HomeMy WebLinkAboutPW13-190 - Original - Petersen Brothers, Inc. - Damaged Guardrail Repair on SE 277th Westbound Lane - 07/26/2013 •
KENT
W.SH IN GTON
PUBLIC WORKS AGREEMENT
between City of Kent and
Petersen Brothers, Inc
THIS AGREEMENT is made by and between the City of Kent, a Washington municipal
corporation (hereinafter the "City"), and Petersen Brothers, Inc organized under the laws of the
State of Washington, located and doing business at 2008 E Valley Highway Sumner, WA 98390
(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:
The Contractor shall repair damaged guardrail on SE 277th westbound lane at the
east end of the bridge. For a copy of the Contractor bid dated 6/17/2013 see the
attached Exhibit A which is 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 such services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks
described in Section I above immediately upon execution of this Agreement. Upon the effective
date of this Agreement, Contractor shall complete the work described in Section I by December
31, 2013.
III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed
$4128.03. Applicable Washington State Retail Sales Tax on this contract shall be governed by
WAC 458-20-171 and its related rules for the work contemplated in this Agreement. The
Contractor shall invoice the City monthly. The City will pay for the portion of the work described
in the invoice that has been completed by the Contractor and approved by the City. The City's
payment shall not constitute a waiver of the City's right to final inspection and acceptance of the
project.
PUBLIC WORKS AGREEMENT - 1
(Roadway/Pedestrian Path - Under$10K and Performance Bond)
A. Payment and Performance Bond. Pursuant to Chapter 39.08 RCW, the
Contractor, shall provide the City a payment and performance bond for the
full contract amount.
B. Retainaae. The City shall hold back a retainage in the amount of five percent
(5%) of any and all payments made to contractor 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. The amount retained shall be placed in a fund by the City pursuant to
RCW 60.28.011(4)(a), unless otherwise instructed by the Contractor within
fourteen (14) calendar days of Contractor's signature on the Agreement.
C. 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.
D. Final Payment: Waiver of Claims. THE CONTRACTOR'S ACCEPTANCE OF
FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CONTRACTOR'S CLAIMS,
EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY
CONTRACTOR AS UNSETTLED AT THE TIME FINAL PAYMENT IS MADE AND
ACCEPTED.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement. By their execution of this
Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
A. The Contractor has the ability to control and direct the performance and
details of its work, the City being interested only in the results obtained
under this Agreement.
B. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
C. The Contractor has an established and independent business that is eligible
for a business deduction for federal income tax purposes that existed before
the City retained Contractor's services and is a service other than that
furnished by the City, or the Contractor is engaged in an independently
established trade, occupation, profession, or business of the same nature as
that involved under this Agreement.
PUBLIC WORKS AGREEMENT - 2
(Roadway/Pedestrian Path - Under$10K and Performance Bond)
D. The Contractor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Contractor has registered its business and established an account with
the state Department of Revenue and other state agencies as may be
required by Contractor's business, and has obtained a Unified Business
Identifier (UBI) number from the State of Washington.
F. The Contractor has a valid contractor registration pursuant to Ch. 18.27 RCW
or an electrical contractor license pursuant to Ch. 19.28 RCW.
G. The Contractor maintains a set of books dedicated to the expenses and
earnings of its business.
V. TERMINATION. The City may terminate this Agreement for good cause. "Good
cause" shall include, without limitation, any one or more of the following events:
A. The Contractor's refusal or failure to supply a sufficient number of properly
skilled workers or proper materials for completion of the Contract work.
B. The Contractor's failure to complete the work within the time specified in this
Agreement.
C. The Contractor's failure to make full and prompt payment to subcontractors
or for material or labor.
D. The Contractor's persistent disregard of federal, state or local laws, rules or
regulations.
E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt.
F. The Contractor's breach of any portion of this Agreement.
If the City terminates this Agreement for good cause, the Contractor shall not receive any
further money due under this Agreement until the Contract work is completed. After
termination, the City may take possession of all records and data within the Contractor's
possession pertaining to this project which may be used by the City without restriction.
VI. PREVAILING WAGES. Contractor shall file a "Statement of Intent to Pay
Prevailing Wages," with the State of Washington Department of Labor & Industries prior to
commencing the Contract work. Contractor shall pay prevailing wages in effect on the date the
bid is accepted or executed by Contractor, and comply with Chapter 39.12 of the Revised Code Y
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
PUBLIC WORKS AGREEMENT - 3
(Roadway/Pedestrian Path - Under$1OK and Performance Bond)
facts and events giving rise to the requested change. If the City determines that the change
increases or decreases the Contractor's costs or time for performance, the City will make an
equitable adjustment. The City will attempt, in good faith, to reach agreement with the
Contractor on all equitable adjustments. However, if the parties are unable to agree, the City
will determine the equitable adjustment as it deems appropriate. The Contractor shall proceed
with the change order work upon receiving either a written change order from the City or an oral
order from the City before actually receiving the written change order. If the Contractor fails to
require a change order within the time specified in this paragraph, the Contractor waives its
right to make any claim or submit subsequent change order requests for that portion of the
contract work. If the Contractor disagrees with the equitable adjustment, the Contractor must
complete the change order work; however, the Contractor may elect to protest the adjustment
as provided in subsections A through E of Section VIII, Claims, below.
The Contractor accepts all requirements of a change order by: (1) endorsing it, (2)
writing a separate acceptance, or (3) not protesting in the way this section provides. A change
order that is accepted by Contractor as provided in this section shall constitute full payment and
final settlement of all claims for contract time and for direct, indirect and consequential costs,
including costs of delays related to any work, either covered or affected by the change.
VIII. CLAIMS. If the Contractor disagrees with anything required by a change order,
another written order, or an oral order from the City, including any direction, instruction,
interpretation, or determination by the City, the Contractor may file a claim as provided in this
section. The Contractor shall give written notice to the City of all claims within fourteen (14)
calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14)
calendar days of the date the Contractor knew or should have known of the facts or events
giving rise to the claim, whichever occurs first . Any claim for damages, additional payment for
any reason, or extension of time, whether under this Agreement or otherwise, shall be
conclusively deemed to have been waived by the Contractor unless a timely written claim is
made in strict accordance with the applicable provisions of this Agreement.
At a minimum, a Contractor's written claim shall include the information set forth in
subsections A. items 1 through 5 below.
FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM
WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY
CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS
SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY.
A. Notice of Claim. Provide a signed written notice of claim that provides the following
information:
1. The date of the Contractor's claim;
2. The nature and circumstances that caused the claim;
3. The provisions in this Agreement that support the claim;
4. The estimated dollar cost, if any, of the claimed work and how that
estimate was determined; and
5. An analysis of the progress schedule showing the schedule change or
disruption if the Contractor is asserting a schedule change or
disruption.
PUBLIC WORKS AGREEMENT - 4
(Roadway/Pedestrian Path - Under$1OK and Performance Bond)
B. Records. The Contractor shall keep complete records of extra costs and time
incurred as a result of the asserted events giving rise to the claim. The City shall
have access to any of the Contractor's records needed for evaluating the protest.
The City will evaluate all claims, provided the procedures in this section are
followed. If the City determines that a claim is valid, the City will adjust payment
for work or time by an equitable adjustment. No adjustment will be made for an
invalid protest.
C. Contractor's Dui 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.
PUBLIC WORKS AGREEMENT - 5
(Roadway/Pedestrian Path - Under$1OK and Performance Bond)
XII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its
officers, officials, employees, agents and volunteers harmless from any and all claims, injuries,
damages, losses or suits, including all legal costs and attorney fees, arising out of or in
connection with the Contractor's performance of this Agreement, except for that portion of the
injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Contractor's work when completed shall not
be grounds to avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW
4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or
damages to property caused by or resulting from the concurrent negligence of the Contractor
and the City, its officers, officials, employees, agents and volunteers, the Contractor's liability
hereunder shall be only to the extent of the Contractor's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONTRACTOR'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY
NEGOTIATED THIS WAIVER.
In the event Contractor refuses tender of defense in any suit or any claim, if that tender
was made pursuant to this indemnification clause, and if that refusal is subsequently determined
by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the
Contractor's part, then Contractor shall pay all the City's costs for defense, including all
reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and
fees incurred because there was a wrongful refusal on the Contractor's part.
The provisions of this section shall survive the expiration or termination of this
Agreement.
XIII. INSURANCE. The Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and
incorporated by this reference.
XIV. WORK PERFORMED AT CONTRACTOR'S RISK. Contractor shall take all
necessary precautions and shall be responsible for the safety of its employees, agents, and
subcontractors in the performance of the contract work and shall utilize all protection necessary
for that purpose. All work shall be done at Contractor's own risk, and Contractor shall be
responsible for any loss of or damage to materials, tools, or other articles used or held for use in
connection with the work.
XV. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City
requires its contractors and consultants to use recycled and recyclable products whenever
practicable. A price preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of
any of the covenants and agreements contained in this Agreement, or to exercise any option
conferred by this Agreement in one or more instances shall not be construed to be a waiver or
PUBLIC WORKS AGREEMENT - 6
(Roadway/Pedestrian Path - Under$IOK and Performance Bond)
relinquishment of those covenants, agreements or options, and the same shall be and remain in
full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by
and construed in accordance with the laws of the State of Washington. If the parties are unable
to settle any dispute, difference or claim arising from the parties' performance of this
Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by
filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court,
King County, Washington, unless the parties agree in writing to an alternative dispute resolution
process. In any claim or lawsuit for damages arising from the parties' performance of this
Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or
bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award
provided by law; provided, however, nothing in this paragraph shall be construed to limit the
City's right to indemnification under Section XII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the
parties at the addresses listed on the signature page of the Agreement, unless notified to the
contrary. Any written notice hereunder shall become effective three (3) business days after the
date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to
the addressee at the address stated in this Agreement or such other address as may be
hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written
consent of the non-assigning party shall be void. If the non-assigning party gives its consent to
any assignment, the terms of this Agreement shall continue in full force and effect and no
further assignment shall be made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of
the City and Contractor.
G. Entire Agreement. The written provisions and terms of this Agreement, together
with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or
other representative of the City, and such statements shall not be effective or be construed as
entering into or forming a part of or altering in any manner this Agreement. All of the above
documents are hereby made a part of this Agreement. However, should any language in any of
the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms
of this Agreement shall prevail.
H. Compliance with Laws. The Contractor agrees to comply with all federal, state, and
municipal laws, rules, and regulations that are now effective or in the future become applicable
to Contractor's business, equipment, and personnel engaged in operations covered by this
Agreement or accruing out of the performance of those operations.
PUBLIC WORKS AGREEMENT - 7
(Roadway/Pedestrian Path - Under �;IOK and 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:Peter en Brothers, Inc. CITY OF KENT:
By: G91 By:
(signature) (signa
Print Name: Ronald G. Petersen Print Name: Bradley Lake
Its: President Its: Operations Manager
(tale)
DATE: 7-16-13 DATE:
Z���
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
Tom Rusbuldt
Petersen Brothers, Inc City of Kent
2008 E Valley Highway 220 Fourth Avenue South
Sumner, WA 98390 Kent, WA 98032
253-833-2544 (telephone) (253) 856-5600 (telephone)
253-863-5951 (facsimile) (253) 856-6600 (facsimile)
PUBLIC WORKS AGREEMENT - 8
(Roadway/Pedestrian Path - Under$10K and 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 16th day of July , 20 1 ,1 .
By: OAqL,
—Ronald G. Petersen, President
For: Petersen Brothers Inc.
Title: President
Date: 7-16-13
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 Petersen Brothers,_In
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as Repair - S. 277th 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 13
By:
Ronald G. Petersen, President
For: Petersen Brothers, Inc.
Title: President
Date:
EEO COMPLIANCE DOCUMENTS - 3
EXHIBIT A
2008 EAST VALLEY HIGHWAY
SUMNER,WASHINGTON 98390
(253)833-2544 (253)863-8136
FAX(253)863-5951
Contractors# CC-01 PETERBI187NZ
277TH GUARDRAIL REPAIR @ GREEN R.BR.
Project Name: CITY OF KENT BID DATE: 06/17/13
Item Q� DESCRIPTION TOTAL
1 37.50 LF W-BEAM GUARDRAIL $ 755 $ 28313
2 . 5 00 EA 6x8x6'WOOD POSTS $ 2625 $ 13125
3 5.00 EA 6x8x14"WOOD BLOCKS $ 580 $ 2900
4 1250 LF RADIUS W-BEAM GUARDRAIL TYPE 1 ANC PLATE $ 1100 $ 137 50
5 1 00 EA 6x8x6'WOOD CRT POST $ 3565 $ 3665
6 1,00 EA 6x8x3'6"'WOOD POSTS $ 1935 $ 1935
7 7 00 EA 5/8 x 18"MASTERBOLT $ 270 $ 1890
8 40 00 EA 518 x 1 1/4 SPLICE BOLTS $ 065 $ 2600
9 47 00 EA 518 NUTS $ 055 $ 2586
10 7 00 EA 5/8 WASHER $ 020 $ 140
11 6 00 HR CREW TIME LABOR $ 48500 $ 2,91000
12 1 00 LS 1PROJECT TRAFFIC CONTROL $ 51000 $ 51000
CLOSING RIGHT LANE OF 2 LANES
TOM CITY OF KENT
253-856-5673
Email trusbuldtk@kentwa.gov
TOTAL $ 4,128.03
**Price does not include traffic control unless specified.
**Prices include material&installation,bond and insurance. Beam Guardrail is available in 12,5'and 6 25'lengths.
**Prices are good if contract is received within 30 days after award of lob,after 30 days prices must be renegotiated.
IF ACCEPTED PLEASE SIGN AND FAX BACK TO 253-863-5951
NO WORK WILL BE PERFORMED WITHOUT PROPER AUTHORIZATION
8y: Date
Title
Company Name Phone:
Address. Fax
EXHIBIT B
INSURANCE REQUIREMENTS FOR
SERVICE CONTRACTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
may arise from or in connection with the performance of the work hereunder
by the Contractor, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-owned, hired
and leased vehicles. Coverage shall be written on Insurance Services
Office (ISO) form CA 00 01 or a substitute form providing equivalent
liability coverage. If necessary, the policy shall be endorsed to provide
contractual liability coverage.
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 Commercial General Liability
insurance shall be endorsed to provide the Aggregate Per Project
Endorsement ISO form CG 25 03 11 85. The City shall be named as
an insured under the Contractor's Commercial General Liability
insurance policy with respect to the work performed for the City using
ISO additional insured endorsement CG 20 10 11 85 or a substitute
endorsement providing equivalent coverage.
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. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$1,000,000 per accident.
2. Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $2,000,000
general aggregate and a $2,000,000 products-completed
operations aggregate limit.
EXHIBIT B (Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The Contractor's insurance coverage shall be primary insurance as respect
the City. Any Insurance, self-insurance, or insurance pool coverage
maintained by the City shall be excess of the Contractor's insurance and
shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage shall
not be cancelled by either party, except after thirty (30) days prior
written notice by certified mail, return receipt requested, has been given
to the City.
3. The City of Kent shall be named as an additional insured on all policies
(except Professional Liability) as respects work performed by or on behalf
of the contractor and a copy of the endorsement naming the City as
additional insured shall be attached to the Certificate of Insurance. The
City reserves the right to receive a certified copy of all required insurance
policies. The Contractor's Commercial General Liability insurance shall
also contain a clause stating that coverage shall apply separately to each
insured against whom claim is made or suit is brought, except with
respects to the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than ANII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Contractor before commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or
shall furnish separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to all of the same insurance
requirements as stated herein for the Contractor.
A� CERTIFICATE OF LIABILITY INSURANCE /17/2013
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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject 10
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) �L
PRODUCER CONTACT
-NA Karen SIDith
HENTSCHELL S ASSOC INC PHONE (253)272-1151 q/X No (253)272-1225
One Pacific Building kaxens@hentschell.com
621 Paclfl0 Ave. , Suite 400 INSURERS)AFFORDING COVERAGE NAIC9
Tacoma WA 98402 INSURERA The Travelers IndemnitV Co.
INSURED INSURERS The Travelers Indemnity Co.
Petersen Brothers, Inc. INSURER Travelers Prop Cas Co of Am
2008 East Valley Hwy INSURERD Great American Insurance Co
INSURER E
Sumner WA 98390 INSURER
COVERAGES CERTIFICATE NUMBER:2012 GL/Auto/Umb/Ex REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR TYPE OF RJSURANCE ADD SUER POLICY NUMBER DEFF MM�IDDIYYY LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE § 1,000,000
DAMAGE RENTED—
X COMMERCIAL GENERAL LIABILITY PREMISES DE2 oc r § 300,000
i A I CLAIMS-MI OCCUR X Y T-00-526D9518-11SID-12 1/1/2012 1/1/2013 MED EXP(Any one person) § 10,000
PERSONAL B ADV INJURY § 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG § 2,000,000
POLIGY JIECT X PRO LOCI §
AUTOMOBILE LIABILITY COMBINED SIRINIT 1
a accdent 1,000,000
X ANY AIrrO BODILY INJURY(Per person) §
A ALLOWNEO SCHEDULED -510-52®t15111-00-12 1 1 2012 1/1/2013
AUTOS AUTOS / / BODILY INJURY(Per accident) §
NON CWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS Pefaccident §
Medical a marts § 5,000
C X UMBRELLA LIAR X OCCUR TSH-ClJP-526D9518-TIL-12 1/1/2012 1/1/2013 EACH OCCURRENCE § 1,000,000
D X EXCESS LIAR CLAIMSMADE AGGREGATE § 1,000,000
DED I X I RETENTION§ 10,000 X I Y UE0196291-02 (8xchass) 1/1/2012 1/1/2013 Each Occurrerce/Aggregate § 5,000,000
A WORKERS COMPENSATION I MSTATU. I OTH
AND EMPLOYERS'LIABILITY YIN TQW I WITS ER
ANY PROPRIETORFARTNER/EXEGUTIVE EL EACH ACCIDENT § 1 ODO OOO
OFFICER/MEMBER EXCLUDEDc ❑ NIA
(Mandatory In NH) T-CO-526D9519-111D-12 1/1/2012 1/1/2013 EL DISEASE-EA EMPLOYEE § 1,000,000
if yes,describe under
DESCRIPTION OF OPERATIONSbeWr (WA-Stop Gap)
EL DISEASE-POLICY LIMIT § 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.If mom space is requlntll
BE: Repair Damaged Guardrail on sE 277th Street W/B Lane. Blanket Additional Insured - Primary and
Non-Contributory basis as required by written contract or agreement per the attached Endorsement
#CGD246(8/05) Blanket Waiver of Subrogation as required by written contract or agreement per the
attached Endorsement #CGD316(11/11) . (*13-004)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Kent ACCORDANCE WITH THE POLICY PROVISIONS
220 Fourth Avenue South
Kent, WA 96032 AUTHORIZED REPRESENTATIVE
Thomas Hentschell/Kis
ACORD 26(2010105) 01988-2010 ACORD CORPORATION. All rights reserved,
INS025 poiooe)of The ACORD name and logo are registered marks of ACORD
r
t
,
Policy#DT-CO-526D9518-IND-12
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following-
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED—(Section II) is amended c) The Insurance provided to the additional In-
to include any person or organization that you sured does not apply to 'bodily injury' or
agree in a "written contract requiring insurance" 'property damage" caused by 'your work'
to include as an additional insured on th s Cover- and included in the "products-completed op-
age Part,but erations hazard' unless the "written contract
a) Only with respect to liability for'bodily injury', requiring insurance" specifically requires you
"property damage"or"personal injury", and to provide such coverage for that additional
insured, and then the insurance provided to
b) If, and only to the extent that, the injury or the additional insured applies only to such
damage is caused by acts or omissions of 'bodily injury" or 'property damage' that oc-
you or your subcontractor in the performance curs before the end of the period of time for
of "your work" to which the 'written contract which the 'written contract requiring insur-
requiring insurance" applies The person or ance" requires you to provide such coverage
organization does not qualify as an additional or the end of the policy period, whichever is
insured with respect to the independent acts earlier
or omissions of such person or organization 3" The Insurance provided to the additional insured
2. The insurance provided to the additional insured by this endorsement is excess over any valid and
by this endorsement is limited as follows collectible "other insurance", whether primary,
a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is
this Coverage Part showr in the Declarations available to the additional insured for a loss we
exceed the limits of liability required by the cover under this endorsement However, if the
"written contract requiring insurance", the in- 'written contract requiring insurance' specifically
surance provided to the additional insured requires that this insurance apply on a primary
shall be limited to the limits of liability re- basis or a primary and non-contributory basis,
guired by that "written contract requiring in- this insurance is primary to 'other insurance"
surance" This endorsement shall not in- available to the add�lionaf insured which covers
crease the limits of insurance described in that person or organization as a named insured
Section III—Limits Of Insurance for such loss, and we will not share with that
'other insurance" But the insurance provided to
b) The insurance provided to the additional In- the additional insured by this endorsement still is
sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in-
erty damage" or "personal injury" arising out surance", whether pnmary, excess, contingent or
of the rendering of, or failure to render, any on any other basis, that is available to the addi-
professional architectural, engineering or sur- tional insured when that person or organization is
veying services, including an additional insured under such "other insur-
1. The preparing, approving, or fading to ance'
prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the
rags, opinions, reports, surveys, field or- additional insured by this endorsement
ders or change orders, or the preparing,
approving, or lading to prepare or ap- a) The additional insured must give us written
prove,drawings and specifications, and notice as soon as practicable of an 'occur-
rence' or an offense which may result in a
If. Supervisory, inspection, architectural or claim To the extent possible, such notice
engineering activities should include
CG D2 48 08 05 0 2005 The St.Paul Travelers Companies, Inc Page 1 of 2
COMMERCIAL GENERAL LIABILITY
1. How, when and where the 'occurrence' any provider of'other insurance'which would ,
or offense took place, cover the additional insured for a loss vie
IL The names and addresses of any injured cover under this endorsement However, this
persons and witnesses, and condition does not affect whether the insur-
ance provided to the additional insured by
III. The nature and location of any injury or this endorsement is primary to 'other insur-
damage ansing out of the'occurrence'or ance" available to the additional assured
offense which covers that person or organization as a
b) If a claim is made or'suit" is brought against named insured as described in paragraph 3.
the additional insured, the additional insured above
must 5. The following definition is added to SECTION V
I. Immediately record the specifics of the —DEFINITIONS
claim or"suit"and the date received,and "Written contract requiring insurance' means
If. Notify us as soon as practicable that part of any written contract or agreement
The additional insured must see to it that we under which you are required to include a
receive written notice of the claim or"suit" as person or organization as an additional at
soon as practicable sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
c) The additional insured must immediately Curs and the 'personal injury" is caused by an
send us copies of all legal papers received in offense committed
connection with the claim or "suit% cooperate a, After the signing and execution of the
with us in the investigation or settlement of contract or agreement by you,
the claim or defense against the "suit", and
otherwise comply with all policy conditions b. While that part of the contract or
d) The additional insured must tender the de- agreement is in effect,and
fense and indemnity of any claim or "suit"to c. Before the end of the policy period
i
Page 2 of 2 0 2005 The St.Paul Travelers Companies, Inc. CG D2 46 08 05
DT-C 0-526 D 9516-I N D-12
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage_However,coverage for any
injury,damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to this Coverage Part,and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement The following ilsbng is a general cover-
age description only Limitations and exclusions may apply to these coverages Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights,duties,and what Is and is not covered
A. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased
B. Damage To Premises Rented To You Equipment
C. Increased Supplementary Payments 1. Blanket Additional Insured — States Or Political
Subdivisions—Permits
D. Incidental Medical Malpractice
E. J Knowledge And Notice Of Occurrence Or Offense
. Who Is An Insured—Newly Acquired Or Formed
Organizations K. Unintentional Omission
F. Who Is An Insured—Broadened Named Insured L. Blanket Waiver Of Subrogation
—Unnamed Subsidiaries M. Amended Bodily Injury Definihon
Q, Blanket Addtional Insured — Owners, Managers N. Contractual Liability—Railroads
Or Lessors Of Premises
PROVISIONS INJURY AND PROPERTY DAMAGE LI.
A. AIRCRAFT CHARTERED WITH PILOT ABILITY
The following is added to Exclusion g., Aircraft, Exclusions c.and g. through n.do not apply
Auto Or Watercraft,in Paragraph 2.of SECTION to "premises damage" Exclusion C(1)(a)
1—COVERAGES - COVERAGE A BODILY IN- does not apply to"premises damage"caused
JURYAND PROPERTY DAMAGE LIABILITY by
This exclusion does not apply to an aircraft that a. Fire;
is b. Explosion,
(a) Chartered with a pilot to any insured, c. Lightning,
(b) Not awned by any insured,and d. Smoke resulting from such fire,explosion,
(c) Not being used to carry any person or prop- or lightning,or
erty for a charge e. Water,
B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion 1,of Section I—Coverage A
1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability
clusion I., Damage To Property, in Para- is replaced by another endorsement to this
graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion—All Pollu-
COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex-
PROPERTY DAMAGE LIABILITY is deleted clusion in its title.
2. The following replaces the last paragraph of A separate limit of insurance applies to
Paragraph 2., Exclusions, of SECTION I — 'premises damage" as described in Para
COVERAGES — COVERAGE A. BODILY graph 6. of SECTION Ig — LIMITS OF IN-
SURANCE
CG D31611 11 02M 1 The Tmmlers Indemnity Cemparry Au Nhis reserved Page 1 of 6
COMMERCIAL GENERAL LIABILITY
3. The following repiaces Paragraph S. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS
TION III—LIMITS OF INSURANCE 1. The following replaces Paragraph i.b. of
Subject to 3. above, the Damage To Prep} SUPPLEMENTARY PAYMENTS - COVER-
ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER-
pay under Coverage A for damages because AGE.
or"premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds
The Damage To Premises Rented To You required because of accidents or traffic
Limit will apply to all "property damage" law violations arising out of the use of any
proximately caused by the same "oomr- vehicle to which the Bodily irkury Liability
rents, whether such damage results from. Coverage applies V&do not have to fur-
fire,explosion, lightning;smoke resulting from nish these bonds
such fire, explosion, of lightning, or water, or any cambinatlon of any of these causes, I The following replaces Paragraph 1.d, of
SUPPLEMENTARY PAYMENTS — COVER-
' The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER-
Limit will be AGES
a. The amount shown for the Damage To d. All reasonable expenses incurred by the
Premises Rented To You Limit on the Insured al our request to assist us in the
Declarations of this Coverage Part or investigation or defense of the claim or
b. $300,000 if no amount is shown for the "suit", including actual loss of eamings up 1
Damage To Premises Rented To You to $500 a day because of time off from
Limit on the Declarations of this Coverage work
Part D. INCIDENTAL MEDICAL MALPRACTICE
4. The following replaces Paragraph S. of the 1. The following is added to the definition of"oc" i
definition of"insured contract" in the DEFINI- currence"in the DEFINITIONS Section.
TIONS Section: "Occurrence"also means an act or omission
a A contract for a lease of premises How- committed in providing or failing to provide
ever, that portion of the contract for a "ircidental medical services", first aid or
lease of premises that indemnifies any "Good Samaritan services"to a person
person or organization for "premises damage"is not an'insured contract", o y, The following is added SECTION II—WHO IS to t INSURED Paragraph 2.a(1)of
5. The following is added to the DEFINITIONS Section Paragraph (1)(d) above does not apply to
"Premises damage" means "property dam- "bodily re arising out of providing or fail-
Ing to provide
age"to (i) 'incidental medical services" by any of
a. Any premises while rented to you or tem- your"employees" who is a nurse practi-
poranly occupied by you with permission tioner,registered nurse,licensed practroal
of the owner,or nurse, nurse assistant, emergency medl-
b. The contents of any premises while such cal technician or paramedic,or
premises is rented to you,if you rent such (11) First aid or"Good Samaritan services"by
premises for a period of seven or fewer any of your "employees" or "volunteer
consecutive days.
workers", other than an employed or vot-
6. The following replaces Paragraph 4.b.(1)(b) unteer doctor Any such "employees" or
of SECTION IV—COMMERCIAL GENERAL 'volunteer workers" providing or failing to
LIABILITY CONDITIONS- provide first aid or"Good Samaritan ser-
(b) That is insurance for"premises damage", vices" during their work hours for you will
or be deemed to be acting within the scope
T. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing
COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi-
DITIONS is deleted. ness
Page 2 of 6 02011 The Travelers Indernnny company A9 rtgtxs reserved CG D3 16 1111
COMMERCIAL GENERAL LIABILITY
3. The following is added to Paragraph 6. of 4. Any organbation you newly acquire or form,
SECTION III—LIMITS OF INSURANCE other than a partnership,joint venture or lim-
For the purposes of determining the applica- ited liability company, of which you are the
ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma-
omissions Committed in providing or fading to jority ownership interest, will qualify as a
provide"incidental medical services", first aid Named Insured if there is no other insurance
or"Good Samaritan services"to any one per- which provides similar coverage to that Or-
son will be deemed to be one"occurrence", ganization However:
4. The following exclusion Is added to Para- a. Coverage under this provision is afforded
graph 2., Exclusions, of SECTION I—COW only
ERAGES—COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or
AND PROPERTY DAMAGE LIABILITY form the organization or the end of the
Sale Of Pharmaceuticals policy period, whichever is earlier, if you
"Bodily injury" or "property damage" arising do not report such organzation in writing
out of the willful violation of a penal statute or to us within 180 days after you acquire or
ordinance relating to the sale of pharmaceuti- form it,or
cals committed by, or with the knowledge or (2) Until the end of the policy period, when
consent of,the insured that date is later than 180 days after you
6. The following is added to the DEFINITIONS acquire or form such organization, if you
Section report such organization in writing to us
"Incidental medical services"means: within 180 days after you acquire or form
a. Medical,surgical, dental,laboratory,x-ray it, and we agree In writing that it will con-
or nursing service or treatment,advice or tinue to be a Named Insured until the end
instruction, or the related furnishing of of the policy period;
food or beverages,or b. Coverage A does not apply to "bodily injury"
b. The furnishing or dispensing of drugs or or "property damage" that occurred before
medical, dental, or surgical supplies or you acquired or formed the organization,and
appliances c. Coverage B does not apply to "personal in-
"Good Samaritan services"means any emer- jury" or "advertising injury" anstng out of an
gency,medical services for which no compen- offense committed before you acquired or
saticn is demanded or received formed the organization
8. The following is added to Paragraph 4.b.,Ex- F. WHO IS AN INSURED—BROADENED NAMED
cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES
MERCIAL GENERAL LIABILITY CONDI- The following is added to SECTION 11 —WHO IS
TIONS AN INSURED
The insurance Is excess over any valid and
collectible other insurance available to the in- Any of your subsidiaries,other than a partnership,
sured,whether primary, excess,contingent or joint venture or limited liability company, that is
on any other basis, that is available to any of not shown as a Named Insured in the Declare-
your "employees" or "volunteer workers" for bons is a Named Insured if you maintain an own-
"bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi-
failing to provide "incidental medical ser- ary on the first day of the policy penod
vices", first aid or"Good Samaritan services" No such subsidiary is an insured for"bodily injury"
to any person to the extent not subject to or"property darnage"that occurred, or"personal
Paragraph 2.a.(1) of Section li —Who Is An injury" or "advertising injury" caused by an of-
Insured fense committed after the date, if any, during the
E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an
OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub-
The following replaces Paragraph 4.of SECTION sidiary
If—WHO IS AN INSURED
CO D3 16 11 11 0 2011 The Travelers Irderrmlly Company AN righle reserved Page 3 of a
,
COMMERCIAL GENERAL LIABILITY
9. BLANKET ADDITIONAL INSURED—OWNERS, N. BLANKET ADDITIONAL INSURED—LESSORS
MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT
The following is added to SECTION II—WHO IS The following is added to SECTION II—WHO 18
AN INSURED. AN INSURED.
w Any person or organization that Is a premises Any person or organtzatlon that is an equipment
9 owner, manager or lessor and that you have lessor and that you have agreed in a written con- J
agreed in a written contract or agreement to in- tract or agreement to include as an insured on
" clude as an additional Insured on this Coverage this Coverage Part is an insured,but only with re-
Part is an Insured,but only with respect to liability
for "bodilyin u "property damage", "personal spec,to"persoiabilitynal
for"bodily injury", "property dam-
for J ry". �Prof Y 9 Pe age' "personal injury"or"advertising injury"that
injury"or"advertising injury"that
a. Is "bodily injury" or "property damage" that a. Is "toddy injury" or "property damage" that
occurs, or is "personal injury' "advertising occurs, or is "personal injury" or"advertising
Injury"caused by an offense that is commit- Injury"s" caused t t t offense that f at coa-
ted, subsequent to the execution of that con- tea, subsequent to the execution of that con- '
tract or agreement, and tractor agreement, and
b. is caused, in whole or in part,by your acts or
b. Arises out of the ownership, maintenance or
omissions the maintenance, operation or
use of that part of any premises leased to
{ YOU equipment
of equipment leased to you by such
i
equipment lessor
The insurance provided to such premises owner, The insurance provided to such equipment lessor
manager or lessor is subject to the following pro- is subject to the following provisions
visions
a. The limits of insurance provided to such a. The limits of insurance provided to such
equipment lessor will be the minimum limits
premises owner, manager or lessor will be which you agreed to provide in the written
the minimum hinds which you agreed to pro-
contract or agreement or the limits shown on
vide in the written contract or agreement, or ?
the limits shown on the Declarations, which the Declarations,whichever are less
ever are less b. The insurance provided to such equip neat
lessor does not apply to any"bodily injury"or
b. The insurance provided to such premises "property damage" that occurs, or "personal
owner,manager or lessor does not apply to injury"or"advertising injury"caused by an of-
(1) Any "bodily injury" or "property damage" fense that is aommrited, after the equipment
that occurs, or"personal injury"or"adver- lease expires.
tising injury"caused by an offense that is 0, The Insurance provided to such equipment
committed,after you cease to be a tenant lessor is excess over any valid and collectible
in that premises,or other insurance available to such equipment
(2) Structural alterations, now construction or lessor, whether primary, excess, contingent
demolition operations performed by or on or on any other basis, unless you have
behalf of such premises owner, lessor or agreed in the written contract or agreement
manager. that this insurance must be primary to, or
e. The insurance provided to such premises non-contributory with, such other insurance,
owner, manager or lessor is excess over any in which case this insurance will be primary
valid and collectible other insurance available to, and non-contributory with, such other in-
to such premises owner, manager or lessor, surance
whether primary, excess• contingent or on 1, BLANKET ADDITIONAL INSURED — STATES
any other basis, unless you have agreed in OR POLITICAL SUBDIYISiONS—PERMITS
the written contract or agreement that this in-
surance must be primary to, or non- The following is added to SECTION 11—WHO 19
AN INSURED.
contributory with, such other insurance, in
which case this insurance will be primary to, Any state or political subdivision that has issued a
and non-contributory with, such other incur- permit in connection with operations performed by
ance you or on your behalf and that you are required
Page 4 of a 02011 The Trowels NrdemN[y Company M r1*ft rsaervad CO D3 18 1111
COMMERCIAL GENERAL LIABILITY
by any ordinance, law or building code to include (11) A manager of any limited liability
as an additional insured on this Coverage Part is company,or
an insured, but only with respect to liiabihty for (Ilil An executive officer or director of
"bodily injury", "property damage", "personal In- any otherorganmation;
jury"or"advertising injury"arising out of such op- that is your partner, joint venture
erations. member or manager,or
The insurance provided to such state or political (b) Any "employee' authorized by such
subdivision does not apply to partnership, joint venture, limited Ir
a. Any "bodily injury," "property damage," "per- ability company or other organization
sonal injury"or"advertising injury"arising out to give notice of an "occurrence" or
of operations performed for that state or po- offense.
irtical subdivision,or (3) Notice to us of such"occurrence"or of an
b, Any "bodily injury" or "property damage" in- offense will be deemed to be given as
eluded in the"products-completed operations soon as practicable it it is given in good
hazard" faith as soon as practicable to your work-
J. KNOWLEDGE AND NOTICE OF OCCUR• ers' compensation insurer This epplies
RENCE OR OFFENSE only if you subsequently give notice to us
The following is added to Paragraph 2.,Duties In of the"occurrence"or offense as soon as
The Event of Occurrence, Offense, Claim or practicable after any of the persons de
Suit, of SECTION IV — COMMERCIAL GEN- scribed in Paragraphs e. 11) or(2)above
ERAL LIABILITY CONDITIONS* discovers that the"occurrence"or offense
may result in sums to which the insurance
e. The following provisions apply to Paragraph provided under this Coverage Part may
a.above, but only for the purposes of the In- apply
surance provided under this Coverage Part to
you or any insured listed in Paragraph 1.or 2. However, if this Coverage Part includes an en-
of Section II—Who Is An Insured dorsement that provides limited coverage for
"bodily injury" or "property damage" or pollution
(1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es-
fense must be given as soon as practica- cape of^pollutants"which contains a requirement
ble only after the"occurrence" or offense that the discharge, release or escape of"pollut-
is known by you(if you are an indivfdual), ants" must be reported to us wthin a specific
any of your partners or members who is number of days after Its abrupt commencement,
an individual (if you are a partnership or this Paragraph e. does not affect that require-
joint venture),any of your managers who ment
is an individual(rf you are a limited liability UNINTENTIONAL OMISSION
company), any of your "executive offs-
cers"or directors (if you are an organize- The following is added to Paragraph 6., Repre-
lion other than a partnership,joint venture sentations, of SECTION IV — COMMERCIAL
or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS•
ployed' authorized by you to give notice The unintentional omission of, or unintentional
of an"occurrence"or offense error in, any information provided by you which
(2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju-
limited liability company,and none of your dice your rights under this insurance However,
partners, joint venture members or man- this provision does not affect our right to collect
agers are individuals, notice to us of such additional premium or to exercise our rights of
')occurrence"or offense must be given as cancellation or nonrenewal in accordance with
soon as practicable only after the "occur- applicable insurance laws or regulations.
rence"or offense Is known by L BLANKET WAIVER OF SUBROGATION
(a) Any individual who is The following is added to Paragraph 8, Transfer
(I) A partner or member of any part- Of Rights Of Recovery Against Others To Us,
nership or joint venture, of SECTION IV—COMMERCIAL GENERAL LI-
ABILITY CONDITIONS
CO D316 11111 6 2011 The Travelers kx*nnky Canpany AN trans murvad Page B of 6
COMMERCIAL GENERAL LIABILITY
If the insured has agreed in a contract or agrees 3 "Boddy injury" means bodily injury, mental
meet to waive that insured's right of recovery anguish,mental injury,shock,fright,disability,
against any person or organization,we waive our humiliation, sickness or disease sustained by
right of recovery against such person or organza- a person, including death resulting from any
tton,but only for payments we make because of of these at any time
a. "Bodily injury' or"property damage"that or, N. CONTRACTUAL LIABILITY—RAILROADS
curs, or 1. The following replaces Paragraph c. of the
b. "Personal Injury" or "advertising injury' definition of"insured contract' in the DEFINI-
caused by an offense that is committed, TIONS Section:
subsequent to the execution of that contract or c. Any easernardorhoenseagreentent,
agreement 2. Paragraph L(1) of the definition of "insured
M. AMENDED BODILY INJURY DEFINITION contract" to the DEFINITIONS Section is de-
The following replaces the definition of "bodily leted ;
injury"in the DEFINITIONS Section I
Page 6 of 6 02et1 The Tie Indemnely ComMy Aft rights respired CG D316 11111
KENT PAYMENT AND PERFORMANCE BOND
TO CITY OF KENT
Bond No 105950519
KNOW ALL MEN BY THESE PRESENTS:
That we, the undersigned, Petersen Brothers. Inc
as Principal, and Travelers Casualty and Surety Company of America
a Corporation organized and existing under the laws of the State of Washington, as a
Surety Corporation, and qualified under the laws of the State of Washington to
become Surety upon bonds of Contractors with Municipal Corporations, as Surety, are
jointly and severally held and firmly bound to the CITY OF KENT In the penal sum of
$a 12803 , together with any adjustments, up or down, In the total contract
price because of changes in the contract work, for the payment of which sum on
demand we bind ourselves and our successors, heirs, administrators or personal
representatives, as the case may be.
This obligation Is entered Into in pursuance of the statutes of the State of
Washington, and the Codes and Ordinances of the CITY OF KENT.
Nevertheless, the conditions of the above obligation are such that:
WHEREAS, under and pursuant to a motion, duly made, seconded and passed
by the City Council of the City of Kent, King County, Washington, the Mayor of the City
of Kent has let or is about to let to the above bounden Principal, a certain contract, the
said contract providing for construction of repairing damaged guardrail located at S
277th Westbound at the East end of the bridge (which contract is referred to herein
and is made a part hereof as though attached hereto), and
WHEREAS, the Principal has accepted, or is about to accept, the contract, and
undertake to perform the work therein provided for In the manner and within the time
set forth:
NOW, THEREFORE, for non-FHWA projects only, if the Principal shall faithfully
perform all the provisions of said contract In the manner and within the time herein
set forth, or within such extensions of time as may be granted under the said contract,
and shall pay all laborers, mechanics, subcontractors and material men, and all
persons who shall supply the Principal or subcontractors with provisions and supplies
for the carrying on of said work and shall indemnify and hold the CITY OF KENT
harmless from any damage or expense by reason of failure of performance as
specified in said contract or from defects appearing or developing in the material or
workmanship provided or performed under said contract, then and in that event this
obligation shall be void; but otherwise It shall be and remain In full force and effect.
IN WITNESS WHEREOF, the above bounden parties have executed this
instrument under their separate seals. The name and corporate seal (if required by
PAYMENT AND PERFORMANCE BOND
Page I of 2
law) of each corporate party is hereto affixed and duly signed by its undersigned
representatives pursuant to authority of its governing body.
TWO ITNESSES: Petersen Brothers, Inc
/�-Jja6 PRINCIPAL (enter prince 's name above)
-04 BY:
TITLE: i'� EStO�c1�
DATE: rI �110 13 DATE: July 15, 2013
CORPORATE SE
q Q u°eofOtE y
PRINT NAME °' S��1
DATE: —1 13 Travelers Casualty an any of America
SURETY
CORPORATE SEAL: BY:
DATE: July 15, 2013
_ TITLE: Karen J Smith, Attorney-In-Fact
Hentschell &Associates, Inc
ADDRESS: 621 Pacific Ave #400
Tacoma, WA 98402
CERTIFICATE AS TO CORPORATE SEAL
I hereby certify that I am the (Assistant) Secretary of the Corporation named as
Principal in the within Bond; that Ft7--)A-t C1. pc-- " YI 1
Who signed the said bond on behalf of the Principal PC�rC �Jt�
Of the said Corporation; that I know his signature thereto is genuine, and that said
Bond was duly signed, sealed, and attested for and in behalf of said Corporation by
authority of its governing body. C��
SECRETARY OR ASSIST AT SECRETARY
W10I n D. a,-T I�
1�lvumal�vn4vN,RVlvvzn.,NRornu,ceBerq Ovc
PAYMENT AND PERFORMANCE BOND
Page 2 of 2
WARNING THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
AM POWER OF ATTORNEY
TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company
Attorney-In Fact No. 218993 Certificate No. 005331457
KNOW ALL MEN BY THESE PRESENTS That Farmington Casualty Company, St Paul Fire and Marine Insurance Company, St Paul Guardian Insurance
Company, St Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connectiwt, that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters Inc,is a corporation duly organized under the
laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make constitute and appoint
Karen Ingram,Karen J Smith,Julie Craker,Thomas P Hentschell, Leslie A Parks, Brad Roberts,and Joanne Reinkensmeyer
of the City of Tacoma ,State of Washinaton ,then true and lawful Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recogmzances,conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law
yy}S Tg'� 'R
IN WITNESS WHEREOF,the Companies have caused this instrum�t ens to4be signed and their corporate seals to be hereto affixed,this 14th
day of January 2013
Farmington Casualty Comm 1 sr r St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company?�(y,gI.GS�r j `�'Y"��F`}'y y,.�,,,. FIRE e6 y OF*M A3,G9 JPt•J�N3V V, 9JP�TY 4NOB 1.'RO w'Vly� q Y'_
O5 jG fl � � "^nNWtED ' 'P 1EOP FOga.E�m WO OOpPORATf2^i ee 09 � 1y�
1 9.8IS o 1,97] -' ! i f _-_ HAflrFOHD, ja/lfRPoim,r1
�yc�'as 19J�7 44 ti® SEAL�ois i�b SEAL D �, coHN ol8 m >ss6
r `R`'d ��dr xaet . �'f4ttl
ANi
State of Connecticut By
City of Hartford ss Robert L Raney Kior Vice President
On this the 14th day of January 2013 More me personally appeared Robert L Raney,who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters.Inc,St Paul
Fire and Marine Insurance Company,St Paul Guardian Insurance Company,St Paul Mercury Insurance Company Travelers Casualty and Surety Company,Travelers
Casualty and Surety Company of America and United States Fidelity and Guaranty Company and that he,as such being authorized so to do,executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer
Tlf
In Witness Whereof,I hereunto set my hand and official seal ' TM M wo 0,
My Commission expires the 30th day of June,2016 j0l/RUG * Mane C Tetreault,Notary Public
CommCommission
se
58440-8-12 Printed in U S A
WARNING THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
WARNING THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity
and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters,Inc St Paul Fire and Marine Insurance Company St Paul Guardian Insurance
Company,St Paul Mercury Insurance Company, I ravelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company which resolutions are now in full force and effect reading as follows
RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice
President,the Treasurer any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf
of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds,recogmzanceS,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her and it is
FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary,and it is
FURTHER RESOLVED that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking
shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice
President,any Second Vice President the Treasurer any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretary,or(b)duly executed(under seal,if required)by one or more Attorney s-m-Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority, and it is
FURTHER RESOLVED,that the signature of each of the following officers President,any Executive Vice President,any Senior Vice President,any Vice President,
any Assistant Vice,President any Secretary,any Assistant Secretary and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds
and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such tacsumle signature or facsimile seal
shall be vand and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached
1,Kevin E Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance
Underwriters,Inc,St Paul Fire and Marine Insurance Company,St Paul Guardian Insurance Company,St Paul Mercury Insurance Company,Travelers Casualty and
Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing
is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies thisl_,_,�. day of 20
Kevin E Hughes,Assistam Sec tary
?�NSU,ii1 T1 E�nF 41 O�PN I NSGB ei 1N4UA9 �a��r 4HD' w��*n��
O ♦,Rn�- �P, �LOPPOP���i QWJ b� uP 9 � ,�'t`
V
--- n- a HAHTFORO H49f Wfl4 < 4
�y�-'M1rcivHat �n ,.r �9Jr� %�c SE AL�o' l SEAL �3°' y coNN �oCONhR N 1896,pI��
To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www travelersbond corn Please refer to the Attomey-In-Fact number,the
above-named individuals and the details of the bond to which the power is attached
WARNING THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
Phl , 3 f 'To
Admin Services Process
1. Once contract received, make sure all proper documentation is included along with
Superintendant approval
2. Write contract according to scope and bid,use link on City Space to determine what contract to
use.
3. X Obtain insurance requirements from Risk Management.
4. *X Print prevailing wage documents for contract.
5. X Compile all info and get approval from Nancy to proceed with sending contract on.
6. Send to Contractor for signature.
7. When contract received back,verify all correct information was received, including proper
additional insured paperwork and verify intent to pay prevailing wages was filed.
8. �</ Get approval from Nancy to continue with contract process.
9. ^ Have Operations Manager sign.
io. '74% Notify P` O rep the contract has been signed.
ii. Make an extra copy of the contract for our records.
12. X Send 1 original of the signed contract with a notice to proceed.
13. Send second original copy to City Clerk office for filing. Use contract cover sheet.
14. Enter into online spreadsheet for tracking.
15. X Give accounting info to Accounting Services Assistant to assign purchase order.
16. X_File copy of contract with this document and all other related documents in the contract books.
Contract Effective Date: -1 / I (a 1 13
Expiration Date:
1 •��� vV
Accepted as Complete Date: 9 20�3
AEG
Retention Release Date: lal
RK