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HomeMy WebLinkAboutPW13-271 - Amendment - #2 - VanDevanter Associates - Green River Levee Animations - 08/11/2014 100 ® Records Manager�n ` ri KENTt,,,. Document W A9NIN GTGN 4i.Y�°> I 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. I Vendor Name: VanDevanter Associates I �i Vendor Number: JD Edwards Number Contract Number: This is assigned by City Clerk's Office Project Name: Green River Levee Projects & Water System Animations Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 8/11/14 Termination Date: 12/31/14 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Kevin Swinfrod Department: PW Operations Detail: (i.e. address, location, parcel number, tax id, etc.): j Amended the scope of work to create water system animations. --- i i S:Publlc\RecordsManagement\Forms\ContractCover\adcc7832 1 11J88 i i r ry^ I KEN ■ WASHINOTa n' I AMENDMENT NO. 2 I NAME OF CONSULTANT OR VENDOR: VanDevanter Associates CONTRACT NAME & PROJECT NUMBER: Green River Levee Projects and Water System 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 is amended to create water system animations. For a description, see the Consultant's scope of work which is attached as Exhibit A and B and incorporated by this reference. 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 I I I AMENDMENT - 1 OF 2 Original Time for Completion 12/31/13 (insert date) Revised Time for Completion under 12/31/14 prior Amendments (insert date) Add'I Days Required for this o 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 CIF KENT: By: By. rgnat r s'`" 'y ignature) Print Name: ,f Print Name: Timothy J. LaPorte P.E. Its FEZ Z Its P blic Works Director _ (title) it/e) DATE: D�� DATE: APPROVED AS TO FORM: j (applicable if Mayor's signature required) I i Kent Law Department VanDevanter-GR LeveesL Water System Amd 21SWWn 10 i AMENDMENT - 2 OF 2 Exhibit A Water System Animation Project Scope of Work: Create an overhead to ground level animation to illustrate the process flow and system dynamics of the City of Kent's Water System. The project will be billed at a rate of$150.00/hr, not to exceed$5000.00 Production schedule and related costs: Refine 3D master model extending to Kent city limits to show a series of overlays including major transmission pipes,reservoirs and related features. 4 hours Create a series of nested 3D models showing specific tanks and pump stations that can be cut in cross section as required. Script and render animated tours over the model and integrate with any still imagery by owner to illustrate the communication objectives outlined in this document. 24 hours Meetings and miscellaneous coordination. 4 hours Projected total hours=32 hours at$150.001hour=$4,800.00 Mark VanDevanter, Architect VanDevanter Associates 12705 SW 248th Street Vashon, WA 98070 (206) 463-7611 I Exhibit B Communication Objectives: 1. Starting east of Kent, show our primary water sources to include: • Clark Springs, Kent Springs, Tacoma intertie#1 and Armstrong Springs wells 2. Show the route of transmission mains. Starting with Clark Springs, fill the transmission main, As it passes (tent Springs start filling that main as well. Move westward filling both mains. As you pass Armstrong show that source providing water to the main(s). 3. Continue westward and show the mains separating at 132"d and Kent Kangley. Continue following Clark Springs transmission main westward, as it passes Seven oaks well show that source filling the main as well. Work westward to 6#1 tank and show the tank filling. 4. Show on site pump station next to 6#1 tank pushing water uphill eastward filling Blue Boy Tank, 640 tank and 3.5 tank or just one of them? In addition we'll want to show how that station not only fills the tanks but also pressurizes the zone piping as well? Show Tacoma intertie#3 and East Hill well filling the east hill zone as well, (it's two primary sources for us on the east hill) 5. Pick up the Kent Springs Transmission main at 132"d and as it passes the Tacoma interne #3 show it filling the line, continue to Guiberson Reservoir filling it (thru the aeration nozzles). 6. From this point show water leaving Guiberson westward into valley floor filling that zone. At this point we may want to show water from the 6#2 reservoir(to the north) filling the valley floor too? 6#2 gets its water from 6#1. Both Guiberson and 6#2 feed the valley floor. 7. We'll want to show pump station#3 pulling water from the valley floor and filling Reith Rd Reservoir on the west hill. From Reith Rd Reservoir water is pumped father up the hill to Cambridge tank where it feeds two pump stations, #6 and#7 supplying water to three zones, 529,587 and 565 on the west hill. 8. Sean was interested in showing a fire hydrant flowing and its effect on draining a reservoir and it re-filling with a pump. it i � fI ) I i �,...-.� MARKV-3 OP ID: LB CERTIFICATE OF LIABILITY INSURANCE 1 DATE 01107114 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS .<TIFICATE 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 ban of such endorsement(s). PRODUCER CONTACT NN;__ ____ -_. Liberty Mutual 188065Insurance PHONE IfAX PO Box 188065 AIC,No,E�te __. Fairfield,OH 45018 EMAIL Liberty Northwest WA-SC ADDRESS: MSURER(S)APPORDINGCOVERAGE _ _NAICIf _ INSURER A:American States Insurance 19704 INSURED Mark Vandevanter INSURER B. DBA VANDEVANTER ASSOCIATES - - — - 12705 Sw 248th St INSURERc:_,__ Vashon,WA 98070 INSURE_RD: 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 i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH APOLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE D POLICY NUMBER MMIDDYIY YY MMIDDIYYYV LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1IAMA X COMMERCIAL GENERAL LIABILITY X OICH71081670 01108/14 01/08/15 PREMIET S 20Q000 PREMISES(Ea oucunence}..__. CLAIMS-MADE �OCCUR MED EXP(Any one person} $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATET$ 1,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPRJP AGO J_$_ 1,000,000 ( POLICY PRO- LOG $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accitlanl _ _ $ __ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - - NON-OWNED PRO PERTY DAMAGE $ HIRED AUTOS AUTOS Per scream _._- $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTIONS TH $ WORKERS COMPENSATION TORY LIMTLL EB AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/EXCLUDED? E] NIA E L DISEASE ICIDEEMPLOYE $ _ (Mandatory in N R EXCLUDED? If a s,dory in and _ _ — er Dyes,RIP describe OF O DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD Jet,Additional Remarks Schedule,it more space is required) The City of Rent is Additional Insured if required in a written contract, agreement, permit or schedule. i CERTIFICATE HOLDER - CANCELLATION THECITK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I The City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. -- Attn: Nancy Yoshitake 400 W. Gowe St AUTHORIZED REPRESENTATIVE Kent,WA 98032dC ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Policy Number: 01CH71081670 COMMERCIAL GENERAL LIABILITY CG 86 74 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGEPART SCHEDULE Name of Person or Organization: The City of Kent Attn: Nancy Yoshitake 400 W.Gowe St Kent,WA 98032 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 to 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 The last paragraph of exclusion e. of SECTION I — will have the right and duty to defend the in- COVERAGE A is replaced by the following: sured against any suit seeking those dam- 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- cept for that part of a contract or agreement that ABILITY CONDITIONS, 2,b. However, we indemnifies any person or organization for their will have no "duty, to defend the insured sole liability. against any ,auf" seeking damages for bodily injury , property damage „ or WRONGFUL EVICTION personal injury or advertising injury to which this insurance does not apply. We The following exclusion is added to SECTION I — May, at our discretion, investigate" any COVERAGE B: occurrence and settle any claim or suit that may result. But: The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a (1) The amount we will pay for damages is room, dwelling or premises arising out of any: limited as described in SECTION III LIMITS OF INSURANCE; and (1) property damage to the room, dwell- ing or premises; or (2) Our right and duty to defend ends when 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 ................. CG 86 74 12 07 Page i of 5 EP ADDITIONAL INSURED — BY WRITTEN CON- This insurance does not apply ton bodily TRACT, AGREEMENT OR PERMIT, OR SCHED- injury property damage", or ULE "personal and advertising Injury" arising out of operations performed for the state The following paragraph is added to SECTION If -- or municipality; WHO IS AN INSURED: c. 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 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 of or the failure to render a. The contract, agreement or permit must be any professional services by or for you, in- in effect during the policy period shown in eluding: the Declarations, and must have been exe- (1) The preparing, approving, or failing to cuted prior to the bodily injury", property prepare or approve maps, drawings, damage, or personal and advertising opinions, reports, surveys, change or- njury". ders, designs or specifications; and b. 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 1.b0dily (1) The ownership, maintenance or use of injury" of "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 organization's 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 if, in the alb- you; sence of this endorsement, no liability would (b) 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 struction or demolition operations or fault according to the applicable 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 potentially provide insurance sured, whether the work is performed for such claim or "suit". by you or for you; h. The insurance provided will not exceed the (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 the following additional provisions: or (a) This insurance does not apply to (2) The coverage and/or limits required by any "occurrence" which takes place said contract, agreement or permit. after the equipment lease expires; NON-OWNED WATERCRAFT AND NON-OWNED (b) This insurance does not apply to " AIRCRAFT LIABILITY bodily injury" or property damage" arising out of the sole Exclusion g. of SECTION I — COVERAGE A is re- negligence of such person or or- placed by the following: ganization; g, "Bodily injury" or property damage" arising (4) Permits issued by any state or political out of the ownership, maintenance, use or subdivislon with respect to operations entrustment to others of any aircraft, auto 11 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 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 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 or entity, for repair, replacement, employment, training or monitoring of others enhancement, restoration or mainte- 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 part of those premises; sured. This exclusion does not apply to: (3) Property loaned to you; 1 A watercraft while ashore on remises (4) Personal property in the care, custody ( ) p or control of the insured; you own or rent; 2 A watercraft you do not own that is: (5) That particular part of real property on ( ) y which you or any contractors or sub- (a) Less than 52 feet long; and contractors working directly or indirectly on your behalf are performing oper- (b) Not being used to carry persons or ations, if the "property damage arises property for a charge; out of those operations, 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 because your work was incorrectly 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 contract" for the ownership, mainte- 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 arising out of-, you. A separate limit of insurance applies to Damage To Premises Rented To You as (a) the operation of machinery or described in SECTION III -- LIMITS OF equipment that is attached to, or INSURANCE. Paragraph (2) of this exclu- part of, a land vehicle that would sion does not apply if the premises are "your qualify under the definition of work" and were never occupied, rented or 11 mobile equipment if it were not held for rental by you. subject to a Compulsory or financial 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. 6. 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-, AGE A, exclusion j., is replaced by the following: fly occupied by you with permission of the owner. j. Damage To Property Page 3 or 5 The Damage To Premises Rented To You Limit is the o. "Bodily i j " or "property damage^ ex- higher ' (f %28O'000or |hoon�ountohovvnin1hoDeu' pcntedo/intandadfrom the standpoint n[the |arat|ono as Damage To Premises Rented To You insured. This exclusion does not apply to Limit. 6odi|yin/ury'^ n/ « ropertydmnoage'' »cnu|t- inghomiheuseofroa000ab|e force Lo pro- WHO |SAN |NSURE0 -- MANAGERS too[ persons orproperty. The following ia added to Paragraph 2,m. ofSECTION INCREASED MEDICAL EXPENSE LIMIT U . WHO |G4NINSURED: The medical expense limit ia amended 1n $10'O0V, Paragraph(1) does not apply tu executive officers, or io managers ai the supervisory level n| above. KNOWLEDGE QFOCCURRENCE SUPPLEMENTARY PAYMENTS ~^ COVERAGES The following is added to Paragraph 2. SECTION |V AND B ~ BAIL BONDS ,- COMMERCIAL GENERAL LIABILITY CONDITIONS Duties |n The Event OfOccurrence, Paragraph 1.b. of SUPPLEMENTARY PAYMENTS Offense, Claim Or Suit of: .. COVERAGES A AND Bia replaced hy the follow- ing: Knowledge of an "Occurrence", o|airA or '^ ui1" by b. UpLo $0.000 for cost uf bail bonds required Your agent, oervantnrnno}doyeeuha|| n(tinitneK because uf accidents or traffic law violations constitute knowledge of the named insured unless mn arising out nf the use o(any vehicle Luwhich officer 0f the named insured has received such notice the Bodily Injury Liability Coverage applies. from the agent, servant oremployee. VVmdu not have to furnish these bonds, INSURED CONTRACT SUPPLEMENTARY PAYMENTS _ COVERAGES AND D ~. |NDEK4N|TEES AND ADDITIONAL IN- The following definition io added io SECTION V ^- 8UNEDS DEFINITIONS, Definition A. "Insured contract" par- agraph f.: � Paragraph 2.t(3) (d) *of SUPPLEMENTARY PAY- (4) That part of any contract or agree- MENTS — COVERAGES A AND B is replaced by noent that indemnifies any person the following: nr organization for the indmnon|tea'a (d) Cooperate with us with respect sole tort liability. |o coordinating other applicable insurance and self-insured OTHER |N8URANCE retention available tu the in- darnVirae; and The first paragraph of Other Insurance ofSECTION |V .. COMMERCIAL GENERAL LIABILITY CON- EMPLOYEES AS INSUREDS ~. HEALTH CARE DIT|ONSio replaced with the following: SERVICE |[other valid and collectible insurance, or any self-in- Paragraph 2.o{1) d. of SECTION |/ _ WHO |SA8 sunad retention, io available to the insured for aloss INSURED io deleted, unless excluded byseparate mo cover under COVERAGE Au/ Bn[this Coverage endorsement. Part, our obligations are limited anfollows: EXTENDED COVERAGE FOR NEWLY ACQUIRED METHOD OF SHARINa. ORGANIZATIONS The second paragraph o[ 4.o. Method of Sharing of Paragraph 3.a. of SECTION || — WHO |S &0IN. SECTION |V ^~ COMMERCIAL GENGRALLI&B|L~ SUREnis replaced by the following: |TY CONDITIONS is replaced with the following: a. Coverage under this provision ioafforded |f any ny the other insurance does not permit ouniri' nniyun1|| 1hoendofthepu)ioyPoriod. bubonby equal shares nris subject tnaself-insured "PROPERTY `, retanhon. vvo will oonhibute by limits. Under this � EXTENDG[� DAN1AGE method, each insurers share is based on the ratio uf its applicable limit o[ insurance or self-insured re- Exclusion n. (VSEOT|0N | ~ COVERAGE Aiy tootionvr both combined to the total applicable limits amended tnread: Page 4mo 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 _ 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 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 coverage under this Coverage 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. CG 86 74 12 07 Page 5 of 5 EP PEMCO 325 Eastlake Avenue East PEMCO Auto Policy Go"bV PO Box778 Renewal Declarations insurance Seci le,WA 98111-0778 PEMCO Mutual Insurance Company Policy Number CA 0416721 EFFECTIVE DATE, b EXPIRATION DATE Valued Customer Since 02{28/14' -' f. 02/28(15, 1986 -- 12.01 A.M.,PACIFIC STANDARD TIME - Named Insureds: This is your Auto insurance renewal.Your proof-DI-Insurance and identification cards are enclosed.Thank you for choosing PEMCO. STEPHANIE B. VANDEVANTER MARK A.VANDEVANTER 12705 SW 248TH ST VASHON WA 98070-7837 615 Please verify all information. If there are changes,please call our office. YOUR VEHICLES 2012 TOYOTA PRIUS V YIN JTDZN3EUOC3044802 COVERAGES Limits/Deductible Premium Bgdlly Injury' - $100,000 each'pgrs66/$306,000 each occurrence, Properly Damage Liability $50,000 each occurrence _ $142 03 Underinsured M&6rW Bodilylnjury $100,000_each perSgriJ$300,000,each occurrence) =$1.07,80°;j Underinsured Motorist Properly Damage $50,000 each occurrence $l l.dl Pe�sonallnu ..Profect(on $14,000.'., ._ .. .: _ —:. ;._ ',', $97.b9 . .. -.-- w. _. I ry, ..__._ .__�-_ Loss of Income vo,o max per week/$10 400 max per occurrence each person Included ` Collisiaq _ _ _ Deductible::$500' - _ .,':$346.4T'i Comprehensive Deductible:$100 $94.38 Auto Loari/lease``+_ No Coverage Towing $100 $3.60 Reim '. Rental bursement $30 per day/$900 per occurrence_; Stereo/Communication Equipment No Coverage - f stomized.Equipment- No Coverage Vehicle Premium $1,164.41 ........ _ _ _ WASHINGTON STATE INSURANCE IDENTIFICATION WASHINGTON STATE INSURANCE IDENTIFICATION PEMCO PEMCO Mutual insurance Company PEMCO Mutual Insurance Company VALUED CUSTOMER VALUED CUSTOMER ' SINCE:7986 ' SINCE:1986 POLICYHOLDERS: STEPHANIE B.VANDEVANTER POLICYHOLDERS: STEPHANIE B.VANDEVANTER MARK A.VANDEVANTER MART(A.VANDEVANTER j POLICY NUMBER: CA 0416721 POLICY NUMBER: CA 0416721 EFFECTIVE DATES: 02/28/14 TO 02/28/15 EFFECTIVE DATES: 02{28{14 TO 02l28/I5 } r INSURED DRIVER: MARK A.VANDEVANTER INSURED DRIVER: STEPHANIE B.VANDEVANTER I 1