HomeMy WebLinkAboutPK12-200 - Original - Valley Floor Company - Kent Municipal Court Entrance Mats - 7/11/12 9 t CF e S�
Records M ,a-nAgerne
WASH INOTON Document
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: Valley Floor Company
Vendor Number: 34626
JD Edwards Number
Contract Number:_& I a- zt)n
This Is assigned by City Clerk's Office
Project Name: Kent Municipal Court Project — Entrance Mats
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 07/11/12 Termination Date: 08/10/12
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Nancy Clary Department: Parks, Facilities Division
Detail: (i.e. address, location, parcel number, tax id, etc.):
Supply and Install Entrance Mats at Kent Municipal Court
S Publlc\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
00
KENT
WASHINGTON
PUBLIC WORKS AGREEMENT
between City of Kent and
Valley Floor Company
THIS AGREEMENT is made by and between the City of Kent, a Washington municipal
corporation (hereinafter the "City"), and Valley Floor Company organized under the laws of the
State of Washington, located and doing business at 25423 74th Ave S, Kent, WA 98032, 253-
852-7008, Greg Madsen (hereinafter the "Contractor").
AGREEMENT
The parties agree as follows:
I. DESCRIPTION OF WORK.
Contractor shall perform the following services for the City in accordance with the h
following described plans and/or specifications:
Supply and Install Entrance Mats at Kent Municipal Court located at 1220 Central
Ave South, Kent in accordance with Quote #16232 dated 06/06/2012 which is
attached as Exhibit A.
Contractor further represents that the services furnished under this Agreement will be
performed in accordance with generally accepted professional practices within the Puget Sound
region in effect at the time such services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks
described in Section I above immediately upon execution of this Agreement. Upon the effective
date of this Agreement, Contractor shall complete the work described in Section I [within 30
, days.
III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed
$4,098.59, including any applicable Washington State Sales Tax, for the work and services
contemplated in this Agreement. The City shall pay the Contractor the following amounts
according to the following schedule:
Progressive billing with final payment due alfter all paperwork is approved by the
State of Washington.
A. No Payment and Performance Bond. Because this contract is under $10,000,
the City has elected to waive both the performance/payment bond and
retainage requirements of Chapter 39.08 RCW.
B. Defective or Unauthorized Work. The City reserves its right to withhold
payment from Contractor for any defective or unauthorized work. Defective
or unauthorized work includes, without limitation: work and materials that
do not conform to the requirements of this Agreement; and extra work and
materials furnished without the City's written approval. If Contractor is
unable, for any reason, to satisfactorily complete any portion of the work, the
City may complete the work by contract or otherwise, and Contractor shall be
liable to the City for any additional costs incurred by the City. "Additional
costs" shall mean all reasonable costs, including legal costs and attorney
fees, incurred by the City beyond the maximum Contract price specified
above. The City further reserves its right to deduct the cost to complete the
Contract work, including any Additional Costs, from any and all amounts due
or to become due the Contractor.
C. Final Payment: Waiver of Claims. THE CONTRACTOR'S ACCEPTANCE OF
FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CONTRACTOR'S CLAIMS,
EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY
CONTRACTOR AS UNSETTLED AT THE TIME FINAL PAYMENT IS MADE AND
ACCEPTED.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement. By their execution of this
Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
A. The Contractor has the ability to control and direct the performance and
details of its work, the City being interested only in the results obtained
under this Agreement.
B. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
C. The Contractor has an established and independent business that is eligible
for a business deduction for federal income tax purposes that existed before
the City retained Contractor's services and is a service other than that
furnished by the City, or the Contractor is engaged in an independently
established trade, occupation, profession, or business of the same nature as
that involved under this Agreement.
D. The Contractor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Contractor has registered its business and established an account with
the state Department of Revenue and other state agencies as may be
required by Contractor's business, and has obtained a Unified Business
Identifier (UBI) number from the State of Washington.
F. The Contractor has a valid contractor registration pursuant to Ch. 18.27 RCW
or an electrical contractor license pursuant to Ch. 19.28 RCW.
G. The Contractor maintains a set of books dedicated to the expenses and
earnings of its business.
V. TERMINATION. The City may terminate this Agreement for good cause. "Good
cause" shall include, without limitation, any one or more of the following events:
A. The Contractor's refusal or failure to supply a sufficient number of properly
skilled workers or proper materials for completion of the Contract work.
B. The Contractor's failure to complete the work within the time specified in this
Agreement.
C. The Contractor's failure to make full and prompt payment to subcontractors
or for material or labor.
D. The Contractor's persistent disregard of federal, state or local laws, rules or
regulations.
E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt.
F. The Contractor's breach of any portion of this Agreement.
If the City terminates this Agreement for good cause, the Contractor shall not receive any
further money due under this Agreement until the Contract work is completed. After
termination, the City may take possession of all records and data within the Contractor's
possession pertaining to this project which may be used by the City without restriction.
VI. PREVAILING WAGES. Contractor shall file a "Statement of Intent to Pay
Prevailing Wages," with the State of Washington Department of Labor & Industries prior to
commencing the Contract work. Contractor shall pay prevailing wages in effect on the date the
bid is accepted or executed by Contractor, and comply with Chapter 39.12 of the Revised Code
of Washington, as well as any other applicable prevailing wage rate provisions. The latest
prevailing wage rate revision issued by the Department of Labor and Industries is attached.
VII. CHANGES. The Citymay issue a written change order for an change in the
Y 9 Y 9
Contract work during the performance of this Agreement. If the Contractor determines, for any
reason, that a change order is necessary, Contractor must submit a written change order
request to the person listed in the notice provision section of this Agreement, section XV(D),
within fourteen (14) calendar days of the date Contractor knew or should have known of the
facts and events giving rise to the requested change. If the City determines that the change
increases or decreases the Contractor's costs or time for performance, the City will make an
equitable adjustment. The City will attempt, in good faith, to reach agreement with the
Contractor on all equitable adjustments. However, if the parties are unable to agree, the City
will determine the equitable adjustment as it deems appropriate. The Contractor shall proceed
with the change order work upon receiving either a written change order from the City or an oral
order from the City before actually receiving the written change order. If the Contractor fails to
require a change order within the time specified in this paragraph, the Contractor waives its
right to make any claim or submit subsequent change order requests for that portion of the
contract work. If the Contractor disagrees with the equitable adjustment, the Contractor must
complete the change order work; however, the Contractor may elect to protest the adjustment
as provided in subsections A through E of Section VIII, Claims, below.
The Contractor accepts all requirements of a change order by: (1) endorsing it, (2)
writing a separate acceptance, or (3) not protesting in the way this section provides. A change
order that is accepted by Contractor as provided in this section shall constitute full payment and
final settlement of all claims for contract time and for direct, indirect and consequential costs,
including costs of delays related to any work, either covered or affected by the change.
VIII. CLAIMS. If the Contractor disagrees with anything required by a change order,
another written order, or an oral order from the City, including any direction, instruction,
interpretation, or determination by the City, the Contractor may file a claim as provided in this
section. The Contractor shall give written notice to the City of all claims within fourteen (14)
calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14)
calendar days of the date the Contractor knew or should have known of the facts or events
giving rise to the claim, whichever occurs first . Any claim for damages, additional payment for
any reason, or extension of time, whether under this Agreement or otherwise, shall be
conclusively deemed to have been waived by the Contractor unless a timely written claim is
made in strict accordance with the applicable provisions of this Agreement.
At a minimum, a Contractor's written claim shall include the information set forth in
subsections A, items 1 through 5 below.
FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM
WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY
CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS
SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY.
A. Notice of Claim. Provide a signed written notice of claim that provides the following
information:
1. The date of the Contractor's claim;
2. The nature and circumstances that caused the claim;
3. The provisions in this Agreement that support the claim;
4. The estimated dollar cost, if any, of the claimed work and how that
estimate was determined; and
5. An analysis of the progress schedule showing the schedule change or
disruption if the Contractor is asserting a schedule change or
disruption.
B. Records. The Contractor shall keep complete records of extra costs and time
incurred as a result of the asserted events giving rise to the claim. The City shall
have access to any of the Contractor's records needed for evaluating the protest.
The City will evaluate all claims, provided the procedures in this section are
followed. If the City determines that a claim is valid, the City will adjust payment
for work or time by an equitable adjustment. No adjustment will be made for an
invalid protest.
C. Contractor's Duty to Complete Protested Work. In spite of any claim, the
Contractor shall proceed promptly to provide the goods, materials and services
required by the City under this Agreement.
D. Failure to Protest Constitutes Waiver. By not protesting as this section provides,
the Contractor also waives any additional entitlement and accepts from the City any
written or oral order (including directions, instructions, interpretations, and
determination).
E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures
of this section, the Contractor completely waives any claims for protested work and
accepts from the City any written or oral order (including directions, instructions,
interpretations, and determination).
IX. LIMITATION OF ACTIONS. CONTRACTOR MUST, IN ANY EVENT, FILE ANY
LAWSUIT ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR
DAYS FROM THE DATE THE CONTRACT WORK IS COMPLETE OR CONTRACTOR'S ABILITY TO
FILE THAT CLAIM OR SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY
APPLICABLE STATUTORY LIMITATIONS PERIOD.
X. WARRANTY. Upon acceptance of the contract work, Contractor must provide the
City a one-year warranty bond in a form and amount acceptable to the City. The Contractor
shall correct all defects in workmanship and materials within one (1) year from the date of the
City's acceptance of the Contract work. In the event any parts are repaired or replaced, only
original replacement parts shall be used—rebuilt or used parts will not be acceptable. When
defects are corrected, the warranty for that portion of the work shall extend for one (1) year
from the date such correction is completed and accepted by the City. The Contractor shall begin
to correct any defects within seven (7) calendar days of its receipt of notice from the City of the
defect. If the Contractor does not accomplish the corrections within a reasonable time as
determined by the City, the City may complete the corrections and the Contractor shall pay all
costs incurred by the City in order to accomplish the correction.
XI. DISCRIMINATION. In the hiring of employees for the performance of work under
this Agreement or any sub-contract, the Contractor, its sub-contractors, or any person acting on
behalf of the Contractor or sub-contractor shall not, by reason of race, religion, color, sex, age,
sexual orientation, national origin, or the presence of any sensory, mental, or physical disability,
discriminate against any person who is qualified and available to perform the work to which the
employment relates.
Contractor shall execute the attached City of Kent Equal Employment Opportunity Policy
Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract
work, file the attached Compliance Statement.
XII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its
officers, officials, employees, agents and volunteers harmless from any and all claims, injuries,
damages, losses or suits, including all legal costs and attorney fees, arising out of or in
connection with the Contractor's performance of this Agreement, except for that portion of the
injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Contractor's work when completed shall not
be grounds to avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW
4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or
damages to property caused by or resulting from the concurrent negligence of the Contractor
and the City, its officers, officials, employees, agents and volunteers, the Contractor's liability
hereunder shall be only to the extent of the Contractor's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONTRACTOR'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY
NEGOTIATED THIS WAIVER.
In the event Contractor refuses tender of defense in any suit or any claim, if that tender
was made pursuant to this indemnification clause, and if that refusal is subsequently determined
by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the
Contractor's part, then Contractor shall pay all the City's costs for defense, including all
reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and
fees incurred because there was a wrongful refusal on the Contractor's part.
The provisions of this section shall survive the expiration or termination of this
Agreement.
XIII. INSURANCE. The Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and
incorporated by this reference.
XIV. WORK PERFORMED AT CONTRACTOR'S RISK. Contractor shall take all
necessary precautions and shall be responsible for the safety of its employees, agents, and
subcontractors in the performance of the contract work and shall utilize all protection necessary
for that purpose. All work shall be done at Contractor's own risk, and Contractor shall be
responsible for any loss of or damage to materials, tools, or other articles used or held for use in
connection with the work.
XV. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City
requires its contractors and consultants to use recycled and recyclable products whenever
practicable. A price preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of
any of the covenants and agreements contained in this Agreement, or to exercise any option
conferred by this Agreement in one or more instances shall not be construed to be a waiver or
relinquishment of those covenants, agreements or options, and the same shall be and remain in
full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by
and construed in accordance with the laws of the State of Washington. If the parties are unable
to settle any dispute, difference or claim arising from the parties' performance of this
Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by
filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court,
King County, Washington, unless the parties agree in writing to an alternative dispute resolution
process. In any claim or lawsuit for damages arising from the parties' performance of this
Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or
bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award
provided by law; provided, however, nothing in this paragraph shall be construed to limit the
City's right to indemnification under Section XII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the
parties at the addresses listed on the signature page of the Agreement, unless notified to the
contrary. Any written notice hereunder shall become effective three (3) business days after the
date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to
the addressee at the address stated in this Agreement or such other address as may be
hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written
consent of the non-assigning party shall be void. If the non-assigning party gives its consent to
any assignment, the terms of this Agreement shall continue in full force and effect and no
further assignment shall be made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of
the City and Contractor.
G. Entire Agreement. The written provisions and terms of this Agreement, together
with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or
other representative of the City, and such statements shall not be effective or be construed as
entering into or forming a part of or altering in any manner this Agreement. All of the above
documents are hereby made a part of this Agreement. However, should any language in any of
the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms
of this Agreement shall prevail.
H. Compliance with Laws. The Contractor agrees to comply with all federal, state, and
municipal laws, rules, and regulations that are now effective or in the future become applicable
to Contractor's business, equipment, and personnel engaged in operations covered by this
Agreement or accruing out of the performance of those operations.
ter
I. Counterparts. This Agreement may be executed in any number of counterparts,,
each of which shall constitute an original, and all of which will together constitute this one
Agreement.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
CONTRACTOR: CITY OF KENT:
By:/'//�X:a&A57/V By: WAZ'--�
(si natu ) (signature)
Print Name: Print Name: Alex Ackley
Its �r Its: Facilities Superintendent
title)
DATE: L0I72 1" DATE:
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
Greg Madsen Alex Ackley, Parks Facilities Superintendent
Valley Floor Company City of Kent
25423 74" Ave. S 220 Fourth Avenue South
Kent, WA 98032 Kent, WA 98032
253-852-7008 (telephone) (253) 856-5081 (telephone)
253-854-1293 (facsimile) (253) 856-6080 (facsimile)
Vatley F1w Cempsny_Courc
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this '2,gK day of �iOA-9 , 201Z
By: A!(J &2�
For: (t52
Title: L
Date: to/Z,0(�1/
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered into on
the (date), between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
Dated this day of 120
By:
For:
Title:
Date:
(iXial('�tT
VA LLE quote
Valley Floor Company, Inc. FLOOR
Quote#
259 ft.,23 74th Ave ., Kent,WA 98032 16232
P:253 �e#VAL�EFC16011. -129 G 0 M A hit Y Customer
Contract#
i : iFax ii �
1 Ship To:
'am—nicipareoult Date
Kent, City of REVISION Sa612012
les Person1
220 4th Ave S 1220 Central Ave South
Kent, WA 98032 Sal jGr
Madsen
ales Pers_on2
Kent WA r
,antity General Information Desenption Unit Cost Total
1 SECTION 12480 ENTRANCE MATS $3,743.00 $3,743.00
Walk off mats as specified C&A Abrasivre Action Modular
One Row of accent
�= Walk off mat to be installed floor level
Adhesives as specified by manufacture.
Rubber Base BY OTHERS
Inclues floor prep f removal of existing
Based on Prevailing Wages
Totals
Grand Total $3,743.00
Date Ck#
Deposit
it signature below Indicates that the above prices,specifications and condNlons of this Quote will constitute a legal contract that is satisfactory and hereby
opted You now authonze us to perform the work and provide the materials specified above This agreement is governed by the following conditions
A 50%deposit is required upon acceptance of all Quotes/Proposals,except upon approval of Valley Floor Company,Inc's credit application
Signed and dated disclosure form(attached) Valley Floor Company, Inc may send a Notice to Owner of hen rights when contracted to perform work by
none other than the property owner
Unless otherwise stated above,no provision has been made for
demolition, abatement or floor preparation,after hours labor, union labor,prevailing wages,lighting or heating, subfiaor or substrate testing or
sealing,product cleaning,polishing or sealing,floor protection,physical measurements,lifting product to multistory work locations,
furniture or appliance moving, Sales or Use Tax
Prices are valid for 60 days from the date of this proposal.
4,
ey Floor Company is a certified Women Owned Business with the State of Washington Our certification number is 1412F5109244
ar Date Seller Date
EXHIBIT B
INSURANCE REQUIREMENTS FOR
SERVICE CONTRACTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
may arise from or in connection with the performance of the work hereunder
by the Contractor, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-
owned, hired and leased vehicles. Coverage shall be written
on Insurance Services Office (ISO) form CA 00 01 or a
substitute form providing equivalent liability coverage. If
necessary, the policy shall be endorsed to provide
contractual liability coverage.
Commercial General Liability insurance shall be written on
ISO occurrence form CG 00 01 and shall cover liability
arising from premises, operations, independent contractors,
products-completed operations, personal injury and
advertising injury, and liability assumed under an insured
contract, The Commercial General Liability insurance shall be
endorsed to provide the Aggregate Per Project Endorsement
ISO form CG 25 03 11 85. The City shall be named as an
insured under the Contractor's Commercial General Liability
insurance policy with respect to the work performed for the
City using ISO additional insured endorsement CG 20 10 11
85 or a substitute endorsement providing equivalent
- � � coverage.
2. Workers' Compensation coverage as required by the
Industrial Insurance laws of the State of Washington.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$1,000,000 per accident.
2. Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $2,000,000
general aggregate and a $2,000,000 products-completed
operations aggregate limit.
EXHIBIT B {Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The Contractor's insurance coverage shall be primary insurance as respect
the City. Any Insurance, self-insurance, or insurance pool coverage
maintained by the City shall be excess of the Contractor's insurance and
shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage shall
not be cancelled by either party, except after thirty (30) days prior
written notice by certified mail, return receipt requested, has been given
to the City.
3. The City of Kent shall be named as an additional insured on all policies
(except Professional Liability) as respects work performed by or on behalf
of the contractor and a copy of the endorsement naming the City as
additional insured shall be attached to the Certificate of Insurance. The
City reserves the right to receive a certified copy of all required insurance
policies. The Contractor's Commercial General Liability insurance shall
also contain a clause stating that coverage shall apply separately to each
insured against whom claim is made or suit is brought, except with
respects to the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than A:VII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Contractor before commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or
shall furnish separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to all of the same insurance
requirements as stated herein for the Contractor.
t
AC"Ra CERTIFICATE OF LIABILITY INSURANCE °o ,2aiz°o1"Z
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(les)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)
PRODU7ER NON FACT RANDY MCLAGAN
-- - ----- ------ --
VIRGIL MCLAGAN COMPANY PHONE
Eal 253-862-3610 L� Nn) 253 862 3265
____
E-MAIL _ _
PO BOX 7950 ADDRESS RANDY@VIRGILMCLAGANCO COM
BONNEY LAKE, WA 98391 INSUREa(sArP.arnNGCOVERAGE NAICx_
__ INSURERA WESTERN NATIONAL ASSURANCE COMPANY '24465
INSURED INSURER B
VALLEY FLOOR COMPANY INC INSURER C -_______-
25423 74TH AVENUE SOUTH INSURER D
KENT,WA 98032 INSURER E____ _ ----------
INSURER F
COVERAGES CERTIFICATE NUMBER: 100592 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 OTHFR DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BF ISSUEF) 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS
-------- — - --
IN'aR HODL SUDR POLICY EFF i POLICY EXP LIMITS
L`R -HYPE GF INSURANCE ___ INSR �L`VD POLICY NUMBER jMMNOIYYYY) (MMIDD{YYVY)
A CPP 1054917 6/01/2012 06/01/2013
GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREri[SES(Ea occurrence) I$ _ 300,000
CA€MS MHDE X OCCUR I MED EXP An, person) S 10,000
— 1 -- Y one--P ) - -
X; VVA STOP GAP _ PERSONAL&aDV INJURY I$_......2 000,000
GENERAL AGGREGATE Is 2,000,000
_I
GE_N'L AGGREGA-_E LIMIT APPLIES PER PRODUCTS-CONPIOP AGG ;$ 2,000,000
POLICY X PECT RO LOG _ ___ __
AUTOMOEILELIABIUTY COMBINED SINGLE LIMI
$ _
A , GPP 1054115 �0610112012 0610112013(Ea accld-en;) 1,000,000
X ANY AUTO BODILY INJURY FPer person) $
ALL OWNED SCHEDULED AUTO DIED 1,000
AUTOS AUTOS BODILY INJURY(Per acodent) $
X HIREDAUTOS X NON-OWNED PROdEHT1DAMAGE $
AUTOS I (per acciderffi --
A ;X_ UMeRELLAL1Ae X_ occuR UMB 1008959 �0610112012 06/01/201 EACH OCCURRENCE a 3,000,000
EXCESSLIAa ;CLAIMS MADE AGGREGATE $
DE X RETENTION$10,000 _ _$_ ---
A
�ANDEMPLERS O EMPLOYERS
LIABTIONILITY
r— CPP 1054917 06101/2012'0610112013 X _To v LIMITS X�eR
AND EMPLOYER$ LIASILnY YIN
ANYoPOPPIEI OW11,,RTNERlEXECUTIVE I N 'NIA EL Ee CH ACCIDENT $ 1,000,000
FFICCR/MENIRER EXCLUDED?
( andatoryinNH) EMPLOYERS LIABILITY EL DISEASE-EA EMPLOYEE $ 1,000,000
If yes describe Linda'
DESCRIPTLON OF OPERATIONS beLow _ _ E L DSEASE-POLICY i IMIT s 1,000,000
A CPP 1054931 06/01/201206/01/2013 CONTRACTORS EQUIPMENT
COVERAGE$20,000 $500 00 DED-
DESCRIPTAN OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schadule,rf Mora space is required)
JOB NAME/NUMBER# KENT MUNICiPLE COURT
THE CITY OF KENT IS ADDITIONAL INSURED WITH RESPECTS TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED ATTACHED
CIS 20 33 10 01
CERTIFICATE HOLDER CANCELLATION
CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN-JIM-PLANNING DEPT ACCORDANCE WITH THE POLICY PROVISIONS
220 FOURTH AVE SOUTH
KENT,WA 98032 AUTHORIZED REPfjE$ENTATIVE
FAX (253)856-6200
`! O 1988-2010 ACORD CORPORATION, All rights reserved.
ACORD 25(2010ID5) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABUTY
CG 20 33 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILETY COVERAGE PART
A. Section 11 — Who Is An insured is amended to b. 'Bodily injury" or"property damage" occur-
include as an insured any person or organization ring after
for whom ycu are performing operations when you (1) All work, including materials, parts or
and such person or organization have agreed in equipment furnished in connection with
writing in a contract or agreement that such per- such work, on the project (other than
son or organization be added as an additional in- service, maintenance or repairs) to be
sured on yogi policy Such person or organization performed by or on behalf of the addi-
is an additional insured only with respect to liabil- tional insured(s) at the site of the cov-
ity ansing out of your ongoing operations per- ered operations has been completed;or
formed for that insured A person's or organiza-
tions status as an insured under this endorsement (2) That portion of"your work" out of which
ends when your operations for that insured are the injury or darnage arises has been
completed put to its intended use by any person or
B. With respect to the insurance afforded to these organization other than another con-
tractor or subcontractor engaged in
additional insureds, the following additional exclu- performing operanons for a principal as
sions apply a part of the same project
2. Exclusions
This insurance does not apply to.
a. "Bodily injury" "property damage" or "per-
sonal and advertising injury" arising out of
the rendering of, or the failure to render,
any professional architectural, engineering
or suiveyrng services, including-
(1) The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field
orders, change orders or drawings and
specificaucns, and
(2) Supervisory, inspection, architectural or
engineering activities,
COMMERCIAL GENERAL LIABILITY
WN GL 49 0109
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRICTION AGREEMENT WITH YOU
PRIMARY AND NONCONTRIBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section It — Who Is An Insured is amended to a. The preparing, approving, or failing to pre-
include as an additional insured any person or or- pare or approve, maps, shop drawings,
gar)zat.on for whcir you are performing operations opinions, reports, surreys, field orders
when you and sicn person or organization have charge orders or drawings and spectfca-
agreed in wnt,ng in a contract or agreement that tons,or
such person or organization be added as an addi-
tional insured on your policy Sucn person or or- b.
is ai,, additional Ensured only wi'h respect engineering activities
to l ability for "bodily injury" "property damage" or 2. "Bodily injury" or "property damage" occurring
"personal and advertising injury" caused, in whole after
or in part cy:
a. All work, including materials parts or equip-
1. Your acts or omissions,or ment furnished in connection with such
2. The acts or omissions of those acting on your work, on the project (other than service,
maintenance or repairs) to be performed by
behalf or on behalf of the additional insured(s) at
in the performance of your ongoing operations for the location of the covered operations has
the additional insured been completed,or
A person's or orgarizabon's status as an additional b. That porno-i of"your work" out of whicn the
Insured under this endorsement ends when your injury or damage arises has been put to its
operations for that additional insured are com- intended use by any person or organization
pleted other than another contractor or subcontrac-
E. The Limits of Insurance applicable to the additional for e,igaged in performing operations for a
insured are those soecrted in the written contract principal as a part of the same project
or written agreement or in the Declarations of this D. As respects the coverage provided under this en-
policy, whichever is less These Limits of Insur- dorsement, Paragraph 4.b. of the Other insurance
ance are inclusive of and not in addition to Limits Condition is deleted and replaced by the following
of Insurance snown in the Declarations
4, Other Insurance
C. With respect to the insurance afforded to these
additional insureds, the following additional exclu- b. Excess tnsuranca
sioris apply This insurance is excess over any other
This insurance does nor apply to insurance naming the additional insured as
an insured whether primary, excess, conbn-
1. "Soddy injury", "property damage" or "personal gent or on any other basis unless the written
and advertising injury"arising out of the render- contract cc agreement described in A.above
ing of or the `allure to render, any professional specifically requires that this insurance be
a,chtectural, eng:neenng or surveying services, provided on either a primary basis or a pri-
including, mary and noncontributory basis
WN GL 49 0109 Includes copunghted matenai of Insurance services Office Jim with its pemnssion Page 1 of 9 ❑
WNGL30 0310
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
The Commercial General Liaoility Enhancement Endorsement is an optional endorsement that provides coverage en-
hancements The following is a summary of broadened coverages provided by this endorsement No coverage is pro-
vided by this summary refer to following endorsement for cnanges in your policy
SUMMARY OF COVERAGES PAGE
Bodily Injury And Property Damage Liability
• Non Owned\Natercraft Up To 50 Feet .... . .......... . ....... . ............... ......... . .. .2
Property Damage Liability
• Elevators -_ 3
• Fire Lightning Explosion Or Sprinkler Leakage Exception 3
• Borrowed Equipmem(S25.000 Per Occurrence,$50,000 Aggregate
$2,500 Dedictible Per Occurrence -..-- . - - --3
Supplementary Payments-Amended
• twit Bonds Up To$5,000 . . .3
• Loss of Earnings Up To S500/Day ... ... _ 3
Who Is An Insured Amendments
Employee Bodily Injury To A Co-Employee. .. 4
• Newly Formed Or Acquired Organizations For Up To 180 Days ..4
• Blanket Additional Insured-Vendors-As Required By Contract .- 4
• Blanket Additional Insured-Lessor Of Leased Equipment_ 5
• B,arket Additional Insured-Managers Or Lessors Of Premises -. - 5
• Blanket Addition of Insu€eo-State Or Governmental Agency Or Subdivision
O,Political Su"�drnsion-Permits Or Authonzaffons . 5
+ Blanket Additional Insured-State Or Governmental Agency Or Subdivision
Or Political Subdivision-Permits Or Authorizations Relating To Premises
Damage To Premises Rented To You - $300,000 5
Medica' Payments increased Limit - $10,000 Or Amount Shown on Declarations...-.. 6
Conditions
• Knowledge of Accident, Claim,Suit Or Loss Amended .. -- 6
• Unintertiona!Failure To Disclose Hazards ..... 6
• Waiver of Subrogation . - - ..1.. 6
Bodily Injury Redefined To Include Mental Anguish.. 6
Insured Contract Amended . ... ..... ... ... .. .... ... . . .. ... ... .. . 6
Personal And Advertising Injury Redefined
+ Televised Videotaped Or Electronic Publication _ . ... . . - 6
WN OL 3P 0310 Inc odes copynghted material of Insurance Services Office with its permission Page R of 8
WN GL 39 03 10
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ} IT CAREFULLY
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
This encorsernent modifies the insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
btrith respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement
w,ii be amended as shown below
SECTION I-COVERAGES AMENDMENTS (9) 'Bodily injury" or "property damage" arising
COVERAGE A — BODILY INJURY AND PROPERTY out of
DAMAGE LIABILITY (a) The operation of machinery or equip-
ment that is attached to, or part of, a
A. Non Owned Aircraft Or Watercraft land vehicle that would qualify under the
Item 2. Exclusions,Paragraph g_is replaced by the definition of`mobile equipment"if it were
following not subject to a compulsory or inancial
g. Aircraft,Auto Or Watercraft respoasioility law or other motor vehicle
insurance law in the state where it is
'Boo(ly injury' or "property damage' arising out licensed or principally garaged or
Of L to ownership, maintenance, use or entrust-
m bhe operation of any of the machinery
eet to others of any aircraft, 'auto" or w ( ) The equipment listed to Paragraph f, (2)
cra; owned or owne or operatec by or rented or loaned or
to any insured Use includes operation and or f. (3) of the definition of 'mobile
"loading or.imcading` equipment'
This eYcluslon apol,es even if the claims against B. Damage To Property Coverage Extensions
any nsured a,lega negligence or other wrong- Item 2. Exclusions, Paragraph j. is replaced by the
doing In the supervision, hiring, employment, following
training or monror nc of others by that;risured if j Damage To Property
the 'occurrence'which caused the"bodily injury"
or property damage" involved in the ownership, Property damage"to:
maintenance use or entrustment to others of (1) Property you own, rent, or occupy, including
any aircraft,"auto'or watercraft that,s owned or any costs or expenses Incurred by you, or
cpera,ed by or rented or loaned to any insured any other person, organizattor or entity, for
Tnis exclusion does not apply to racial r, replacement, enhancement, resiora-
(2) Awatercraft white ashore on premises you tion or maintenance of such property for any
a Nn or rent reasar, including prevention of injury to a
person or damage to anther's property,
(2) A watercraft you do not own that is: (2) Premises you sell, give away or abandon, ff
(a) Less than 50 feet long, end the"property damage' arises out of any part
(b) Not being used to carry persons or prop- of those premises,
erty for a charge, (3) Property loaned to you,
This Subparagraph (2) applies to any per- (4) Personal property in the care, custody or
son who with, your expressed or implied control of the insured,
consent either uses or Is responsible for the (5) That particular oart of real property on which
use of the watercraft, you or any contractors or subcontractors
(3) Parkiog an'auto'on, or on the ways next to, working directly or indirectly on your behalf
premises you own or rent, provided the are performing operatons, if the "property
"auto'is not owned by or rented or loaned to damage"arises out of those operations, or
you or the insured, (6) That particular part of any prooerty that must
(4) Liabi ity assumed under any 'insured con- oe restored, repaired or replaced because
tract for the ownership, maintenance or use "your work"was incorrectly performed on it
Of aircraft or watercra=t,or
WN GL 39 0310 lnc€Ldes copyrighted material of Ins+aance Serv,ces Office,with its permission Page 2 of 6
WN GL 39 0310
Paragraphs (1) (3) and (4) of this exclusion do not C. Damage To Premises Rented To You
apply to property damage' (other than damage by Item 2 Exclusions, -,.ne last paragraph is replaced
fire, 3igntnlng, explosion or sprinkler leakage) to by the following
premises including ttte contents of such premises, Exclusions c. through n. do not apply to damage by
rented to you for a period of 7 or fewer consecuttve fire, lightning, explosion or sprinkler leakage to
days A separate iirr t of insurance applies to Dam-
age To Premises Rened To You as described in premises while rented to you or temporarily occupied
SECTION III —LIMITS OF INSURANCE However, by you with permission of the owner A separate
the provisions of this paragraph do not apply if cov- limit of insurance applies to this coverage as de-
erage for Damage To Premises Rented To You is scribed in Paragraph 6.of SECTION III—LIMITS OF
excluded by endorsement INSURANCE.
Paragraph (2)of this exclusion does not apply if the COVERAGE B — PERSONAL AND ADVERTISING
premises are "your wak and were never occupied, INJURY LIABILITY
rented or held for rentai by you D. Personal And Advertising Injury
Paragraphs(3)and(4)of this exclusion do not apply Item 2 Exclusions is amended by replacing Sub-
to the use of elevators. paragraphs b.and c.with the following
Paragraphs (3), (4) (5) and (g) of this exclusion do b. Material Published With Knowledge Of
not apply to liaority assumed under a sidetrack Falsity
agreement
of
Paragraph (4) of this exclusion does not apply to "Personal and advertising injury' arising out
oral, written, televised videotaped
d or electronic
'property; damage' to borrowed equipment while no, publication of material, if done by or at the direc-
being used to peror<m operations at the jobsite tion of the Ensured with knowledge of its falsittj_
Suoiect to Paragraph 2 of SECTION III — LIMITS
OF INSURANCE, ;he rules below ix the most we c. Material Published Prior To Policy Period
will pay far"property darnage"under this provision "Personal and advertising injury" arising out of
(1) $25,300 any one -occurrence', regardless of the oral, written, televised, videotaped or electronic
numoer or pe-sons or crganizat:ons wrio sustain publication of material whose first publication
darrages because o`that"occurrence", took place before the beginning of the policy pe-
(2) $50 000 annual aggregate, and nod
(3) We will pay on y for damages in excess of SUPPLEMENTARY PAYMENTS — COVERAGES A
$2 500 as a result of any cne "occurrence", re- AND B
garGless of the cumber of persons or organza- E. Supplementary Payments—Coverages A and B
tions who sustair damages because of that oc-
currence" Item is amended by replacing Subparagraphs b.
We may, or it required by law, pay all
or any par,of any deductible amount, d appiica- and d with the t1lowing
ble, io effect se:Iement of any clam or `suit" b. Up to $5,000 for cost of bail bonds required be-
Upcn notice of our payment of a deductible cause of accicents or traffic law violations ans-
amount, you shall promptly reimburse us for the trig out of the use of any vehicle to which the
part of the oeductible amourtwe paid Bodily Injury Liability Coverage applies We do
Paragraph (-5) of this exclusion does not apply to not have to furnish these bonds
'property damage" inducted in the "producrs-com- d. All reasonable expenses incurred by the insured
plated operations hazard" at our request to assist us in the investigation or
The insurance provided for"property damage"from defense of the claim or "suit . including actual
the use of elevators and for "property damage" to loss of earnings up to $500 a day oecause of
borrowed equipment is excess over any other valid time off from work
anc coilectio,e property insurance (including any de-
ductible portion thereof) available to the ,rsured
whether primary, excess, contingent or on any other
basis.
WN GL 39 03 10 tnadudes copynyhted material of insurance Services Office with its permission Page 3 of 6
WN GL 39 0310
SECTION 11—WHO IS AN INSURED AMENDMENTS d. Repackaging, except when unpacked solely
A Employee Bodily Injury Tc A Co-Employee for the purpose of inspection, demonstration,
testing, or the substitution of pars under in-
Paragraph 2. a.(1) is replaced by the following structions from the manufacturer, and then
(1) "Bodily injury" or "personal and advertising repackaged in the original container,
irlury" e. Any failure to make such inspections,adjust-
(a) To you, to you,partners or members (if you ments, tests or servicing as the vendor has
are a partnership or joint venture), to your agreed to make or normally undertakes to
members (.f you are a limited liability com- make in the usual course of business, in
pany), or :o your other "volunteer workers" connection with the distribution or sale of the
while per>orming auties related to the con- products
duct of your business U Demonstration, installation, servicing or re-
(b) For which there is any obligation to share pair operations, except such operations
damages with or repay someone else who performed at the vendor's premises in con-
must pay da—ages because of the injury nection with the sale of the product
described r.Paragraph(1)(a)above, or g. Prcoucts which, after distribution or sale by
(c) Arising out of his or her providing or failing to you, have been labeled or relabeled or used
provide professional health care services as a container, part or ingredient of any
B. newly Acquired Organizations other 'thing or substance by or for the ven-
dor or
Paregraph 3.a is replaced by the following h. "Bodily injury or "property damage' arising
a. Coverage under this provision is afforded only out of the sole negligence of the vendor for
until the 180 i cay after you acquire or form the its own acts or omissions or those of its em-
Organization or the end of the policy period, ployees or anyone else acting on its behalf
wniohever is earlier, However, this exclusion does iot apply to
The following are added. (1) The exceptions contained in Subpara-
C. Blanket Additional Insured — Vendors — As Re- graphs d.orf.; or
quired By Contract (2) Sucri inspections, adjustments, tests or
Section it —Who is An Insured is amended to in- servicing as the vendor has agreed to
cluce as an additional insured any perscn(s) or or- make or normally undertakes to make in
ganizat:on(s) {referred to below as vendor) with the usual course of business, in con-
whom you have agreed in a written contract, exe- nection with the distribution or sale of
cuted prior to loss, to name as an additional insured, the products
but only with respect to "boody injury" or "property 2 This Provision C.does not apply
oamage" arising out of "your products" which are a. To any insured person or organization from
distr;buted or said in the regular course of the ven- whom you have acquired such products, or
dor's business, subject to `.he following additional any ingredient, part or container, entering
exclusions into, accompanying or containing such
1. The insurance afforded the vendor does not ap- products,
ply to b. To ary vendor for which coverage as an
a. "Bodily iplury" or "property damage" for additional insured specifically is scheduled
which the vendor is obligated to pay dam- by endorsement,or
ages oy reason of the assuription of liability c. When liability included within the "products-
in a contract or ag eement This exclusion completed operations hazard" has been ex-
does not apply to habii,ry for damages that ciuded for such product either by the provi-
the vendor would have n the absence of the stuns of the coverage part or by endorse-
contract or ageement, ment
b. Any express warranty unauthorized by you;
c. Any physical or chemical criange in the
product made intentionally by the vendor,
WN GL 39 03 10 Includes copyrighted material of insurance Services Office with its perrms,on Page 4 of 6
WN GL 39 0310
D. Blanket Additional Insured - Lessor Of Leased 2 This insurance does not apply to
Equipment a. "Bodily injury", "property damage" or "per-
t. Section Ii-Who Is An Insured is amended to sonal and advertising injury" ansrng out of
include as an additional insured any person or operations performed for the federal govern-
organization frorr whom you lease equipment merit, state or municipality, or
when you and sucri person or organization have b. "Bodily injury" or "property damage" in-
agreed in writing in a contract or agreement, cluded within the "products-completed op-
execi.ted pno^ to loss, thai such person or or- erations hazard"
garizatior, be added as an additiona? insured on
your policy S,;ch person or organization ,s an G. Blanket Additional Insured - State Or
insured on:y wilt- respect to liability for "bodily Governmental Agency Or Subdivision Or Politi-
injury' "property damage" or "personal and ad- cal Subdivision -Permits Or Authorizations Re-
vert,sing injury" causer in whole or in part, by lating To Premises
yotr maintenance, operation or use of equip- Section If -Who is An Insured is amended to in-
ment leased to you by such person or organiza- crude as an insured any state or governmental
tion agency or subdivision or political subdivision with
A ,persons or orgarimation's status as an addi- whom you have agreed in a written contract, exe-
tienal insured under this endorsement ends cuted prior to loss, to name as an additional insured,
when ire.: contract or agreement with you for subject to the following provision:
such teased equipment ends This insurance apoiies only with respect to the foi-
l. V+lth respect to the insurance affordec to these lowing hazards for which the state or governmental
adcitionai insureds t ins insurance does not ap- agency or subdivision cr poPhcal subdivision has is-
ply to ary "accur-ence" which takes place after sped a permit or authorization in connection with
the equipment lease expires premises you own, rent or control and to which this
E. Blanket Additional Insured - Managers Or Les- insurance applies
sors Of Premises 1. The existence, maintenance, repair, construc-
Seetion If -Who Is An Insured is amended to in- tion, erection or removal of advertising signs
crude as an nsured any person or organza*ion with awnings, canopies. cellar entrances, coal holes,
whom you have agreed n a written contract, axe- driveways, manholes, marquees, hoist away
cuteu prior to!ess,to name as an addi;ccnal insured openings, sidewalk vaults, street banners or
but only with respect to liability arising out of the decorations and similar exposures,or
ownership, maintenance or use of that part of the 2. The construction, erecvcn or removal of eleva-
premises teased to you, subject to the following tors,or
additional exciussors 3. The ownership, maintenance or use of any ele-
This insurance does not apply to: vators covered by this insurance
1. Any "cccurrec ce" which takes place after you
cease to be a terart in that premises SECTION III - LIMITS OF INSURANCE AMEND-
2 Structural aiterat.ons, new construction or MENTS
demolition operations performed by or on behalf A. Damage To Premises Rented To You
of such additional irsured
Paragraph 6.is reciaced by the following,
P. Governmental
Blanket AdditionalrSuInsured - State are 6. Subject to Paragraph 5.above the most we will
cal Subdivision
Agency Or Subdivision on Polite- pay under Coverage A for damages because of
cal Subdivision-Permits Or Authorizations "property damage" to any one premises, while
Section It -Who is An Insured is amended to in- rented to you or in the case of damage by fire,
crude as an Ensured any state or governmental lightning, explosion or sprinkler leakage, while
agency or subdivision or political subdivision with rented to you or temporarily occupied by you
whom you have agreed in a written contract, exe- with permission of the owner is the greater of
cuter: prior to loss,to name as an additional insured, a. $300,000;are
subject to tree foilovnng provisions
1 Th,s insurance applies only with respect to op- b. The amount shown next to the Damage To
arat ors performer by you or on your oehalf for Premises Rented To You Limit in the Darla-
whic'n the state or govemmen:ai agency or sub- rations
division or politicai subdivisior has issued a However, the provisions of this paragraph do not
permit or authorization apply if Damage To Premises Rented To You
Coverage is excluded by endorsement
WN GL 39 03 10 includes eopwrghted mat:nai or Insurance Services Office,oath its permission Page 5 of 6
WN GL 39 0310
B. Medical Expense Limit b. If you unintentionally fail to disclose any haz-
ards 7 s replaced with the following: ards existing at the inception cate, of your
poky, we will not deny coverage under this
T. Subject to Paragraph 5 above the most we will Coverage Part because of such failure
pay under Coverage C for all medical expenses However, this provision does not affect our
because of"bod.ly injury' sustained by any one right to collect additional premium or exer-
person is the gi eater of we our right of cancellation or non-renewal
a. 510,000, or
b. The amount shown next to the Medical Ex-
penseD.Limit in the Declarations SECTION IV —COMMERCIAL GENERAL LIABIL-
This insurance does not apply if coverage for ITY CONDITIONS, 8. Transfer of Rights of Re-
Medical 'Expenses is excluded either by the pro- covery Against Others to Us is hereby amended
visions of the ocverage part or by endorsement by the addition of the following
We waive any right of recovery we may have be-
cause of payments we make for injury or damage
SECTION IV — COMMERCIAL GENERAL LIABILITY arising out of your ongoing operations or"your work"
CONDITIONS AMENDMENTS done under a written contract,executed prior to loss,
A. Knowledge Of Occurrence requiring such waiver vvith that person or organiza-
Item 2. Duties In The Event Of Occurrence, Of- ttcn and included in the"products-completed opera-
fense, Claim or Suit is amended by adding the'al- tions hazard" However, our rights may only be
warred prior to the "occurrence" giving rise to the
lowing injury or damage for which we make payment under
e. You must give us or our authorized representa- this Coverage Pal The insured must do nothing
tive prompt notice of an 'occurrence", claim or after a loss to impair our rights At our request, the
loss only when the"occurrence", claim or loss is insured will bring "suit" or transfer those rights to us
known to and help us enforce those rights
(1) You, if you are an individual,
(2) A partner, if you are a partnership, SECTION V—DEFINITIONS AMENDMENTS
(3) An executive officer or irsurance manager,if A. Bodily injury Redefined
you are a corporation,or
(4) A member or manager, ,if you are a limited towing
Paragraph 3. Bodily injury" is replaced by the fol-
�abi(ity company
3. "Bodily injury" means bodily injury sickness or
B. Other Insurance disease sustained by a person, including death
Item 4. Other Insurance, b. Excess Insurance (1) resulting from any of these at any time "Bodily
(a)(d)is replaced by the fciiowrig injury' includes mental anguish or other mental
(ji) That is fire, I ghtning, explosion or sprinkler leak- injury resulting from such bodily injury.
age insurance for premises rented to you or B. insured Contract Amended
temporanily occupied by ya_ vith permission of
the owner Paragraph 9 a s replaces by the following-
a. A contract for a lease of premises However,
C. Unintentional Failure To Disclose Hazards that portion of the contract for a lease of prem-
Paragraph 8- Representations is replaced by the ises that incemnifies any person or organization
following for damage by fire, lightning, explosion or sprin-
8. Representations And Unintentional Failure kler leakage to premises while rented to you or
To Disclose Hazards temporarily occupied by you with permission of
a. 6y accepting this policy,you agree-
the owner is not an"insured contract",
(1) The sto-ments in the Declarations are C. Personal And Advertising Injury Redefined
accurate and complete, Paragraph 14. d. and a are replaced by the follow-
(2) Those statements are based upon mg
representations you made to us and d. Oral, written, televised videotaped or electronic
(3) We have issued this policy in reliance publication of material that slanders or libels a
uccn your representations person or organizanon or disparages a person's
or organization's goods, products nr service,
e. Oral, written, televised, videotaped or electronic
publication of material that violates a person's
right of privacy,
WN GL 39 03 10 md-Iii:es copyrighted mate•iat of Insurance Services Office,with its permission Page 6 of 6
Page 1 of 2
I
State of Washington
Department of Labor & Industries
Prevailing Wage Section - Telephone 360-902-5335
PO Box 44540, Olympia, WA 98504-4540
Statement of Intent to Pay Prevailing Wage
Document Received Date- Intent Id. Affidavit Id: Status: Approved On
6/29/2012 519710 6/29/2012
Company Details
VALLEY FLOOR COMPANY INC UBI#, 600512992
25423 74TH AVE 5 Reg#: VALLEFC161JL
KENT, WA 98032 E-mail aprils@valleyfloorinc.com
253-852-7008
Industrial Insurance Account Id- 824,631-00
r
Filed By Sta. Rosa, April
Prime Contractor
Company Name VALLEY FLOOR COMPANY INC
Contractor Registration No. VALLEFC161JL
i
WA UBI Number 600512992
i
j Phone Number 253-852-7008
Project Information `
' Award mg Agency KENT, CITY OF
220 - 4TH AVE S KENT, WA- 98032-5895
�Award€ng Agency Contact Alex Ackley
,I
Awarding Agency Contact Phone Number 253-856-5081
Contract Number
I Project Name Kent Municipal Court
I Bid due date 6/6/2012
it 1
1,I Award Date 6/20/2012
https://secureaccess.wa.gov/lni/pwiaNiewIntent.aspx 7/8/2012
i
Page 2 of 2
Project Site Address or Directions 1220 Central Avenue South Kent, WA
Intent Details
� I
Does your company intend to hire subcontractors to No
perform all work?
Does your company intend to hire any subcontractors? No
Will your company have employees perform work on this Yes {
project?
Do you intend to use any apprentices?(apprentices are No E
i
considered employees.) ,
Will this project utilize American Recovery and No
'Reinvestment Act (ARRA) funds?
Specifically, will this project utilize any weathenzation or No
energy efficiency upgrade funds (ARRA or otherwise)?
How many owner/operators performing work on the 0 I
project own 30%or more of the company? I
What is the estimated contract amount? Or is this a time $4,098.59
and materials estimate?
Expected project start date: (MM-DD-YYYY) 7/2/2012
f I
a
In what county(or counties)will the project be done? King
E In what city (or nearest city)will the project be done? Kent
journey Level Wages
County�.�.Trade..�.._..._�.... _..,. �.....__�...,_..Occupation,.,.o.,,�m....,.�..�„_._. Wage..,..�...Fringe.�..�,
Workers
King Soft Floor Layers _ _.Journey Level $41.95 $0.00 1
ice...__._..____ ...__.,.-.,�._,_._..__._........_._ ,,,......_.... w..._.___-._. .,.........�..,._.w._.�.._,_,,,.,..,ww..,_.._ n___...__...._M._._.._,N.
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https:Hsecureaccess.wa.govllrti/pwiaNiewlntent.aspx 7/8/2012