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HomeMy WebLinkAboutPW13-271 - Amendment - #1 - VanDevanter Associates - Green River Levee Animations - 12/12/2013 Records Management-- KEN T nt Docume WPS HINGTON 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: VanDevanter Associates Vendor Number: JD Edwards Number J� Contract Number: � 13 ;►i 1 This is assigned by City Clerk's Office Project Name: Green River Levee Animations Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: A engf men+ Ale. 1 Contract Effective Date: 12/12/13Termination Date: 12/31/14 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Toby Hallock Department: Engineering Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to December 31, 2014 so the Vendor can make necessary changes to drawings as project designs have changed. S Public\RecordsManagement\Forms\ContractCover\adcc7832 i 11/08 s KENT AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: VanDevanter Associates CONTRACT NAME & PROJECT NUMBER: Green River Levee Proiects Animations ORIGINAL AGREEMENT DATE: August 19, 2013 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: The scope of work remains the same, however an amendment is needed to extend the time of completion to December 31, 2014 so the Vendor can make necessary changes to drawings as project designs have changed. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $9,600.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $9,600.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $9,600.00 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/13 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days Required (t) for this '365 calendar days Amendment Revised Time for Completion 12/31/14 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT: By: By'I -.Mess (signa ure) /� (signature) Print Name: ! f2 Print Name: Timothy J. LaPorte, P.E. Its Jly c,) P-A-k� Its Public Works Director f ri l€ DATE: l 20,21 �D`2 1/e-, DATE:T( j) APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Va,Davante,-GH Le1e AMi/HaH.,k AMENDMENT - 2 OF 2 MARKV-3 OP ID:VM CERTIFICATE OF LIABILITY INSURANCE OAT 08/12D/YYYY) 08/12/13 '.... 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 policy(ies) 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 800.289-0930 CONTACT Liherty Northwest Insurance NAME: PO Box 188065 800-845.3666 PHONE Exit: FAX No): Fairfield, ADDRE Liberty NorthwOHe45018st WA-SC SS: INSURERS)AFFORDING COVERAGE NAIC9 INSURER A:American States Insurance 19704 INSURED Mark Vandevanter INSURER 9: DBA VANDEVANTER ASSOCIATES 12705 Sw 248th St INSURER C Vashon,WA 98070 INSURERD: 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. ILTR TYPE OF INSURANCE - DD BR POLICY NUMBER MMI�IDYTYYFYY MMIDDIYYYY I LIP41TS GENERAL LIABILITY ®RRENCECCURRENCE Us201,'0111(l A X COMMERCIAL GENERAL LIABILITY X 01CH71081860 01/08/13 01/08/14 S Eaoccunence DCLAIMS-MADE OCCUR (Anyone person)AL B ADV INJURY L AGGREGATE GENIAGGREGATE LIMITAPPLIES PER: TS-COMPIOP AGG X POLICY .P O LOCAUTOMOBILE LIABILITY D SINGLE LIMITentANYAUTO NJURY(Per person) MALL OVdJEDI HEDULED BODILY INJURY Per emlden $ ALTOS TOS ( U N-OWNED PROPERTY DAMAGE HIRED AUTOSTOS per acdtlenj)UMBRELLA LIARCCUR EACH OCCURRENCEEXCESS LIABCLAIM: AGGREGATE_ $ DED RETENTION$ $ WORI<ERB COMPENSATION VJC STAI'U- OTH- AND EMPLOYERS'LIABILITY YIN ORY LIMITS„ ER ANY PRCPRIETORIPARTNER/-XECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDE09 - - — (MandatoryinNH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under _SE DESCRIPTION OF OPFRATIONS belm:' E.L.DISEASE LIMIT S OESCRIPTION OF OPERATIONS ILOCATIDNS 1 VEHICLES (AHach ACORD 101,Additional Remarkc Schedule,If more space is rcqulred) The City Rent is Additional Insured if recp..ired in. an written contract-, agreement, permit or schedule. CERTIFICATE HOLDER CANCELLATION _ THECITK 6AUTHORIZIO LD ANY OF 1 HB ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOP, NOTICE WILL BE DELIVFRED IN The City Kent RDANCE WITH THE POLICY PROVISIONS. Attn: Nancy Yoshitake 400 W. Gowe St REPRESENTATIVE Kent,WA 98032 Y�1 I i ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2.010105) The ACORD name and logo are registered marks of,ACORD _ . . _.... u, ., , ruIly .,u u44 cu4q uoilsfzuld I4:0 #d19 P-001/005 ®® ®® '-R-ePRIMEOFROM THE FORMS LIEP.ARY Policy OICH71081660 COMMERCIAL GENERAL LIABILITY CG 86 74 12 07 THIS ENI70RSFMENT CHANCES THE POLICY, PLEASE BEAD IT CAREFULLY, CONTRACTORS LIABILITY KUS IENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of Kent Attention Nancy Yoshitake 400 West Gowe Avenue Kent, WA 98032 DUTY 10 UEFEND or B or medical expenses under COV- ERAGE C. Paragraph a. of SECTION 1 th COVERAGEA and No otter obligation or liability to pay sums or COVERAGE f3 is replaced by rite following:wing: perform acts or services Is covered unless ex. a. We will pray those sums that the insured be- plictly provided for under SUPPLEMENTARY comes legally obligated to pay as damages PAYMENTS _ COVERAGES AAND R. because of "bodily Injury", '"prope.'ty 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 o, of SECTION I — sured against any 'Isult" seeking those dam- CCVCRAGE A!s replaced by'Ihe following: ages. Our duty to defend begins once you notify us of a "suit" as described to SEC- This exclusion does not applyto liability assumed TION IV — COMMERCIAL GENERAL. LI- by the insured under an `insured contract" ex- A131LITY CONDITIONS, 2.1h. However, we cept for that part of a contract or agreement that will have no duty to defend the Insured Indemnifles any parson or organization for their against any "sult" seeking damages for sole liability. "bodily injury", "properly darnage", or "personal injury or advertising Injury" to WRONGFUL EVICTION 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 "sult" COVERAGE Et: ' 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 Or INSURANCE; and (1) "property damage" to the room, dwell- (2) Our right and duty to defend ends when ing or premises; or we have used up the applicable.limlt of (2) "bodily injury" sustained through eccc!- Insuiance in the payment of judgments pancy of a room, dwelling or promises. or settlements under COVERAGES A Meru and fin Salem Inp aze reltard h6omBA(s of Salem corporalm CO Be 74 12 07 Psge 1 of 5 EP Received Time Aug, 13. 2013 2:44PM No. 0031 Frq,m:Safeco Insurance Company 509 944 2024 08/13/2013 14:49 #819 P.002/005 ^^RRPRINTED FROM THEFORMS LIBRhVY ADDITiONAL INSURED — BY WPdTTEN 'CON- This Insurance does not apply to "bodily TRACT, AGREEMENT OR PERMIT, OP SCHED- injury", "property damage" or dt-Epersonal and advertising Injury" arising out of operations performed for the state The following paragraph Is added to SECTION II --• or municipality; WHO IS AN INSl9RED: c. The insurrance 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 tract, agreement or permit to provide Insurance "bodily injury", property damage", or is an Insured, subject to the following additional "personal and advertising injury" arising out provisions: of the rendering at or the failure to render any professional services by or for you, in- a. The contract, agreement or permit must be cluding: in. effect during the policy period shown in the Declarations, and must have been exe- (1) The preparing, approving, or failing to cured prior to the "bodily injury", 'property prepare or approve maps, drawings, damage", or "personal and advertising opinions, reports, surveys, change or- injury". dare;designs or spoolfications; and 13. The person or organization added as an In- (2) Supervisory, inspection or engineering sured by this endorsement is an insured 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 premises you -own, rent, the "products-completed operations lease or occupy, subject to the following hazard". additional provisions: e. A person's or organlzatlorfs status as an In- (a) This insurance does 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 provided it, in the ab- you; Bence of this endorsement, no IlabllitywGuld (h) This insurance does not apply to be imposed by law on you. Coverage shall any structural alterations, new con- be limited to the extent of your negligence struc'rion or dernolitian operations or fault according to the'appllcable principles 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 Insured; tendered as soon•as practicable to all other (2) Your ongoing operations for that In— insurers which poten'tally provide Insurance cured, whether the Nark is performed for such claim or "suit". by you or for you; h. The insurance pt•ovlded will.not exceed the (3) The maintenance, operation or use by lesser of: you of equipment leased to you by such (1) The coverage andlorlimits of[his policy, person or organization, subject to the or following additional provisions: (9) The coverage anctInr limits required by (a) This Insurance does not apply to sald contract, agreement or permit, any"occurrence"which takes place after the equipment lease expires; NON-OWNED AND N0fJ-0VVPfEI3 (b) This insurance does not apply to AIRCRAFT LIABILi`IY "bodily injury" or "property darnage° arising out of the solo Excluslon ,y. of SECTION I — COVERAOG A is re- negligence of such person or or- placed by the following: ga.nlzat!on; g, °Bodlly injury" or 'property damage" arising (4) Permits issued by any state or polalcal 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 of 5 eceived Time Aug. 13, 2013 2:44PM h. 0031 From:Safeco Insurance Company 509 944 2024 08/1312013 14:49 8819 P.003l005 ^^REPRINTED EROM THE FORMS LIBRARY"^ or loaned to any insured. Use includes oper. "Properly damage"to: atlon and "ioading or unloading". O 1 Property y,ert you own, rent, or occupy, in- This exclusion applies even if the claims cluding any costs or expenses incurred against any insured allege negligence or by you, or any other person, organiza- other wrongdoing In the supervision, hiring, tion of entity, for repair, replacement, employment, training or monitoring of others enhancement, restoration or malnte- by that Insured, if the "occurrence^ which hence of such property for any reason; caused the "bodily -injury" or "property Including prevention of injury to a per- damage" invo€ved the ownership, malnte- son or damage to another's property; trance, use or entrustment to others of any Promises you sell, gi ve ive away or aban- aircraft, "auto, or watercraft that is owned (2) don, the "properly eve damage"arises out su ed operatedor by or rented or loaned to any In- of any part of those premises; This exclusion does not apply to: (33) Property loaned to you; (1) A. watercraft while ashore on premises (4) Personal property In the care, custody you own or rent; or control of the In'sured,- (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 feet long; and contractors working directly or Indirectly (h) Not being used to carry persons or an your behalf are performing oper- property for a charge; atlons, if the "property damage" arises out of those operations, or pr{3} Parking auto" on, on the ways (6) That particular part of any property that hide to, premises you owvv n or rent, pro- must be restored repaired or replaced vided the auto is not owned by or � ap P •' P rented or loaned to you or the insured; because `your work" was incorrectly performed on it. (4) Liability assumed under any insured contract" for the ownership; malnte- Paragraphs (1), (3) and (4) of this exclusion nance or use of aircraft or watercraft; or do not apply to property damage" (other than damage by fire) to premises, including (5) `Bodily injury" or "properly damage" the contents of such premises, rented to arising out of: you. A separate limit: of insurance applies to (a) the operation of machineq , 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 exclu- 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 subject to a compulsory or financial held for rental by you. responsibility law or other motor ve- Paragraphs (3), (A.), (6) and(6) of this exclu- hicle insurance law in the state sion do not apply to liability assumed under where it is Iicensed or princlpafly 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 cry or equipment listed in Paragraph "products completed operations hazard", f.(2) or C(3) of the definition of °mobile equipment". Paragraph 6, of Sectiot III is replaced by the follow- (6) An aircraft you do not own provided It Is ing: not operated by any insured. 6. Subject to Paragraph S. above, the Damage To Premises Rented To You Limit is the most we TENANTS' PROPERTY DAMAGE HAP31LITY will pay under COVERAGE A for damages be- cause of "property damage" to any one prom- When Damage To Premises Rented To You Limit is lses, while rented to you, or in the case of shown In the Declarations, SECf10Pf 1 — COVER- damage by fire, while rented to you or tomporar- AGElt, exclusion j., is.replaced by the following: ily occupied by you with panrdssion of the owmer. j. Damage To Property CG 86 74 12 07 Paga 3 of 5 EP isceived Time Au;. 13, 2013 2; 44PM No. 0031 From`Safece Insurance Company 509 944 2624 08/13/2013 14:50 8819 P.004/005 "REPRIMED FROM THE FORMS LOWY- The Damage To Premises Rented To You Limit is the a. OBoolly Injury° or "property damage° ex. higher of $200,000 or the amount shown in the Dec- peeled 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 feet persons or property. The following is added to Paragraph 2.a.of SECTION INCREASED MEDICAL EXPENSE LIMIT II —WHO IS AN INSURED; Paragraph (1)does not apply to executive officers, or The medical expense limit Is amended to $10,000. to managers at the supervisory level or above. KNOWLEDGE OF OCCURRENCE SUPPLEMENTARY PAYMENTS — CDVERAGESA The following is added to Paragraph 2. SECTION IV AND.13 —'BAIL BONDS — COMMERCIAL GENERAL LIABILITY CONDITIONS Duties In The Event Of Occurrence, Paragraph 1.b. of SUPPLEMENTARY PAYMENTS . Offense, Claim Or Suit of: COVERAGES A AND IS Is replaced by the follow- ing: Knowledge of an "occurrence;, claim or °suit" by b, Up to $3,000 for cost of bail.bonds required Your agent, servant or employee shall not in itself ' 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 the Bodily Injury Liability Coverage applies- from the agent, servant or employee. We do not have to furnish these bonds. ENSURE® CONTRACT i SUPPLEMENTARY PAYMENTS — COVERAGES A AND B — INDEMNITEES AND AD131TIOMAL IN- The; following definition is added to SECTION V SUREDS DEFINITIONS, Definition a. "Insured contract" par- agraph f.: Paragraph 2.f.(1) '(d) 01 SUPPL EMENTAVY PAY- (4) That part of any contractor agree MENTS =-= COVERAGES A AND 8 Is replaced by ment that indemnifles any person H1 following: or organization-for the Indemnitee's (d) Cooperate with us with respect sole tort liability. to coordinating other applicable ®TI1CR INSURANCE insurance arid ' self-insured retention available to the in- demnitee; and the first paragraph of Other Insurance'of SFCTIOM IV — COMMERCIAL GENERAL LIABILITY GUN- EMPL:Ol'LE5 Afi INSUREDS — HEALTH CASE DI PIONS is replaced with the following: SERVICE If other valid and collectible Insurance, or-any self-In- Paragraph 2.a.(1) el.'of SECTION II m VVI-10 IS AN sured retention, is available to the Insured for a loss INSURED is deleted, unless excluded by separate We cover wider COVERAGE A or B of this Coverage endorsemenl. Part, our obligations are Bruited as follows: EX""ENDELD C0Vt=RAG;E FOR NEWLY ACQUIRED METHOD OF SHARING ORGANIZLI-I"IONS life second paragraph of I.c. Method of Sharing of Paragraph 3,0. of SECTION II — V'VI-IO IS AN IN- SECTION IV — COMMERCIAL GENERAL LlAdIL- SURFD Is replaced by the following: ITY CONDITIONS is replaced with the following: n. Coverage under' this provision Is afforded If any of the other Insurance does not penult conul- only until the end of the policy perlod. bution by equal shares or is subject to a self-insured retention, we will contribute by limits. Under this EXTENDElD "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 — COVERAb:E A Is tention or both combined 'to tha total applicable limits amended to read: Page 4 of 5 eceived lime Aug. 13• 2013 2:44PM No. 0031 I IVIII.JRIcuv maul argue uumpany buy U44 'zuz4 08/13/2013 14:50 #819 P.0051005 REPRINTEO FROM THE FORMS LIBRARY- -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 m The following Is added to Paragraph 6. Representa- COMMERCIAL GENERAL LIABILITY CONDI- tions of SECTION Iv - COMMERCIAL GENERAL TIONS: LIABILITY CONDITIONS: 10. If a revision to this Coverage Part, which would If you unintentionally fail to disciose any hazards ex- provide more coverage with no additional !sting at the inception date of your policy, we will not premium, becomes effective during the policy deny coverage under this Coverage Form because of period in the state shown in the Deciarations, 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, I 00 N 74 12 07 Pzge 5 of 5 - EP received Time Aug, 13, 2013 2:44PM No, 0031 325 Eastlake Avenue East PEMCO AUTO POLICY ' PO Box 778 RENEWAL COVERAGE SUMMARY J r1ISilYail6� Seattle,WA 98171-0778 PEMCO Mutual Insurance Company Policy Number CA 0416721 ® ., Policy ENe'dive Oale ; Peliry&PI.lion Do le Valued Aulo Customer Since ® 02/28/13 02/28/14 1986 12:01 A.M.p PACIFIC STAN0AR0 TIME NAMED INSURED: This is your Auto insurance renewal.Your proof-of-insurance and identification cards are enclosed.Thank you for choosing PEMCO. STEPHANIE B VANDEVANTER MARK A VANDEVANTER 12705 SW 248TH ST VASHON WA 98070 Renewal Effective Date: 02/28/13 Please ver all information.If there are changes,please call our office. Your Vehicles 2012 TOYOTA PRIUS V VIN JTDZN3EUOC3044802 Coverages Limits/Deductible Premium Bodily Injury Liability $100,900 each person/$300,000 each occurrence $253.88. Property Damage Liability $50,000 each occurrence $125.90 Underinsured Motorist BodilyInjury ...,., . - � .. . ... Y I n' $100,000ea'th person/$300,OD0 each occurrence, . $100.37 Underinsured Motorist Properly Damage $50,000 each occurrence $11.39 Personal Injury Protection - $10,000. $82.65 Loss of Income $200 max per weeV$10,400 max per occurrence each person Included Collision Deductible:$500 ° $393.01 Comprehensive Deductible:$100 $122.78 AuloConn/Cease —"—' C^age - - Towing $100 $3.60 .Rental Reimbursement $30 per day/Saw per occurrence - $21.45 Stereo/Communication Equipment No Coverage Customized Equipment No Coverage Vehicle Premium: $1,174.97 repair or servlcmd oYRTu®TOr V�fillcles.. a �1`ASNINGTON STATE INSU}L41110E 1©ENTIPICAYION• a WR1SIdINf3Ta0N STATE INSURANCE IDENTIFICATION AEMCb F/lcpieal Insurapm Company PEMCO Mutual Insurance Company t, VALUED CUSTOMER . VALUED CU5710t.1E11 SINCE_ 19$6 SINCE '1986 POLICYHOLDERS; STEP47AN/G B VANDEVANTER �� ' POLICYHOLDERS: STEAHFlNiE B VANDEVANTER MARKAVANDEVANyER r MARK AVANDEVANTER POLICY NUMBER: CA 0416727 POLICY NUMBER: CA 0416721 EFFECTIVE DATES: 02/28/73 1'O 02/2$/74 ! EFFECTIVE DATES: 02/28/13 TO 02/28/14 INSURED DRIVER: STEPHANIE B VANDEVANTER INSURED DRIVER: P,tAffiCA VAWDEVANTER i l