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HomeMy WebLinkAboutPK12-223 - Original - Holt Services, Inc. - Decommission Wells at Clark Lake - 10/10/2012 r �arP- n '�ICT; Records MaInageme r��= TDocument WA$NtNGTON c 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: Holt Services, Inc Vendor Number: JD Edwards Number Contract Number: to 4�r' e2' 2 2-3 This is assigned by City Clerk's Office Project Name: Decommsision Wells at Clark Lake Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 10/12/12 Termination Date: 11/9/12 Contract Renewal Notice (Days): 0 Number of days required notice for termination or renewal or amendment Contract Manager: Andy Martin(tp) Department: Park Operations Detail: (i.e. address, location, parcel number, tax id, etc.): S Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 KENT WASHINGTON PUBLIC WORKS AGREEMENT between City of Kent and Holt Services Inc. THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Holt Services Inc., organized under the laws of the State of Washington, located and doing business at 10621 Todd Road East Edgewood Wa, 98372 253-604-4878, Randy Holt (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 following described plans and/or specifications: Attached and incorporated herein, Scope of Services for Dug Well #1, Dug Well #2, and Drilled Well at Clark Lake Park. 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, the Contractor shall complete the work described in Section I On or before November 9'h 2012 . III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed Thirteen Thousand, nine hundred ninety four and 10/100 ($13,994.10), including any applicable Washington State Sales Tax, for the work and services contemplated in this Agreement. The City shall pay the Contractor fifty percent (50%) of the Contract amount upon completion and acceptance of the work by the City, and the remainder upon fulfillment of the conditions listed below and throughout this Agreement. A. No Payment and Performance Bond. Because this contract, including applicable sales tax, is less than $35,000, and pursuant to Chapter 39.08 RCW, the Contractor, in lieu of providing the City a payment and PUBLIC WORKS AGREEMENT - 1 (Over$1OK, under$35K, and No Performance Bond) performance bond, has elected to have the owner retain the final fifty percent (50%) of the Contract amount for a period of sixty (60) days after the date of final acceptance, or until receipt of all necessary releases from the State Department of Revenue, the State Department of Labor & Industries, and the State Employment Security Department, and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. 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 (EXCLUDING WITHHELD RETAINAGE) 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 PUBLIC WORKS AGREEMENT - 2 (Over$1OK, under$35K, and No Performance Bond) 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 City may issue a written change order for any change in the 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 PUBLIC WORKS AGREEMENT - 3 (Over$10K, under$35K, and No Performance Bond) 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. PUBLIC WORKS AGREEMENT - 4 (Over$1OK, under$35K, and No Performance Bond) 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. PUBLIC WORKS AGREEMENT - 5 (Over$1OK, under$35K, and No Performance Bond) 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 PUBLIC WORKS AGREEMENT - 6 (Over$IOK, under$35K, and No Performance Bond) d 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. PUBLIC WORKS AGREEMENT - 7 (Over$1OK, under$35K, and No Performance Bond) 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: 6 By By: gnatu}rr (signature) Print Nam �r�c�—Q . f� Pr[n N e. zette Cooke Its �ire_s . Sisp Its Mayor (title) DATE: DATE: o a l NOTICES TO BE SENT TO: NOTICES TO BE fCFNT TO: CONTRACTOR: CITY OF KENT: Randy Holt Andy Martin Holt Services Inc City of Kent 10621 Todd Rd East 220 Fourth Avenue South Edgewood, Wa 98372-2527 Kent, WA 98032 253-604-4878 (telephone) (253) 856-5124 (telephone) 253-604-4063 (facsimile) (253) 856-6120 (facsimile) APPROVED AST FORM. Kent Law Department [In this field,you may enter the electronic file0ath where the contras has been saved] PUBLIC WORKS AGREEMENT - 8 (Over$1OK, under$35K, and No Performance Bond) 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 day of �C� � , 20/-;P, By: "eo eo�e�-Z� For: //� Title: Date: ��— EEO COMPLIANCE DOCUMENTS - 1 a 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. EEO COMPLIANCE DOCUMENTS - 2 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: EEO COMPLIANCE DOCUMENTS - 3 Holt Services Inc Ic,E 4 October 3, 2012 City of Kent Andy Martin Parks Operations 220 Fourth Avenue South Kent,WA 98032 Proposal Project:City Wells Pull Pump Abandon 75'Well Abandon 22'Well Affidavits Tax Kent#1715 Total cost, $12,780 00 Kent Tax#1715 $ 1,214.10 Total $13,994.10 Cost includes DOE Start Card with fees and submittal of Well Report upon completion. Signed, 1t' Gal Randy Holt Project Manager Holt Services Inc. 10621 Todd Rd E Edgewood WA 98372-2527 PH (253)604-4878 FAX (253) 604-4063 City of Kent Parks Dept. Lake Wells 7o k-4 • 12651 SE 240th Street KENT Kent, WA 98042 WASHINGTON Dug Well # 1 Location: King Co. NW, NE, S-21, T-22-N, R-05-E Dimensions: 3.5' X 4', static water level 3' from surface, 22' to bottom of well. ,^ '�• Construction: Upper levels constructed of concrete sections. Lower levels unknown. Material at the W bottom of the well unknown. w ° Well Log: Not found. Home originally built 1911's Dug well northern po of property Scope of work: Contractor Responsibilities 119P RK . ,, • Decommission well per Wa. State DOE regulations. e • All work must be done by a licensed well driller, • Fill entire well with regulation acceptable materials " ' „ ,,•; (bentonite, cement, ready-mix). • Complete and submit any DOE required forms or paperwork. - a'c�� • Complete any permits/fees that are required. -on", wpAjy, City Responsibilities: • Provide access to site - • Provide any fencing or security measures re- quested by contractor Dug well northern portion of property Provide BMP's for surface water management if re- quired , f City of Kent Parks Dept.400 'rM Lake Wells • 12651 SE 240th Street KENT Kent, WA 98042 WASHINGTON Dug Well #2 A. . Location: King Co. NW, NE, S-21, T-22-N, R-05-E Dimensions: Approximately 4' X 4' top, changes to a tapering round/drilled construction. Static ' F water level 66', bottom level of well 74.2' Construction: Concrete at surface, changing to earthen material. Well Log: Not found. Home originally built 1911's Scope of work: Contractor ResponsibilitiesrY • Decommission well per Wa. State DOE regula Y tions. " • All work must be done by a licensed well :. driller. x��zyy yT. rr a}S5v • Fill entire well with regulation acceptable ma- ' ,- - > terials at regulation levels. (chlorinated sand chlorinated pea gravel, bentonrte, cement, x �; �� .�;•� �� ° ', � ��� ready-mix) '� �;,, i y , • Complete and submit any DOE required forms •�. - _ _Y, -• ` � r,� or paperwork. • Complete and submit any permits/fees that Dug well middle portion of property are required. City Responsibilities: ' • Provide access to site • Provide any fencing or security measures re- quested by contractor • Provide BMP's for surface water management if required. • Remove and dispose of wood structure prior to work by contractor • Removal and disposal of concrete if required 6 t' E6r portionDug well middle . • 440 City of Kent Parks Dept. Lake Wells \S7 KENT 12651 SE 240th Street WASHINGTON Kent, WA 98042 Drilled Well Location: King Co. NW, NE, S-21, T-22-N, R-05- E. 150 feet +- South of hand dug wells. ,. Dimension: 6 inch casing, pump set depth Ct (unknown) Scope of work: Contractor Responsibilities , Convert drilled well to observation well. • Remove existing pump and all associated pip- ing. Dispose of all piping as appropriate • Raise casing a minimum of 12 inches above ground and weld on a steel cap with access port for taking water level measurements. ,R ;�t a; Access port shall be 3/4 inch minimum with threaded plug - • All work must be done by licensed well driller City Responsibilities: • Provide access to site R, • Provide any fencing or security measures re- quested by contractor • Provide BMP's for surface water management if required Drilled well southern portion of property 9 y'4, �5:'ilk $',_• lu EXHIBIT B INSURANCE REQUIREMENTS FOR CONSTRUCTION PROJECTS 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. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 or its equivalent, with minimum limits of $3,000,000 per occurrence and in the aggregate for each 1 year policy period. This coverage may be any combination of primary, umbrella or excess liability coverage affording total liability limits of not less than $3,000,000 per occurrence and in the aggregate. Products and Completed Operations coverage shall be provided for a period of 3 years following Substantial Completion of the work. 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 Additional Insured under the Contactor's Commercial General Liability insurance policy with respect to the work performed for the City. All endorsements adding Additional Insureds shall be issued on form CG 20 10 11 85 or a form deemed equivalent, providing the Additional Insureds with all policies and endorsements set forth in this section. 2. 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. 3. 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. Commercial General Liability insurance shall be written with minimum limits of $3,000,000 per occurrence and in the aggregate for each 1 year policy period. This coverage may be any EXHIBIT B (Continued) combination of primary, umbrella or excess liability coverage affording total liability limits of not less than $3,000,000 per occurrence and in the aggregate. Products and Completed Operations coverage shall be provided for a period of 3 years following Substantial Completion of the work. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 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: 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. Contractor's Insurance for Other Losses The Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, Contractor's employee owned tools, machinery, equipment, or motor vehicles owned or rented by the Contractor, or the Contractor's agents, suppliers or contractors as well as to any temporary structures, scaffolding and protective fences. EXHIBIT B (Continued) E. Waiver of Subrogation The Contractor and the City waive all rights against each other any of their Subcontractors, Sub-subcontractors, agents and employees, each of the other, for damages caused by fire or other perils to the extend covered by Builders Risk insurance or other property insurance obtained pursuant to the Insurance Requirements Section of this Contract or other property insurance applicable to the work. The policies shall provide such waivers by endorsement or otherwise. F. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. G. 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 Automobile Liability and Commercial General Liability insurance of the Contractor before commencement of the work. H. 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. A� CERTIFICATE OF LIABILITY INSURANCE °11/16/2011`Y' THIS CERTIFICATE 15 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 polfcy(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 1-253-627-7183 XAAMEACT Emmalee Pabalate Arthur J. Gallagher Risk Management Services, Inc. PHONE JAIC.No EA. 253-236-1160 FAX No 253-572-1430 P.O. Box 2925 ADDRESS Emma Pabalate®AJG.Com Tacoma, WA 98401-2925 INSURE S AFFORDING COVERAGE NAIC9 EmmaLee Pabalata INSURER AMERICAN PIRE L CAS CO 24066 INSURED INSURERS WEST AMERICAN INS CO 44393 Holt Services, Inc. INSURER C Ohio Coo 'no Cc 1481 10621 Todd Road East INSURERD INSURER E Edgewood, WA 98372-2527 INSURER F COVERAGES CERTIFICATE NUMBER: 24119537 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 AD SUER POLICY EFF POLICY EXP 'NSR LT TYPE OF INSURANCE POLICY NUMBER MIDD MWD LIMITS A GENERAL LIABILITY BLA54436874 03/18/1 03/18/12 EACH OCCURRENCE § 1,000,000 DAMAGE TO RENTED X PREMISES(Ea occunerce § 100,000 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE r-K-1 OCCUR MED EXP Any one person) § 10,000 PERSONAL&AOV INJURY § 1,000,000 GENERAL AGGREGATE § 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG § 2,000,000 POLICY PRO- LOC S B AUTOMOBILE LIABILITY BAWS4436874 18 1 03/18/12 (Eaa COMBINED SINGLE accidI LIMIT 1,000,000 X ANYAUTO BODILY INJURY(Per person) § ALL OWNED SCHEDUTOSULED BODILY INJURY(Per accident) § AUTOS NON-OWNED PROP RTYDAMAGE § HIRED AUTOS AUTOS ua idenl S C UMBRELLA LIAB X OCCUR US054436874 03/18/1 03/18/12 EACH OCCURRENCE §4.000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE §4,000,009 DED X RETENTION§10,000 § OTH C WORKERS COMPENSATION T4436874 (WA Stopgap) 03/18/1 03/18/12 WC STATIU- .EE AND EMPLOYERS'LWBILITY YIN ANY PROPRIETOP/PARTNER/EXECUTIVE❑ NIA EL EACH ACCIDENT § 1,000,000 OFFICER/MEMBER EXCLUDED? ' (Mandatory in NH) ELDISEASE-EA EMPLOYEE § 1,000,000 Ifyes,desonbe under E L DISEASE-POLICY LIMIT § 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(Attach ACORD 101.Additional Remarks Schedule,If mom apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' Holt Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10621 Todd Road East AUTHORIZED REPRESENTATIVE Edgewood, WA 98372 '��'> USA ©1988-2010 ACORD CORPORATION All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD epabalate 24119537 Coverage Is Provided In: Policy Number: Liberty Ampnran Fire and Casualty Company OKA (13) 5443 6874 llemNorthwest. Policy Period: of n'"'"�'c"" From W18012 To 03/11812913 Common Policy Declaratlons 12:01 am Standard Time at insured Mailing Location Named Insured&Mailing Address Agent Mailing Address&Phone No. HOLT SERVICES INC (253) 627-7183 10621 Todd Rd E ARTHUR 1 GALLAGHER RISK MGMT Edgewood, WA 98372 SERVICES INC PG BOX 2925 TACOMA, WA 98401-2925 Flamed Insured Ts:CORPORATION Named Insured Business Is: WATER WELL DRILLING AND PUMP In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. SUMMARY OF COVERAGE PARTS AND CHARGES This policy consists of this Common Policy Declarations page, Common Policy Conditions, Coverage Parts (which consist of coverage forms and other applicable forms and endorsements, if any, issued to form a part of them)and any other forms and endorsements issued to be part of this policy COVERAGE PART CRARGES Commercial Property Commercial Inland Marine t'nmmerrial G-eneral I iahilily Total Charges for all of the above coverage parts: $4,641.00 Cerfifted Acts of Terrorism Coverage: $25.00 (Included) Note: This is not a bill IMPORTANT MESSAGES . This policy is auditable. Please refer to the conditions of the policy for details or contact your agent. Servicing Office LIBERTY NORTHWEST-WEST WA-AK and Issue Date 03/01/2012 Authorized Representative ro report a claim,call your Agent or 1-800 09-0930 DS 70 2101 OR 03/0112012 54436874 N0178060 235 NCAOPPNO INSURED COPY 000532 PAGE 19 OF 172 1. BLANKET ADDITIONAL INSURED(Owners,Lessees,Contractors or Lessors) (Includes a Primary/Non-Contrlbutory provision) Who Is An insured Section II Is amended to include as an insured any person or organization whom you are required to name as an additional Insured on this policy In a written contract or written agreement, The written contract or written agreement must be currently in effect or becoming effective during the term of this policy and executed prior to the "bodily Injury," "property damage" or "personal and advertising injury." The Insurance provided the additional Insured Is limited as follows: A. The person or organization is only an additional Insured with respect to liability: 1. Arising out of real property,as described In a written contract or written agreement,that you own, rent,lease or occupy; or 2. Caused In whole or In part by your ongoing operations performed for that Insured The Insurance provided the additional insured in 1.A.2.above does not apply to: a. Coverage A - Bodily Injury and Property Damage Liability, Coverage B - Personal and Ad- vertising Injury Liability or defense coverage under the Supplementary Payments arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: (1) The preparing, approving, or falling to prepare or approve maps, shop drawings, opin- ions,reports,surveys,field orders,change orders or drawings and specifications;and (2) Supervisory,Inspection,architectural or engineering activities, b. "Bodily Injury"or"property damage"occurring after: (i) All work,including materials,parts or equipment furnished In connection with such work, on the project (other than service, maintenance or repairs) were performed by or on behalf of the additional insured(s) at the site where the covered operations have been completed;or (2) That portion of"your work" out of which the injury or damage arises has been put to Its Intended use by any person or organization other than another contractor or subcontrac- tor engaged In performing a principal as part of the same project. B. The limits of Insurance appilcable to the additional insured are those specified in a written contract or written agreement or the limits of Insurance as stated In the Declarations of this policy and defined in Section III-Limits Of Insurance of this policy,whichever are less.These limits are inclusive of and not in addition to the limits of insurance available underthis policy C. The insurance provided the additional Insured does not apply to the liability resulting from the sole negligence of the additional insured. I Includes copyrighted material of ISO Properties., Inc.,with Its permission. CG 88 301203 0 ISO Properties, Inc.,2003 Page 2 of 8 D. As respects the coverage provided to the additional insured under this endorsement, Section IV- Conditions is amended as follows: 1. The following is added to Condition 2.Duties in The Event Of Occurrence,Offense,Claim,or Suit An Arlriifinnal Inanrarl,mrinr thtc nnrinrcamant will ae ennn na nrArtsr4hln' a. Give written notice of an "occurrence" or an offense, that may result in a claim or "suit" under this Insurance to us; b. Tender the defense and Indemnity of any claim or "suit"to all Insurers whom also have Insurance evellable to the additional Insured; and e. Agree to make available any other insurance which the additional Insured has for a loss we cover under this Coverage Part. 2. The following Is added to Condition 3.Legal Action Against Us: We have no duty to defend or indemnify an additional Insured under this endorsement until we receive written notice of a claim or"suit"from the additional insured. 3. The following Is added to Paragraph a.,Primary Insurance of Condition C Other Insurance: If the additional Insured's policy has an Other Insurance provision making its policy excess, and a Named Insured has agreed in a written contract or written agreement to provide the additional Insured coverage on a primary and noncontributory basis,this policy shall be primary and we will not seek contribution from the additional Insured's policy for damages we cover. 4. The following is added to Paragraph b.,Excess Insurance of Condition d,Other Insurance: Except as provided in Paragraph A.a.Primary Insurance as amended above,any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis. In the event an additional Insured has other coverage available for an "occurrence" by virtue of also being an additional insured on other policies,this insurance Is excess over those other policies. 2. FIRE,LIGHTNING,EXPLOSION AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT If Damage To Premises Rented To You under Coverage A Is not otherwise excluded from this policy,the following appiias: A. The last paragraph of 2,Exclusions of Section I-Coverage A is replaced by the following: If Damage To Premises Rented To You Is not otherwise excluded,Exclusions c.through n.do not apply to damage by fire, lightning, "explosion" or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III-Limits Of Insurance, Incivaes copyrighted material of 1$0 Properties., Inc.,with its permission. CG 83 3012 03 o ISO Properties, Inc., 2003 Page 3 of 6 B. Paragraph B of Section III-Limits Of Insurance is replaced by the following: 6. Subject to U. above, the Damage To Premises Rented To You Limit shown In the Summary of Limits and Charges section of this policy is the most we will pay under Coverage A for damages because of"property damage" to premises rented to you or temporarily occupied by you with the permission of the owner arising out of any one fire, lightning, "explosion" or sprinkler leakage incident. C. Paragraph h.(1)(b) of Condition 4.Other Insurance ISeetion IV-Conditions)Is replaced by the foliow- Ing: (1) That is Fire, Lightning, Explosion or Sprinkler Leakage Insurance for premises rented to you or temporarily occupied by you with the permission of the owner; D. Paragraph 9.a. of the definition of "Insured contract' in Section V- Definitions Is replaced by the following: 9. "Insured contract' means: a. A contract for the lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damages by fire, lightning, "explo- sion" or sprinkler leakage to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured conti act"; E. The following definition is added to Section V-Definitions: "Explosion" means a sudden release of expanding pressure accompanied by a noiso,a bursting forth of material and evidence of the scattering of debris to locations further than would have resulted by gravity alone. E "Explosion" does not include any of the following: i i 1. Artificially generated electrical current including electrical arcing that disturbs electrical de- vices,appliances or wires; 2. Rupture or bursting of water pipes; 3. Explosion of steam boilers,steam pipes,steam engines or steam turbines owned or leased by you,or operated under your control;or 4. Rupture or bursting caused by centrifugal force. 3. NON-OWNED WATERCRAFT Subparagraph g.(2)of Paragraph 2.,Exclusions of Section I-Coverage A is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 51 feat long;and (b) Not being used to carry persons or property for a charge; 4. SUPPLEMENTARY PAYMENTS In the Supplementary Payments•Coverages A and B provision: The limit for the cost of ball bonds In Paragraph 1.b. is changed from$26eto$1000. Includes copyrighted material of ISO Properties., Inc.,with Its permission. CG 83 3012 03 ® ISO Properties,Inc.,2003 Page 4 of 8 i S. PERSONAL AND ADVERTISING INJURY-ELECTRONIC PUBLICATION EXTENSION Paragraphs 14.b.,d.and e.of Section V-Definitions are replaced by the following: b. Malicious prosecution or abuse of process; d. Oral, written, televised, videotaped or electronic publication of material that slanders or libels a person or organization ordlsparages a person's or organization's goods,products or services; e. Oral, written, televised, videotaped or electronic publication of material that violates a persons right of privacy; The following is added to Paragraph 14."Personal and Advertising Injury" of Section V-Definitions: It. Discrimination or humiliation that results In injury to the feelings or reputation of a natural person, but only If such dlscrimination or humiliation Is: (1) Not done Intentionally by or at the direction of: (a) An Insured;or (b) Any"executive officer"director,stockholder,partner or member of the Insured;and (2) Not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured. Subparagraphs b, and c. of 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability are replaced by the following: b. Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic publication of material,If done by or at the direction of the Insured with knowledge of its falsity; c. Material Published Prior To Policy Period "Personal and advertising Injury" arising out of oral, written, televised, videotaped or electronic publication of material whose first publication took place before the beginning of the policy pe- riod; 6. AGGREGATE LIMITS OF INSURANCE(PER LOCATION) The General Aggregate Limit under Section IiI Limits Of Insurance applies separately to each of your "locations"owned by or rented to you or temporarily occupied by you with the permission of the owner. "Location" means premises Involving the same or connecting lots, or premises whose connection is Interrupted only by a street,roadway,waterway or right•of-way of a railroad. 7. AGGREGATE LIMITS OF INSURANCE(PER PROJECT) The General Aggregate Limit under Section Ili Limits Of Insurance applies separately to each of your projects away from premises owned by or rented to you, includes copyrighted material of 150 Properties.,inc,, with its permission. CO 83 3012 03 0 160 Properties,Inc.,2003 Page 5 of 8 8. VOLUNTARY PROPERTY DAMAGE COVERAGE At your request,we will pay for"loss" to property of others caused by your business operations.The most we wild pay for this coverage is$500 each "occurrence." The "loss" must occur during the policy period. The"occurrence"must take place in the "coverage territory". "Loss" means unintended damage or destruction. "Loss" does not mean disappearance, abstraction or theft, This coverage does not apply to: 1. Damage arising out of the use of any "auto"; 2. Property you own,occupy,rent or lease from others; or 3. Property on your premises for sale,service,repair or storage. None of the other policy exclusions apply to this coverage If the policy to which this endorsement Is attached is written with a property damage liability deductible, the deductible shall apply to Voluntary Property Damage. The limit of coverage stated above shall not be reduced by the amount of this deductible. A. OFF PREMISES CARE,CUSTODY OR CONTROL COVERAGE A. We will pay those sums that you become legally obligated to pay as damages because of "property damage"to personal property of others while in your or your"employees" care,custody or control or real property of others over which you or your "employees" are exercising physical control if the "property damage" arises out of your business operations,This coverage Is subject to sections B"C., D,and E.below. B. Exclusions This insurance shall not apply to: 1. "Property damage" of property at premises owned,rented,leased,operated or used by you; 2. "Property damage"of property while in transit; 3. The cost of repairing or replacing: Jai Any of your work defectively or Incorrectly done by you or by others on your behalf;or (bj Any product manufactured, sold or supplied by you, unless the "property damage"is caused directly by you after delivery of the product or completion of the work and resulting from a subsequent undertaking; or 4. "Property damage" of property caused by or arising out of the "products•completed operations hazard". C. Limits Of Insurance-The most we will pay for"property damage" under this Section 9. is $6,000 for each "occurrence". The most we wtil pay for this sum of all damages covered under this Section 9. because of"property damage" is an annual aggregate limit of$25,000. The Limits Of Insurance provided under this Section 9. are Inclusive of and not In addition to any other Ilmits provided in the policy or endorsements attached to it. D. Deductible • We will not pay for "property damage" In any one "occurrence" until the amount of "property damage" exceeds $250. Ii the policy to which this endorsement is attached contains a "property damage"deductible,that deductible shall apply if it is greater than$250, E. In the event of "property damage" covered by this endorsement,you shall, If requested by us,replace the property or furnish the labor and materials necessary for repairs thereto at your actual cost, excluding profit or overhead charges. Includes copyrighted material of ISO Properties., Inc.,with its permission. CG 83 3012 03 ® ISO Properties,Inc., 2003 Page a of 8 10. NEWLY FORMED OR ACQUIRED ORGANIZATIONS A. Paragraph 4.of Section It-Who Is An Insured Is deleted and replaced by the following: 4. Any business entity acquired by you or Incorporated or organized by you under the laws of any Individual state of the United States of America over which you maintain majority ownership Interest exceeding fifty percent, Such acquired or newly formed organization will qualify as a Named Insured if there is no similar insurance available to that entity. However: a. Coverage under this provision applies only until the expiration of the policy period in which the entity was acquired or incorporated or organized by you. b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before the entity was acquired or incorporated or organized by you. c. Coverage 8 does not apply to "personal and advertising injury" arising out of an offense committed before the entity was acquired or incorporated or organized by you. d. Records and descriptions of operations must be maintained by the first Named Insured. 0. This Section 10. does not apply to newly formed or acquired organizations If coverage Is excluded either by provisions of the Coverage Part or by other endorsement(s)attached to it. 11. DUTIES IN THE EVENT OF OCCURRENCE,OFFENSE,CLAIM OR SUIT A. The requirements in Section IV-Conditions,Paragraph 2.a.,that you must see to it that we are notified of an "occurrence"applies only when the 'Occurrence" is known to: 1. You, If you are an individual; 2. A partner,If you are a partnership; 3. A member or manager,If you are a limited liability company; 4. An executive officer er designee,if you are a corporation; S. A trustee,if you are a trust; or S. A designee,If you are any other type of organization. B. The requirements in Section IV-Conditions, Paragraph 2.11 that you must see to It that we receive written notice of a claim or"suit" will not be considered breached unless the breach occurs after such claim or"suit' is known to: 1. You,if you are an individual; 2. A partner, if you area partnership; 3. A member or manager If you are a limited liability company; 4. An executive officer or designee,if you are a corporation; 5. A trustee,If you are a trust; or 6. A designee,If you are any other type of organization. Knowledge of an "occurrence," claim or "suit' by the agent, servant or "employee° of any Insured shall not in Itself constitute knowledge of the Insured unless an officer or designee shall have received notice from Its agent,servant or"employee", Includes copyrighied material of ISO Properties., inc„ with its permission. CG 83 3012 03 0 ISO Properties,Inc.,2003 Page 7 of 8 Y � I 12. BODILY INJURY Paragraph S.of the definition of"bodily injury" In the Section V-Definitions Is replaced by the following: 3. "Bodily injury" means bodily injury,sickness or disease sustained by a person, including mental anguish or death resulting from any of these at any time. 13. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against any person or organization for whom you perform work under a written contract that requires you to obts i n this agreement from us. This agreement shall not operate directly or Indirectly to benefit anyone not named In the agreement. 14. MEDICALPAVMENTS If Coverage C Medical Payments Is not otherwise excluded, the Medical Expense Limit provided by this policy shall be the greater of: A. $10,000,or B. The amount shown in the Declarations. All other terms end conditions of your policy remain unchanged. Includes copyrighted material of ISO Properties.,Inc.,with Its permission. CG 8330 12 03 0 ISO Properties,Inc,, 2003 Page a of a /I ;s REQUEST FOR MAYOR'S SIGNATURE KENT Please Fill in All Applicable Boxes Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH HE LAW DEPARTMENT) Reviewed by Director Originator: Andy Martin x 5130 Dept.: Park Operations Date Sent 10/9/2012 Date Required: 10/12/2012 Return Signed Document to: Andy Martin CONTRACT TERMINATION DATE: 11/9/2012 VENDOR NAME: Holt Services, Inc. DATE OF COUNCIL APPROVAL: n/a <$-Tk ATTACH MOTION SHEET FOR THE MAYOR Brief Explanation of Document: Decommission of three wells at Clark Lake Park. All Contracts Must Be Routed Through The Law Department (This area to be completed by the Law Department) Received: Approval of Law Dept Law Dept Comments: OCT 10 2012 i Date Forwarded to Mayor: iu u Shaded Areas To Be Completed By Administration t`aff [Received �L J 6 Recommendations and Comments CITE'Of h-J Disposition: /O1O11-Z� Date Returned: