. THE INSURANCE PROVIDED TO THE ADDITIONAL INSUREL UY THI'Sb ENr+0R5F,1:- 2:;.N'1' IS LIMITED AS FOLLOWS, A. N nil, r.,w;IHT TI•>'A.'" THE LIMITS OF INSURANCE IF THIS COVERAGE PART SHOWN IN THE DECLARAT Ui'!I' &� &CEED TH2, 111'141TS OF LIABILITY REQUIRED B7 THE -WRITTi-V C:OI TFUkOT REQUIRING INSURANCU-, THZ INSURAI&C:E P i0`fID13D TO THE ADDITIONAL INSURED a,HALI, BE LIIAITED TO THE LIMITS OF a,IABILIT`I' RLQU".'17.ED B1' THAT "WRITTEN CONTRACT R%UIR:'14G INSURANCE`. THIS ENDORSE- MENT SKALL N07' YNCRI1"!A:' E TL-AE LIMITS OF INSUR- ANCE DESCRIBED 1114 SIY,C:1`!()N III - LIMITS OF INSURANCU. B. 'Ti° E '(N'Skllt,i-`..NCE > 9UGj V'A;LD TO 'NHS ADDITIONAL INSURRFI NOT APPf-r'7 "v'O "BODILY INJURY ", "PROPEi<.T'x ;a AMAt"rrs" OR "PlWISONAi"L INJURY" ARISING GTIT, OF THE i E1,4k; +ii ;RING 01, OR FAILURE TO RENDIT" . , I NY IsRCE I TECTURAL ENGINIi°;F,R?NO', O1.* SURV'U'11]:N4 INCLUDIKG: i � THE PREPAI��ING, OR FAILING TO PREPARE CoR 1,4,_ %'➢il.e;JVE;, 14,ie' P,",,. SHOP DRAWINGS, PART Insu,artco Services Office, Inc., 1983 INSURANCE M 79 00 f.7 ?7 Page 1 of 2 EP c.ac-31.PRjWW.1904aM•r Page 2 of 2 C- AG31 - PRINT001. 1904-0042 -Y Ltlltrlj, COMMERCIAL GENERAL LIABILITY Northwest, CG 79 00 07 87 Vtdrf d t.a/.' Y.ul naR' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12011195 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PIAYS'CI NS, SURGE; NS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, A9PROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii. SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY IINJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED TN TIFF "PRODUCTS— COMPI,31TED OPERA- TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT REQUIRING INSURANCE- SPECIFICALLY REQUIRES YOU TO P'E O"71DE SUCH COVERAGE FOR THAT ADDITIONAL INSURED, AND THEN THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED APPLIES ONLY TO SUCH "BODILt' INJU1RYff OR "PROPERTY DAMAGE" `IHA7" OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT t;OQUIIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICd,2"'VER IS EARLISR. 3. THE "14SWLki9r E Px3rE,54'TL';.D TO THI ADDITIONAL INSUR'IL BY THIS END, RI,,;u). ZNT 1S ;7,'RCESS OVER ANY VALID 'BIND "OTHER INSURANCE", WHETHER .79',W ;.HAE'i'r, E:XESS, CONTINGENT OR ON ANY OTHER BALI'S THAT IS 1a';A1LABL3 TO THE ADDITIONAL, INSURED FOR' A LOSS WO COVER UNDER THIS EWDOItS.l:°:IEC HT . I%0'4 Ct V'LR , IF 'PHEB "MRI TTEN CONTRACT INS ,RAWCE" aaPEC:IFICALLY REQUIRES `I'WiT THIS IlvS;tL U,?CR Ail ?LY ON A PRIMARY JA S< S O::R A ::�,�Wi,4kRY AND NON—CONTRIBU- TORY BAST: , T'IitIS INilkw".;44 E 1S -RIMAI Y TO "OTHER ;.a+�': VIk�AN E"' A'il %.L- r.BLS TO THiG ADDITIONAL INSURED 'WW`; CH O:jVLR -2, 'PE i A.T PERSON CSR ORGANIZA- TION AS A NAMED INSURE.P. FOR SUCH LOSS, AND WE WI R.,T, N(ITT' �FjjA RE W I: "Or" TAA T "(, T) "AMR INSURA)�;T7�i" B11. T 'I "r ; "a 1.''` ISURANC. , 'i='r1OVIDED TO THE, Ar.Tii'i'10ANiAL INS+yRED L1 THIS YsNDO RSEMENT STILL IS OVEM .; iil' VALID ' -'UiD COLLECTI- BLE "O'.i'lt Fa T 3'F+i�{:p. a:NC,I °P , re :E'a'HY�SR ?RI1V.1kRY, EXCESS, o;,nYi.' m(,,.aq,r a'ANI OTHER HASIS, THAT J;F'A'<i;`,j :Ls.?=LE TO ADDITIONAL INSURED WHEN 't'] hT i;1','3 .S('jN Oil (;jI 1 '­ U4I ZAT.14; A IS AN l;.s urunCe Services Office, Inc., 1963 C CG 79 03 N EI pe: "e,1 c6 s EP C- AG-31 .PRINS001.5904 -My Page 2 of 2 C-AG -M -PRI mom- I9W- 0094-Y Liberty COMMERCIAL GENERAL LIABILITY t\Iortbs"., CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSIC °+DNS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE ". 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE. i . HOW, WHEN AND WHiE,RE THE `OCCURRENCE" OR OFFENSE TOOK, PLACE,- i i . THE FA,NIEF AND .1%rmFSSES OF ANY INJURED PERSONS AND WITNESSES; AND iii. THE NATURZ AND LOCATION OF ANY INJURY OR DAMAGE ARISING OUT OF THE "OCCURRENCE" OR OFFENSE. B. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADDITIONAL INSURED, THE ADDITIONAL INSURED MUUS16 ; i . IHMEDIA.TEI�Y REC01M, THE SPECIFICS OF THE CLAIM GR ';:QUIT'" A14D Tllk:; I'DATE RECEIVED; AND i i . HOTi FY U S AS SCC)�H AS PRACTICABLE. THE ADDI IC,NAL INSURED KJST SEE TO IT THAT WE RECEIVE TRRI'IT'IEN NGTI:4".6 QF THE CLAIM OR "SUIT" AS SOON AS E��1A TbCAUd�E ".. C. THE, Al-:UI` IOC+AL II1S;.ii"'F10 MUST Ii4iEDIATELY SEND US C;GI I F,S OF ALL 1,11 I' vAL PAPERS RECEIVED IN CONNECTION WITH 'TEE CLAIM OR "SUIT ", COOPERATE WITH US Ili THO !RVESTIGATION OR SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST THE - SUIT -, AND OTI42RW'b`913 C014PLYC WIR ALL POLICY COIOk ITIONS. D. 7142 A;i DI T:[GNAL 11iSURED MUST:' TENDER THE DEFEN:s'i''n .i ;i:5 I3tII2E',Kii1T"1 OF ANY CLAIM OR "SUIT" TO ANY PROVIDER 0 Z INSURANCE" WHICH WOULD COVB,11? TIC& i4I,D :`11' ;, ;+NAL INS15RED FOR A LOSS WE COY])tT -,' U14i )ER Th'.4':S I "14'P()RSE;MEN'j% HOWEVER, .e THIN DOES NOT AF €'E,CT WHETHER THE INSURANCE PPOV':irDBD `1O T14R,, ADDITIONAL, INSURED BY THIS Ei li's° CSR S ll:bl�ila `i` ;i , i'.1 .k HARP TO ' CoTHER INSURANCE" AVAILABLE TO `.t'HE ADD11'IONAL INSURED WHIIC H COVERS `.'`HAT PERSON OR. ORGANIZA- TION AS A. NAMED :I:NSbRED AS DESCRIBED IN °— Ccp1might, lnsur�s1cu Saarvices Office, Inc., 1983 CG 79 00 U7 -37 Pa ,� 31 of 2 EP C- AG- M- PRIRTOM 4904M&Y Page 2 of 2 C- AG31 -PR I NTOM -t 904 MWY ONorLiberty thtir�est. fVdpdfMeq xmntuW� COMMERCIAL GENERAL LIABILITY CG 79 00 07 67 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSIC -P.NS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3. ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V ° DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRTTTE.N CONTRACT OR AGREE- MENT UNDER. WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR OR':GANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS ANn THE "PERSONAL INJURY" IS CAUSED BY AN OFFEE4513 C:ONIM!TTED: A. AFTER 'd`HE SIGNING AND EXECUTION OF THE CONTRACT OR AGREEMENT BY YOU; B. WHILE THAT PART OF THE CONTRACT OR AGREEMENT IS IN EFFZC'P; AND C. BEFORE THE END OF THE POLICY PERIOD. s= i_ Z.- Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP C- AG- 31 ?N{NTOM-1 W44)097 -Y Page 2 of 2 GAG-3/ - ANINT001- %%44my COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION Paragraph 2.b. of the CANCELLATION Common Policy Condition is replaced by the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. TEMPORARY SUBSTITUTE AUTO — PHYSICAL DAMAGE COVERAGE Under paragraph C. — CERTAIN TRAILERS, MO- BILE EQUIPMENT AND TEMPORARY SUBSTITUTE AUTOS of SECTION 1 — COVERED AUTOS, the following is added: If Physical Damage coverage is provided by this Cov- erage Form, then you have coverage for: Any "auto" you do not own while used with the per- mission of its owner as a temporary substitute for a covered "auto" you q own that "s out of service be- cause cif its brraakdbwn, repair, servicing, loss" or destruction. BROAD FORM NAMED MISURIED SECTION If -- LIA131LITY COVERAGE — A.I. WHO IS AN INSURED provision is amended by the addition of the followings: d. Any business entity newly acquired or formed by you during the policy period provided you own 50% or more of the business entity and the business entity is not separately insured for Bus+ness Auto Coverages. Coverage is extended up to a maximum of 180 days following acquisi- tion or formation of the business entity. Coverage under thl4 provision is afforded only until the end of the policy period. BLANKET ADDITIONAL INSURED SECTION II — LIABILITY COVERAGE — A.I. WHO IS AN INSURED provision is amended by the addition of the following: e. Any person or organization for whom you are re- quired by an `insured contract" to provide insur- ance Is an ` insured", subject to the following additional provisions: (1) The "insured contract" must be in effect during the policy period shown in the Decla- rations, and must have been executed prior to the "bodily injury" or "property damage ". (2) This person or organization is an `insured" only to the extent you are liable due to your ong6mg operations for that insured, whether the work is performed by you or for you, and only to the extent you are held liable for an "accident" occurring while a covered "auto" is being driven by you or one of your em- ployees. (3) There is no coverage provided to this person or organization for "bodily injury" to its em- ployees, nor for "property damage" to its property. (4) Coverage for this person or organization shall be limited to the extent of your negli- gence or fault according to the applicable principles of comparative negligence or fault. (5) The defense of any claim or "suit' must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or "suit ". Includes copyrighted material of Insurance Services Office, Inc., with its permission. Coayright, Insurance Services Office, Inc., 1997 CA 71 10 03 07 Page 1 of 6 EP (6) The :overage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION I {[ -- PHYSICAL DAMAGE COVER - (a) 'The coverage andlor iimits of this policy; AGE, A.4. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or limits required by c. Personal Effects Coverage the "insured contract ". For any Owned "auto" That is involved in a (7) A person's or organization's status as an covered loss ", we will pay up to $500 for `insured" under this subparagraph d ends °'personal effects" that are lost or damaged when your operations for that "insured" are as a result of the covered loss", without completed. applying a deductible. EMPLOYEE AS INSURER Under Paragraph A. of Section 11 - -- LIABILITY COV- ERAGE itern 1. is added as follows: Your "employ e" while using his owned 'auto", or an "auto" owned h!1 a member of hi.; or her household, in your business or your personal affairs, provided you do not own, hire or borrow that "auto ". This coverage is excess to any other collectible Insurance coverage. FELLOW EIV.PLOYEE COVERAGE Exclusion S. FELLOW EMPLOYEE of SECTION 11 — LIABILITY COVERAGE — B. EXCLUSIONS is amended by flnie addition of the following: However, this exclusion does not apply if the "bodily injury„ results f,om the use if a covered "auto" you own or hire, ariJ provided cat any coverage under this provision only applies In excess over any other collectible insurance. BLANKET WAIVER OF SUBROGATION We waive the right of recovery we may have for pay- ments made fc :r "bodily injury" or "property damage" on behalf of -ihe persons or orgarizazlons added as "insureds" ..fnder Section 11 -- Lli &1_17Y COVERAGE — A.I.D. BROAD FORM NAMED INSURED and AA.e. BLA14KET ADDITIONAL INSURED. PHYSICAL, I'.IAM A1'�E •— ii'r DDi "i"iiONAL TRANS - PORTAT60kk fPE k C( :J !'a`A 1.GF_ The first sentence cf paragraph AA. of SECTION III — PHYSICAW DAMAGE COw CLING . is amended as follows: We will pay up to $60 per day to a maxis „um of $1,500 for teri,:f ;orai,y ,�rartspc)rta..c =r expense Incurred by you because of i; -ic dotal ine i of a covered `auto” of the private passenger type. EXTRA EXPENSE —BROADENED COVERAGE Paragrapn A. — COVERAGE of SECTION Of — PHYSICAL DAMAGE COVERAGE is amended to add: 5. We will pay for the expense of returning a stolen covered "auto" to you. AIRBAG COVERAGE Under paragraph B. — EXCLUSIONS of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. NEW VEHICLE REPLACEMENT COST Under Paragraph C — LIMIT OF INSURANCE of Section III — PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: 2. An ad;ustment for depreciation and physical con- dition will be made in determining actual cash value in the event of a total loss. However, in the event of a total loss to your "new vehicle" to which this coverage applies, as shown in the declarations, we will pay et your option: a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- cluding any insurance or warranties pur- chased; b. 'The purchase price, as negotiated by us, of a new vehicle of the same make, model and equipment, not including any furnishings, parts ar equipment not installed by the manufacturer or manufacturer's dealership. if the same model is not available pay the purchase price of the most similar model available; 'age 2 of 6 c. The market value of your damaged vehicle, not including any furnishings, parts or equip- ment not installed by the manufacturer or manufacturer's dealership. This coverage applies only to a covered "auto" of the private passenger, light truck or medium truck types (20,000 Ibs or less gross vehicle weight) ar.d does not apply to initiation or set up costs associated with loans or leases. TWO OR MORE: DEDUCTIBLES Under SECTION I P _- PHY3Ir,i.1_ DAMAGE COV- ERAGE, if two) or more "comprn,," ;policies or cover- age forms app!y to the samr:, ,ac:1 lent, the following applies to par graph. D, Derfz' .`tihfr :: a. If "he - applirable Bu riness Auto deduct- ible is the sma'ler ;a:• smallest) deduct- Ole it will bewaived.7 or ice. l': the applicabla Business Auto d :duct - ibie is not tine orria.11er (or smallest) de- ductible it will be reduced by the amount of the smaller yor smallest) deductible; c. r c. ! the loRzs invnlv.,�.- , -vro or more Brrs}- ness /,uto coverage +orms or policies t'le sm a;ler (cr sm- rlest) deductible will be waived. For $r e ,.urpose of this endorsement "comt ?e.ny" means: . �:rrfeco Insuran e Company of America b. taa;terican Staie:a it „urance Company e. :'ornoany of America d. American Econcamy Insurance Company it 3t i , siona Frr.:,r. ,•rarjce Company of I�n,eric�:a f. oxneri<:an Stmes Insurance Company of i'e xas R. , ,niericzn `hates preferred Insurance t ".ampany h. Snfeco Insurance C �mpany of Illinois LOAN /LER.S! :; r rAts J!ORrEI ;'h,t`I:' Under paragr,:aoh f:. — LW 'T INSURANCE.' of SECTION 'If .._ I'IrM,. 1CAL 0,11' V: F COVERAGE, the followino i{ a. Actual cash value of the damaged or stolen property as of the time of the "loss", less an adjustment for depreciation and physical condition; or b. Balance due under the terms of the loan or lease that the damaged covered "auto” is subject to at the time of the "loss ", less any one or all of the following adjustments: (1) Overdue payment and financial penalties associated with those payments as of the date of the "loss". (2) Financial penalties imposed under a lease due to high mileage, exces- sive use or abnormal wear and tear. (3) Costs for extended warranties, Cre- dit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or -lease. (4) Transfer or rollover balances from previous loans or leases. (5) Final payment due under a "Balloon Loan ". (3) The dollar amount of any urrrepaired damage that occurred prior to the "total loss" of a covered "auto ". (7) Security deposits not refunded by a lessor. (8) All refunds payable or paid to you as a result of the early termination of a lease agreement or any war - *anty or extended service agree- ment on a covered "auto ". (1 Any amount representing taxes. (10) Loan or lease termination fees GLASS REPAIR -• WAIVER OF DEDUCTIBLE Under paragraph D,. — DEDUCTIBLE of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. AMENDED 01UT'FS IN THE EVENT OF ACCI- DENT, CLAIMI, SUIT OR LOSS 4. The mos. viz; pay a ccta$ "loss" in arty one The requirement in LOSS CONDITION 2.a. — "accident" !s tho greatr r of the following, subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a $'1,500 ma:,Jrnurn limi ?: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONa,rias that you must notify us of an CA 71 10 03 07 Page 3 of 6 EP "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, it you are a partnership; or (3) An execu ik�'e officer or insurance manager, if you are a corporation,. UNINTENTIONAL FAILURE T'O DISCLOSE HAZARDS SECTION IV ,... BU :!.�'I d'ESS AUTO CONDITIONS — B.2. is amenced by the addition of the following,: if you unintert'cnallyr trill to disclose any hazards ex- isting at the inception date ai yoi.r policy, we will not deny covsrate ..ind,Sr iris Cc, eii,.p-, Form because of such failure. 1=owever, this provision does not affect our right to coliect add,dona5 pror,ilurn or exercise, our right of eancelrai:ion Dr hon- renewal. HIRED AU1C,a LIVIiTE'D tr'14'6:3RLD WIDE COVER- AGE Under Secdon i`rl _... li usine.Ss i ,oaltions, Paragraph 121.7.b.e(1) is replaced ny the foilowing: 11' T3 in "arc i *.'eni" or "loss" results from ''h? wie of as, 'auto" hired for u!' di':ys o" :P�,r RESULTANT 51EWTAL AR'QUIFl11-1 COVERAGE* SECTION V - -- DEFINITIONS — C. is replaced by the following- - "Bodily injury'' means bodily injury, sickness or dis- ease sustah -wA ;,y r incl ..!'ng mental anguish or death re :.0 :`!A frc;n ant HIRED AUTO; P'HY:`,ACA COVERA.IAE If hired are ucove,'eu for Liability cov- erage and if Comprehensive, S.uecified Causes of Loss or Guihi Jut, cc,vufages iir,�i p.ruvided under this Coverage FcNT; for any "aijtc" you own, then the Physical Darr;age Govarages provided are extended to "autos' you ;'lire borrov.. The most we will par+ for ions a) any hired "au- €o" is $50,000 o, Ac;l'ual s " 'ash, c,r Cost of Repair, whichever is snialle.si, minus iii ui,ductible, The de- ductible will br eaua .l to the larpe A deductible appli- cable 'to any ovoipd '-a.uiu' of ';11c private passenger or light truck t,rpe for that. coverage. Hired Auto Phy- sical Damage coverage is exce:a , over any other col- lectible irisur,ioce. "Surfed "< c`�e above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. HIRED AUTO PHYSICAL DAMAGE COVERAGE — LOSS OF USE SECTION 111 --- PHYSICAL DAMAGE AA.b. Form does not apply. Subject to a maximum of $1,000 per accident, we will cover loss of use of a hired "auto" if it results from an accident, you are legally liable and the lessor in- curs an actual financial loss. RENTAL REIi1 BURSEMENT COVERAGE A. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" be- cause of a covered "foss" to a covered "auto ". Payment applies in addition to the otherwise ap- plicable amount of each coverage you have on a covered "auto ". No deductibles apply to this coverage. B. We will pay only for those expenses incurred during this policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: 1. The number of days reasonably required to repair or replace the covered "auto ". If `loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. 2. 30 days. C. Our payment is lir,,,ited to the lesser of the fol- €owing arnourits: 1. Necessary and actual expenses incurred. 2. 850 per day. D. This coverage does not apply while there are spare or reserve "autos" availableto you for your operations. E. If `Tess" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reirni: ursemert expenses which is not al- ready provided for under the PHYSICAL DAM- AGE COVERAGE Coverage Extension. F. The Pental Reimbursement Coverage described above does riot apply to a covered "auto" that is described or designated as a covered "auto" on Page 4 of 6 Rental Ri )lmbursement Coverage Form CA 99 2i. AUDIO, VISUAL AND Dial "A: ELECTRONIC, EQUIPiVIENT COVEW GE A. Coverage 1. We wrl!i pay with res act to a covered "auto" for "lciss" to any electronic equipment that receiv -as or transmits au,clio, visual or data signals and that is not designed solely for the reproduction of soun'::I. °f'r.ls coverage applies only it t re pi.-j ipment is parmanently installed in th,. ., cow. :irE cl "a.uto" a' the time of the 'loss' or the equipment is removable from a housing unit which is permanently installed in thF ,overed "auto'' :a': the time o't the "loss", and such equipment is designed to he solely operated by use of the power from the " uto's "' electrical sy.;tem, in or upon the oo-feio :l 'au o ". 2. rAfo vi,ll pair with respec, :n e covered "auto" for ", ss" t0, :.ny accew,50Mr s used with the electronic o.qulpme -° dn;^ ri`oed in parepraph l•YObVi::`JE:r, 11IYS, Gth:::; ri,:rt include tapes, re1;U;'d., or dis( ;s. 3. IP �,Y_jrit4. Vis,ial arc. DatR Electronic E.quip- rner! Coverage 'or?r. CA P9 60 or CA 99 94 is att ^c"ied to this policy, then the Audio, Vt- skrai and D.:ata Elect or;c 'Equipment Covr:r- r:ce aho +�. d.�E;s not apply. B. E�rcls :ie:. L'c The exclusions ihat apviy; io PHYSICAL DAM- AGE CONtrr=tAGE', excel)t ftr the exclusion relal- ing to l'.:tdio, s;suat ar'ct Data Electronic Equi %i,,u , aiso rr,)pl) i'., thus .-overage, In ac:c!,- tion, .; (,Iusions apply: We .viti 1, ;; parr f °:r cifh;.,. Fv i electronic :cluip- menL .., «c;�. 'r,rs; :: c :.,ad ,r!ir such cleC_- r :s: equi °irnn.. t *. that s 1. Npc4sE;sary for Vhe iorrr ,,;i operation of the cover -1rj "ruto`, f:r° the monitoring of, the system; or 2. a, lrnegreI part LA sarne: unit huusirrg un, sound reorodu:.in,;) equip'ri'ierA dtt ,3�gned b"Ie;ly or ,no ic3;arouucac.,r1 of sourid if iho "eu —,d reproducing f!% covrr -'d "?'OC": : rd b, ermanently installed in the opening of =' da:: ` c - rlorrna! "y us -d by the manufacturer for the installation of a radio. C. Limit of Insurance With respect to this coverage, the LIMIT OF IN- SURANCE provision of PHYSICAL DAMAGE COVERAGE:_ is replaced by the following: 1. The most we will pay for "loss" to audio, vi- sual or data electronic equipment and any accessories used with this equipment as a result of any one "accident" is the lesser of: a. The actual cash value of the damaged or stolen property as of the time of the 'Sloss "; or b. 7ne cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. 2. An adjusffirient for depreciation and physical condition will be made in determining actual cash value at the time of the "toss ". 3. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. D. Deductible 1. If to the audio, visual or data elec- trons,;; equipment ar accessories used with this eciuipment is the result of a 'loss" to the covereca "auto" under the Business Auto 3overage = orrn's Co riprehensive or Colli- .,ion .;overage, then for each covered "auto" our obligation to pay for, repair, return or re- place damaged or stolen property will be re- duced by the applicable deductible shown in the Declarations. Any Comprehensive Cov- erage deductible shown in the Declarations does -ot apply to "loss" to audio, visual or data electronic equipment caused by fire or hghtn,t g. 2. "less" to the audio, visual or data elec- -:roric; equipment or accessories used with "iris er!idpment is the result of a "loss" to the .ove;nn d "auto" under the Business Auto e overage f=orm's Specified Causes of Loss cnveragr:, thee for each covered "auto" our obligation to pay for, repair, return or replace € +ma',Y0 cir stolen property will be reduced kiy a $100 dedtrctlb s. 3. i; `lu�.c °' occurs solely to the audio, visual or data, 'rtecrronic equipment or accessories used uvi�h this equipment; then for each cov- -re:f "ryut'r" i,r r et�Iig ?ticn to pay for, repair, CA 71 10 03 07 Page 5 of 6 EP return or replace damaged or stolen property SECTION V -- DEFINITIONS is amended by adding %till be reduced by a :$1XJ deductible. the following: 4. In the event that there i-l. more than one ap- plicab!e deductible, t)nly `he highest deduct- ible will apply. in no avx ?r;i ojill nnore than one dedur: tittle apply. Page 6 of 6 0. "Personal effects" means your tangible properly that is worn or carried by you, ex- cept for tools, jewelry, money, or securities. R. "New vehicle" means any "auto" of which you are the original owner and the "auto" has ral been previously titled and is less than 365 days past the purchase date. Washington State Department of Labor and Industries Department of Labor and Industries Employer Liability Certificate Employer Lbability Certificate Date: 08/26/2013 UBI #: 60= 082 4-_15 Legal Business Name: SPOKANE ROCK PRODUCTS INC Account #: 133,446 -07 'Doing Business As' Name: SPOKANE ROCK PRODUCTS INC Estimated Workers Repoiied: Quarter 2 of Year 200 3 " Greater than 100 Workers' (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and pai,:! their premiums. L tensed Contractor? License: Expire Date: 'Yes SPOKARP990BH 2/1/'2014 Account Representative: T8 / DALE MCMASTER (360)902 -5617 -Email: '1.1C.PJS235 @lni wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the cumber of full time position requiring at least 480 hours of work per calendar quarter. A single 430 hour position may be filled by one person, or several part time workers. Industrial Insurance Informiition Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). • • • CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:37nm PO)1 •• ■■d QR/-1•- DATE{.AM/DDlTTTT) IJ CERTIFICATE OF LIABILITY INSURANCE 1/2/2014 ■•�NI CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ■ ■ RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES •*j LOW. 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 •NT'c Jacqueline Hernandez, ACSR NAME, Conover Insurance ZONE (509)595-3800 /AC ,,,,,..—(-5-0-97.5.--I 7-7950 1804 West T.ewis Street EMAIL tIS INSURER(S)AFFORDING COVERAGE 1 NAIC of Pasco WA 99301 INsuRERA mez .Can States Insurance Co. 19704 INSURED INSURERB-AlttriCan Guarantee & Liab Ins 126247 Spokane Rock Products Inc. INSuReRC:Houston Casualty Company k2374 P.O. Box 3808 menu),Great American Insurance Co 6691 INSURER E:Zurich American Insurance Co [1 6535 . 00kane WA 99220 leave RF: I, COVERAGES CERTIFICATE NUMBER:2014-2015 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 vVHICH 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. (NSR ADUL SU•K POLICY EFF POLICY EXP TR TYPE OF INSURANCE , , ,a . P.LICY N M: L MIDorrrry M/DD/YYYY LIMITS GENERAL LIABILITY 1,000 000 EACH OCCURRENCE $ � � X COMMERCIAL GENERAL LIASIL ITY DAMAGE TI RENTED 200 000 PR6M($ES Ea gge ren,e) $ r A I CLAIMS-MADE © OCCUR 01CI74054110 1/1/2014 1/1/2015 MED EXP(Any one person) _$ 10,000 X Contractual PERSONAL&A,OV INJURY ,$ 1,000,000 X Includes X, C, U GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY 1�1 jF T I I LOC $ AUTOMOBILE LIABILITY iE1NED MI ' EUT ) $ 1,00Q,900 pp A-, X ANY AUTO BODILY INJURY(Por peron) $ ALL OWNED -SCHEDULED J P378494000 1/1/2014 1/1/2015 BODILY INJURY(Per Sodden() S AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ �^ AUTOS (Per occident) S UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAB CLAIMS-MADE AGGREGATE t 4,000,000 DED I 1RPTENTI0N$ R14YC5029500 1/1/2014 1/1/2015 $ A wORKERS COMPENSATION X1=7-1M1-41 IOTH- AND EMPLOYERS'LIABILITY �,/N ER / ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I I N/A (Mandatory In NH) 01CI74054110 1/1/2014 1/1/2015 E.),DISEASE-EA EMPLOYEE $ 1,000,000 If yeo describe undsr DESI P.IPTI•NI OF OPERATIONS belcw STOP GAP E.L.DISEASE-POLICY LIMIT $ 1 000 000 A CONTRACTORS POLLUTION 01C174054110 1/1/2014 1/1/2015 Limn 1,000,000 DESCRIPTION op OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is IequIred) Company A, Excess Liability, Policy #TUE066081300, 1/1/2014 to 1/1/2015, $5,000,000- Company E: Multi-State Workers Compensat,i,or1./Employers Liability, Policy #WC932718001, 1/1/2014 to 1/1/2015, $1,000,000. Rel'Carnahan, Indiana & Sprague Street Preservation Project #0180 Phase 3 - 2013 Street Preservation Program SVPW'.Contract 13-035. City of Spokane Valley is additional insured. If required by written agreement; Business Auto additional insured applies per attached blanket Form #UCA424EC+7 (04-11) . Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87, Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09. Per-Project Aq per Form #CG 25 CERTIFICATE HOLDER CANCELLATION (509)921-1008 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 Ave Suite 106 AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99206 / J Hernandez, ACSR/JAC y u - � ACORD 25(2010/05) 41988-2010 ACORD CORPORATION, AU rights reserver(. II4C-110 /•manes n. T1... Anne,,-,-........a I--- --------*.......a•••■ ••••••■■••• ,C An"SOfl Cain-157 CONOVER INSURANCE Fax:509-547-7960 Jan 3 201d 01:38pm P002/018 COMMENTS/REMARKS 03 05 09. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. I CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:38pm PO 3/018 �.E Liberty GENERAL U�ABILITY �'Northwest. CG 2 03 5 W 05 OS POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY, DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED Information required to complete this Schedule, if not shown above. will be shown in the Declarations. A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section I — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acct- Aggregate Limit shown in the Declarations dents under Section 1 —Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply_ However, instead of being Aggregate limit shown in the Declarations_ subject to the General Aggregate Limit shown in the Declarations, such limits will be 2 The Designated Construction Project Gen subject to the applicable Designated Con- struction Aggregate Limit is the most we will pay struction Project General Aggregate Limit, for the sum of all damages under Coverage A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or "property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section I — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number ot: dents under Section 1 -- Coverage C, which a. Insureds; cannot be attributed only to ongoing operations b, Claims made or "stits" brought; or at a single designated construction project shown Ears 9 in the Schedule above: c, Persons or organizations making claims 1. Any payments made under Coverage A for or bringing 'suits', damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and 4)Insurance Services Office,Inc., 2008 9QINC",y,d Iho 3aimo hero roe Ae'a¢and tr.dim..b d salemoorporattors CG2so305oe Paps oft EP c.nol_ORInTO -Ig 15-Y CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:38pm P004/018 2. Such payments shall not reduce any Des;g- Aggregate limit nor the Designated Construction Rated Construction Project General Aggro- Project General Aggregate Limit. gate Limit. 0. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned, delayed, or abandoned and ~products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints. designs, 'bodily injury' or "propery damage" included in specifications or timetables, the project will stilt the 'products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General 6, The provisions of Section ICI — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Pace 2ot2 d1G.3]4'1QTDQi-7234..m DT CONOVER INSURANCE Fax:509-5d7-7960 Jan 3 201d 01:38pm P005/018 Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Dete of End. Producer No. Add'I.Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Liability Coverage: The following are also "insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts • performed within the scope of employment by you. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs a. and b. above, d. Any person(s) or organization(s) where required by written contract or written agreement executed prior to any "accident" provided the "accident"arises out of operations contemplated by such contract or agreement. 2. The following is added to the Other Insurance Provision in the Conditions Section: Coverage for any person(s) or organization(s) where required by written contract or written agreement executed prior to any "accident" will apply on a primary basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the coverage form, B. Amendment—Supplementary Payments Paragraphs a.(2)and a_(4) of the Coverage Extensions Provision in Section II—Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the"insured"at our request, including actual loss of earnings up to$500 a day because of time off from work. C_ Fellow Employee Coverage The Fellow Employee Exclusion contained in Section ll—Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II—Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. U-CA-424-E CW(04-11) Page 1 of 5 InnblAne nnn..rinhtcv4 ■pt.nni of Inenronrm RnnAroe rlffie. 1.... ..ath ify nomiiq¢inn CONOVER INSURANCE Fax;509-547-7960 Jan 3 2014 01:38pm P006/018 2_ The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b, in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss"to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. Any amount paid under the Physical Damage Coverage Section of the coverage form; and b. Any: (1) Overdue lease or loan payments at the time of the"loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous leases or loans. F. Towing and Labor The following is added to Paragraph A.2. of the Physical Damage Coverage Section: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible will be $100 or the deductible shown in the Declarations, whichever is less. If glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Loss Of Use Expenses Provision of the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered"auto". However, the most we will pay for any expenses for loss of use is$100 per day, to a maximum of$3000. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to $750 for"loss"to personal effects which are: (1) Personal property owned by an "insured'; and u-CA-424-E CW(04-11) Page 2 of 5 In,Ii,tl c r■nvriniood moMOrizi.4 Ina.Irpnno ConrinoG I-Wing, Ines .p.i+I itQ nomni¢Qinn CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:38pm P007/018 (2) In or on a covered "auto". b. Subject to Paragraph a_above, the amount to be paid for"loss"to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value, c. The coverage provided in Paragraphs a_ and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for"loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. ('5) Tapes, records, discs or other similar devices used with audio,visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same"loss". J. Tapes, Records and Discs Coverage t_ The Exclusion in Paragraph B.4_a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form do not apply. 2. The following is added to Paragraph 1.a_ Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment, We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". K. Airbag Coverage The Exclusion in Paragraph B.3.a_ of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form do not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or coverage form and by another policy or coverage form issued to you by us, the following applies for each covered "auto"on a per vehicle basis: 1. If the deductible on this policy or coverage form is the smaller(or smallest) deductible, it will be waived; or 2. If the deductible on this policy or coverage form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered "autos"damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all"loss" from any one cause is $5,000. U-CA-424-E CW(04-11) F age 3of5 Ir.nli.loc rnnurinhtorl m&ori.l ni Ingnrpn,- Co ryirpQ(fro Inr with itc ncirmicclnn CONOVER INSURANCE Fax:509-547-7960 Jan 3 201d 01:39pm P038/019 N. Temporary Substitute Autos— Physical Damage • 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos—Physical Damage If Physical Damage Coverage is provided by this coverage form on your owned covered "autos", the following types of vehicles are also covered "autos"for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered • "auto" you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3_ Servicing; 4. "Loss", or 5. Destruction. 2. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos—Physical Damage We will pay the owner for"loss"to the temporary substitute"auto" unless the"loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owners rights against any other party The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. O. Amended Duties In The Event Of Accident, Claim,Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a_ In the event of"accident", claim, "suit" or"loss", you must give us or our authorized representative prompt notice of the"accident", claim, "suit" or"loss". However, these duties only apply when the"accident", claim, "suit"or "loss" is known to you (if you are an individual), a partner(if you are a partnership), a member(if you are a limited liability company) or an executive officer or insurance manager(if you are a corporation). The failure of any agent, servant or employee of the"insured"to notify us of any "accident", claim, "suit"or"loss"shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the "accident"or"loss"occurred and if a claim is made or"suit" is brought, written notice of the claim or"suit" including, but not limited to, the date and details of such claim or"suit"; (2) The"insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit" or"loss"to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or"loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos— Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance--Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: U-CA-424-E CW(04-11) Page 4of5 Innlnr/ec rnn„rin Lte/materiel of(nm,ranra RPnIIrae(lfflrc Inr ,.dth'ft nnrrruscinn CONOVER INSURANCE Fax:509-517-7960 Jan 3 201d 01:39pm P039/018 (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee"or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official's duties as respect their obligations to you. However, any"auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this coverage form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this coverage form; or (2) Make an error, omission, improper description of"autos"or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph (5)(a) of the Policy Period, Coverage Territory Condition is replaced by the following: (a) A covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less; and T, Bodily injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. All other terms and conditions of this policy remain unchanged. U-CA-424-E CW(04-11) Page 5of5 Inrh'rlue rnnvrinhtorl material of Ine,ranr4 Rond•aa Cl rw Inr , h 1SR no rrtiaginn CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:39pm PO10/018 • • Liberty COMMERCIAL GENERAL LIABILITY North:rest. ---.—r•« CG 24 04 05 09 POLICY NUMBER! WAdVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART • SCHEDULE Name Of Person Or Organization; • ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8, Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of "your work^ done under a contract with that person Section IV — Conditions: or organization and included in the We waive any right of recovery we may have against "products completed operations hazard"_ This waiver applies only person or organization shown in the Schedule to the person or organzation shown in above because of payments we make for injury or the Schedule above. • a a • • _ 0 Insurance Services Office, Inc-,2008 Sate:*and the Sarcoo logo ate ro0ieiete4 tradermarim d F¢Icco Corpa¢ilan CG 24 04 05 09 EP C-AG31-PAtnrgot-%4.0Qrr4 CONOVER INSURANCE Fax:509-5d7-7960 Jan 3 201d 01:39pm P011/018 . Ipir Liberty COMMERCIAL GENERAL LIABILITY North3vest. CG 79 00 07 87 !ITC Mlltva.M�00..q • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • POLICY CHANGES • IL12011185 • . This endorsement modifies insurance provided under the following: • • COMMERCIAL GENERAL LIABILITY COVERAGE PART • LIQUOR LIABILITY COVERAGE PART . OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART • PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART . • PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) • 1. WHO IS AN INSURED - (SECTION 1) IS • AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION • THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, • BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY" , "PROPERTY DAMAGE" OR . "PERSONAL INJURY" ; AND • B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS OR OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES • NOT QUALIFY AS AN ADDITIONAL INSURED WITH RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS • OF SUCH PERSON OR ORGANIZATION. 2. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS LIMITED AS FOLLOWS: A. IN THE EVENT THAT THE LIMITS OF INSURANCE OF THIS COVERAGE PART SHOWN IN THE DECLARATIONS EXCEED THE LIMITS OF LIABILITY REQUIRED BY THE WRITTEN CONTRACT REQUIRING INSURANCE", THE INSURANCE PROVIDED TO THE • ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- MENT SHALL NOT INCREASE THE LIMITS OF INSUR- ANCE DESCRIBED IN SECTION III - LIMITS OF INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL = INSURED DOES NOT APPLY TO "BODILY INJURY" , . - "PROPERTY DAMAGE" OR "PERSONAL INJURY" . ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, ENGINEERING OR SURVEYING SERVICES, INCLUDING: i . THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, --- Copyright, Insurance Services Office,Inc., 1983 • CG 79 00 07 87 Page l of 2 [:P • • GAGitAftrNllui a 98�OWf-s' • CONOVER INSURANCE Fax:509-5d7-7960 Jan 3 201A 01;39pm P012/018 Page 2of2 CONOVER INSURANCE Fax;509-547-7960 Jan 3 201d 01:39pm P013/018 Vt-J Liberty COMMERCIAL GENERAL LIABILITY r North..- t. CG 79 00 07 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT3/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS,SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii . SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERA- TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES YOU TO .PROVIDE SUCH COVERAGE FOR THAT ADDITIONAL INSURED, AND THEN THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED APPLIES ONLY TO SUCH "BODILY INJURY" OR "PR.OPERTY DAMAGE" THAT OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS EXCESS OVER ANY VALID AND COLLECTIBLE "OTHER INSURANCE", WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, IF THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES THAT THIS INSURANCE APPLY ON A PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBU- TORY BASIS, THIS INSURANCE IS PRIMARY TO ' ,== "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL T"" INSURED WHICH COVERS THAT PERSON OR ORGANZZA- TION AS A NAMED INSURED FOR SUCH LOSS, AND BEE WE WILL NOT SHARE WITH THAT "OTHER INSURANCE" , BUT THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT STILL IS EXCESS OVER ANY VALID AND COLLECTI- BLE "OTHER INSURANCE", WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Pgg:t1a2 EP GA931 rgIM7001•{904.0:93' CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:40pm P014/018 • x Page 2o12 CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:40pm P015/018 Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: i . HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii . THE NAMES AND ADDRESSES OF ANY INJURED PERSONS AND WITNESSES; AND iii . THE NATURE AND LOCATION OF ANY INJURY OR DAMAGE ARISING OUT OF THE "OCCURRENCE" OR OFFENSE. B. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADDITIONAL INSURED, THE ADDITIONAL INSURED MUST: - i. IMMEDIATELY RECORD THE SPECIFICS OF THE CLAIM OR "SUIT" AND THE DATE RECEIVED; AND ii. NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE RECEIVE WRITTEN NOTICE OF THE CLAIM OR "SUIT" AS SOON AS PRACTICABLE. C. THE ADDITIONAL INSURED MUST IMMEDIATELY SEND US COPIES OF ALL LEGAL PAPERS RECEIVED IN CONNECTION WITH THE CLAIM OR "SUIT" , COOPERATE WITH US IN THE INVESTIGATION OR SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST ttt THE "SUIT", AND OTHERWISE COMPLY WIH ALL POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE • DEFENSE. AND INDEMNITY OF ANY CLAIM OR "SUIT" • TO ANY PROVIDER OF "OTHER INSURANCE" WHICH WOULD COVER THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, - THIS CONDITION DOES NOT AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER —. INSURANCE" AVAILABLE TO THE ADDITIONAL fag INSURED WHICH COVERS THAT PERSON OR ORGANIZA- • TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc., 1983 CG 79 0D 07 87 Page 1 or 2 EP r.A0.71-PRIniovuS14ne y CONOVER INSURANCE Fax:509-5d7-7960 Jan 3 2O1d O1:40pm P016/O18 Pap2or2 C-AG$1-PR IMP:Qt•f 904-003-Y CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:40pm P017/018 Y `,lribertl COMMERCIAL GENERAL LIABILITY - f fvortlx+�est. CG 78 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3. ABOVE_ 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS AND THE "PERSONAL INJURY" IS CAUSED BY AN OFFENSE COMMITTED: A. AFTER THE SIGNING AND EXECUTION OF THE CONTRACT OR AGREEMENT BY YOU; B. WHILE THAT PART OF THE CONTRACT OR AGREEMENT IS IN EFFECT; AND C. BEFORE THE END OF THE POLICY PERIOD. Copyright, Insurance Services Office, Inc., 1983 CG 79 0D 07 87 Paw 1 012 Ep CaC.31-PIW1TM49oww7-T CONOVER INSURANCE Fax:509-547-7960 Jan 3 201d 01:40Pm P018/018 x Page 2of2 CA65t-PAlNTQo1-1234:09t,Y ■ ■ ■ CONOVER INSURANCE Fax;509-547-7960 Jan 3 2014 01:53pm P001 i CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:53nm P0D2 COMMENTS/REMARKS Insured apply per attached blanket Form #CG 79 00 07 87_ Waiver of Subrogation applies per . attached blanket Form #CG 24 04 05 09. Per-Project Agg per Form *CG 25 03 05 09. • 4111ftOFREmAR.P COPYRIGHT 2000, AMS SERVICES INC. ■ IMMEMEMMEMb CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:53Pm P003 Liberty COMMERCiAL GENERAL L,IADILfTY Northwest. CG 25 03 05 09 POLICY NUMBER: THIS -ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) • GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project, "occurrences" under Section 1 — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section 1 —Coverage C,which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gie designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense corn limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations, subject to the General Aggregate Limit shown in the Declarations,such limits will be 2- The Designated Construction Project Gen- sub Q ppl' g Brat Aggregate Limit is the most we will pay Con- struction tProject General Aggregate Limit. for the sum of all damages under Coverage A, ,except damages because of 'bodily B. For all sums which the insured becomes legally injury" or `property damage" included In the obligated to pay as damages caused by "products-completed operations hazard", -occurrences" under Section 1 — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section 1 -- Coverage C, which a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown b. Claims made er "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1, Any payments made under Coverage A for or bringing 'suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and a Insurance Services Office.Inc.,2008 Salton nd,fle Woo°logo arc rcq!!.lzrcd unar mrlo of Ba1,9.0 Corygsi on CO 25 CO 05 09 Pam 1 of 2 EP Cal0-31-Pad Mfima gatmrsr CONOVER INSURANCE Fax:509-5d7-7960 Jan 3 201d 01:53pm POOd/018 2. Such payments that not reduce any Desig- Aggregate limit nor the Designated Construction Hated Construction Project General Aggro- Project General Aggregate Limit. gate Limit, D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned, delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, 'bodily injury" or `propery damage" included in specifications or timetables, the project will still the `'products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section Ili — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. • Paps 2of2 GAQ.31.PA1NTmpt-1 'O 1GT CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:53pm P035/018 Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I.Prem Return Pram. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured • 1. The following is added to the Who Is An Insured Provision in Section li—Liability Coverage: The following are also"insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs a. and b. above. d. Any person(s) or organizations) where required by written contract or written agreement executed prior to any "accident" provided the "accident"arises out of operations contemplated by such contract or agreement. 2. The following is added to the Other Insurance Provision in the Conditions Section: Coverage for any person(s) or organization(s) where required by written contract or written agreement executed prior to any "accident" will apply on a primary basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the coverage form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II—Liability Coverage are replaced by the following: (2) Up to$5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured"at our request, including actual loss of earnings up to$500 a day because of time off from work. C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II—Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. U-CA-424-E CAI(04-11) Page 1 of 5 Innlnrlsac rnn.rrinh/orl rnpt■ ripl of in4„rjnra Can,inoe(Win. Inn a i0,ita norrriaainn CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:53pm P006/018 2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto'', less: a_ Any amount paid under the Physical Damage Coverage Section of the coverage form; and b. Any: (1) Overdue lease or loan payments at the time of the"loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous leases or loans. F. Towing and Labor The following is added to Paragraph A.2. of the Physical Damage Coverage Section: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3_a.of the Physical Damage Coverage Section: If glass must be replaced, the deductible will be $100 or the deductible shown in the Declarations, whichever is less. If glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Loss Of Use Expenses Provision of the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto'; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of$3000. I, Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to$750 for"loss"to personal effects which are: (1) Personal property owned by an "insured'; and U-CA-424-E CW(04-11) Page 2 of 5 I n,- vloa^„nu•■ htc+.A materiel of Ins,vp n..o Corvi” (Win. Inn with ite nerwdeeinn CONOVER INSURANCE Fax:509-547-7960 Jan 3 201d 01:53pm P007/018 (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for"loss" to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for"loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same"loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B,A.a, of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2,c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form do not apply. 2. The following is added to Paragraph 1_a_ Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices; (a) Are the property of an"insured"; and (b) Are in a covered "auto"at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". K. Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV— Physical Damage Coverage in the Motor Carrier Coverage Form do not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section_. If an accident is covered both by this policy or coverage form and by another policy or coverage form issued to you by. us, the following applies for each covered "auto"on a per vehicle basis: 1_ If the deductible on this policy or coverage form is the smaller(or smallest) deductible, it will be waived; or 2_ If the deductible on this policy or coverage form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller(or smallest) deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss"from any one cause is$5,000, U-CA-424-E C W(04-11) Page 3 of 5 Inn„moo c mntariol oInarpnnea C lffina Inr •d11.ife n ...,iacinn CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:5dpm P038/018 N. Temporary Substitute Autos—Physical Damage 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos—Physical Damage If Physical Damage Coverage is provided by this coverage form on your owned covered "autos", the following types of vehicles are also covered "autos"for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its: 1_ Breakdown; 2. Repair; 3. Servicing; 4_ "Loss"; or 5. Destruction. 2. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos—Physical Damage We will pay the owner for"loss"to the temporary substitute "auto" unless the"loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. O. Amended Duties In The Event Of Accident, Claim,Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of"accident", claim, "suit"or"loss", you must give us or our authorized representative prompt notice of the"accident", claim, "suit' or"loss". However, these duties only apply when the"accident", claim, "suit" or "loss" is known to you Of you are an individual), a partner(if you are a partnership), a member(if you are a limited liability company) or an executive officer or insurance manager(if you are a corporation). The failure of any agent, servant or employee of the"insured"to notify us of any"accident", claim, "suit"or"loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the"accident"or"loss"occurred and if a claim is made or"suit" is brought,written notice of the claim or"suit"including, but not limited to, the date and details of such claim or"suit"; (2) The"insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit"or"loss"to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or"loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. O. Employee Hired Autos— Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered"autos"you own: U-CA-424-E CW(04-11) Page 4of5 Innl,d �n mirinhtor!mo+nriol.,F Inan.pnno.R 'i"..0()ffino Inn i..19,i,'o no...,igainn CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:54pm P0J9/018 (1) Any covered "auto"you lease, hire, rent or borrow; and (2) Any covered "auto' hired or rented under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's"employment by you or that elected or appointed official's duties as respect their obligations to you However, any "auto"that is leased, hired, rented or borrowed with a driver is not a covered"auto", R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this coverage form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this coverage form; or (2) Make an error, omission, improper description of"autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph (5)(a) of the Policy Period,Coverage Territory Condition is replaced by the following: (a) A covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less; and T. Bodily.Injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. All other terms and conditions of this policy remain unchanged. u-cA-24-E co/(04-11) Page 5 of 5 Inn6 vloq rnn...i.,hmrl material R■ rvirnq('frn Inn ,.,74h ifq normiggirn CONOVER INSURANCE Fax:509-5d7-7960 Jan 3 201d 01:5dpm P010/018 • Liberty COMMERCIAL GENERAL LIABILITY t5., N nh�.rse. CO2s040909 POLICY NUMBER: WAIVER OF TRANSFER OF RIGHTS OF • RECOVERY AGAINST OTHERS TO US This endorsement moNfles insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE • Name Of Parson Or Organization: ANY PERSON OR ORGANIZATION FOR WI-IOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. Information required to complete this Schedule, if not shown above,'wilt be shown In the Declarations. The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of your work' clone under a contract with that person Section IV — Conditions: or organization and included in the We waive any right of recovery we may have against °Products comflleted operations hazard^.This waiver the person or organization shown in the Schedule aPPlies only to the person or organization shown in above because of payments we make for injury or the Schedule above_ • 0 Insurance Services Office, inc.,2008 `3�1eco e"el Me=lege ma reOleteel teeeemn,im d Salcco Cerycvetla„ - CC 2a-04 Os 09 EP lift M.PRftlfiOi4m44:0714 CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:54pm P011/018 IJbcrty COMMERCIAL GENERAL LIABILITY N.o rtlmest. „a..,_.,,,,,,,,,� CO 7900 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • POLICY CHANGES IL 12 01 11 05 This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILU Y COVERAGE PART • OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART • PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED - (SECTION 1) IS • AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE” TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, BUT: . A. ONLY WITH RESPECT TO LIABILITY FOR . • "BODILY INJURY", "PROPERTY DAMAGE" OR . "PERSONAL INJURY"; AND B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS OR OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES • ' NOT QUALIFY AS AN ADDITIONAL INSURED WITH . RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS OP SUCH PERSON OR ORGANIZATION. • . 2. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS LIMITED AS FOLLOWS: .. ,1✓ A. IN THE EVENT THAT THE LIMITS OF INSURANCE OF THIS COVERAGE PART SHOWN IN THE DECLARATIONS EXCEED THE LIMITS OF LIABILITY • REQUIRED BY THE "WRITTEN CONTRACT REQUIRING INSURANCE", THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN • � . CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- ' MENT SHALL NOT INCREASE THE LIMITS OF INSUR- ANCE DESCRIBED IN SECTION III - LIMITS OF ' ~ .:� INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY", "PROPERTY DAMAGE" OR "PERSONAL INJURY" ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, .7.1=r, ENGINEERING OR SURVEYING SERVICES, INCLUDING: i . THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, . Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP C•AG.31frnN1w1.1919-0V-Y • • • CONOVER INSURANCE Fax;509-5d7-7960 Jan 3 201d 01:54pm PG13/018 • it..Liberty COMMERCIAL GENERAL LIABILITY • • f�' Nortl�wcst. CG 79 00 07 87 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. . POLICY CHANGES IL12011185 This endorsement modifies insurance provided under the following: . COMMERCIAL GENERAL LIABILITY COVERAGE PART • LIQUOR LIABILITY COVERAGE PART . OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART ' POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS,SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, . OR FAILING TO PREPARE OR APPROVE, DRAWINGS . . AND SPECIFICATIONS, AND ii . SUPERVISORY, INSPECTION, ARCHITECTURAL • . OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED. IN THE "PRODUCTS-COMPLETED OPERA- . • TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT • • REQUIRING INSURANCE" SPECIFICALLY REQUIRES • YOU TO PROVIDE SUCH COVERAGE FOR THAT ADDITIONAL INSURED, AND THEN THE INSURANCE • . PROVIDED TO THE ADDITIONAL INSURED APPLIES • ONLY TO SUCH "BODILY INJURY" OR "PROPERTY DAMAGE" THAT OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN . • CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE . POLICY PERIOD, WHICHEVER IS EARLIER. ' . 3. THE INSURANCE PROVIDED TO THE ADDITIONAL ' • INSURED BY THIS ENDORSEMENT IS EXCESS OVER E ANY VALID AND COLLECTIBLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR .ON ANY • OTHER BASIS, THAT IS AVAILABLE TO THE • ADDITIONAL INSURED FOR A LOSS WE COVER UNDER • THIS ENDORSEMENT. HOWEVER, IF THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES THAT THIS INSURANCE APPLY ON A s PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBU- TORY BASIS, THIS INSURANCE IS PRIMARY TO ' • .— "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL .. C INSURED WHICH COVERS THAT PERSON OR ORGANIZA- TION AS A NAMED INSURED FOR SUCH LOSS, AND WE WILL NOT SHARE WITH THAT "OTHER . . ME ' INSURANCE" . BUT THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT STILL IS EXCESS OVER ANY VALID AND COLLECTI- • • BLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, .. EM THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 CG 79000787 Paget of EP CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01:55pm P015/018 V:. Liberty COMMERCIAL GENERAL LIABILITY Northwest. CO 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS,SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: I . HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii . THE NAMES AND ADDRESSES OF ANY INJURED PERSONS AND WITNESSES; AND iii . THE NATURE AND LOCATION OF ANY INJURY OR DAMAGE ARISING OUT OF THE "OCCURRENCE" OR OFFENSE, R. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADDITIONAL INSURED, THE ADDITIONAL INSURED MUST: i . IMMEDIATELY RECORD THE SPECIFICS OF THE CLAIM OR ^SUIT" AND THE DATE RECEIVED; AND NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE r RECEIVE WRITTEN NOTICE OF THE CLAIM OR "SUIT" AS SOON AS PRACTICABLE. C. THE ADDITIONAL INSURED MUST IMMEDIATELY SEND US COPIES OF ALL LEGAL PAPERS RECEIVED IN CONNECTION WITH THE CLAIM OR "SUIT", COOPERATE WITH US IN THE INVESTIGATION OR SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST THE "SUIT", AND OTHERWISE COMPLY WIH ALL POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE u DEFENSE AND INDEMNITY OF ANY CLAIM OR "SUIT" • TO ANY PROVIDER OF "OTHER INSURANCE" WHICH WOULD COVER THE ADDITIONAL INSURED FOR A LOSS 'WE COVER UNDER THIS ENDORSEMENT. HOWEVER, THIS CONDITION DOES NOT AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL INSURED WHICH COVERS THAT PERSON OR ORGANIZA- T'ION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 or2 EP Ca(i31-P111/17071.10N-004s1 CONOVER INSURANCE Fax:509-547-7960 Jan 3 2014 01;55pm P017/018 ' N �� COMMERCIAL GENERAL LIABILITY CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3 . ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS AND THE "PERSONAL INJURY" IS CAUSED BY AN OFFENSE COMMITTED: A. AFTER THE SIGNING AND EXECUTION OF THE CONTRACT OR AGREEMENT BY YOU; BI WHILE THAT PART OF THE CONTRACT OR AGREEMENT IS IN EFFECT; AND C. BEFORE THE END OF THE POLICY PERIOD. Copyright, Insurance Services Office, Inc., 1983 0(3 79 00.07 87 Page 1 of 2 EP FAG$I?AINTf101.19344:67-Y t o(go • Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L------ 12/23/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jacqueline Hernandez, ACSR NAME: Conover Insurance PHONE.Fxtl: (509)545-3800 FAX No): (509)547-7960 1804 West Lewis Street E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Pasco WA 99301 INSURERA:Atnerican Economy Insurance Co 19690 INSURED INSURER B:American Guarantee & Liab Ins. 26247 Spokane Rock Products Inc. INSURER c:Houston Casualty Company 42374 P.O. Box 3808 INsuRERD:Great American Insurance Co 16691 INSURER E:Zurich American Insurance Co 16535 Spokane WA 99220 INSURERF: COVERAGES CERTIFICATE NUMBER:2015-2016 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 WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 200,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR X 01CI74054120 1/1/2015 1/1/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X FIE_ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED BAP378494001 1/1/2015 1/1/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ C UMBRELLA LIAR OCCUR H15XC50295-01 1/1/2015 1/1/2016 EACH OCCURRENCE $ 4,000,000 D X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ TUE066081301 1/1/2015 1/1/2016 2nd Layer Excess $ 5,000,000 E WORKERS COMPENSATION WC932718002 1/1/2015 1/1/2015 X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE MULTI STATE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A O1CI74054120 1/1/2015 1/1/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under WASHINGTON STOP GAP DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 A CONTRACTORS POLLUTION 01CI74054120 1/1/2015 1/1/2016 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Carnahan, Indiana & Sprague Street Preservation Project #0180 Phase 3 - 2013 Street Preservation Program SVPW Contract 13-035. City of Spokane Valley is additional insured. Business Auto additional insured applies per attached blanket Form #UCA424ECW (04-11) . Additonal Insured/Primary Additional Insured apply per attached blanket Form #CG 79 00 07 87. Waiver of Subrogation applies per attached blanket Form #CG 24 04 05 09. Per-Project Agg per Form #CG 25 03 05 09. CERTIFICATE HOLDER CANCELLATION (509)921-1008 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 Ave Suite 106 AUTHORIZED REPRESENTATIVE Spokane Valley, WA 99206 J Hernandez, ACSR/NATcd'Q.e-�Lam- -`-7'_' ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 19mnncl01 Tha ArnRrt Homo,.,4 Inn.,m.a retnicteirctri.,,,.4,e.,f Arnwn ( B—(57 Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Addl. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Liability Coverage: The following are also "insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs a. and b. above. d. Any person(s) or organization(s) where required by written contract or written agreement executed prior to any"accident" provided the"accident"arises out of operations contemplated by such contract or agreement. 2. The following is added to the Other Insurance Provision in the Conditions Section: Coverage for any person(s) or organization(s) where required by written contract or written agreement executed prior to any "accident" will apply on a primary basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the coverage form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4)of the Coverage Extensions Provision in Section II—Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the"insured"at our request, including actual loss of earnings up to $500 a day because of time off from work. C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II —Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. U-CA-424-E CW(04-11) Page 1 of 5 Inrli,rloc rnn„rinhtorl rn 4orinl of Inc,,ronro Con,iroc(lffiro Inn ,e,ith itc normiecinn 2. The following is added to Paragraph 2. in the Exclusions of Section Ill — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss"to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. Any amount paid under the Physical Damage Coverage Section of the coverage form; and b. Any: (1) Overdue lease or loan payments at the time of the"loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous leases or loans. F. Towing and Labor The following is added to Paragraph A.2. of the Physical Damage Coverage Section: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible will be $100 or the deductible shown in the Declarations, whichever is less. If glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Loss Of Use Expenses Provision of the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of$3000. I. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to$750 for"loss"to personal effects which are: (1) Personal property owned by an "insured"; and U-CA-424-E CW(04-11) Page 2 of 5 InrI,glee rnnarinhforf m,terinl of Inenranre Cen,irec(lffire Inr with ife nermiceinn • (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for"loss"to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same"loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form do not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". K. Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV— Physical Damage Coverage in the Motor Carrier Coverage Form do not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or coverage form and by another policy or coverage form issued to you by us, the following applies for each covered "auto" on a per vehicle basis: 1. If the deductible on this policy or coverage form is the smaller(or smallest) deductible, it will be waived; or 2. If the deductible on this policy or coverage form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller(or smallest) deductible. M. Physical Damage— Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered "autos"damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss" from any one cause is $5,000. U-CA-424-E CW(04-11) Page 3 of 5 Inn!,irdoe rnnvrinhtorl mofori*l of Incnronro Con,iroc(lffiro Inn ,,,ifh ife normiceinn N. Temporary Substitute Autos— Physical Damage 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos— Physical Damage If Physical Damage Coverage is provided by this coverage form on your owned covered "autos", the following types of vehicles are also covered "autos" for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. "Loss"; or 5. Destruction. 2. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos— Physical Damage We will pay the owner for"loss" to the temporary substitute "auto" unless the"loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. 0. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of"accident", claim, "suit" or"loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit"or"loss". However, these duties only apply when the"accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member(if you are a limited liability company) or an executive officer or insurance manager(if you are a corporation). The failure of any agent, servant or employee of the"insured"to notify us of any"accident", claim, "suit"or"loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the"accident" or"loss" occurred and if a claim is made or"suit" is brought, written notice of the claim or"suit" including, but not limited to, the date and details of such claim or"suit"; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit"or"loss"to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or"loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos—Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: U-CA-424-E CW(04-11) Page 4 of 5 InnI.,rlee nnnvrinhferl moforiol of Ine,,ronro Cen,ir>e flffino Inn with ife nc,rmiceinn • (1) Any covered"auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee"or elected or appointed official with your permission while being operated within the course and scope of that "employee's"employment by you or that elected or appointed official's duties as respect their obligations to you. However, any"auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this coverage form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this coverage form; or (2) Make an error, omission, improper description of"autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph (5)(a)of the Policy Period, Coverage Territory Condition is replaced by the following: (a) A covered"auto" is leased, hired, rented or borrowed for a period of 60 days or less; and T. Bodily Injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. All other terms and conditions of this policy remain unchanged. U-CA-424-E CW(04-11) Page 5 of 5 InrI vice rnn,rin hfoii motori,I of I nen ranre Cen,inoe(lffiro Inn waif itc narmice inn • �.` Liberty COMMERCIAL GENERAL LIABILITY r ' Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE BLANKET ADDITIONAL INSURED (CONTRACTORS) 1. WHO IS AN INSURED - (SECTION 1) IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A "WRITTEN CONTRACT REQUIRING INSURANCE" TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, BUT: A. ONLY WITH RESPECT TO LIABILITY FOR "BODILY INJURY" "PROPERTY PROPERTY DAMAGE" OR . "PERSONAL INJURY"; AND B. IF, AND ONLY TO THE EXTENT THAT, THE INJURY OR DAMAGE IS CAUSED BY ACTS OR OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE PERFORMANCE OF "YOUR WORK" TO WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" APPLIES. THE PERSON OR ORGANIZATION DOES NOT QUALIFY AS AN ADDITIONAL INSURED WITH RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS OF SUCH PERSON OR ORGANIZATION. 2. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS LIMITED AS FOLLOWS: A. IN THE EVENT THAT THE LIMITS OF INSURANCE OF THIS COVERAGE PART SHOWN IN THE DECLARATIONS EXCEED THE LIMITS OF LIABILITY REQUIRED BY THE "WRITTEN CONTRACT REQUIRING INSURANCE" , THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED SHALL BE LIMITED TO THE LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN CONTRACT REQUIRING INSURANCE" . THIS ENDORSE- ' = MENT SHALL NOT INCREASE THE LIMITS OF INSUR- nmm ANCE DESCRIBED IN SECTION III - LIMITS OF EEE INSURANCE. B. THE INSURANCE PROVIDED TO THE ADDITIONAL EEE INSURED DOES NOT APPLY TO "BODILY INJURY", igi "PROPERTY DAMAGE" OR "PERSONAL INJURY" ARISING OUT OF THE RENDERING OF, OR FAILURE TO RENDER, ANY PROFESSIONAL ARCHITECTURAL, = ENGINEERING OR SURVEYING SERVICES, INCLUDING: i . THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, MAPS, SHOP DRAWINGS, Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Page 1 of 2 EP c-nG-a1-PArnrWt a so4.o91-r x Page 2 of 2 C-AG-31-PRINT001.1904-0042-Y iN.f• Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL12011185 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS,SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR CHANGE ORDERS, OR THE PREPARING, APPROVING, OR FAILING TO PREPARE OR APPROVE, DRAWINGS AND SPECIFICATIONS; AND ii . SUPERVISORY, INSPECTION, ARCHITECTURAL OR ENGINEERING ACTIVITIES. C. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERA- TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES YOU TO PROVIDE SUCH COVERAGE FOR THAT ADDITIONAL INSURED, AND THEN THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED APPLIES ONLY TO SUCH "BODILY INJURY" OR "PROPERTY DAMAGE" THAT OCCURS BEFORE THE END OF THE PERIOD OF TIME FOR WHICH THE "WRITTEN CONTRACT REQUIRING INSURANCE" REQUIRES YOU TO PROVIDE SUCH COVERAGE OR THE END OF THE POLICY PERIOD, WHICHEVER IS EARLIER. 3. THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT IS EXCESS OVER ANY VALID AND COLLECTIBLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, THAT IS AVAILABLE TO THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, IF THE "WRITTEN CONTRACT REQUIRING INSURANCE" SPECIFICALLY REQUIRES THAT THIS INSURANCE APPLY ON A ▪ PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBU- TORY BASIS, THIS INSURANCE IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL M▪an INSURED WHICH COVERS THAT PERSON OR ORGANIZA- • TION AS A NAMED INSURED FOR SUCH LOSS, AND SEE WE WILL NOT SHARE WITH THAT "OTHER EEE INSURANCE" . BUT THE INSURANCE PROVIDED TO SEM THE ADDITIONAL INSURED BY THIS ENDORSEMENT mm-- STILL IS EXCESS OVER ANY VALID AND COLLECTI- ram ▪ BLE "OTHER INSURANCE" , WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY OTHER BASIS, ME THAT IS AVAILABLE TO THE ADDITIONAL INSURED WHEN THAT PERSON OR ORGANIZATION IS AN Copyright, Insurance Services Office, Inc., 1983 mmm CG 79 00 07 87 Page 1 of 2 EP C-AS31-PRINTt 1.1904.0093-Y Page 2 o12 CAC 31-PRI NT001-1904-0094-Y • %. ' Liberty COMMERCIAL GENERAL 79 00 LIABILITY 87 Northwest. 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE ADDITIONAL INSURED UNDER SUCH "OTHER INSURANCE" . 4. AS A CONDITION OF COVERAGE TO THE ADDITIONAL INSURED BY THIS ENDORSEMENT: A. THE ADDITIONAL INSURED MUST GIVE US WRITTEN NOTICE AS SOON AS PRACTICABLE OF A "OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH NOTICE SHOULD INCLUDE: i . HOW, WHEN AND WHERE THE "OCCURRENCE" OR OFFENSE TOOK PLACE; ii. THE NAMES AND ADDRESSES OF ANY INJURED PERSONS AND WITNESSES; AND iii . THE NATURE AND LOCATION OF ANY INJURY OR DAMAGE ARISING OUT OF THE "OCCURRENCE" • OR OFFENSE. B. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT AGAINST THE ADDITIONAL INSURED, THE ADDITIONAL INSURED MUST: i . IMMEDIATELY RECORD THE SPECIFICS OF THE CLAIM OR "SUIT" AND THE DATE RECEIVED; AND ii. NOTIFY US AS SOON AS PRACTICABLE. THE ADDITIONAL INSURED MUST SEE TO IT THAT WE RECEIVE WRITTEN NOTICE OF THE CLAIM OR "SUIT" AS SOON AS PRACTICABLE. C. THE ADDITIONAL INSURED MUST IMMEDIATELY SEND US COPIES OF ALL LEGAL PAPERS RECEIVED IN CONNECTION WITH THE CLAIM OR "SUIT" , COOPERATE WITH US IN THE INVESTIGATION OR SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST THE "SUIT" , AND OTHERWISE COMPLY WIH ALL ▪ POLICY CONDITIONS. D. THE ADDITIONAL INSURED MUST TENDER THE DEFENSE AND INDEMNITY OF ANY CLAIM OR "SUIT" • TO ANY PROVIDER OF "OTHER INSURANCE" WHICH BEE WOULD COVER THE ADDITIONAL INSURED FOR A LOSS WE COVER UNDER THIS ENDORSEMENT. HOWEVER, Mal THIS CONDITION DOES NOT AFFECT WHETHER THE INSURANCE PROVIDED TO THE ADDITIONAL INSURED ▪ BY THIS ENDORSEMENT IS PRIMARY TO "OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL mEm INSURED WHICH COVERS THAT PERSON OR ORGANIZA— TION AS A NAMED INSURED AS DESCRIBED IN Copyright, Insurance Services Office, Inc., 1983 CG 79 00 07 87 Paget of 2 EP C-A1 31-P R I NTOOt 4 9D4-W9F.Y Page 2of2 C-AC-31-PRINT0014904D09F Y L Liberty COMMERCIAL GENERAL LIABILITY I ' Northwest. • CG 79 00 07 87 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES IL 12 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE PARAGRAPH 3. ABOVE. 5. THE FOLLOWING DEFINITION IS ADDED TO SECTION V - DEFINITIONS: "WRITTEN CONTRACT REQUIRING INSURANCE" MEANS THAT PART OF ANY WRITTEN CONTRACT OR AGREE- MENT UNDER WHICH YOU ARE REQUIRED TO INCLUDE A PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED ON THIS COVERAGE PART, PROVIDED THAT THE "BODILY INJURY" AND "PROPERTY DAMAGE" OCCURS AND THE "PERSONAL INJURY" IS CAUSED BY AN OFFENSE COMMITTED: A. AFTER THE SIGNING AND EXECUTION OF THE CONTRACT OR AGREEMENT BY YOU; • B. WHILE THAT PART OF THE CONTRACT OR AGREEMENT IS IN EFFECT; AND C. BEFORE THE END OF THE POLICY PERIOD. mow IMENE Copyright, Insurance Services Office, Inc., 1983 CG790D0787 Page 1of2 EP C-AG31•PRIN7001-1904-0097-Y • • Page 2 of 2 C-AG-31-PRINT001.1904 B-Y • Wi•Liberty COMMERCIAL GENERAL LIABILITY NNorthrest CG 24 04 05 09 POLICY NUMBER: WARIER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO WAIVE RIGHTS OF RECOVERY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or Rights Of Recovery Against Others To Us of "your work" done under a contract with that person Section IV — Conditions: or organization and included in the "products-completed operations hazard". This waiver We waive any right of recovery we may have against applies only to the person or organization shown in the person or organization shown in the Schedule the Schedule above. above because of payments we make for injury or • a Insurance Services Office,Inc., 2008 Saleco and the Saleco logo are registered trademark of Sateco Carper at Ion CG 24 04 05 09 EP C AG-31•PRI NTW1-1904-0071.Y Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 25 03 05 09 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL PROJECTS OF THE NAMED INSURED UNLESS SPECIFICALLY EXCLUDED Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section I — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I —Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project • 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit 2. The Designated Construction Project shown in the Declarations, such limits will be Gen- eral Aggregate Limit is the most we will pay subject to the applicable Designated Con- for the sum of all damages under Coverage struction Project General Aggregate Limit. A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or `property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section I — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- 11.111.01116 C regardless of the number of: dents under Section I — Coverage C, which a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown MUM b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing "suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and Insurance Services Office,Inc., 2008 Safn o and the Sacco logo are registered trndnmarlo:of Sateco Corporation CG 25 03 05 08 Page 1 of 2 EP CiA^,St-PRI NT001-I 9114- T5-Y 2. Such payments shall not reduce any Desig- Aggregate Limit nor the Designated Construction nated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. if the applicable designated construction project C. When coverage for liability arising out of the has been abandoned, delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, "bodily injury" or "propery damage" included in specifications or timetables, the project will still the "products-completed operations hazard" will be deemed to be the same construction project. • reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. -The provisions of Section ttt — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2ot2 C•AG•31•PRIflNOl-I 9O4-007G-Y SUPERIOR COURT OF WASHINGTON FOR SPOKANE COUNTY In the Matter of: ADVERTISEMENT FOR BIDS No. City of Spokane Valley ) Public Works Department Bid # 13 -035 ) AFFIDAVIT OF PUBLISHING Phase 3 - 2013 Street Preservation NOTICE Program STATE OF WASHINGTON ) )ss. County of Spokane ) MICHAEL HUFFMAN . being first duly sworn on oath deposes and says that he is the EDTTOR . of The Spokane ValleyNews Herald, a weeklynewspaper. Thatsaidnewspaper is a legalnewspaper and itis nowandhas beenfox 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 Superior Court of the State of Washington in and for Spokane County. That the following is a true copy of a ubli ti as it was published in regular issues conunencing on the 2nd day of August, 2013 and ending the 9th dVf!A d us' ,and that stub ewspaper was regularly distributed to its subscribers during all of said peri ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY SU CRIBED and SW to before me PUBLIC WORKS DEPARTMENT BID # 13.035 this 9th day of August, 2013. CARNAHAN, INDIANA & SPRAGUE STREET PRESERVATION PROJECT e� 1' d r �' N State Of Washington PHASE ESER 3- 2013STREET 1e PRESERVATION PROGRAM 0 Notice is hereby that the Caryofgto- ka ^Pe YY. °y).`�e> County Of Spokane care Valley, Spokane County, Washington r �' m, will accept sealed bids for the Carnahan, . N EXPIRE Indiana and Sprague Street Preservation <0P y�o s •� Icertify that Iknow or have satisfactory evidence that Project. The projectconsists ofbituminous.o'S �" Michael Huffman is the person whoappeared before planning; hot mix asphalt paving and patch- ing: drywall and stormdrain construction; •� .� s Cj °me, and said person ac owledged at he signed sidewalk and curb construction; and other • o G -_this instrument and acknowledged it to be his free related work. f"° g Copies of the bid packet including specifi- ° , `�V •' (� and voluntary act for the uses and purposes men - cations and plans may be obtained in PDF ; Q 222 s format by downloading from the Spokane ,`h/ : tion m the Instillment. Valley FTP site. To obtain the FTP site • 6'•• r� password and to submita bid for this project, (��; • �• ••5•� PJ `�� Contractors must contact Darla Arnold,. ,..AA Spokane Valley Public Works, at 720 -5003 // '7 - MondayailatdhrFk&spfromlue 0l motto ®�� �,O 0' � `O`a fol a __Rae' Wentz 5:00 p.m. Contractors will then be placed Title: otary Public on the City's Planholder's list. Anyaddenda to this projectwill besent onlyto those listed My appointment expires: 5 -16 -15 on the Planholder's list. 1, All bids must be accompanied by a bid µ, �� 2c, deposit in the form of a surety bond, postal lY money order, cash, cashiers check, orcerti- fled check in an amount equal to five percent �� �S (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 2:00 P.m PSDT, Monday, August 19, 2013. Bid openings will be held immediatelytherealter and read aloud in the City 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 farina bid opening, or before the award and execution of the contract, unless the award is delayed for a period exceeding sixty (60) days. PUBLSH: Spokane August 2, and August 9.201 3 Christine Bainbridge, MIMIC Spokane Valley City Clerk 612, 3l9 ADVERTISEMENT FOR BIDS CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT BID # 13 -035 CARNAHAN, INDIANA & SPRAGUE STREET PRESERVATION PROJECT PHASE 3 - 2013 STREET PRESERVATION PROGRAM Notice is hereby given that the City of Spokane Valley, Spokane County, Washington will accept sealed bids for the Carnahan, Indiana and Sprague Street Preservation Project. The project consists of bituminous planning; hot mix asphalt paving and patching; drywell and stormdrain construction; sidewalk and curb construction; and other related work. Copies of the bid packet including specifications and plans may be obtained in PDF format by downloading from the Spokane Valley FTP site. To obtain the FTP site password and to submit a bid for this project, Contractors must contact Darla Arnold, Spokane Valley Public Works, at 720 -5003 or by email at darnold@sookanevalley.org Monday through Friday from 8:00 a.m, to 5:00 p.m. Contractors will then be placed on the City's Planholder's list. Any addenda to this project will be sent only to those listed on the Planholder's list. All bids must be accompanied by a bid deposit in the form of a surety bond, postal money order, cash, cashier's check, or certified check in an amount equal to five percent (5 %) of the amount of the bid proposed. Failure to furnish a bid bond in compliance with the City's bid deposit surety bond form shall make the bid non- responsive and cause the bid to be rejected. Bids must be submitted in sealed envelopes addressed to the City Clerk of the City of Spokane Valley, 11707 E. Sprague Avenue, Suite 106, Spokane Valley, Washington, 99206, and received not later than 2:00 p.m. PSOT, Monday, August 19, 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. PUBLISH: Spokane, August 2, and August 9, 2013 Christine Bainbridge, MMC Spokane Valley City Clerk SR26498 "'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. SR26498 No. Lines: Total Cost: $699.44 i 42365 82 Order No. 132283 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: August 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. �� L VINO 'O �",&VONF�q /� v0� TAR)( 9N NUBLtc �a No Public in and for the State of Washington, residing at Spokane County, Washington CFWAS�� f I,o Lb) Notary Stamp Paper Affidavits