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HomeMy WebLinkAboutPW13-032 - Original - GPA Trueman - Hawley Road Levee Field Review Appraisals - 02/28/2013 Records Maaagemeht, KENT Document WAS HIXGTON sl 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: Pw / 3 -&;, a This is assigned by City Clerk's Office i S Project Name: Hawley Road Levee Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 2/28/13 Termination Date: 10/1/13 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 Public\RecordsManagement\Forms\contractcover\adcc7832 1 11/08 • KENT A',. .IHGTOX 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 Hawley Road Levee Project. For a description, see the Contractor's February 26, 2013 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 October 1, 2013. III. COMPENSATION. The City shall pay Contractor a total amount not to exceed One Thousand, Eight Hundred Dollars ($1,800.00) 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 g 9 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) 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 OFFKK,ENT: By: / By: � (sig ature) (signature) Print Name: Print Name: Mark Howlett Its: /Q!�$iGtGn Its: Design Engineering Manager (title) DATE: 0.2_ }17rn13 DATE: �_Z�, ( �I NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONTRACTOR: CITY OF KENT: Richard Pinkley Timothy J. LaPorte, P.E. GPA Trueman City of Kent 7522 281h 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 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 77-/4) day of 20-Za. By: For: 6 PA i ru en>an Title: Pre s;d-e-r7 f Date: .2.47-}b i EEO COMPLIANCE DOCUMENTS - 1 e 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 Appi aisers and Consultants 7522 28'h Street West Richard E Puiltley,President John R Tmeman,bl ,SRA Guy Wessels,MAI University Place,Wa5t11RgfOR 98466 Edward0 Gner?Nta rw JeferA fem inan www gpavaluafion net Bruce te RobertL Sternquistgwst Matthew D Haner (253)564-1342 Michael D Weame Fax(253)566-9560 February 26, 2013 Ingrid P. Whims-Dixon, Project Analyst Design Engineering / Public Works Department 220 Fourth Avenue South Kent, WA 98032 Re. Field Appraisal Review Hawley Road Project Dear Ms.Wilims-Dixon, This letter is to provide a fee quote for completion of the field review appraisal requested. The fee for these services will be $1,800 A signed copy of this agreement is required before work is commenced We will provide three copies of the 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 review within two to three weeks of notice to proceed, unless major corrections are needed and there are delays from the appraiser. The scope of work is to provide a field appraisal review of an appraisal performed by Allen Brackett Shedd dated November, 21, 2012 1 understand the appraisal and review are to meet WSDOT standards and guidelines, 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 I authorize GPA Trueman to proceed with the appraisal review on the above referenced property with the terms noted above Dated this day of 2013 I Signature I 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, Fired 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. 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 A:VII. 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. CERTIFICATE ©F LIABILITY INSURANCE D01/2 A/2013Y) ACE a112a�2o13 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 tho certlflcato holder Is an ADDITIONAL INSURED,the pollcy(ics)niust be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statomont on this corbftcato does not confer rights to the certificate holder In Ilou of such endorsement(s) CONACT PROOUCER NAME, Eloise Patton <' jaMcKendryInsurance _�._N c,No 23473-0713 I _ 8031 Pacific Ave FARE -MAILss Bp atton@mckondrylnsuranco cam _ Tacoma,WA98408 _. INSURERL)AFFORDING COVERAGE _ NAICO__ INsuRERA- MUTUCLOFENUMCLAW jA7111— INSURED INSURER B GPA Valuation INSURER C. Rick Pinkley INSURER D. 7522 28th Ave W INSURER Tacoma,WA 98466 E' INSURER F: COVERAGES CERTIFICATE NUMBER, 00004222.122035 REVISION NUMBER. 2 TIiIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED DEI HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSIANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR CTI IER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NIAY BE ISSUED OR MAY PERTAIN,THE INSURPNCE AFFORDED BY THE POLICIES CESCRIEED HERE114 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS 01:SUCH(POLICIES LIMITS SI IOVVN MAY I IAVE BEEN PEDUCED BY PAID CLAIMS _ ILTR TYPE Or INSURANCE AOR ywn POLICYNUMBCR 'At VDDNYYY) IWAIDWYYYY1 LIMITS A GENERAL LIABILITY Y N BOP0006562 0110112013 01/01/2014 bsCHOCCURRENCE is 2J_r— O00 000 � bAtrA�o�l -tJtEO X COIAr.IFRCiAL GENERAL LIABILITY P3PIy1l�$1Ca occurtcr-LCO 5 100 000 _I CLAIMS-MADE a OCCUR MEDEXP IA ny ono parson) 5 10,000_ PERSONAL aADVINJURY s 2,000 000_ Gr_IJERALAGGREGATE s 4,000,000 GEN L AGGREGATE LIMIT APPLIES PER _PRODUCTS-COMP/OP AGG _5 _2,000,000 RO — X�POLICY P ELI LOC S A AUTOMOBILE LIABILITY N N BOPD006562 0111112113 /11/0112014 CGMBulED51^,GLEuralr (fa,cdaonp _ S ANYPUTO BODILY INJURY(Per person) S ALI DOJJI D i�SCHEDULED DODILYINJURYtPeraccWenl) 5 nUTOS AL-FpNON 0ATIEO PROPERTY OAIIAGE 5 X HIREDAUTOS X AUTOS _(Per imden) S UMBRELLA LIAD OCCUR EACH OCCURRENCE 5 EXCESS LIAR CL/Jh9S bbVDE AGGREGATE S CGU I ,RETETInCris S WORKERS COMPENSATION NC STAN OTH A At4BEMPLOYERS•LIABIUT N BOPD006562 01f0112013 0110112014 X_ TORY_WHES _.ER __ STOP GAP_ ANY PR0FR,ETOR,P..RTHLR'EXECUTIVE YIN NIA EL EACH ACCIDENT S 2,000,000 OFFIGCRRAIMI)CR EXCI UCCC7 O (Mnndalory In NH) I DISEASE-EA EMPLOYEE S 2,000,000 It yes desolbo 6ndcr CESCPIPTIOH OF OPERATIOt SbdvV I El DISehSF FO'-ICY11MIT 5 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AfWcII ACOft0101,Additional ftomirkn Scl,adufc,fl moro space tc mgnlrod) The City of Kent is additional insured perform#BP0450 attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Kent ACCORDANCE WIIH THE POLICY PROVISIONS 400 W Gowe Kent,WA 98032 AUTHORIZED REPRESENTATIVE EMP ©1988-2010 ACORD CORPORATION All rights reserved ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Pnnled by EMP on January 24,2013 at 1019ANI 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 Hert Fcirs&Serwws BP 04 50 01 97 Copynghi, Insurance Services Office, Inc., 1996 R�wd�,No 14 ZB28 Liberty_ Real Instate Appraisers Professional Intc,n,tumal U nd crest ccr s. Liability ,. I.i" Dale Issued Policy Number previous Pal icy Umber 00/22/1012 LWOU5965-011 LILI005945-010 LIBERTY INSURANCE UNDERWRITERS, INC. (A Stool.111WN u,c Company,IILICIIhIRCI Ih, l ompan}") 55 Weler I8th 1 loor Nits 1',,I A,hS' 1004I THIS IS A CLAIMS ill ADO REPORTED POLICY PL EAS E AL AI)I T CAREFULLY. Item DECLARATIONS I. Customer 10: 134858 Named Insured CPA VAI W T 1011 7 GPA TRUWAM Greer,Pa Ucrs OnEAssou ates,Inc. 7522 Z8th SO eet hest University Place,14A96465 2 POhc) Pulod t'rmn 09r0U2012 'Po: 09/01/2013 1201 A bi Slandard'I une 01 the eddress slated in (tun I 3 DeduUlhle S2,500 [em.h Claim 4 Relroyclhc Dale D910111989 1 S. Ilreephon Dale, 09!0112002 6 Lunrts of I r,dnidy: )be Llnul of I lab,lily fm C Ich Claun and ul A 31,000,000 k uLll Clmm Ihr Aggrsgatc Is IVdu(ml lit 1)111Aages and I) 52,000,000 Aggr,galc Clauus Lepncses as defined ul the 11011cy 7 Akdf All Nolkes to Agent LIA Admuuslralnn&fnsurantt 5crvlucs l 1600 Anacapa Sil l Santa M ull C ullfurma 93 10 1 r (805)9h3 6024, Fax (805)963-0652 i 8 Annual Premium: wmp� 9 Number cf Apprat secs- 9 d 2 t ACT? 08 11 LIA013 08/11 10 fm7as att.¢huf al tssuo LIAO(12(i0/it) L1AIfl(I lil) 1 ( / 1 ( ) LIAD15 @and) unol5 (01n0) <2 LIAM (e3n0) I IA025(03101 Of AC(08/09) I I ])its Decle,ehons Ntn w9elhrr will,0m corry>Irlerl dnd sl9ncd PoUoy Appllcalion v dudmg all atW<hroruls and exhlLas Ihorolo and the Real Esldlc Af%✓r nwn Prole+srnnal Lidhlllf y IroV�ance PobcV sFwll eoln5lulo Ihn cl L�eDttepn the Named Insured and iliaCompan BY y t� by LIA001 (01110) Author lzrd St9natute State Farm Fire and Casualty Company RENEWAL CERTIFICATE P05rnSorb MLCYHUWER A7 f`r ,'U1.6 Otpcnr WA rrl r"I Wo 'Sia,rn-al 4du,lj I(, nc ,r I , o JAN 20 2013 to JAN 26 2014 RII C,16 L27e FleO l RI_LLU TtIHUJaII 5I Pl' BENT , JANET it - -- - "—"—"'— RINKLEY, RICHARD E COVERAGES AND LIMITS Grr.,Y Z809 LOUTSE ST W L PorxonalUnblldy S1,000,000 UNIVERSITY PL WA 95466-4120 Seel insured Retention None W Undnnnvu,rd Irn lWin0 1,000,000 Uninsured Motor Vehicle G� UNDERLYINQ EXPOSURES Onr rocorcl;,show the loflov7m0 undedyvng tniormal,on T tiro Informallcn urns used In defer li'mog 111a e;ile of th'n µnilq AUTOMOBILE EXPOSURES Autrnnn LJt(�i) 5 Aulornnbk Operato7(s) 2 i SFPP No 0351 BN515 OTHER LIABILITY EXPOSURES Pet-onal PeslClenOul Forms and Endorsements Personnt Uabddy Umbrella FP-7950,2 Amondnlory Endorsou+onl FE-7670 3 Pw,�PnUcr Cloddy Injury L-xt I FL-//72,1 Undornrsurod Motor Veh Cov FE-5889 FL*1 Oil EXciJ;l„N FE-5837 Rct;Wered Dornostic Partmehip FE-6858 Annual Premium $325 00 Covorago L 165 00 CovufaUu W 160 DO 'Notify your agont Immediately 11 the above listed Coverages andfor Underlying Exposures are incorrect Your Coverages and'or bill c.in be allerlud it this mlormahon le not cuwroct i The Class 50 Discount has reduced the pramium on your policy by$41 00 A - Requhad UrWarlying Insurance on reverse side t A A I;A%6010-At(LrV A AC w r t' Movvp 7 See Inur State Farm agent Agent PFTEMATTICII Sou rvc Writ her urywrfanf„rhvnr+two Telephone(360) 154 1818 'a r• PisT,arosl VF( 012012 4 CONTINUED FROM FRONT Required Underlying Insurance (Tonne of Bald in ilia sccbc-rife(k6nod if,too Po") NWHITUm Llnderlyirvd Learns Combined UneW Type of Polley (Soddy Injury and Properly Dainage) or Slaill Umle Automobile Liability t 30 U,U 0 D Bodily injury- i 10 U,0 0 0 Per Person Undenn{ured and Uninsured t 3 0 0,D 0 0 Per Aceldent Motor Vehicia(.r,vvrn0e Property Damage t 25,000 Per Accident Recratlonal Motor Vehicle Liability 0300,000 Bodily in)ury- t 10 0,DUU Per Person inebidin0 Passeugor Bodily Injury 6° 00 ,0 00 Per Aocuienl Property Damage 1;16,000 Pet Accident Peraonal Residential Liability 4100 1000 Watercraft Liability @ 100,0U0 NOTICE TO POLICYHOLDER: P,Ary ehangea requoRtod balore the 'Dale t'+clr.��cd', wh�clr ,ppesr on Ira_ �r,hce,are eflecl bo wi I it, Ltleetrve Dale of th pohry unlaaa otriorw,,a vOicaled by a enpwarc an(k)ispa„nl, bindor,or numorkri der laraUens Any eovern0a forms nllacha to IlrA no'xco are nko effoclwe on the t Ilecirve Date of that poky Pali:y cyangPIA larloosled a'ler the 'Date, PrePalecl wdf txo tio,d to you as nil amended dreidraltousl or as an endorsement t + you,PnIRIy E3ioinrrd lot ally odddronol p,0itixmi for auoh changnx will he mailed fit n later date Plea,,a loop lhro Willi your policy ,y now 0441 ON (01130 4) otlDee l6