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HomeMy WebLinkAboutPW14-285 - Amendment - #1 - VanDevanter Associates - Animation to Illustrate the City's Storm Water System - 11/06/2014 ems/ ICENT REP Records Manag��' �e�er` 4 W ASNINGTON ocument '.. n 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: ]D Edwards Number Contract Number: This is assigned by City Clerk's Office Project Name: Storm Water System I Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/31/14 Termination Date: 12/31/15 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Toby Hallock Department: Engineering Contract Amount: Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail. (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to December 31, 2015 because services are still required ------ ----- ------- ------ through 2015. As of: 08/27/14 DENT AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: VanDevanter Associates CONTRACT NAME & PROJECT NUMBER: Storm Water System ORIGINAL AGREEMENT DATE: November 6, 2014 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, 2015 because services are still required through 2015. 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, $4,800.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $4,800.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $4,800.00 I AMENDMENT - 1 OF 2 Original Time for Completion 12/31/14 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days Required (f) for this 365 calendar days Amendment Revised Time for Completion 12/31/1.5 (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. i 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. i i 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: CIT�G AF, KENT: (slgnatuie)� (signature) Print Name /4, :° A� 1ti t"� rr nt Name: Michael Mactutis P.E. Its 71" '- t«' "� ' � t Its Environmental En inee ing Manager >' (itle) (title) , DATE: t '~I ` �` t DATE; 'Z /` �/ APPROVED AS TO FORM: (applicable if Mayor's signature required) I, i i Kent Law Department VanD.v te,-St.,n System Ama 1/Ha11.ck AMENDMENT - 2 OF 2 MARKV-3 OP ID:LB ® CERTIFICATE OF LIABILITY INSURANCE DA 01107DlYYYY) 01t07t14 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS .xTIFICATE 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 '... 2EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the srtificate holder in lieu of such endorsement(s). )DUCER CONTACT arty Mutual Insurance NAME: BOX 188055 PHOA 0NNo EAX AAC No: 'field,ON 45018 &MA- '.. arty Northwest WA-SC ADDRESS: INSUR'cR($)AFFOft01NG COVERAGE NAICfl '... INSURER A:American States Insurance 19704 )RED Mark Vandevanter INSURER B: DBA VANDEVANTER ASSOCIATES 12705 Sw 248th St INSURERC: Vashon,WA 98070 INSURER D; NSURERE: USURER F: VERAGES CERTIFICATE NUMBER: REVISION NUMBER: 118 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, (CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.SUM TYPE OFINSURANCE POLICY NUMBER MMIDGYYYY MMIDOIYYYY LIMITS GENERALUABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY X 01CH71081670 01/O8(74 01(08/15 'PRE'MI, ES Ea Otto rence $ 200,000 CLAIMS-MADE I(OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 "(_AGOREGATELIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,000,001 POLICY PE D LOC $ AUTOMOBILE LIABILITY COMBINED SI GLE LIMIT Ea no kient S ANYAUTO BODILY INJURY(Perperson) $ AUTOSNED SCHEDULED BODILY INJURY(Per accident) $ HIREDAUTOSearn NON-OWNED AUTOS POPPcERTY DAMAGE $ d. $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ' EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I IRETENTION$ IS WORKERS COMPENSATION WCSTATU- TH- AND EMPLOYERS'LIABILITY YIN TORY IMITS E ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICERIM EMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If es,Gescdbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ ;IPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,irmore space Is required) City of Kent is Additionai Insured if required in a written contract, ement, permit or schedule. 'IFICATE HOLDER CANCELLATION THECITK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Nancy Yoshitake 400 W.Gower St AUTHORMED REPRESENTATIVE Kent,WA 98032 i ©1988.2010 ACORD CORPORATION. All rights reserved, ID 28(2010105) The ACORD name and logo are registered marks of ACORD I I Policy Number:OICH71081670 COMMERCIAL GENERAL LIABILITY CO 86 74 12 07 I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, CONTRACTORS LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COM M ERCIAL GENERAL LIABILITY COVERAGE PART 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 1 — 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- pllcltly provided for under SUPPLEMENTARY' comes legally obligated to pay as damages PAYMENTS COVERAGES 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- 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 pi a suit's 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 .suit„ 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 r " ra 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- (2) Our right and duty to defend ends when ing or premises; or we have used up the applicable limit of (2) 'bodily Injury" sustained through occu- Insurance in the payment of judgments pancy of a room, dwelling or premises. or settlements under COVERAGES A ). I 03 8$ 14 U 07 Page 1 of 5 ER ! i ADDITIONAL INSURED _ BY WRITTEN CON. This insurance does not apply to"bodily TRACT, AGREEMENT OR PERMIT, OR SCHED- injury", property dam age", or ULE personal and advertising Injury" arising out of operations performed for the state The following paragraph is added to SECTION 11 — 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 cluding: the Declarations, and must have been axe- (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- Injury". 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 "bodily (1) The ownership, maintenance or use of in o; 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 ab- 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 " Insured; g• The defense of any claim or suit must be 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 person or organization, subject to the (1) The coverage and/or limits of this policy, 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 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: I Page 2 of 5 or loaned to an insured. Use includes oper- ation and 'loading or unloading". Property damage"to: This exclusion applies even If the claims (1) Property you own, rent, or occupy; In- eluding any costs or expenses Incurred against any insured allege negligence or by you, or any other person, organize- other wrongdoing in the supervision, hiring, tfon or entity, for repair, replacement, employment, training or monitoring of others enhancement, restoration or malnte- 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 O 2 Premises you sell, aircraft, a " "auto'or watercraft that is owned Y give away or aban- or operated by or rented or loaned to any In- don, if the property damage"arises out sured. of any part of those premises; This exclusion does not apply to: (3) 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 insured; (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 62 feet long;and contractors working directly or indirectly on your behalf are performing oper- (b) Not being used carry persons or ations if the "propertydame property for a charge; e arises 9 out of those opetations, 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- vided the "auto" Is not owned b must be restored, rewired or replaced y or because your work was incorrectly rented or loaned to you or the Ensured; performed on it. t (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'ffre) to premises, including (6) "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.qualify under the definition of sfon 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), (4), (5) and (6) of this exclu- ' hcle 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 nr in- ply to "property damage" included in the i 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 fellow- (6) An aircraft you do not own provided it fs Ing: not operated by any insured. 6. Subject to Paragraph 5, above, the Damage To Premises .Rented To You Limit Is the most we I TENANTS'PROPERTY DAMAGE LIABILITY will pay under COVERAGE A for damages be- cause of property damage"to any one prern- Ihen Damage To Premises Rented To You Limit is !sea, 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 j AGE A, exclusion J., is replaced by the following: fly occupied by you with permission of the owner. J. Damage To Property Page 3 of 5 I li The Damage To Premises Rented To You Limit is the a. "Bodily injury or "property damage" ex- higher of $200,000 or the amount shown in the Dec- pected or intended from the standpoint of the larations as Damage To Premises Rented To You insured. This exclusion does not apply to Limit bodily injury" or property damage" result- WHO IS AN INSURED _ MANAGERS ing from the use of reasonable force to pro- tect persons or property. The following is added to Paragraph 2.a, of SECTION INCREASED MEDICAL EXPENSE LIMIT 11 - 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 - COVERAGES A The following is added to Paragraph 2. SECTION IV AND B _ BAIL BONDS _ COMMERCIAL GENERAL LIABILITY CONDITIONS Duties In The Event Of Occurrence, Paragraph 1.b. of SUPPLEMENTARY PAYMENTS Offense, Claim Or Suit of: _ COVERAGES A AND B 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, INSURED CONTRACT SUPPLEMENTARY PAYMENTS _. COVERAGES A AND B .- INDEMNITEES AND ADDITIONAL IN- The following definition is added to SECTION V _ SUREDS DEFINITIONS, Definition 9. "insured contract" par- agraph f.: Paragraph 21(1) (d) 'of SUPPLEMENTARY PAY- (4) That part of any contract or agree- MENTS - COVERAGES A AND B is replaced by meet that indemnifies any person the following: or organization for the indemnitee's (d) Cooperate with us with respect sole tort liability. to coordinating other applicable insurance and self-Insured OTHER INSURANCE j retention available to the in- demnitee;and The first paragraph of Other Insurance of SECTION IV _ COMMERCIAL GENERAL LIABILITY CON- EMPLOYEES AS INSUREDS - HEALTH CARE DITIONS is replaced with the following: SERVICE If other valid and collectible insurance, or any self-in- Paragraph 2.a.(1) d. of SECTION II _ WHO 15 AN sured retention, is available to the insured for a loss INSURED is deleted, unless excluded by separate we cover under COVERAGE A or B of this Coverage endorsement. Part, our obligations are limited as follows: EXTENDED COVERAGE FOR NEWLY ACQUIRED METHOD OF SHARING ORGANIZATIONS The second paragraph of 4.c. Method of Sharing of Paragraph 3.a. of SECTION If — WHO IS AN IN- SECTION IV - COMMERCIAL GENERAL LIABIL. SURED Is replaced by the following: ITY CONDITIONS is replaced with the following: a. Coverage under this provision is afforded only until the end of the policy period. If any of the other insurance does not permit con tri- bufion by equal shares or is subject to a self-insured retention we will contribute by limits. Under this EXTENDED"PROPERTY DAMAGE" method, each insurer's share is based on the ratio of Exclusion a. of SECTION I COVERAGE A is Its applicable limit of insurance or self-insured re- amended to read: tention or both combined to the total applicable limits Page 4 of 8 I, I 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- tlons 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. I i I .............. CG 88 74 t2 07 Page Sot 5 EP i i j �pp PEM CO pp EastlBox ake Avenue East PEMCO Auto Policy �ll, Insurance Seattle,WA981114778 Renewal Declarations PEMCO Mutual Insurance Company Policy Number CA 0416721 ' EFFECTIVE;PdTE'',:.`Z1-,',;, EXPIRATIONDATE';=q• dCustgmer$I,n,'cE�'; 02/28AS .. .•'''i986.:c': :'.:'.''r_a:`a+_p.12a7'AM':,PACIFIC STANDARD TIME •. .�. :.• ., :.•:. :a.. 'i., :• Named Insureds: This is your Auto insurance renewal.Your proofofinsurance and identification cards ore enclosed.Thank you for STEPHANIE B.VANDEVANTER choosing PEMCO. MARK A.VANDEVANTER 12705 SW 248TH ST ' VASHON WA 98070-7837 als Please verif r all information, 1f there are changes,please call our office. YOUR VEHICLES 2012 TOYOTA PRIUS V VINJTDZN3EU0C3044802 COVERAGES Limits/Deductible Premium x:� : .... ., . . .r:,- --t-,•... ,.?-r�.:.-s::*;:cam ,: ;;:Bodil}':191!!ry•�,,Properly Damage Liob,•.::'< .,. .;;', . %'$i,00+000�eUcfa•;igrion/;$3Q0,006:edc}h:ocEur�eticei:: :{;',,;:•.;:'.Y.i:�::. ...i4'-t:$28_4,14'E ility F _ 560,000 each occurrence 142.03 U,Srderinsur2+o'_Ivlotoi'isf;Badify $100,0'O'**;h'personf$300.0OO, rich o. ccurrence,•`„ �r'r:,:, '�,;% .E•.�r,; $X07$0, Unclennsured Motorist Properly Damage $50,000 each occurrence $1141 9 Y Y-A Persono�GlugyProtachon $10000 y '.; r V .,+ _:,�, :,r., ,..�$7b.9, Loss of Income $200 max per week/$1 Oc400 max'per occurrence each person Induded f;Cgf(isigQ:;t _ _ ,'Deductibe;$5Q0;;, . ' `i'A;r•.-t`'s„'i-' 'r:>,'.i Comprehen Sty s ,' . •Dedudio�e:$70Q $94.39 ,.AUtb_oan Lease:`..:',•_.::�. r:^.:::d.;ti:_:. ..oCoverage ,'. -., .:,,'r.., ;. ,:;,.]:,r..f , .. :..'S. P , z �.•,_:� ", '.:.t',.,":`: ,: .r.•_ate"a ., Ed.. S^„� Towing $100 $3 60. ':Ren a1 Re{mbu�sement' '.` _ _,,•: $30 per,day/$900 per occur once, Stereo/Communication Equipment _ No Coverage • Cy"stomized E vi me :No CoLera e. '+` "s"• Vehicle Premium $1,1b4.41 i WASHINGTON STATE INSURANCE IDENTIFICATION WASHINGTON STATE INSURANCE IDENTIFICATION PEMCO Mutual insurance Company PEMCO Mutual Insurance Company I VALUED CUSTOMER ' VALUED CUSTOMER ' SINCE:1986 SINCE:1986 i POLICYHOLDERS: STEPHANIE B.VANDEVANTER POLICYHOLDERS: STEPHANIE B.VANDEVANTER MARK A.VANDEVANTER MARK A.VANDEVANTER I POLICY NUMBER: CA 0416721 POLICY NUMBER: CA 0416721 I EFFECTIVE DATES: 02/28/14 TO 02/28(15 EFFECTIVE DATES: 02/28/14 TO 02/28/15 i INSURED DRIVER: MARK A.VANDEVANTER INSURED DRIVER: STEPHANIE B.VANDEVANTER i j i i I