Loading...
HomeMy WebLinkAboutPD13-229 - Original - Western Systems, Inc. - Emerald Park & Pine Tree Elementary School Zone Flashing Lights - 08/20/2013 KENT GOODS & SERVICES AGREEMENT between the City of Kent and Western Systems, Inc. THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Western Systems, Inc. organized under the laws of the State of Washington, located and doing business at 909 S.E. Everett Mall Way, A120, Everett, WA 98208, Zach Hoiting, Territory Manager, 425-438-1133 (hereinafter the "Vendor"). AGREEMENT I. DESCRIPTION OF WORK. Vendor shall provide the following goods and materials and/or perform the following services for the City: Provide equipment for School Zone Flashing Lights for Emerald Park and Pinetree Elementary Schools. See Exhibit A Vendor acknowledges and understands that it is not the City's exclusive provider of these goods, materials, or services and that the City maintains its unqualified right to obtain these goods, materials, and services through other sources. II. TIME OF COMPLETION. Upon the effective date of this Agreement, Vendor shall complete the work and provide all goods, materials, and services by October 31, 2013. III. COMPENSATION. The City shall pay the Vendor an amount not to exceed $21,544.56, including applicable Washington State Sales Tax, for the goods, materials, and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: The City of Kent shall pay Western Systems, Inc, net 30 days. Additionally, the City of Kent will be reimbursed the total amount expended by the Washington Traffic Safety Commission grant funds. See Exhibit B. GOODS & SERVICES AGREEMENT - 1 (Over$10,000.00, including WSST) If the City objects to all or any portion of an invoice, it shall notify Vendor and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. A. Defective or Unauthorized Work. The City reserves its right to withhold payment from Vendor for any defective or unauthorized goods, materials or services. If Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services from other sources, and Vendor 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 Agreement price specified above. The City further reserves its right to deduct these additional costs incurred to complete this Agreement with other sources, from any and all amounts due or to become due the Vendor. B. Final Payment: Waiver of Claims. VENDOR'S ACCEPTANCE OF FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. 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 Vendor 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 Vendor maintains and pays for its own place of business from which Vendor's services under this Agreement will be performed. C. The Vendor has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Vendor's services, or the Vendor is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Vendor 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 Vendor has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Vendor's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Vendor maintains a set of books dedicated to the expenses and earnings of its business. GOODS & SERVICES AGREEMENT - 2 (Over$10,000.00, including WSST) y V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. VI. CHANGES. The City may issue a written amendment for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines, for any reason, that an amendment is necessary, Vendor must submit a written amendment request to the person listed in the notice provision section of this Agreement, section XIV(D), within fourteen (14) calendar days of the date Vendor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Vendor'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 Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the amended work upon receiving either a written amendment from the City or an oral order from the City before actually receiving the written amendment. If the Vendor fails to require an amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the adjustment as provided in subsections A through E of Section VII, Claims, below. The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. An amendment that is accepted by Vendor 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. VII. CLAIMS. If the Vendor disagrees with anything required by an amendment, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Vendor may file a claim as provided in this section. The Vendor 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 Vendor 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 Vendor unless a timely written claim is made in strict accordance with the applicable provisions of this Agreement. At a minimum, a Vendor'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 Vendor's claim; 2. The nature and circumstances that caused the claim; GOODS & SERVICES AGREEMENT - 3 (Over$10,000.00, including WSST) 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 Vendor is asserting a schedule change or disruption. B. Records. The Vendor 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 Vendor'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. Vendor's Duty to Complete Protested Work. In spite of any claim, the Vendor 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 Vendor 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 Vendor completely waives any claims for protested work and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). VIII. LIMITATION OF ACTIONS. VENDOR 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 VENDOR'S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. IX. WARRANTY. This Agreement is subject to all warranty provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington. Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, and will perform in accordance with their specifications and Vendor's representations to City. The Vendor 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 part of the goods are repaired, 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 Vendor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. X. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, GOODS & SERVICES AGREEMENT - 4 (Over$10,000,00, including WSST) 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. Vendor 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. XI. INDEMNIFICATION. Vendor 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 Vendor'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 Vendor's work when completed shall not be grounds to avoid any of these covenants of indemnification. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'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 Vendor 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 Vendor's part, then Vendor 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 Vendor's part. The provisions of this section shall survive the expiration or termination of this Agreement. XII. INSURANCE. The Vendor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit Insert Exhibit C attached and incorporated by this reference. XIII. WORK PERFORMED AT VENDOR'S RISK. Vendor 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 Vendor's own risk, and Vendor 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. XIV. 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 GOODS & SERVICES AGREEMENT - 5 (Over$10,000,00, Including WSST) 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 provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section XI 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 Vendor. 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 Vendor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Vendor'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. GOODS & SERVICES AGREEMENT - 6 (Over$10,000.00, including WSST) VENDOR: CITY OF KENT: By: By: (s! not ) 4t(rtieg nature) Print Name: d2 Pr' Cooke ItsSec //%n.�cL-S I (title) DATE: KI i t-a I t DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: VENDOR: CITY OF KENT: Zach Hoiting Debra LeRoy Western Systems City of Kent 909 SE Everett Mall Way #A120 220 Fourth Avenue South Everett, WA 98208 Kent, WA 98032 425-438-1133 (telephone) (253) 856-5856 (telephone) 425-438-1585 (facsimile) (253) 856-6803 (facsimile) APPR VED AS O F RM: Kent Law Department [e;//IrMnc Gnntr/3013 WTSC SZ RUhnq Becton GrinVVemom GOODS & SERVICES AGREEMENT- 7 (Over$10,000.00, including WSST) 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 1 �p day of 20—ja r By: �- ^-- For: UJ 2S-�-e rn Title: 5 cv A//��-S Date: EEO COMPLIANCE DOCUMENTS - 1 of 3 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. i EEO COMPLIANCE DOCUMENTS - 2 of 3 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. Dated this day of 120 By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 of 3 EXHIBIT A i 2 .�p �s�q July 31,2013 estea.l: ¢Systems WSQ WZH3721 Innovativo Transportation Solutions CARMANAH Prepared By: Zach Hoiting I Sales Manager To: CITY OF KENT Western Systems Inc. Debra Leroy Cell' 503-349-5970 Fax 425-438-1585 Email.zhoitinggwesternsystems-mc.com Western Systems is pleased to submit the following price quotation for the above referenced project, Qty Item# Description Line Total 600 8530020065 SOLAR ENGINE(829C)SCHOOL ZONE 10W W/TIME CLOCK $ 11,220 78 MANAGER&UPLOAD H KIT(GREEN) 600 8530040180 MOUNTING 4 5"ROUND POLE WITH WEDGE,DUAL VERTICAL $ 5,92208 8"BEACONS&8"AMBER LEDS(GREEN) 600 7110010000 LED TATTLE TAIL LIGHT YELLOW(SCHOOL ZONE) $ 15000 600 7520010360 POLE SPUN ALUMINUM 4-1/2"SCHEDULE 40 12'LENGTH $ 1,24870 600 7710020530 SIGN(SCHOOL ZONE)24"X 48"ENGINEERED GRADE(S5-1) $ 74805 1100 1 � T SHIPPING $ 38579 QUOtahon preparedi, Zacli L. Hotting This is a quotation on the goods named,subject to the conditions noted below $ 19,675 40 Delivery 60-90 days after release Terms Net 30 Days If Credit in Good Standing Tax Not Included $ 19,675 40 This quote is good for 60 days This quote includes only the items listed herein FOB Destination(Freight Included) We impose a surcharge of 2%on the transaction amount on VISA and MasterCard credit card products,which is not greater than our cost of acceptance. We do not surcharge VISA and Master Card debit cards Exhibit B STATE OF WASHINGTON WASHINGTON TRAFFIC SAFETY COMMISSION PO Box 40944 Olympia, Washington 98504-0944 (360) 753-6197 June 17, 2013 Debra LeRoy, Research Development Analyst City of Kent 220 4th Avenue S Kent, WA 98032 dleroVRkentwa gov RE: School Zone Flashing Beacon/Lighting Project Dear Ms. LeRoy: On behalf of the Washington Traffic Safety Commission (WTSC), I am pleased to inform you that you have met the qualifications of the School Zone Flashing Beacon grant You have agreed to install approved flashing beacons, as outlined in the RFP, in designated and legally marked school zones following the requirements outlined in RCW 46.61.440 (2). Funding for School Zone Flashing Lights in the amount of$15,000 00 is approved for the following school zones at Emerald Park Elementary School/Kent School District: • 116ih Ave SE • SE 216th Your project(s) must begin no sooner than July 1, 2013, and installation must be completed by January 1, 2014 (6 months from grant approval date as outlined in the signed agreement). Reporting Requirements A final post-installation data report must be submitted no later than January 1, 2015, (within one year of installation) detailing the impact of this project within the school zone(s), and should include whether or not the goals outlined in your original proposal were achieved The data collected for the final report should be consistent with the conditions existing during pre-installation data collection (same time of day, same day of the week, same length of time) Post installation collision data should be included as well i Please use the Post Installation Data Report Form enclosed Additional graphs, diagrams or data reports are not necessary. Fill in the information for each zone that 1 Exhibit B you were approved for. Print additional pages of the form as needed for additional zone tables Invoicing Requirements Final reimbursement requests must be received by the WTSC no later than February 28, 2014. 1 have detailed the order/reimbursement procedure below• 1. Your agency must order/purchase the equipment granted and be billed for the equipment or goods and services 2. Your agency must receive the equipment and install the beacons at the designated sites Following installation, your agency must submit the required documentation below ➢ The enclosed A19-1A form (every area with an arrow 4 is required), '➢ A duplicate copy of your vendor's billing invoice, ➢ Proof of payment, and ➢ Photos of installed flashing beacons (photos inside the control panels are not necessary) Label each photo to coordinate with the appropriate zone. Please note that we cannot accept a FAX or emailed request. 3. Upon receipt of the required documentation above, your agency will be reimbursed Failure to submit reimbursement requests or to file the required final report could lead to termination of the project agreement, forfeiture of reimbursement, and denial of future grant requests If you have any questions or concerns regarding your project, please contact me at (360) 725-9883, or e-mail me at kdroke(aDwtsc.wa gov. Sincerely, Kathy Droke Electronic Approval Enclosure: Al Invoice Voucher , r > - ay Y '� Exhibit B STATE OF WASHINGTON WASHINGTON TRAFFIC SAFETY COMMISSION PO Box 40944 Olympia, Washington 98504-0944, (360) 753-6197 June 17, 2013 Debra LeRoy, Research Development Analyst City of Kent 220 4th Avenue S Kent, WA 98032 dleroyCa),kentwa gov RE: School Zone Flashing Beacon/Lighting Project Dear Ms LeRoy: On behalf of the Washington Traffic Safety Commission (WTSC), I am pleased to inform you that you have met the qualifications of the School Zone Flashing Beacon grant You have agreed to install approved flashing beacons, as outlined in the RFP, in designated and legally marked school zones following the requirements outlined in RCW 46 61.440 (2) Funding for School Zone Flashing Lights in the amount of$7,500.00 is approved for the following school zone at Pinetree Elementary School/Kent School District: • 118th Avenue SE Your project(s) must begin no sooner than July 1, 2013, and installation must be completed by January 1, 2014 (6 months from grant approval date as outlined in the signed agreement) Reporting Requirements A final post-installation data report must be submitted no later than January 1, 2015, (within one year of installation) detailing the impact of this project within the school zone(s), and should include whether or not the goals outlined in your original proposal were achieved The data collected for the final report should be consistent with the conditions existing during pre-installation data collection (same time of day, same day of the week, same length of time) Post installation collision data should be included as well Please use the Post Installation Data Report Form enclosed. Additional graphs, diagrams or data reports are not necessary Fill in the information for each zone that you were approved for Print additional pages of the form as needed for additional zone tables 3 I Exhibit B Invoicing Requirements Final reimbursement requests must be received by the WTSC no later than February 28, 2014. 1 have detailed the order/reimbursement procedure below: 4. Your agency must order/purchase the equipment granted and be billed for the equipment or goods and services. 5. Your agency must receive the equipment and install the beacons at the designated sites Following installation, your agency must submit the required documentation below: ➢ The enclosed A19-1A form (every area with an arrow* is required), ➢ A duplicate copy of your vendor's billing invoice, ➢ Proof of payment, and ➢ Photos of installed flashing beacons (photos inside the control panels are not necessary) Label each photo to coordinate with the appropriate zone Please note that we cannot accept a FAX or emailed request 6. Upon receipt of the required documentation above, your agency will be reimbursed Failure to submit reimbursement requests or to file the required final report could lead to termination of the project agreement, forfeiture of reimbursement, and denial of future grant requests. If you have any questions or concerns regarding your project, please contact me at (360) 725-9883, or e-mail me at kdroke(o)wtsc wa qov Sincerely, Kathy Droke Electronic Approval Enclosure: Al Invoice Voucher 4 Ex /SAr0_� WESSY-1 OP ID: K2 A R CERTIFICATE OF LIABILITY INSURANCE DAT 08/19DNYYV) 08M 9/13 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(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) PRODUCER 425-489-4500 NAMEACT Hub International NWIHCJ 425.489-4501 �CNNc Ext AIC No PO Box 3018 E MAIL Bothell,WA 98041-3018 ADDRESS Jay Gaffney INSURERS AFFORDING COVERAGE NAIC A INSURER A Western National Assurance Cc INSURED Western Systems,Inc INSURER B 909 SE Everett Mall Way,*A120 Everett,WA 98208 INSURER C INSURER D INSURER E INSURER F 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 OFINSURANCE ADDL US POLICY POLICY NUMBER �MM DD EFF POLICY MM DD EXP LIMITS LTR GENERALLIABILITY EACHOCCURRENCE $ 1,000,000 A X COMMERCIALGENERALLIABILITY CPP001684403 04/07/13 04/07114 PREMISES Ea occurrence $IN 100,OD CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEWL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2r000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY (Ea awdeCCMBINEDSINGLE LIMIT $ 1,000,00 A X ANY AUTO CPPOO1681904 04/07/13 04/07114 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X HIIREDSAUTOS Ix NON OWNED PROPERTY OAMAGE $ AUTOS Perawidenl X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 A EXCESS LIAB CLAIMS-MADE CPP001681903 04/07/13 04107/14 AGGREGATE $ 2,000,00 DED I X I RETENTION$ 10000 WC $ WCSWORKERS COMPENSATION T RYLIMIUS X OTR AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTHER/EXECUTIVEY❑ NIA CPP001684403 04107/13 04/07/14 EL EACH ACCIDENT s 1,000,00 OFFICERIMEMBER EXCLUDED? WA STOP GAP E L DISEASE-EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes descrbe under EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mom space Is required) ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT: CITY OF RENT. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY. COMPLETED OPERATIONS APPLIES. SEE ATTACHED ENDORSEMENT(S) . RE: SCHOOL ZONE FLASHING LIGHTS FOR EMERALD PARR & PINETREE ELEMENTARY SCHOOLS CERTIFICATE HOLDER CANCELLATION CITYOFK 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 98032 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY WNGL490109 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11—Who Is An Insured is amended to In- a. The preparing, approving, or failing to pre- clude as an additional Insured any person or organ- pare or approve, maps, shop drawings,opin- ization for whom you are performing operations ions, reports, surveys, field orders, change when you and such person or organization have orders or drawings and specifications;or agreed in writing in a contract or agreement that b. Supervisory, inspection, architectural or en- such person or organization be added as an addi- gineering activities. tional insured on yo4r pol_cy. Such person or organ- ization is an additional insured only with respect to 2. "Bodily injury' or "property damage" occurring liability for "bodily injury", "property damage" or after: "personal and advertising injury' caused, in whole a. All work, Including materials, parts or equip- or in part, by: ment furnished on connection with such 1. Your acts or omissions;or work, on the project (other than service, 2. The acts or omissions of those acting on your maintenance or repairs) to be performed by behalf; the on behalf of the additional insured(s) at the location of the covered operations has In the performance of your ongoing operations for been completed,or the additional insured. b. That portion of'your work" out of which the A person's or organization's status as an additional injury or damage arises has been put to its insured under this endorsement ends when your Intended use by any person or organization operations for that additional insured are com- other than another contractor or subcontrac- pleted. for engaged in performing operations for a B. The Limns of Insurance applicable to the additional principal as a part of the same project. insured are those specified in the written contract D. As respects the coverage provided under this en- or written agreement or in the Declarations of this dorsement. Paragraph 4.b. of the Other Insurance policy, whichever is less. These Limits of insur- Condition is deleted and replaced by the following: ante are inclusive of, and not in addition to Limits 4, Other Insurance of Insurance shown in the Declarations. C. With respect to the insurance afforded to these ad" b. Excess Insurance ditional insureds, the following additional exclusions This insurance is excess over any other in- appy: surance naming the additional insured as an This insurance does not apply to: insured whether primary, excess, contingent or on any other basis unless the written con- 1. "Bodily injury", "property damage" or "personal tract or agreement described in A. above and advertising injury" arising out of the render- specifically requires that this insurance be ing of, or the failure to render, any professional provided on either a primary basis or a pri- architectural, engineering or surveying services, mary and noncontributory basis. including: WN GL 49 0109 Includes copynghted material of Insurance Services 04ices Inc.with Its permission. Page 1 of 1 WN GL 39 0310 COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT The Commercial General Liability Enhanow"rit Endorsement is an optional endorsement that provides coverage en- hancements. The following is a summary of broadened oaverages provided by this endorsement. No coverage is pro- vided by this summary,refer to following endorsement for changes In your Policy. SUMMARY OF COVERAGE$ PAGE BowAy Injury And Property Darnagis Liability * Non Owned Watercraft Up To 50 Feet...........................I....................., .....,......................2 Property Damage Liability • Elevators....... ..................-- ............. .......... ....... ................................... ..........3 • Fire,Lightning,Explosion Or Sprinkler Leakage Exception.......--- - ... . ... 3 • Borrowed Equipment($U.ODO Per Occurrence,$50,000 Aggregate, $2,500 Deductible Per Occurrence......................._._.. .... ....................... .3 Supplementary Payments-Amended * Bag Bonds Up To$500.................................................. ....... ................--....... ...... .......3 0 Loss of Earnings Up To$500/Day .................................. ............. . ... ........3 Vft Is An Insured Amendments • Employee Bodily Injury To A Co-lftiip.............. . ..........................................................4 • Newly Formed Or Acquired Orgarilzatlions For Up To I 8C Days............................................4 • Blanket Additional insured-Vendors-As Required By Contract.............. ............. 4 a Blanket Additional Insured-Lessor Of Lowed Equipment .................................................. 5 • Blanket Additional Insured-Managers Of Lessors Of Premises..........................................5 • Blanket Additional Insured-State Or Governmental Agency Or Subdivision Our Political Subckvlslon-Pem*sOrAuthorizations - ... ....I..... ............5 • Blanket Additional Insured-State Or Govemmental Agency Or Subdivision Or Political SuixWslon-Permits Or Authorizations Relating To Premises................ .......5 Damage To Premises Rented To You - $300,000................. ............ ....... ........... ......... ..........5 Medical Payments Increased Limit - $10,000 Or Amount Shown on Declarations..........................6 Conditions • Knowledge of AWdort,Claim,Suit Or Lou Amended. ,...... ..................... ....... ...... • Unintentional Failure To Disclose Hazards. .................................... .... • Waiver of Subrogation............................ ... .... ............................................. ...................-6 Bodily Injury Redelined To Include Mental Anguish ............................ -.........................................8 Insured Contract Amended . ..... ..--... ... . ............................. ......... ......... ....... ...... Personal And Advertising Injury Redefined • Televised,Videotaped Or Electronic Publication-..... ..... ....... WN OL 39 03 10 Includes copyrighted material of Durance Services Office,with Its permission Page 1 of 6 WN GL 39 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. SECTION I—COVERAGES AMENDMENTS (6) "Bodily injury' or "property damage' arising out of COVERAGE A — BODILY INJURY AND PROPERTY (a) The operation of machinery or equip- DAMAGE LIABILITY ment that is attached to, or part of, a A. Non Owned Aircraft Or Watercraft land vehicle that would qualify under the Item 2. Exclusions, Paragraph g. is replaced by the definition of'mobile equipment' If it were following: not subject to a compulsory or financial g, Aircraft,Auto Or Watercraft responsibility law or other motor vehicle insurance law in the state where it Is `Bodily injury' or 'property damage" arising out licensed or principally garaged;or of the ownership, maintenance, use or entrust- (b) The operation of any of the machinery ment to others of any aircraft, 'auto' or water- or equipment listed in Paragraph f, (2) craft owned or operated by or rented or loaned or f. (3) of the definition of "mobile to any insured. Use includes operation and equipment' "loading or unloading'. This exclusion applies even If the claims against B. Damage To Property Coverage Extensions any insured allege negligence or other wrong- Item 2. Exclusions, Paragraph J. is replaced by the doing in the supervision, hiring, employment, following training or monitoring of others by that insured,If j, Damage To Property the'occurrenW which caused the bodily injury' "Property damage"to- or"property damage' involved in the ownership, maintenance, use or entrustment to others of (1) Property you own, rent, or occupy, including any aircraft, 'auto'or watercraft that is owned or any costs or expenses incurred by you, or operated by or rented or loaned to any insured. any other person, organization or entity, for This exclusion does not apply to: repair, replacement, enhancement, restora- tion or maintenance of such property for any ( ) p y reason, including prevention of injury to a own or rent; person or damage to anther's property; (2) A watercraft you do not own that is: (2) Premises you sell, give away or abandon, if (a) Less than 50 feet long, and the'property damage'anses out of any part (b) Not being used to carry persons or prop- of those premises, erty for a charge, (3) Property loaned to you; This Subparagraph (2) applies to any per- (4) Personal property in the care, custody or son, who with your expressed or implied control of the insured; consent,either uses or is responsible for the (5) That particular part of real property on which use of the watercraft; you or any contractors or subcontractors (3) Parking an*auto! on, or on the ways next to, working directly or indirectly on your behalf premises you own or rent, provided the are performing operations, if the 'property "auto'is not owned by or rented or loaned to damage'arises out of those operations;or you or the insured; (6) That particular part of any property that must (4) Liability assumed under any "insured con- be restored, repaired or replaced because tract'for the ownership, maintenance or use 'your work'was incorrectly performed on it. of aircraft or watercraft;or WIN GL 39 03 10 Includes cMdghted matedN of Insurance Ser Acn Office,with its permission Page 2 of 6 WN GL 39 0310 Paragraphs (1), (3) and (4) of this exclusion do not C. Damage To Premises Rented To You apply to•properly damage' (other than damage by Item 2. Exclusions, the last paragraph is replaced fire, lightning, explosion or sprinkler leakage) to by the following- premises, including the contents of such premises, Exclusions c.through n. do not apply to damage by rented to you for a period of 7 or fewer consecutive fire, lightning, explosion or spnnkler leakage to days. A separate limit of insurance applies to Dam- premises while rented to you or temporarily occupied age To Premises Rented To You as described in by you with permission of the owner. A separate SECTION III—LIMITS OF INSURANCE. However, limit of insurance applies to this coverage as de- the provisions of this paragraph do not apply if cov- scribed in Paragraph S.of SECTION III—LIMITS OF erage for Damage To Premises Rented To You is INSURANCE. excluded by endorsement. Paragraph (2) of this exclusion does not apply if the COVERAGE B — PERSONAL AND ADVERTISING premises are"your work' and were never occupied, INJURY LIABILITY rented or held for rental by you. D. Personal And Advertising Injury Paragraphs(3)and(4)of this exclusion do not apply Item 2. Exclusions is amended by replacing Sub- to the use of elevators. paragraphs b.and c.with the following. Paragraphs (3), (4), (5) and (6) of this exclusion do b. Material Published With Knowledge Of not apply to liability assumed under a sidetrack Falsity agreement. "Personal and advertising injury' arising out of Paragraph (4) of this exclusion does not apply to oral, written, televised, videotaped or electronic "property damage'to borrowed equipment while not publication of material, if done by or at the direc- being used to perform operations at the jobsite. tion of the insured with knowledge of its falsity. Subject to Paragraph 2 of SECTION III — LIMITS c, Material Published Prior To Polley Period OF INSURANCE, the rules below fix the most we will pay for Nproperty damage' under this provision: "Personal and advertising injury' arising out of (1) $25,000 any one"occurrence', regardless of the oral, written, televised, videotaped or electronic number of persons or organizations who sustain publication of material whose first publication damages because of that"occurrence'; took place before the beginning of the policy pe- nod. (2) $50,000 annual aggregate;and (3) We will pay only for damages in excess of SUPPLEMENTARY PAYMENTS — COVERAGES A $2,500 as a result of any one "occurrence', re- AND IS gardless of the number of persons or organize- E. Supplementary Payments—Coverages A and B tons who sustain damages because of that'oc- Item 1. is amended by replacing Subparagraphs b. currence'. We may, or If required by law, pay all and d.with the following: or any part of any deductible amount, if applica- ble, to effect settlement of any claim or 'suit' b. Up to $5,000 for cost of bail bonds required be- Upon notice of our payment of a deductible cause of accidents or traffic law violations aris- amount, you shall promptly reimburse us for the ing out of the use of any vehicle to which the part of the deductible amount we paid. Bodily Injury Liability Coverage applies. We do Paragraph (6) of this exclusion does not apply to not have to furnish these bonds. "property damage' included in the 'products-com- d. All reasonable expenses incurred by the insured plated operations hazard' at our request to assist us in the investigation or The insurance provided for `property damage" from defense of the claim or 'suit', including actual the use of elevators and for "property damage' to loss of earnings up to $500 a day because of borrowed equipment is excess over any other valid time off from work. and collectible property Insurance (including any de- ductible portion thereof) available to the insured whether primary, excess,contingent or on any other basis. INN GL 39 03 10 Includes oMrighted noWdal of Inamrice Services Office,with b permission Page 3 of 6 WN GL 39 0310 SECTION II—WHO IS AN INSURED AMENDMENTS d. Repackaging, except when unpacked solely for the purpose of inspection,demonstration, A. Employee Bodily injury To A Co-Employee testing, or the substitution of parts under in- Paragraph 2.a.(1)is replaced by the following* structions from the manufacturer, and then (1) "Bodily injury" or "personal and advertising repackaged In the original container, injury": e. Any failure to make such inspections,adjust- (a) To you, to your partners or members(if you ments, tests or servicing as the vendor has are a partnership or joint venture), to your agreed to make or normally undertakes to members of you are a limited liability com- make In the usual course of business, in pany), or to your other "volunteer workers" connection with the distribution or sale of the while performing duties related to the con- products; duct of your business; f. Demonstration, installation, servicing or re- (b) For which there is any obligation to share pair operations, except such operations damages with or repay someone else who performed at the vendor's premises In con- must pay damages because of the injury nection with the sale of the product; described in Paragraph(1)(a)above;or g. Products which, after distribution or sale by (c) Arising out of his or her providing or failing to you, have been labeled or relabeled or used provide professional health care services. as a container, part or ingredient of any d or or substance by or for the ven- B. Newly Acquired Organizations or; r Paragraph 3.a is replaced by the following: h. "Bodily injury or "property damage" ansing a. Coverage under this provision is afforded only out of the sole negligence of the vendor for until the 1809' day after you acquire or form the its own acts or omissions or those of its em- organizaition or the end of the policy period, ployees or anyone else acting on its behalf whichever is earlier, However,this exclusion does not apply to The following are added (1) The exceptions contained in Subpara- C. Blanket Additional Insured — Vendors — As Re- graphs d.orL; or quired By Contract (2) Such inspections, adjustments, tests or Section li—Who is An Insured is amended to in- servicing as the vendor has agreed to dude as an additional insured any person(s) or or- make or normally undertakes to make in ganization(s) (referred to below as vendor) with the usual course of business, In con- whom you have agreed in a written contract, exe- nectlon with the distribution or sale of cuted prior to loss,to name as an additional insured, the products but only with respect to "bodily Injury" or "property 2. This Provision C.does not apply: damage" ansing out of "your products" which are a. To any insured person or organization from distributed or sold in the regular course of the van- whom you have acquired such products, or dots business, subject to the following additional any ingredient, part or container, entering exclusions, into, accompanying or containing such 1. The insurance afforded the vendor does not ap- products; ply to: b. To any vendor for which coverage as an a. "Bodily injury" or "property damage" for additional insured specifically is scheduled which the vendor is obligated to pay dam- by endorsemerrt;or ages by reason of the assumption of liability c. When liability included within the "products- in a contract or agreement. This exclusion completed operations hazard" has been ex- does not apply to liability for damages that duded for such product either by the provi- the vendor would have in the absence of the sions of the coverage part or by endorse- contract or agreement; ment. b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made Intentionally by the vendor; WN GL 39 0310 Includes copyrighted material of insurance Services Office,vAth Its permission Page 4 of 6 WN GL 39 0310 D. Blanket Additional Insured — Lessor Of Leased 2• This insurance does not apply to: Equipment a. "Bodily injury", "property damage" or "per- 1. Section it—Who Is An Insured is emended to sonal and advertising injury" arising out of Include as an additional insured any person or operations performed for the federal govem- organization from whom you lease equipment ment,state or municipality;or when you and such person or organization have b. "Bodily injury" or "property damage" in- agreed in writing in a contract or agreement, cluded within the "products-completed op- executed prior to loss, that such person or or- orations hazard" ganization be added as an additional insured on your policy. Such person or organization is an G. Blanket Additional Insured — State Or Insured only with respect to liability for "bodily Governmental Agency Or Subdivision Or Poiiti- Inju►y", "property damage" or "personal and ad- cal Subdivision — Permits Or Authorizations Re- veriising injury' caused, in whole or In part, by lating To Premises your maintenance, operation or use of equip- Section 11 —Who Is An Insured is amended to in- ment leased to you by such person or organza- dude as an Insured any state or governmental tion. agency or subdivision or political subdivision with A person's or organizabon's status as an add]- whom you have agreed in a written contract, exe- tional insured under this endorsement ends cuted prior to loss,to name as an additional insured, when their contract or agreement with you for subject to the following provision• such leased equipment ends. This insurance applies only with respect to the fol- 2. With respect to the insurance afforded to these lowing hazards for which the state or governmental additional insureds, this Insurance does not ap- agency or subdivision or political subdivision has is- ply to any "occurrence" which takes place after sued a permit or authorization in connection with the equipment lease expires. premises you own, rent or control and to which this E. Blanket Additional Insured — Managers Or Les- insurance applies: sors Of Premises 1. The existence, maintenance, repair, oonstruc- Section II —Who Is An Insured is amended to in- tion, erection or removal of advertising signs, dude as an insured any person or organization with awnings, canopies, cellar entrances, coal holes, whom you have agreed in a written contract, exe- driveways, manholes, marquees, hoist away cuted prior to loss,to name as an additional insured, openings, sidewalk vaults, street banners or but only with respect to liability arising out of the decorations and similar exposures;or ownership, maintenance or use of that part of the 2. The construction, erection or removal of eleva- premises leased to you, subject to the following tors;or additional exclusions: 3. The ownership, maintenance or use of any ele- This insurance does not apply to: vators covered by this insurance. 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. SECTION III — LIMITS OF INSURANCE AMEND- 2. Structural alterations, new construction or MENTS demolition operations performed by or on behalf A. Damage To Premises Rented To You of such additional insured. Paragraph 6.is replaced by the following: F. Blanket Additional Insured — State Or S. Subject to Paragraph 6. above,the most we will Governmental Agency Or Subdivision Or Poiitl- pay under Coverage A for damages because of cal Subdivision—Permits Or Authorizations "property damage" to any one premises, while Section II —Who Is An Insured is amended to in- rented to you, or in the case of damage by fire, dude as an insured any state or governmental lightning, explosion or sprinkler leakage, while agency or subdivision or political subdivision with rented to you or temporarily occupied by you whom you have agreed in a written contract, exe- with permission of the owner Is the greater of: cuted prior to loss,to name as an additional insured, a. $300,000;or subject to the following provisions: 1. This insurance applies only with respect to op- b. The amount shown next to the Damage To Premises Rented To You Limit in the Deda- erations performed by you or on your behalf for which the state or governmental agency or sub- division or political subdivision has issued a Howover,the provisions of this paragraph do not permit or authorization. apply If Damage To Premises Rented To You Coverage Is excluded by endorsement WN GL 39 0310 Includes copyriolied material of insurance Services Office,wKh its permission Page 6 of 6 a WN GL 39 0310 B. Medical Expense Limit b. If you unintentionally fail to disclose any haz- Paragraph 7.is replaced with the following: ards existing at the inception date of your policy, we will not deny coverage under this 7. Subject to Paragraph 6. above, the most we will Coverage Part because of such failure. pay under Coverage C for all medical expenses However, this provision does not affect our because of"bodily injury' sustained by any one right to collect additional premium or exer- person is the greater a.. cise our right of cancellation or non-renewal. a. $10,000,or b. The amount shown next to the Medical Ex- pense Limit In the Declarations. SECTION IV — COMMERCIAL GENERAL LIABIL- This insurance does not apply if coverage for coverITY CONDITIONS, 8. Transfer of Rights of Re- Medical Expenses is excluded either by the pro- by the Against Others addition of the following to Us is hereby amended visions of the coverage part or by endorsement. W the We waive any fight of recovery we may have be- cause of payments we make for Injury or damage SECTION IV — COMMERCIAL GENERAL LIABILITY arising out of your ongoing operations or"your work" CONDITIONS AMENDMENTS done under a written contract, executed prior to loss, A. Knowledge Of Occurrence requiring such waiver with that person or organize- Item 2. Duties In The Event Of Occurrence, Of- Lion and included in the "products-completed opera- fense,Claim or Suit is amended by adding the fol- tions hazard". However, our rights may only be lowing: waived prior to the "occurrence" giving rise to the wtn 9 injury or damage for which we make payment under e. You must give us or our authorized representa- this Coverage Part. The insured must do nothing tive prompt notice of an '000urrence', claim or after a loss to Impair our rights. At our request, the loss only when the'occurrenoe', claim or loss is Insured will bring "suit" or transfer those fights to us known to- and help us enforce those rights. (1) You,if you are an individual; (2) A partner, It you are a partnership; SECTION V—DEFINITIONS AMENDMENTS (3) An executive officer or insurance manager,N A. Bodily Injury Redefined you are a corporation; or Paragraph 3. "Gaddy injury is replaced by the fol- (4) A member or manager, if you are a limited lowing: liability company. 3. 'Bodily injury' means bodily injury, sickness or B. Other Insurance disease sustained by a person, including death item 4. Other Insurance, b. Excess Insurance (1) resulting from any of these at any time. "Bodily (a)(11)is replaced by the following: injury' includes mental anguish or other mental (11) That is fire, lightning,explosion or sprinkler leak- injury resulting from such bodily injury. age insurance for premises rented to you or B. Insured Contract Amended temporarily occupied by you with permission of Paragraph 9.a.is replaced by the following: the owner, a. A contract for a lease of premises. However, C. Unintentional Failure To Disclose Hazards that portion of the contract for a lease of prem- Paragraph $. Representations is replaced by the ises that indemnifies any person or organization following: for damage by fire, lightning, explosion or sprin- 6. Representations And Unintentional Failure kler leakage to premises while rented to you or To Disclose Hazards temporarily occupied by you with permission of a. By accepting this policy,you agree- the owner is not an"insured contrad'; (1) The statements in the Declarations are C. Personal And Advertising injury Redefined accurate and complete; Paragraph 14. d. and a are replaced by the follow- (2) Those statements are based upon ing: representations you made to us;and d. Oral, written, televised, videotaped or electronic (3) We have issued this policy in reliance publication of material that slanders or libels a upon your representations person or organization or disparages a person's or organization's goods,products or service; 6. Oral, written, televised, videotaped or electronic publication of material that violates a person's right of privacy; WN GL 39 03 10 Indudes copyrighted material of Insurance Services Office,with Its perinissbn Page 6 of 6 POLICY NUMBER.CPP 0016819 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective- Countersigned By: Named Insured WESTERN SYSTEMS INC (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): CITY OF KENT 220 FOURTH AVENUE SOUTH KENT, WA 98032 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement ) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained b in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc , 1998 Page 1 of 1 REQUEST FOR MAYOR'S SIGNATURE N7 KENT Please Fill in All Applicable Boxes WASHINGTON Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Originator ;I,�I Phone (Originator) � � Date Sent `' Date Required Return Signed Docun ent to (> � CONTRACT TERMINATION DATE:/, , VENDOR NAME: 1� =6LI DATE OF COUNCIL APPROVAL: Brief Explanation of Document: pgp P I Ij S � /J) FF � - 9. r l-'t t 9LJ l r r , I Ul Office of the M aY All Contracts Must Be Routed Through the Law Department (This Area to be completed By the La", Department) Received: v}:�Approval of Law Dept £. FVED Law Dept. Comments: AUG 2 0 2013 Ul h Date Forwarded to Mayor: C^� k . Shaded Areas to Be Completed by Administration Staff ECEN D Received: AUG 0 2C Recommendations & Comments: CCny( FKr:N CLERK Disposition. / /U j Date Returned: lage5870 • 3/05 PDo-aaq