Loading...
HomeMy WebLinkAboutLW15-274 - Original - Grandview Apartments, LLC - Contract- 07/24/2015 A�dd I ® fi W pSHINOTON Document 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: #�i6fv7i, b�6 �t .. . 4.° tV# Eft Vendor Number: _ JD Edwards Number I Contract Number: 4,JI L 1 This is assigned by City Clerk's Office Project Name: i`. ` i c 's t, If i. l :� y'T , r}•t, . _ Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ❑ Contract Other: ftmd € i,iEE if {lrC.f bY' ° F7 Contract Effective Dater Termination Date Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Y.,cwo Department: Lr .1 Contract Amount: Approval Authority: ❑ Department Director ®Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): t MAIJ- vm `/,,4 r 1y"f Ov`Y adccW10877_8_14 i TEMPORARY LIMITED LICENSE AGREEMENT FOR A CONSTRUCTION STAGING AREA PARTIES THIS TEMPORARY LIMITED LICENSE AGREEMENT FOR A CONSTRUCTION STAGING AREA ("License") is between the CITY OF KENT, a Washington municipal corporation ("City"), and Grandview Apartments, LLC, a Washington limited liability company ("Licensee"). RECITALS 1. Licensee seeks to construct a multi-family apartment development, located approximately at 3900 Veterans Drive, Kent, Washington, 98032. 2. Licensee has requested that the City grant a permit to use City property to temporarily store materials and equipment for staging purposes during Licensee's construction of the Grandview Apartments development. 3. The City has agreed to issue this license. NOW, THEREFORE, THE CITY AND LICENSEE AGREE AS FOLLOWS: LICENSE 1. License Granted. In consideration of payment of $2,888.35 per month until this License is terminated, and for mutual benefits derived and other valuable consideration receipt of which is hereby acknowledged by the City and Licensee, the City grants this License ("License") for a period of two years from the Effective Date (the "Term") for Licensee's use to temporarily store materials and equipment for staging purposes during Licensee's construction of the Grandview Apartments development across and upon a portion of the City's property located on King County parcel number 1522049170, described in Exhibit A ("Property") and approximately shown in Exhibit B and Exhibit C. This License is subject to all the terms and conditions established below. 2. Damage to Property and Restoration. Licensee will repair any damage to the Property caused by Grantee arising from or in any way connected to the Grantee's use of the Property. Upon revocation, termination, or expiration of this License, Licensee will restore, at Licensee's sole cost and expense, the Licensed Area to its original condition prior to the issuance of the License. This restoration obligation will survive the expiration of this License. LIMITED LICENSE (between City of Kent and Grandview Apartments, LLC) Page 1 of 6 (plus Exhibits A through D) i 3. Revocation and Termination. This License affects a valuable property interest owned by the City. This License does not grant an estate in the Property; it is not an easement; it is not a franchise; it is not exclusive; and it does not exclude the City from full possession of the Property. As a License upon real property, it is revocable at the will of the City. However, prior to the City's termination or revocation, the City will provide Licensee with at least fifteen calendar days' written notice of termination or revocation. Licensee must remove all equipment, materials, and debris and restore the Licensed Area, unless the City and Licensee agree, in writing, otherwise. If Licensee fails to remove the Improvements within the allotted time, the City may remove all or part of the Improvements, restore the Licensed Area, and Licensee will compensate the city, all costs of the removal and restoration, within forty-five calendar days from the date the city submits to Licensee an accounting of costs incurred. Licensee waives any right it may have to any claim for damages of any kind incurred as a result of the City's removal of all or part of the Improvements. 4. Permits Required. The City's grant of this License does not release Licensee from any of its obligations to obtain applicable local, state and federal permits necessary to install, construct, use and inspect the Grandview Apartments. Licensee's failure to comply with this Section 4 will constitute grounds for immediate revocation by the City. The consideration in Section 1 is in addition to any fees required for applicable local, state and federal permits. 5. Maintenance. Licensee will maintain the Property in a clean, well- kept, orderly condition to the satisfaction of the City. 6. Emergency. In the event of any emergency in which any portion of the Property becomes an immediate danger to the property, life, health or safety of any individual, Licensee will immediately take the proper emergency measures to remedy the dangerous condition without first applying for and obtaining a permit as required by this License. However, this emergency work will not relieve Licensee from its obligation to obtain all permits necessary for this purpose, and Licensee will apply for those permits within the next two succeeding business days. 7. Indemnification. Licensee will comply with the following indemnification requirements: 7.1 Licensee will defend, indemnify, and hold the City, its officers, officials, employees, agents, assigns, and volunteers harmless from any and all claims, actions, injuries, damages, losses, or suits, including all reasonable legal costs, witness fees, and attorney fees, arising out of or in connection with the performance of any of Licensee's rights or obligations granted by this License, except to the extent caused by the sole negligence of the City, its employees, agents, contractors, or invitees. LIMITED LICENSE (between City of Kent and Grandview Apartments, LLC) Page 2 of 6 (plus Exhibits A through D) i it 7.2 The City's inspection or acceptance of any of Licensee's work when completed will not be grounds to avoid any of these covenants of indemnification. 7.3 These indemnification obligations will extend to any claim, action or suit that may be settled by compromise, provided that Licensee will not be liable to indemnify the City for any settlement agreed upon without the consent of Licensee; however, if Licensee consents to the agreed upon settlement, the Licensee will indemnify and hold the City harmless as provided for in this Section 7 by reason of that settlement. Moreover, if Licensee refuses to defend the City against claims by third parties, Licensee will indemnify the City regardless of whether the settlement of those claims is made with or without Licensee's consent. 7.4 In the event that Licensee refuses to accept tender of defense in any claim, action, or suit by a third party pursuant to this Section 7 and if Licensee's refusal is subsequently determined by a court having jurisdiction (or other tribunal that the parties will agree to decide the matter) to have been a wrongful refusal, then Licensee will pay all the City's costs for defense of the action, including all reasonable legal costs, witness fees, and attorney fees and also including the City's costs, including all legal costs, witness fees and reasonable attorney fees, for recovery under this Section 7, indemnification clause. 7.5 The provisions of this Section 7 will survive the expiration or termination of this License. S. Insurance. Licensee will procure and maintain for the duration of this License, insurance of the types and in the amounts described in Exhibit D, attached. 9. Modification. This License may not be modified, altered, or amended unless first approved in writing by the City. 10. Assignment. Licensee will not assign all or any portion of its rights, benefits, or privileges, in and under this License without prior written approval of the City, which approval will not be unreasonably withheld or delayed. 11. Compliance with Laws. Licensee will comply with all federal, state and local laws, rules and regulations that are applicable to this License. 12. Venue and Jurisdiction. This License will be construed in accordance with the laws of the State of Washington. Venue and jurisdiction for the resolution of disputes will be in the Superior Court for King County, Washington. In the event of claim or litigation regarding the enforcement of the terms of this License, each party will be responsible for its own legal costs and attorney fees except as noted in Section 7. LIMITED LICENSE (between City of Kent and Grandview Apartments, LLQ Page 3 of 6 (plus Exhibits A through D) 13. Notices. All notices, requests, demands, or other communications provided for in this License, unless otherwise noted, will be in writing and will be deemed to have been given when sent by registered or certified mail, return receipt requested, to the addresses listed below for each party, or to another person or address as either party will designate to the other party in writing: CITY: LICENSEE: City of Kent Grandview Apartments, LLC Attn: City Clerk Attn: Evan Hunden 220 Fourth Avenue South 10900 NE 81h St., Ste. 1200 Kent, WA 98032 Bellevue, WA 98004 With a copy to: Economic and Community Development Director City of Kent 220 Fourth Avenue South Kent, WA 98032 14. No Waiver of Rights. Nothing in this License will constitute a waiver of either party's right to challenge any portion of the License that is not in accordance with applicable federal, state and local laws. 15. Warranty of Authority to Execute. Each person executing this License warrants that he/she has the requisite authority to bind the party for whom that person is executing. 16. Entire Agreement and Effective Date. This License contains the entire agreement between the parties and, in executing it, the City and Licensee do not rely upon any statement, promise, or representation, whether oral or written, not expressed in this License. This License will be effective upon the last day executed below ("Effective Date"). LIMITED LICENSE (between City of Kent and Grandview Apartments, LLC) Page 4 of 6 (plus Exhibits A through D) Y I CITY OF KENT LICENSEE Aeartweo , . --. ?e.v G�.e�ru'�va�,v Nety1 ,�'�r[.L�, @l _v�cr�l.��r6zm�n�✓ Print Na e[:SUZEI�-E COOKE Print Name: lux, X tfuoefe� Ifs: M 0 Its: t uoeir4: ftebmbe v, 'Data: "� ` 5 J Dater 22 at, f f STATE OF WASHINGTON ) ss. COUNTY OF KING ) I hereby certify that I know or have satisfactory evidence that Suzette Cooke is the person who appeared before me, and said person acknowledged that she signed this instrument, on oath stated that she is authorized to execute the instrument on behalf of the City of Kent as its Mayor, and such execution to be the free and voluntary act of such party for the uses and purposes mentioned in the foregoing instrument. -Notary Seal Must Appear Within This Box- IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year first above written. /a P BR/c ev,,`ggtOk@�.pryCis i% ro' '(Aky '0' NOTARY PUBLIC, in and for theState of Washington, residing at,- 014'p'rV?/ N',, A�®�.� p = My appointment expires t' i � ''a, y.tg.lrO.`��e 11, OF LIMITED LICENSE (between City of Kent and Grandview Apartments, LLC) Page 5 of 6 (plus Exhibits A through D) i STATE OF WASHINGTON ss. COUNTY OF KING ) I hereby certify that I know or have satisfactory evidence that 6-yait k,iti ert is the person who appeared before me, and said person acknowledged that he/she signed this instrument, on oath stated that he/she is alhorized to 4iie fL';o+ a�� He,Atk'v execute the instrument on behalf of6t,eiJv ew 4Wyfm&>5 Li as Ids Mewijj V, h e , and such execution to be the free and voluntary act of such party for the uses and purposes mentioned in the foregoing instrument. -Notary Seal Must Appear Within This Box- IN WITNESS WHEREOF, I have hereunto set my hand and official seal the da and year first above written. NNW ,_ a NOTARY PUBLIC, in and for-the State of Washington, residing at My appointment expires {' ad' ; e;Ci,il4'Ilb(Ipmlila",I811Gmhiedylefl^pfa[iesemLwz LIMITED LICENSE (between City of Kent and Grandview Apartments, LLC) Page 6 of 6 (plus Exhibits A through D) I I EXHIBIT A THAT PORTION OF THE NORTHWEST QUARTER OF SECTION 15, TOWNSHIP 22 NORTH, RANGE 4 EAST OF THE W.M., IN KING COUNTY, WAHINGTON, DESCRIBED AS FOLLOWS: COMMENCING AT THE WEST QUARTER CORNER OF SECTION 15, FROM WHICH POINT THE NORTHWEST CORNER OF SAID SECTION BEARS N01"11'50"E 2627.97 FEET DISTANT, AND FROM WHICH POINT THE SOUTHWEST CORNER OF SAID SECTION BEARS S01019'30"W 2629.88 FEET DISTANT;THENCE S89"51'29"E, ALONG THE EAST WEST CENTER OF SECTION LINE OF SAID SECTION 15,A DISTANCE OF 897.78 FEET; THENCE N24044'16W 53.27 FEET; THENCE N20°12'27"E 43.80 FEET TO A POINT ON A 1340.00 FOOT RADIUS, CIRCULAR CURVE TO THE LEFT, FROM WHICH POINTTHE CENTER OF SAID CURVE BEARS N24°42'56"W;THENCE NORTHEASTERLY,ALONG SAID CURVE, THROUGH A CENTRAL ANGLE OF 02023'08" AN ARC DISTANCE OF 55.79 FEET TO A POINT OF TANGENCY;THENCE N62°53'56"E 355.76 FEET TO A POINT OF TANGENCY WITH A 1960.00 FOOT RADIUS CIRCULAR CURVE TO THE RIGHT; THENCE NORTHEASTERLY ALONG SAID CURVE, THROUGH A CENTRAL ANGLE OF 10°00'58" AN ARC DISTANCE OF 342.64 FEET;THENCE S65"09'41" E 22.56 FEET TO A POINT ON A 1945.00 FOOT CIRCULAR CIRVE TO THE RIGHT, FROM WHICH POINT THE CENTER OF CURVE BEARS 516035'26"E AND THE TRUE POINT OF BEGINNING OF THE HEREIN DESCRIBED TRACT OF LAND;THENCE EASTERLY,ALONG SAID CURVE,THROUGH A CENTRAL ANGLE OF 11°0722", AN ARC DISTANCE OF 377.58 FEET;THENCE 505"28'04"E 7.00 FEET;THENCE N84°31'56"E 332.00 FEET; THENCE S73"00'00"E 61.09 FEET TO A POINT ON A 192.00 RADIUS CIRCULAR CURVE TO THE LEFT, FROM WHICH POINT THE CENTER OF SAID CURVE BEARS N72°44'58"E;THENCE SOUTHEASTERLY, ALONG SAID CURVE, THROUGH A CENTRAL ANGLE OF 70-01-18", AN ARC DISTANCE OF 234.64 FEET TO A POINT OF REVERSE CURVATURE AND THE BEGINNING OF A 35 FOOT RADIUS, CIRCULAR CURVE TO THE RIGHT,THENCE SOUTHEASTERLY,ALONG SAID CURVE, THROUGH A CENTRAL ANGLE OF 81°47'57",AN ARC DISTANCE OF 49.97 FEET TO A POINT OF TANGENCY; THENCE 505°28'23" E 313.25 FEET TO THE EAST WEST CENTER OF SECTION LINE OF SAID SECTION 15; THENCE N89°51'29"W, ALONG SAID CENTER SECTION LINE, 392.47 FEET;THENCE N23°56'42"W 163.36 FEET TO A POINT THAT BEARS S65°09'41"E FROM THE TRUE POINT OF BEGINNING;THENCE N65°09'41"W 592.96 FEET TO THE TRUE PONT OF BEGINNING. CONTAINING APPROXIMATELY 280,027 SQUARE FEET OR 6,4285 ACRES, MORE OR LESS. it EXHIBIT B o + iP 1 n1 I D I v I i m I � ml° � \ yA 2y, n4 N 1 a �Iy 8 0 C7 WO nt,: OT o� m N7� m Am - z CZm �d Fi n a O�� 'N , S 3 2 �.E,t a.eae aos ___-- �� is•QA76M�IAkl3AIH � I EXHIBIT C n nl N 6' r a66�'Z+c�SC a �M1 'A "ltr-1 F/ �' � fk3 ��je ✓Y., I g C 44 Y t I � 2 � � F s , t f�. N�. f �Y ' J ti) F % p LF5 P 1 EXHIBIT D INSURANCE REQUIREMENTS FOR LIMITED LICENSE AGREEMENT Insurance GRANDVIEW APARTMENTS, LLC shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by GRANDVIEW APARTMENTS, LLC, their agents, representatives, employees or subcontractors. j A. Minimum Scope of Insurance GRANDVIEW APARTMENTS, LLC shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non- owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. 2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 or a substitute form providing equivalent liability coverage. Coverage shall cover liability arising from premises, operations, independent contractors and personal injury and advertising injury. The City shall be named as an Additional Insured under the GRANDVIEW APARTMENTS, LLC's Commercial General Liability insurance policy with respect to the work performed for the City. 3. Excess Liability insurance covering both the Commercial General Liability and Automobile policies. 4. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance GRANDVIEW APARTMENTS, LLC shall maintain the following minimum insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate and a $2,000,000 products-completed operations aggregate limit. EXHIBIT D (Continued) 3. Excess Liability insurance shall be written with limits no less than $2,000,000 per occurrence and $2,000,000 aggregate in excess of the CGL policy cited above. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability: 1. GRANDVIEW APARTMENTS, LLC's insurance coverage shall be primary insurance as respects the City. Any insurance maintained by the City shall be excess of GRANDVIEW APARTMENTS, LLC's insurance and shall not contribute with it. 2. GRANDVIEW APARTMENTS, LLC insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies as respects work performed by or on behalf of GRANDVIEW APARTMENTS, LLC and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. GRANDVIEW APARTMENTS, LLC's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. GRANDVIEW APARTMENTS, LLC's Insurance For Other Losses GRANDVIEW APARTMENTS, LLC shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, employee owned tools, machinery, equipment, or motor vehicles owned or rented by GRANDVIEW APARTMENTS, LLC, or GRANDVIEW APARTMENTS, LLC's agents, suppliers or contractors as well as to any temporary structures, scaffolding and protective fences. E. Waiver of Subrogation GRANDVIEW APARTMENTS, LLC and the City waive all rights against each other any of their Subcontractors, Sub-subcontractors, agents and employees, each of the other, for damages caused by fire or other perils to the extend covered by Builders Risk insurance or other property insurance obtained pursuant to the Insurance Requirements Section of this Agreement or other property insurance applicable to the work. The policies shall provide such waivers by endorsement or otherwise. EXHIBIT D (Continued) F. Verification of Coverage GRANDVIEW APARTMENTS, LLC shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the Automobile Liability, Commercial General Liability and/or Excess insurance, of the GRANDVIEW APARTMENTS, LLC before commencement of the work. G. Subcontractors GRANDVIEW APARTMENTS, LLC shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for GRANDVIEW APARTMENTS, LLC. i� I A CERTIFICATE OF LIABILITY INSURANCE °ATE'MM'°°"YY' 07/22/2015 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($), 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 CONTACT NAME: Parker,Smith&Feek,Inc. PHCH o .425-709-3600 FAX Ne EMAIL 425-709-7460 2233 112th Avenue NE Bellevue,WA 98004 ADDRESS: INSURERS AFFORDING COVERAGE NAIL# _ INSURER A: Colony Insurance Company INSURED Grandview Apartments,LLC INSURER B: Berkley National Insurance Company Heartland Construction, Inc. INSURER C: 10900 NE 8th St.,STE 1200 INSURER D Bellevue,WA 98004 INSURER B: 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 'I INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIODM'YY A GENERAL LIABILITY 103GL000060701 8/10/2014 8/10/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50,000 X PREMISES En occurrence $ _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 X $10,000 Deductible PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY X PRO- LOCJECT S A AUTOMOBILE LIABILITY 103GL000060701 8/1012014 811012015 Ea eBINEDtSINGLE LIMIT 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per account) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B UMBRELLA LIAB X_ OCCUR CEX0960115300 8/10/2014 8/10/2015 EACH OCCURRENCE $ 2.000,000 _X EXCESS LIAB I CLAIMS-MADE AGGREGATE $ 2,000,000 DEO I X RETENTIONS NIL is A WORKERS COMPENSATION 103GL000060701 WC STATU� X OTH- AND EMPLOYERS'LIABILITY YIN 8/10/2014 8/10/2015 ANY PROPRIETORIPARTNEWEXECUTIVE❑ NIA "WA Stop Gap E.L.EACHACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If,,dascdhe Under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re:3900 Veterans Drive;Kent,WA 98032. City of Kent is included as Additional Insured for General Liability per attached endorsement CG 20 10 07 04. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Kent 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent,WA 98032 � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1 of 2 HEARCONS(DEK00) 103 GL 0000607-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations All persons or organizations as required by written contract As designated in written contract with the Named with the Named Insured Insured Information required to complete this Schedule, if not shown above,will shown in the Declarations. A. Section II —Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insureds) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 2 of 2 HEARCONS(DEK00) gp ,i-y+ REQUEST FOR MAYOR' SIGNATURE ® Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Approved by Director Originator: Kim Komoto Phone (Originator): 5788 Date Sent:7123/815 Date Required:ASAP Return Signed Document to: Kim Komoto Contract Termination Date: None VENDOR NAME: Date Finance Notified: (Only required on contracts N/A 10 000 and over or on any Grant DATE OF COUNCIL APPROVAL: Date Risk Manager Notified: N/A 7/21/15 (Required on Non-City Standard Contracts/Agreements) Has this Document been Specifically Account Number: N/A Authorized in the Budget? 0YES @ NO Brief Explanation of Document: Temporary Limited License Agreement for a Construction Staging Area for Grandview Apartments, LLC. Two year license to temporarily store materials and equipment during Grandview's development located adjacent to City property. All Contracts Must Be Routed Through The Law Department (This area to be completed by the Law Department) Received: Approval of Law Dept.: - Law Dept. Comments; fi, Date Forwarded to Mayor: w, € l Shaded Areas To Be Completed By Administration Staff Received: Recommendations and Comments: I; Disposition / <r/,,0X7' t _'j�Vy,[+ Date Returned: P.OAI ......0-1111.t assinglRb /or llayoi59111aWle,tlocr