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HomeMy WebLinkAboutPK14-103 - Original - Blue Line Water, Inc. - Clark Lake Shared Well Dissolution - 04/15/2014 m ecords Markigeme, � KENT �.. Document WASHINGTON 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: Blue Line Water, Inc. Vendor Number: 716234 ]D Edwards Number h Contract Number: ? ,LAB 1y06 This is assigned by City Clerk's Office Project Name: Clark Lake Shared Well Dissolution Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 4/15/14 Termination Date: 5/15/14 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Brian Levenhagen Department: Parks Planning & Dev. Detail: (i.e. address, location, parcel number, tax id, etc.): Dissolution of shared well between Schulte & LeCompte properties, & direct connection to LeCompte property. YIN PPD Contract # PPD13-23 S•Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 i KENT WAN HI NOT ON PUBLIC WORKS AGREEMENT between City of Kent and Blue Line Water, Inc. THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Blue Line Water, Inc. organized under the laws of the State of Washington, located and doing business at 2531 Inter Ave., Suite A, Puyallup, WA 98372, Christopher Lee (253) 841-2101 (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: See attached Exhibit A - Quotation #070313A Contractor further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time such services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon execution of this Agreement. Upon the effective date of this Agreement, Contractor shall complete the work described in Section I within thirty (30) days. III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed Eight Thousand, One Hundred Forty-seven dollars and ninety cents ($8,147.90), including any applicable Washington State Sales Tax, for the work and services contemplated in this Agreement. The City shall pay the Contractor the following amounts according to the following schedule: Payment will be made upon the submission of an invoice. PUBLIC WORKS AGREEMENT - 1 (Under$10K - OPTIONAL PROCESS) A. No Payment and Performance Bond. Because this contract is under $10,000, the City has elected to waive both the performance/payment bond and retainage requirements of Chapter 39.08 RCW. B. Defective or Unauthorized Work. The City reserves its right to withhold payment from Contractor for any defective or unauthorized work. Defective or unauthorized work includes, without limitation: work and materials that do not conform to the requirements of this Agreement; and extra work and materials furnished without the City's written approval. If Contractor is unable, for any reason, to satisfactorily complete any portion of the work, the City may complete the work by contract or otherwise, and Contractor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Contract price specified above. The City further reserves its right to deduct the cost to complete the Contract work, including any Additional Costs, from any and all amounts due or to become due the Contractor. C. Final Payment: Waiver of Claims. THE CONTRACTOR'S ACCEPTANCE OF FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CONTRACTOR'S CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY CONTRACTOR AS UNSETTLED AT THE TIME FINAL PAYMENT IS MADE AND ACCEPTED. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Contractor has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Contractor maintains and pays for its own place of business from which Contractor's services under this Agreement will be performed. C. The Contractor has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Contractor's services and is a service other than that furnished by the City, or the Contractor is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Contractor is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Contractor has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Contractor's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. PUBLIC WORKS AGREEMENT- 2 (Under$10K - OPTIONAL PROCESS) I F. The Contractor has a valid contractor registration pursuant to Ch. 18.27 RCW or an electrical contractor license pursuant to Ch. 19.28 RCW. G. The Contractor maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. The City may terminate this Agreement for good cause. "Good cause" shall include, without limitation, any one or more of the following events: A. The Contractor's refusal or failure to supply a sufficient number of properly skilled workers or proper materials for completion of the Contract work. B. The Contractor's failure to complete the work within the time specified in this Agreement. C. The Contractor's failure to make full and prompt payment to subcontractors or for material or labor. D. The Contractor's persistent disregard of federal, state or local laws, rules or regulations. E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt. F. The Contractor's breach of any portion of this Agreement. If the City terminates this Agreement for good cause, the Contractor shall not receive any further money due under this Agreement until the Contract work is completed. After termination, the City may take possession of all records and data within the Contractor's possession pertaining to this project which may be used by the City without restriction. VI. PREVAILING WAGES. Contractor shall file a "Statement of Intent to Pay Prevailing Wages, with the State of Washington Department of Labor & Industries prior to commencing the Contract work. Contractor shall pay prevailing wages in effect on the date the bid is accepted or executed by Contractor, and comply with Chapter 39.12 of the Revised Code of Washington, as well as any other applicable prevailing wage rate provisions. The latest prevailing wage rate revision issued by the Department of Labor and Industries is attached. VII. CHANGES. The City may issue a written change order for any change in the Contract work during the performance of this Agreement. If the Contractor determines, for any reason, that a change order is necessary, Contractor must submit a written change order request to the person listed in the notice provision section of this Agreement, section XV(D), within fourteen (14) calendar days of the date Contractor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change 9 9 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 PUBLIC WORKS AGREEMENT- 3 (Under$10K - OPTIONAL PROCESS) 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. j At a minimum, a Contractor's written claim shall include the information set forth in subsections A, items 1 through 5 below. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. A. Notice of Claim. Provide a signed written notice of claim that provides the following information: 1. The date of the Contractor's claim; 2. The nature and circumstances that caused the claim; 3. The provisions in this Agreement that support the claim; 4. The estimated dollar cost, if any, of the claimed work and how that estimate was determined; and 5. An analysis of the progress schedule showing the schedule change or disruption if the Contractor is asserting a schedule change or disruption. B. Records. The Contractor shall keep complete records of extra costs and time incurred as a result of the asserted events giving rise to the claim. The City shall have access to any of the Contractor's records needed for evaluating the protest. The City will evaluate all claims, provided the procedures in this section are followed. If the City determines that a claim is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. C. Contractor's Duty to Complete Protested Work. In spite of any claim, the Contractor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. PUBLIC WORKS AGREEMENT- 4 (Under$IOK - OPTIONAL PROCESS) i 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 j DAYS FROM THE DATE THE CONTRACT WORK IS COMPLETE OR CONTRACTOR'S ABILITY TO ! FILE THAT CLAIM OR SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. X. WARRANTY. Upon acceptance of the contract work, Contractor must provide the City a one-year warranty bond in a form and amount acceptable to the City. The Contractor shall correct all defects in workmanship and materials within one (1) year from the date of the City's acceptance of the Contract work. In the event any parts are repaired or replaced, only original replacement parts shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for that portion of the work shall extend for one (1) year from the date such correction is completed and accepted by the City. The Contractor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Contractor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Contractor shall pay all costs incurred by the City in order to accomplish the correction. XI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Contractor, its sub-contractors, or any person acting on behalf of the Contractor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Contractor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. XII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Contractor's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Contractor's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a coup` 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 PUBLIC WORKS AGREEMENT- 5 (Under$10K - OPTIONAL PROCESS) i and the City, its officers, officials, employees, agents and volunteers, the Contractor's liability hereunder shall be only to the extent of the Contractor's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONTRACTOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Contractor refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Contractor's part, then Contractor shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Contractor's part. The provisions of this section shall survive the expiration or termination of this Agreement. XIII. INSURANCE. The Contractor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. XIV. WORK PERFORMED AT CONTRACTOR'S RISK. Contractor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Contractor's own risk, and Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XV. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award PUBLIC WORKS AGREEMENT - 6 (Under$10K - OPTIONAL PROCESS) i 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. 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. I PUBLIC WORKS AGREEMENT- 7 (Under$10K - OPTIONAL PROCESS) CONTRACTOR: CITY OF KENT: By: ��� �� By: (signature) (signature) Print Name: Christopher Lee Print am : Jeff Watling, Direc r Its President Its: Parks, Recreation and Community � 1 ) Services Department DATE:_ DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONTRACTOR: CITY OF KENT: Christopher Lee Brian Levenhagen, Park Planner Blue Line Water, Inc City of Kent 2531 Inter Ave Ste A 220 Fourth Avenue South Puyallup, WA 98372 Kent, WA 98032 (253) 8471-2101 (telephone) (253) 856-5116 (telephone) (253) 799-9105 (facsimile) Email: bjlevenhagen@kentwa.gov services@bluelinewater.com APPROVED AS TO FORM: Kent Law Department PUBLIC WORKS AGREEMENT - 8 (Under$10K - OPTIONAL PROCESS) 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. By: � For: �luc [ .'�� W -Mv Title: Date: 'LI EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY I NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 i I 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. I I I By: ' For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 BL UE L INE WA TER TREATMENT&PUMP S YS TEMS Quotation# 070313A To: Hope Gibson, RLA Manager Park Planning&Development 220 4"Ave S Kent, WA 98032 Address Location: 12639 SE 240i"St, Kent, WA 98031 Reference: Shared Well Dissolution/Group B water system Inactivation Prepared By: Christopher Lee { Discussion: The shared well is located on an adjacent residential property being acquired by the City of Kent The city plans to demolish the home and incorporate the land into the existing park adjacent both parcels. The drilled well with 6"casing, cap and pitless adaptor are located adjacent a pump house built partially below grade with steps down into the entrance door The building is older and is in poor to fair condition Information on the pump controls indicates that a(Goulds Model 10GS07412CL)submersible pump is installed in the well with a conventional control box,pressure switch, and pressure tank. In light of the city's plans to incorporate the property into a public park we make the following recommendations ✓ install anew waterline from well to the single dwelling to be served by the water system The existing waterline has multiple joints in addition to the existing service connection and has a history of leaks Replacing this line with a single contiguous run of pipe, property installed, will ensure system integrity and diminish the likelihood of future excavation due to joint failures ✓ Install new pump controls within the boundary of the single family home to be served by the pump system The existing structure is not secure and would pose a safety hazard to the general public that would have access to the area it would be in the City's best(risk reduction)interest to demolish the existing pump house and to have all pump controls relocated onto the private property and with the private property owner managing the water system without having to access the controls in an area open to the general public Once completed, the only above grade structure remaining would be the well head ✓ Replace the existing well cap with a lockable(padlock) well cap to reduce the likelihood of tampering with a water supply ✓ Install both a well head cover, a"mock rock"for instance, to reduce the visibility of the well head to passersby and install some physical protection banner(bollards or boulders)around the well head to prevent damage to the well by equipment(mowers, vehicles)traffic ✓ Consult King County Health regarding the inactivation/conversion of the Group B water system to a private well ✓ Complete filing of easement for homeowner to access well,run utilities on City owned property Proposal-Water System Modifications: Scope of work: Provide the following materials and tasks with noted exceptions and assumptions: ✓ Excavate and cover of ditch(including non-native fill, if required)perrequired specification from well head to water service entrance/motor load cable exit at dwelling, with excess matenal to be left on site ✓ Up to 200-feet of 200-PSI, I %'polyethylene pipe service line from well to service entrance of dwelling adjacent the well ✓ Up to 200-feet of 1213+Ground direct burial cable between well and dwelling ✓ Burial Compression connectors for each end of water service line ✓ Line size reduction at service entrance ✓ Install waterline from well to service entrance 2531 Inter Ave., Suite A,Puyallup, WA 98372 • (253)841-2101 a www.bluelinewater.com 1 ✓ Install direct Burial OF cable from well to well to new controller ✓ Pump Controller, constant pressure, 1PH input/1PH output, 230V ✓ Pressure tank manifold with gauge, relief, shut-off and dram ✓ 5-gallon diaphragm pressure tank ✓ CPVC interior piping ✓ Install Controller, Pressure tank, Tank manifold and pressure sensor on backer board assembly in garage adjacent water heater ✓ Connect new circuit!me and load to controller ✓ Following required inspections and approval to cover, connect water service line to well discharge and service entrance. ✓ Connect new pump circuit at well head ✓ Install new locking Well Cap ✓ Cover Well head with"mock rock"boulder ✓ Start-up and test system Assumptions: ✓ Existing pump circuit, underground piping, cable, pump house structure and appurtenances will be abandoned and left in place. Any removal shall be completed by others ✓ Installation of bollards orboulders around well head by others ✓ Communication with King County Health regarding well and inactivation of Group B water system completed by others Proposal Price-$7441 00 Notes- Taxes additional Price FOB JOB Site i Required permits and fees additional I I 2531 Inter Ave., Suite A.,Puyallup,WA 98372 9 (253)841-2101 9 www.bluelinewater.com i 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. 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 Contractor's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Automobile Liability insurance covering all owned, non- owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: 1. Commercial General Liability insurance shall be written with limits no less than $2,000,000 each occurrence, $2,000,000 general aggregate and a $2,000,000 products-completed operations aggregate limit. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $2,000,000 per accident. 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. 1 The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Contractor. I TUS DATE(VINGDD,'y YYY) CERTIFICATE OF LIABILITY INSURANCE R045 2/11/2014 THIS CERTIFICATES ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT.If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed If SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT NAME NE WELLS FARGO INS (AiC N.EA) (217) 398-4400 iu b) (877) 302-2930 850034 P: (217) 398-9400 F: (877) 302-2930 ADDRESS 4800 WABASH AVE MAC X2803-01M INSURER(S)AFFORDING COVERAGE NAICY SPRINGFIELD IL 62711 INSURER Hartford Casualty Ins Co INSURED INSURER B INSURER C BLUE LINE WATER, INC. INSURER 2531 INTER AVE STE A INSURER PUYALLUP WA 98372 INSURER COVERAGES CERTIFICATE NUMBER 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 INSC RASCE ADDL SCBR POLICY At IIBLR POLICYLPF POLICY 6tP LIMITS ITR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1, 000, 000 DAMAGE TO RENTED 5300, OOO CLAIMS-MADE71 OCCUR PREMISES(Ea occurrence) A X General Liab X 83 SBA UQ6648 02/27/2014 02/27/2015 MED EXP(Any one persor) $10, 000 PERSONAL B ADV INJURY <1, 000, 000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2, O O O, O O O POLICY PRO ❑ LOC PRODUCTS-CCMPIOP AGG s2, 000, 000 ECT OTHER COMB $ AUTOMOBILE LIABILITY (Ea acIcidde SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) 3 ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE s 5, 0 0 0, 0 0 O A EXCESS LIAB CLAIMS-MADE 83 SBA UQ6646 02/27/2014 02/27/2015 AGGREGATE s5, 000, 000 DE X RETENTION$I0,000 PORAERSCOMPENSATION RER OTH- ANDEMPLOYERS LABILITY STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED ❑ WA $ (Mandalory In AiE L DISEASE-EA EMPLOYEE If yes,describe under E L DISEASE-POLICY LIMIT s DESCRIPTION OF OPERATIONS below A EMP STOP GAP 83 SBA UQ6648 02/27/2014 02/27/2015 $1,000,000/1,000,000/_,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Those usual to the Insured' s Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE City of Kent DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS Attn: Brian Levenhagen AUTHORIZED REPRESENTA TIVE 220 4TH AVE S KENT, WA 98032 ©1988-2014 ACORD CORPORATION All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD A a TUS DATE(MM/DD/YYM CERTIFICATE OF LIABILITY INSURANCE R045 12/11/2014 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed If SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT NAME PHOWELLS FARGO INS INCN.E.n (217) 398-4400 acNo) (877) 302-2930 850034 P: (217) 398-9400 F: (877) 302-2930 ADMDRESS 4800 WABASH AVE MAC X2803-01M INSURER(S)AFFORDING COVERAGE NAICR SPRINGFIELD IL 62711 INSURER Hartford Casualty Ins Co INSURED INSURER B INSURER C BLUE LINE WATER, INC. INSURER 2531 INTER AVE STE A INSURER PUYALLUP WA 98372 INSURER COVERAGES CERTIFICATE NUMBER 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 TERM S,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OFINSGRANCE ADDL St BR POLIO Y AEIMBLR POLICII POLLCII LIMITS N,1f/DD/}1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS-MADE 1 OCCUR DAMAGE TO RENTED s300, 000 PREMISES(Ea occurrence) A X General Llab X 83 SBA UQ6648 02/27/2014 02/27/2015 MED EXP(Anyone parson) $10, 000 PERSONAL&ADV INJURY $1, 000, OOO ' GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s2, 000, 000 POLICY PRO-❑LOC PRODUCTS-COMP/OPAGG s2, 000, 000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTO AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE s5, 000, 000 A EXCESS LIAB CLAIMS-MADE 83 SBA UQ6648 02/27/2014 02/27/20_5 AGGREGATE s5, 000, 000 OE X RETENTION$10,000 WORKERS COMPENSA T/ON PER OTH 1NDENPLOYERS'LLABILlTY STATUTE I ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED (Mandatorym NH) ❑ N/A EL DISEASE-EA EMPLOYEE $ If yes,describe under $ DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT A EMP STOP GAP 83 SBA UQ6648 02/27/2014 02/27/2015 $_,000,000/1,000,000/1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of Kent BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE y DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS Attn• Brian Levenhagen AUTHORIZED REPRESENTATIVE 220 4TH AVE S KENT, WA 98032 ©1988-2014 ACORD CORPORATION All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below PollcyNumber: 83SBAUQ6648 SA Named Insured and Mailing Address, BLUE LINE WATER, INC. 2531 INTER AVE. STE A PUYALLUP WA 98372 Policy Change Effective Date: 02/10/14 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 005 Agent Name: WELLS FARGO INS Code: 850034 POLICY CHANGES: HARTFORD CASUALTY INSURANCE COMPANY ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSUREDS) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY LOCATION 001 BUILDING 001 SEE FORM IH 12 00 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: PRO RATA FACTOR: 0.047 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 0405T Page 0ol (CONTINUED ON NEXT PAGE) Process Date: 02/11/14 Policy Effective Date: 02/27/13 Policy Expiration Date: 02/27/14 POLICY CHANGE (Continued) Policy Number: 83 SBA UQ6648 Policy Change Number: 005 IH12001185 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR Form SS 12 1104 05 T Page 002 Process Date: 02/11/14 Policy Effective Date: 02/27/13 Policy Expiration Date. 02/27/14 POLICY NUMBER: 83 SBA UQ6648 X THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR CITY OF KENT ATTN: BRIAN LEVENHAGEN 220 4TH AVE S KENT, WA 98032 Form IH 12 00 1185 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02/11/14 Expiration Date: 02/27/14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below Policy Number: 83 SBA UQ6648 SA Named Insured and Mailing Address; BLUE LINE WATER, INC. 2531 INTER AVE. STE A PUYALLUP WA 98372 Policy Change Effective Date: 02/27/14 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 001 Agent Name: WELLS FARGO INS Code: 850034 POLICY CHANGES: HARTFORD CASUALTY INSURANCE COMPANY ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSUREDS) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY LOCATION 001 BUILDING 001 SEE FORM IH 12 00 PRO RATA FACTOR: 1.000 THIS ENDORSEM ENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 1211 04 05 T Page o 01 (CONTINUED ON NEXT PAGE) Process Date: 02/11/14 Policy Effective Date: 02/27/14 Policy Expiration Date: 02/27/15 POLICY CHANGE (Continued) Policy Number: 83 SBA UQ6648 Policy Change Number. 001 FORM NUMBERS OF ENDORSEMENTS DELETED AT ENDORSEMENT ISSUE: SX21610697 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR Form SS 12 11 04 05 T Page 002 Process Date: 02/11/14 Policy Effective Date: 02/27/14 Policy Expiration Date: 02/27/15 POLICYNUMBER: 83 SBA UQ6648 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR CITY OF RENT ATTN: BRIAN LEVENHAGEN 220 4TH AVE S KENT, WA 98032 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02/11/14 Expiration Date: 02/27/15 ® DATE IMMIDDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE 4/4/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s) PRODUCERCT A Alain Bohhot, CSR Sunset Corridor Ins Services PHONE (503)624-9111 Ext 278 arc No, (503)941-8016 A! No Ext 17933 NW Evergreen Pkwy nUepss AIL alainb@emerykarrigan.com Ste. 350 INSURER(S)AFFORDING COVERAGE NAIC JI Beaverton OR 97006 INSURERA Liberty Mutual Insurance 23043 INSURED INSURERB BLUE LINE WATER INC INSLRERC 2531 INTER AVE STE A INSLRERD INSURERE PUZALLUP WA 98372 INSURER COVERAGES CERTIFICATE NUMBER 14/15 cert 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 ADDL SUER POLICYEFF POLICYEXP ILTSR TYPE OF INSURANCE POLICY NUMBER MMfDDIYWY MMIDDIYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DANI)ICI,TU H1,N I ED COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence $ CLAIMS-MADE OCCUR MED EXP(A�y one pe•son) $ PERSCNAL&ACV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY I I- LOC $ AUTOMOBILE LIABILITY (Ea @COMBcic Dt L MI 1,000,000 BCDLY"JURY(Perperson) $ A ANY AUTO ALL OWNED X SCHEDULED 1CI63308620 /30/2013 /30/2014 BCD LY INJURY(Per exidert) $ NON-OVNED PROPERTY DAM 4GE $ HIRED AUTOS AUTOS Pe,radant Lndenrisured notorst $ 1 000 000 X UMBRELLA LIAe HOCCUR E4CH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ 1%5166379 /6/2014 16/2015 $ WORKERS COMPENSATION VvC SAT U-IMITS OER TH- ANDEMPLOYERS'LIABILITY YIN T RY E L EACH ACC ID ENT $ ANI PRO-RIETORIPFRTNERfEXEIX1TIVE❑ NIA XC OPFICEPIMEMEER ELUDED (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ DfyYes describe under EL DISEASE-POLICY LIMIT $ ESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERATIO14SI LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) The city of Kent is named as additional insured per the attached endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS 220 Fourth Avenue South, AUTHORIZED REPRESENTATIVE Kent, WA 98032 . i ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD thertp COMMERCIAL GENERAL LIABILITY t `ibertrs« CIS 86 74 12 07 zi r,. k`n,e.w lhzue+w,i d THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following, Commercial Auto; 01C16330862 Commercial Umbrella Policy: 01XS166379 SCHEDULE Name of Person or Organization: The city of Kent DUTY TO DEFEND or B or medical expenses under COV- ERAGE C. Paragraph a. of SECTION I — COVERAGE A and No other obligation or liability 10 pay sums or COVERAGE B is replaced by the following perform acts or services is covered unless ex- a. We will pay those sums that the insured be- plicitly provided for under SUPPLEMENTARY comes legally obligated to pay as damages PAYMENTS — COVERAGES A AND B. because of "bodily injury", `property damage" or "personal injury and advertising EMPLOYERS LIABILITY injury" to which this insurance applies We will have the right and duty to defend the in- The last paragraph of exclusion e. of SECTION I — sured against any `suit" seeking those dam- COVERAGE A is replaced by the following ages Our duty to defend begins once you This exclusion does not apply to liability assumed notify us of a "suit" as described in SEC- by the insured under an `insured contract" ex- TION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS, 2 b. However, we cept for that part of a contract or agreement that will have no duty to defend the insured indemnifies any person or organization for their against any `suit" seeking damages for sole liability `Ibodily injury", "property damage", or WRONGFUL EVICTION "personal injury or advertising injury" to which this insurance does not apply We may, at our discretion, investigate any The following exclusion is added to SECTION I — "occurrence° and settle any claim or "suit" COVERAGE B: that may result But The wrongful eviction from, wrongful entry into, (1) The amount we will pay for damages is or invasion of the right of private occupancy of a limited as described in SECTION III — room, dwelling or premises arising out of any. LIMITS OF INSURANCE; and (1) "property damage" to the roam, dwell- (2) Our right and duty to defend ends when ing or premises, or we have used up the applicable limit of (2) "bodily injury" sustained through occu- insurance in the payment of judgments pancy of a room, dwelling or premises or settlements under COVERAGES A $afaca fend re Weco logo are registered trademarks of Safeco Corporation GG 86 74 12 07 Page 1 of 5 EP ADDITIONAL INSURED — BY WRITTEN CON- This insurance does not apply to 'bodily TRACT, AGREEMENT OR PERMIT, OR SCHED- injury", "property damage", or ULE "personal and advertisinq injury" arlsinq out of operations performed for the state The following paragraph is added to SECTION II — or municipality; WHO IS AN INSURED: , The insurance with respect to any architect, 4. Any person or organization shown in the Sched- engineer, or surveyor added as an insured ule or for whom you are required by written con- by this endorsement does not apply to "bodily injury", "property damage", or tract, agreement or permit to provide insurance "poroonal and advertming injury" arising out is an insured, subject to the following additional of the rendering of or the failure to render provisions any professional services by or for you, in- a. The contract, agreement or permit must be cludinq- in effect during the policy period shown in (1) The preparing, approving, or failing to the Declarations, and must have been exe- prepare or approve maps, drawings, cuted prior to the bodily Injury". "property opinions, reports, surveys, change or- damago", or "personal and advorticing ders, designs or specifications; and injury" b. The person or organization added as an in (2) Supervisory, inspection or engineering surod by this ondoreomont is an incurod only services to the extent you are held liable due to, d. This insurance does not apply to "bodily (1) The ownership, maintenance or use of injury" or "property damage" included within that part of promicoc you own, rant, the "products-completed operations lease or occupy, subject to the following hazard" additional provisions: e. A person's or organization's status as an in- (a) Thic incuranco d000 not apply to sured under this endorsement ends when any "occurrence" which takes place your operations for that insured are com- after you cease to be a tenant in pleted any premises leased to or rented to f. No coverage will be Drovided if in the ab- you; sense of this endorsement, no liability would (b) This insurance does not apply to be imposed by jaw on you Coverage shall any structural alterations, new con- be limited to the extent of your negligence struction or demolition operations ur rauk acuurUiny lu the applicdUle p111t,iple5 performed by or on behalf of the of comparative fault person or organization added as an g. The defense of any claim or "suit" must be inoured; lenuerua cis suun ds prdclluaUle lu dll oilier (2) Your ongoing operations for that in- insurers which potentially provide insurance sured, whether the work is performed for such claim or "suit" by you or for you, n. The Insurance provided will not exceed me (3) The maintenance, operation or use by lesser of you of equipment leased to you by such (1) The coverage and/or limits of this policy, person or organization, subject to tho or following additional provisions (2) The coverage and/or limits required by (a) This insurance does not apply to said contract, agreement or permit any "oecui rcnoc" which takea place after the equipment lease expires; NON-OWNED WATERCRAFT AND NON-OWNED (b) This insurance does not apply to AIRCRAFT LIABILITY "bodily Injulyarising or "Plthe soty le Exclusion g. of SECTION I — COVERAGE A is re- negligence of such person or or- placed by the following- ganization; g. 'Bodily injury" or aproporty damage" artcmg (4) Permits issued by any state or political out of the ownership, maintenance, use or subdivision with respect to operations entrustment to others of any aircraft, "auto" performed by you or on your behalf, or watercraft owned or operated by or rented subject to the following additional pro- vision page 2 6f 6 or loaned to any insured Use includes oper- `Property damage" to: ation and `loading or unloading" (1) Property you own, rent, or occupy, in- This exclusion applies even if the claims clueing any custb or expenseb Incurred against any Insured allege negligence or by you, or any other person, organiza- other wrongdoing in the supervision, hiring, tion or entity, for repair, replacement, employment training or monitoring of others enhancement, restoration nr mainto- by that Insured, if the "occurrence" which nance of such property for any reason, caused the "bodily Injury" or "property Including prevention of injury to a per- damage" Involved the ownership, mainte- son or damage to another's property, nance, use or entrustment to others of any (2) Premises you sell, give away or aban- aircraft, "auto" or watercraft that is owned don, if the "property damage" arises out or operated by or rented or loaned to any in- of any Dart of those premises: aured This exclusion does not apply to- (3) Property loaned to you, ( (4) Personal property in the care, custody 1) A watercraft while ashore on premises or control of me Insures; you own or rent, (2) A watercraft you do not own that is (5) That particular part of real property on which you or any contractors or sub- (a) Less than 52 teet long, and contractors working directly or indirectly (b) Not being used to carry persons or on your behalf are performing oper- ations, if the "property damage" arises out of thoac operationa, or (3) Parking an "auto" on, or on the ways (6) That particular part of any property that next to, premises you own or rent, pro- must be restored, repaired or replaced vided the "auto" is not owned by or Ueiaube -your wurK" was tricurrecuy rented or loaned to you or the insured; performed on it (4) Liability assumed under any "insured Paragraphs (1), (3) and (4) of this exclusion rontrar:t" for tha nwnarship mninta- do not apply to "property damage" (other nance or use of aircraft or watercraft, or than damage by fire) to premises, including (5) "Bodily injury" or "property damage" the contents of such premises, rented to arcing out of, you A coparato limit of incuranoo oppiioc to (a) the operation of machinery or Damage To Premises Rented To You as equipment that Is attached to, or described in SECTION III — LIMITS OF part of, a land vehicle that would INSURANCE. Paragraph (2) of this exelu- qualify under the definition of sion does not apply if the premises are "your "mobile equipment" if it were not work" and were never occupied, rented or suhiect to a compulsory or financial held for rental by you responsibility law or other motor ve- Paragraphs (3), (4), (5) and (6) of this exclu- hicle insurance law in the state sion do not apply to liability assumed under where it is licensed or principally a sidetrack agreement garaged;or Paragraph (6) of this exclusion does not ap- (b) the operation of any of the machin- ply to "property damage" included in the ery or equipment listed in Paragraph "products-completed operations hazard" f.(2) or f.(3) of the definition of "mobile equipment" Paragraph 6. of Section III is replaced by the follow- (6) An aircraft you do not own provided it is ing not operated by any insured. S. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we TENANTS' PROPERTY DAMAGE LIABILITY will pay under COVERAGE A for damages be- cause of "property damage" to any one prem- When Damage To Premises Rented To You Limit is ises, while rented to you, or in the case of shown in the Declarations, SECTION I — COVER- damage by fire, while rented to you or temporar- AG6 N oxciucion j., ie roplaood by tho following fly occupied Dy you witn permission or me owner j. Damage To Property 00 86 74 12 07 Page 3 of 5 EP The Damage To Premises Rented To You Limit is the a. 'Bodily injury" or "property damage" ex- higher of $200,000 or the amount shown in the Dec- pected or Intended from the standpoint of the larations as Damage To Premises Rented To You insured This exclusion does not apply to Limit. 'bodily injury" or "property damage" result- ing from the use of reasonable force to pro- WHO IS AN INSURED — MANAGERS tect persons or property, The following is added to Paragraph 2.a. of SECTION INCREASED MEDICAL EXPENSE LIMIT II — WHO IS AN INSURED: The mcdroal cxpcnsc limit io amcndcd to C10,000 Paragraph (1) does not apply to executive officers, or to managers at the supervisory level or above KNOWLEDGE OF OCCURRENCE SUPPLEMENTARY PAYMENTS — COVERAGES A The following is added to Paragraph 2, SECTION IV AND B — BAIL BONDS — COMMERCIAL GENERAL LIABILITY CONDITIONS Duties In The Event Of Occurrence, Paragraph 1.b. of SUPPLEMENTARY PAYMENTS Uitense, Ulaim Ur bust ot: — COVERAGES A AND B is replaced by the follow- ing: Knowledge of an "occurrence", claim or "suit" by b. Up to S3,000 for cost of bail bonds required your agont, corvant or ompioyoo chall not in itcolf because of accidents or traffic law violations constitute knowledge of the named insured unless an arising out of the use of any vehicle to which officer of the named insured has received such notice Lhc Buddy hyuiy L,abnhly Cuvwayc cipyliG7 from the agent, servant or employee We do not have to furnish these bonds, INSURED CONTRACT SUPPLEMENTARY PAYMENTS — COVERAGES A Tne ioiiowing definition is aaaea to SECTION v — AND B — INDEMNITEES AND ADDITIONAL IN- DEFINITIONS, Definition 9. `insured contract" par- SUREDS agraph f.: Paragraph 2.f.(1) (d) of SUPPLEMENTARY PAY- (4) That part of any contract or agree- MENTS — COVERAGES A AND B is replaced by ment that indemnifies any person the following* or organization for the indemnitee's (d) Cooperate with us with respect axle tort liability. to coordinating other applicable OTHER INSURANCE insurance and self-insured retention available to the In- The first paragraph of Other Insurance of SECTION demnitee; and IV — COMMERCIAL GENERAL LIABILITY CON- EMPLOYEES AS INSUREDS — HEbLTI.1 CARE DITIONS is replaced with the following, SERVICE If other valid and collectible insurance, or any self-in- Paragraph 2.a.(1) d. of SECTION II — WHO IS AN sured retention, is available to the insured for a loss INSURED is deleted, unless excluded by separate we cover under COVERAGE A or D of this Coverage endorsement Part, our obligations are limited as follows, EXTENDED COVERAGE FOR NEWLY ACQUIRED METHOD OF SHARING ORGANIZATIONS The second paragraph of 4.c. Method of Sharing of Paragraph 3.a_ of SECTION 11 — WHO IS AN IN- SECTION IV — COMMERCIAL GENERAL LIABIL- SURED is replaced by the following, ITY GUNDITIONS is replaced with the tollowing: a. Coverage under this provision is afforded If any of the other insurance does not permit contri- oniy until tho and of tho policy poriod, bution by oqual charoo or is oubjoot to a oclf inourod retention, we will contribute by limits Under this EXTENDED "PROPERTY DAMAGE" method, each insurer's share is based on the ratio of its applicable limit of insurance or self-insured re- Exclusion a. of SECTION I — COVERAGE A is tention or both combined to the total applicable limits amended to read P902 4 of 5 of insurance of all Insurers and the amount of any our right to collect additional premium or exercise our self-insured retention right of cancellation or non-renewal UNINTENTIONAL FAILURE TO DISCLOSE ALL LIBERALIZATION CLAUSE HAZARDS The following paragraph is added to SECTION IV — Ihe tollowing Is added to Paragraph 5. Hepresenta- COMMERCIAL GENERAL LIABILITY CONDI- tlons of SECTION IV — COMMERCIAL GENERAL TIONS: LIABILITY CONDITIONS: 40_ If a rpvioihn to thiG [:wprapa Part which wradd If you unintentionally fad to disclose any hazards ex- provide more coverage with no additional isting at the Inception date of your policy, we will not premium, becomes effective during the policy deny coveraae under this Coveraae Form because of period in the state shown In the Declarations, such failure. However, this provision does not affect your policy will automatically provide this addi- tional coverage on the effective date of the re- vision CO 86 74 t2 07 Page 6 of 6 EP