Loading...
HomeMy WebLinkAboutPW13-031 - Original - GPA Trueman - Lower/Lowest Russell Road Levee - 01/30/2013 T Records Manage" ment-0, KEN WAS„INGTON Document x :fie 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: GPA Trueman Vendor Number: JD Edwards Number Contract Number: Pw13- 19.9 This is assigned by City Clerk's Office Project Name: Lower/Lowest Russell Road Levee Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 1/30/13 Termination Date: 12/31/13 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Ingrid Willms-Dixon Department: Engineering Detail: (i.e. address, location, parcel number, tax id, etc.): Complete seven field review appraisals for the project. S Pub I ic\RecordsM anage ment\Forms\ContractCover\adcc7832 1 11/08 KENT PROFESSIONAL SERVICES AGREEMENT between the City of Kent and GPA Trueman THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and GPA Trueman organized under the laws of the State of Washington, located and doing business at 7522 28th Street West, University Place, WA 98466, Phone: (253) 564-1342/Fax: (253) 566-9560, Contact: Richard Pinkley (hereinafter the "Contractor"). I. DESCRIPTION OF WORK. Contractor shall perform the following services for the City: The Contractor shall complete seven field review appraisals for the Lower/Lowest Russell Road Levee Project. For a description, see the Contractor's October 30, 2012 Scope of Work which is attached as Exhibit A and incorporated by this reference. 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 those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement, and Contractor shall complete the work by December 31, 2013. III. COMPENSATION. The City shall pay Contractor a total amount not to exceed Three Thousand, Six Hundred Dollars ($3,600.00) for the services described in this Agreement. The Contractor shall invoice the City monthly based on time and materials incurred during the preceding month. The hourly rates charged for Contractor's services shall be as delineated in the attached and incorporated Exhibit A All hourly rates charged shall remain locked at the negotiated rates throughout the term of this Agreement. 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, 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. PROFESSIONAL SERVICES AGREEMENT - 1 (Under$10,000) 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 maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party seven (7) calendar days written notice at its address set forth on the signature block of this Agreement. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Contractor, its subcontractors, or any person acting on behalf of the Contractor or subcontractor shall not discriminate against any person who is qualified and available to perform the work to which the employment relates as provided for by the City of Kent's Equal Employment Opportunity Policy. 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. VII. 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. The provisions of this section shall survive the expiration or termination of this Agreement. 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. VIII. 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. XII. CONTRACTOR'S WORK AND RISK. 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 services. 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. XIII. 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. PROFESSIONAL SERVICES AGREEMENT - 2 (Under$10,000) r , 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 VII 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. 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. 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. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. CONTRACTOR: CITY OF KENT: By: �21_ 1��K By: 44 A (signature) /� (signature) Print Name: �hcz.-c-CC F., P;nxt�„ Print Name: Mark Howlett Its: � res;,d-C_„ t Its: Design Engineering Manager DATE: !T/��2.0i DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONTRACTOR: CITY OF KENT: Richard Pinkley Timothy 1. LaPorte, P.E. GPA Trueman City of Kent 7522 28`h Street West 220 Fourth Avenue South University Place, WA 98466 Kent, WA 98032 (253) 564-1342 (telephone) (253) 856-5500 (telephone) (253) 566-9560 (facsimile) (253) 856-6500 (facsimile) PROFESSIONAL SERVICES AGREEMENT - 3 (Under$10,000) 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 rt 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 , 20 13. For: / r c c�� �, tot, 4 k�-e-W Title• / ryes % Cc, Date: e // S LIB EEO COMPLIANCE DOCUMENTS - 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. 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 , 20_. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 EXHIBIT A GPA TRUEMAN Real Estate Appraisers and Consultants 7522 28`h Street West Ricliard E Pmkley,President University Place,Washington 98466 BohnR Tard0 MAI,SRA EdwardB ce E MAT Gary K Womb,MAI Bruce 6 rah 7cnmfer A Tnieman www gpavaluatton net �' RobertE St Wearnt MatILew D Haner (253)564-1342 Michael D eame Fax(253)566-9560 October 30, 2012 Ingrid P.Willms-Dixon, Project Analyst Design Engineering /Public Works Department 220 fourth Avenue South Kent, WA 98032 Re. Seven Field Appraisal Reviews Dear Ms.Willms-Dixon, This letter is to provide a fee quote for completion of the seven field review appraisals requested. The fee for these services will be a total of$3,600 A signed copy of this agreement is required before work is commenced We will provide three copies of each field review unless prior arrangements have been made It must be noted that if work is stopped by the client before completion, the client will be responsible for work completed as of the date of notice to stop work. ° ' & I anticipate completion of the reviews within two weeks of notice to proceed, unless major corrections are needed and there are delays from the appraiser. The scope of work is to provide field appraisal reviews of seven appraisals performed by the Eastman Company I understand the appraisals and reviews are to meet WSDOT standards and guidelines, with four of the appraisals being full residential fee takes and three partial fee and/or easement takes GPA Trueman senior appraisers are certified WSDOT appraisers and three of them are MAI designated and are well-qualified to meet your appraisal review needs Thank you for giving GPA Trueman the opportunity to assist you Very truly yours, GPA TRUEMAN Richard E Pinkley, President State-Certified General Real Estate Appraiser Number 1101074 REP gee authorize GPA Trueman to proceed with the appraisal reviews on the above referenced properties with the terms noted above Dated this day of 2012 I Signature EXHIBIT B INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant 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 Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant 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. 2. 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 City shall be named as an insured under the Consultant'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. 3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 4. Professional Liability insurance appropriate to the Consultant's profession. B. Minimum Amounts of Insurance Consultant 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 $1,000,000 products-completed operations aggregate limit. G EXHIBIT B (Continued) 3. Professional Liability insurance shall be written with limits no less than $1,000,000 per claim and $1,000,000 policy aggregate limit. 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 Consultant'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 Consultant's insurance and shall not contribute with it. 2. The Consultant'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 Consultant 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 Consultant'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 ANII. E. Verification of Coverage Consultant 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 Consultant 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 Consultant. W � CERTIFICATE OF LIABILITY INSURANCE DATeIMMo0nm1 ll.. 01/24/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the pollcy(los)must be endorsed if SUBROGATION IS WAIVED,subject to the tones 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 liou of such endorsoment(s). PRODUCER NA41L T Eloise Patton PHONE 475.5313 ac McKendry Insurance _IKC,N ,No1_ 3)473.0713 P.BxO (253) — E MAIL o atton mckond insurance.com 8031 Pacific Ave ADDRESS_ P _ —ry Tacoma, WA 96408 ___■^� INSURER(S)AFFO RDU+GCOVERAGE_ _ _NAIIC4 riF INSURERA UU_AI_ys_ENUM QI_AW __L4M1_ INSURED INSURERS GPA Valuation IN SURERC_ Rick Pulkley INSURERD 7522 28th Ave W INSURER E Tacoma,WA 98466 INSURER F COVERAGES CERTIFICATE NUMBER- 00004222.122085 REVISION NUMBER 2 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 OFANY CONTRACTOR O"HER DOCUMENT IN TH RESPECT TO'WHICH THIS CERTIFICA•E tv1AY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDLD 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 I ` TYPE OF INSURANCE IAO —POLICY Q WVn MMD POLICY NUMBER DIYYYY MIADMYYYY LTRI LIMITS LTR GENERAL LIABILITY A GEN '_ Y N B0P0006562 0110112013 01J0112014 � EACH OCCURRENCE 1 s _2,000,000 UAMAOE'f LiRLtJ 1 ED X CCOMMERCIAL GENERAL LIABILITY PRUlytl$E$(faocprg9nC6tj__ $ 100,000_ ICLAIMS MACE a OCCUR _M_EDEYP(Anyalepersonl $ _ 10,000 a PERSONAL&ADV INJURY S '2,000,000_ GENERAL AGGREGATE S 4,000,000 G_EN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000 X I PO'Icy PRC- LOC $ A AUTOMOBILE LIABILITY N N BOP0006562 0110IJ2013 01/01/2014 COMBINED SINGLE LIMIT _ _ i acunonl S - AN)AUTO RODIV INJURY(Perpereon) S ALI OV,NED F7 O SCHEDULED BODILY INJURY IPer accdent) S = AUTOS NON PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS ,Per ncadonli $ UMBRELLA LIAB I OCCUR EACHOCCJRRENCE $ EXCESS LIAB (CLAIMS MADE AGGREGATE S QED RE rLNTICN$ S WORKERS COMPENSATION VrC STATU OTH A AND EMPLOYERS LIABILITY YIN{ N BOP000656? 91/©1/2013 0110112014 X _TCRY LIMITS _ER-_STOP GAP_ I AN T FRCFRwCTCR FV,r IERIEXECUTIVE50 NIA E�EACH ACCIDENT $ _ 2,000,000 f O,FACER MCMDEP Crd-LUDEDY T'- (ManCatorylnAHl EL DISEASF-EA EMPLOYEE S 2,000,000 Y f}as d's_'tO"dcr ;ESCf�-T OI OF OPERATIONS be E I DISEASE POLICY LI41IT S 2,000 000 t DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD IDt,Additional Remarks Schedule,If mare space Is"Trod) The City of Kent is additional insured per form#13P0450 attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Kent ACCORDANCE WITH THE POLICY PROVISIONS 400 W. Gowe Kent,WA 98032 AUTHORIZED REPRESENTATIVE -)2-7 'L/'��!-�` 91988-2010 ACORD CORPORATION All rights reserved ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Printed by EMP on January 24,2013 at 10 19AM POLICY NUMBER: BOP 0006562 01 BUSINESSOWNERS BP 04 50 01 97 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY SCHEDULE* Name of Person Or Organization- THE CITY OF KENT The following is added to Paragraph C WHO IS AN 4. Any person or organization shown in the Sched- INSURED in the Businessowners Liability Coverage ule is also an insured, but only with respect to lia- Form: bility arising out of your ongoing operations per- formed for that insured Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. Hai roams a s BP 04 50 01 97 Cop yright, Insurance Services Office, Inc., 1996 RaordorNa 1a-2828aexa e F I.(begy Real Estate Appraisers Professional International Underwriters. Liability Date issurd Policy Number Previous Policy Number 081 W?012 I l Uo0h965-011 1111005965-010 LIBFR'TY INSURANCE UNDERWRITERS, INC. (A Ji,wk insurance t ompary,huzmatmr III, 't ompacy') 55 Walsr Sirca 18111}Imr Nc„pork,N)` ICMWI THIS IS A CLAIMS MADE AND REPORTED POLICY. PLEASE REAR IT CAREFULLY Item DECLARATIONS I Customer ID: 134858 Named Insured, GPA VALUATION!6PA TRUEMRN Wieei,Patterson&Associates, Inc. /522 28th Street West Univen sity Place,WA 98466 2. Policv Perini Iron 0't11i2012 In 0910U2013 12 01 A M Standard 7 one at the address stated in Itcm 1 3 Deductible $2,500 Each Claim 4. NetroucOse Date: 09101,11984 S. Incepunu Dal¢ (1,9/01/2002 6. 1,unils of LiabOnt) 'l he Limit of Liability for Pach(-loim and in A S1,000 000 Path Ctann the Aggregate is reduced by Damages and B S2,000(ft Aggiegam t lama LvI>enses as defmcd ui the P01MV 7 7. Mall All Notices to Agent: L IA Administrators&Insurance Sen'iaes I 1600 Anacaps Street Sanld Barbara California 93101 ( (805)963 6624, Fax (805)962-0652 8 Annual Prrodum: I i 9. Number of Appraisers. 9 10 Form attached at issue, LIA0O2(10/11) L1AWA(12/11) 1 A01e (08f 11) LLA01i (08/11) I LIA015 (03110) LIA015(01/10) /2 LIA021 (03110) tIA025 (OJ/10) OFAC (08109) This Deddrahwis Page"ther will tho completed and signed Policy Appla.ahon including all anxhmonta and exhibits thereto,and the Rocd Fsuue Aowaisers Prrafossarnai Liabdlt4 Insurance Policy shall censaiule the it U between the Named Insured and the Company By IIAOOI (04/10) Authorized Signature I state Farm fte suit Casualty Comparty, P"'WN"Al flr"Trtf`ATF P0 rwx 50M OWt WA WWtaWO ";Ky-- ATI c is ftWF4W L F BENt, JANET 6 PINXICY, RICNARD E 4OVERAGfiS AND LtMITS 09 LOU114E ST W UNIVERSITY Pl. WA 98466-412a L Nrsoiiel L�twb04y SO'insured Ret"lon None W Lindoneaured lrwiLdnii 1,000,000 Uninsured Motor Vebialo UNDEMYNO EXPOSURE.$ 04jr to.w4v Mu)w Oie f0lowng uriderlying; mWmAon The, gftfrnalior)wag used rn dorHr-o tiM the sato of thif I�Ajcy AO tomostt-a E xP05URks Aurmrot-lo(g) 3FIPFANoM51809615 OTHER LIABILITY EXPOSURES Personal Pomdanhal Fume and Erglorgerne"til, Petsof at babilely UmbroM FP-7950 ? Amer3dalory Eitd rr tr rr ont FE-7670 3 Passenger 80dily Injury rX01 FE-1/72 I UndernALIted Motor Vah COY FE-!A89 Fuel 00 Lxotwson FE-"j/ Fl"Wewd DOMOSho PadnMh;p FE-6858 Annual Promrkmi $3ZS 00 Coverage 1 W, 00 COYW400 W Ific, 00 -Natily ycw agent Immediately 11 th®above Usted Coverages andVor UndorWnq Exposures are incorrect. Your Coverages anWor bill can be all acted ifthis intonnation,Is Not correct. The Class 50 Discount tm*reduced the promium on your policy by$4140 Required Underlying Insurance on reverse side ff MOVAtVV Soo VW State F',Rfm,vmt AV*M PETE MATTICH $00 tevor-so Air urtj,mlm#i6k,*fiWfke N Teiophom(360)754-7878 01" P?Akpdi*d DEC 07 2012 it CONTINUED FROM FRONT Asqufred Undertying insurance (term in Beeed su tnw semen am dehrstd ur the p k") ►Aiurmurrr L,ndel lylr g Uarrate Cernbmed„vtnaa Type of pohvj adaiy tiny snrl Prct�ao rzy lJLama st Automobile LtObility t 30 0 r 0 0 D 8o"beffury• 41 D 0 ,0 0 0 Per Pomm Undo-rrtsuttrd and Uninsured 4�300,0 U 0 Per Accedorh Motor vehhoo coverage Property Damage, 025,000 Per Acc thad Recreational Motor Vehicle LScefhty 0 30 0,00fi &Afly M}ery- t 100,000 Per Person InaliAdrng Pa%,,4 qor Soddy Inlury s 3 D tl ,0 00 Per Accident Propotty Damage- S 25,0 0 U Pot Aze dent Pereuxhd"wilWoMW LbdilYty t100,000 Watercraft Lfaballty It 10 0 10 tt 0 NOTICE TO POLICY. Policy nhangen requested before the "Dale Prepared'°, ar oft that frohoo,am oHechve on tho Effective Date of th policy unlaxs olherwr�,e rndicalod by a soptarate andorsamont, binder,or arteandod doolarations Arty coverage forms attache to this notice are aoso offoctive on the Effective Date of terse polaay Polly changes nahiosto a'tar the 'Date Prepared"Will be seat to you as an amended tie about or as an endorsement i your policy 8*1np kx any additional prbrnnnn for such changes will oo m4lad of a later date Ptessa hoop this wath your poboy, o P"00-01- tat eeg tb