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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: The Eastman Company
Vendor Number:
JD Edwards
� Number
s
Contract Number: t V'i
This is assigned by City Clerk's Office
Project Name: Mill Creek Re-Establishment
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment x Contract
❑ Other:
Contract Effective Date: 11/19/15 Termination Date: 12/31/16
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Ingrid Willms-Dixon Department: Engineering
Contract Amount: $9,600.00
Approval Authority: ❑ Department Director ❑ Mayor ❑ City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
The Contractor shall provide appraisal services for the Mill Creek Re-Establishment
Project.
As of: 08/27/14
KENT
PROFESSIONAL SERVICES AGREEMENT
between the City of Kent and
The Eastman Company
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and The Eastman Company organized under the laws of the State of Washington,
located and doing business at 6206 35th Ave NE, Seattle, WA 98115, Phone: (206) 363-6111, Contact:
Donald Melton (hereinafter the "Contractor").
I. DESCRIPTION OF WORK.
Contractor shall perform the following services for the City:
The Contractor shall provide appraisal services for the Mill Creek Re-
Establishment Project located in Kent, WA.
For a description, see the Contractor's Scope of Work which is attached as
Exhibit A and incorporated by this reference.
Contractor further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices within the Puget Sound region in effect at the
time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
Section I above immediately upon the effective date of this Agreement, and Contractor shall complete the
work by December 31, 2016,
III. COMPENSATION. The City shall pay Contractor a total amount not to exceed Nine
Thousand, Six Hundred Dollars ($9,600.00) for the services described in this Agreement. The Contractor
shall invoice the City monthly based on time and materials incurred during the preceding month. The
hourly rates charged for Contractor's services shall be as delineated in the attached and incorporated
Exhibit A. All hourly rates charged shall remain locked at the negotiated rates throughout the term of this
Agreement.
IV, INDEPENDENT CONTRACTOR. The parties intend that an Independent Cpntractor-
Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in
accordance with Ch. 51.08 RCW, the parties make the following representations:
A. The Contractor has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreement.
B. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
C. The Contractor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Contractor's services, or the Contractor is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
PROFESSIONAL SERVICES AGREEMENT - 1
($20,000 or Less)
D. The Contractor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Contractor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Contractor's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
F. The Contractor maintains a set of books dedicated to the expenses and earnings of
its business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party seven (7) calendar days written notice at its address set forth on the signature
block of this Agreement.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Contractor, its subcontractors, or any person acting on behalf of the
Contractor or subcontractor shall not discriminate against any person who is qualified and available to
perform the work to which the employment relates as provided for by the City of Kent's Equal
Employment Opportunity Policy. Contractor shall execute the attached City of Kent Equal Employment
Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the
contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or
suits, including all legal costs and attorney fees, arising out of or in connection with the Contractor's
performance of this Agreement, except for that portion of the injuries and damages caused by the City's
negligence. The City's inspection or acceptance of any of Contractor's work when completed shall not be
grounds to avoid any of these covenants of indemnification. The provisions of this section shall survive
the expiration or termination of this Agreement.
In the event Contractor refuses tender of defense in any suit or any claim, if that tender was made
pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having
jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Contractor's part, then
Contractor shall pay all the City's costs for defense, including all reasonable expert witness fees and
reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful
refusal on the Contractor's part.
VIII. INSURANCE. The Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by
this reference.
IX. CONTRACTOR'S WORK AND RISK. The Contractor agrees to comply with all federal,
state, and municipal laws, rules, and regulations that are now effective or in the future become applicable
to Contractor's business, equipment, and personnel engaged in operations covered by this Agreement or
accruing out of the performance of those services. All work shall be done at Contractor's own risk, and
Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held
for use in connection with the work.
X. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3,80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price
preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this
PROFESSIONAL SERVICES AGREEMENT - 2
($20,000 or Less)
Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those
covenants, agreements or options, and the same shall be and remain in full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any
dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the
parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred
in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or
award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's
right to indemnification under Section VII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at
the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the City
and Contractor.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative
of the City, and such statements shall not be effective or be construed as entering into or forming a part
of or altering in any manner this Agreement. Should any language in any of the exhibits to this
Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall
prevail.
H. Public Records Act. The Contractor acknowledges that the City is a public agency subject to
the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents,
notes, emails, and other records prepared or gathered by the Contractor in its performance of this
Agreement may be subject to public review and disclosure, even if those records are not produced to or
possessed by the City of Kent. As such, the Contractor agrees to cooperate fully with the City in satisfying
the City's duties and obligations under the Public Records Act.
I. City Business License Required. Prior to commencing the tasks described in Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of
the Kent City Code.
PROFESSIONAL SERVICES AGREEMENT - 3
($20,000 or Less)
J. Counterparts and Signatures by Fax or Email, This Agreement may be executed in any
number of counterparts, each of which shall constitute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the original signature was received in person.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below.
CONTRACTQf� _ g CITY OF--iKENT:
By 1, c�a ::�it k. 0 gy: z
(sign t re) (si nature)
Print Na�ne. ��V0—st �� � t Print Name: Timothy J. LaPorte, P.E.
Its: l" SSc` _•4 Its: Public Works Director
j
DATE: ( It � (�t`i DATE:— ZZ?f2eO.5r-
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
Donald Melton Timothy J. LaPorte, P.E.
The Eastman Company City of Kent
6206 351h Ave NE 220 Fourth Avenue South
Seattle, WA 98115 Kent, WA 98032
(206) 363-6111 (telephone) (253) 856-5500 (telephone)
N/A (facsimile) (253) 856-6500 (facsimile)
PROFESSIONAL SERVICES AGREEMENT - 4
($20,000 or Less)
I`
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this day of G L ` 20L�.
1
y �.
For:
Title: SSI xG '
Date:
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
it
I
EEO COMPLIANCE DOCUMENTS - 2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered into on
the (date), between the firm I represent and the City of
Ke nt.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
Dated this day of 20 .
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
EXHIBIT A
The Easiman Compgoy
RReal Estate AppratsetdAnciOls/ConsOltaras Phone[2061363 6611
eal —36"Avenue ME don@wbvalue.coM
3ea61e,WA 98116
Ocfober 28,2015
lv1s.Ingrid Wtl[ms-DlXbt;,Project Analrysf
Design&gineerung-Agblfq\Works I)tpartment
City of Kent
229 Fourth avenueSoutb
Kent,WA 98032
Re: Rcvised Appraisal Bid—Mill CmkRe$sft6tislfnieAtPkofeet(#.13-3002),
Kent,Washington
])ear Ingrid:
Thank you for the opportunity to bid on tiro above-referenced asslgaufen,We are.Interested in
providing apppraisal secviees for lbe nbnve referonceclProtcet. Our appraisal fee for a brief and/or
surnmary fdimat WSDOT arid,tySPAP,compliant, appraisal tepor�'1s as follows: ParcelPW2015-001 ig$4,000(Optioft 1®$1,400,Opiioa:2 $Z 600).;Parcel P W2015-0021s$1,400;
Parcel PW2015-D20'is$1,400;and Parcel PW2015-026 is$2,800. Elie total est mated appra sal
fee is$9f,600($4;000+$1`,4.00+$1,400+$2,800-$9,600). Please note that it is my belief that
Parrzi PW2015-001 and 020,m*yregpl>#a pnore:oomple>tiB.ofor'e%After anaiysCa due to the large
taking and
ft1C associated cbmpensaflotK Please note that if a 336fore/After aaalyS}s is not
required on.either Parcel 001 and/or 026 then tl'ne fee would be i'idJced Wier to fvflect'this
change inmethodblogy
The specific completion date depends on when tlye assipment i!rActually awatited,and when all
necessary information is provided to us((egad description,maps, wetlad studies, and contact
information for the owner's representative). We can IWO(fief assigamolit completed,In 45 days
after receiving written notiffeation to proceed. Than14 You for the opportnnity to bid.on this
assignment, ,
Sincerely,
Donald K.Melton
The°Fasfmartcompany
I
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Consultant 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 the Consultant, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Consultant shall obtain Insurance of the types described below;
1. Q1i.to mlalle Llabllity Insurance covering all owned, non-awned,
hired and ieased vehicles. Coverage shall be written on Insurance
Services Office (ISO) form CA 00 01 or a substitute form pproviding
equivalent liability coverage. If necessary, the policy shall be
endorsed to provide contractual liability coverage.
2. Commercial General Liability insurance shall be written on ISO
occurrence form CG 00 01 and shall cover liability arising from
premises, operations; Independent contractors, products-completed
operations, personal Injury and advertising Injury, and Ilabillty.
assumed under an Insured contract. The City shall be namedyas an
Insured under the Consultant's Commercial General Liability
Insurance policy with respect to the work performed for the City
using ISO additional Insured endorsement CG 20 10 1185 or a
substitute endorsement providing equivalent coverage.
3, Workers' Compensation coverage as required by the Industrial
Insurance laws of the State of Washington.
4, Professional Liability insurance appropriate to the Consultant's
profession.
0. Minimum Amounts of Insurance
Consultant shall maintain the following Insurance limits:
1. Automobile Llabllity Insurance with a minimum combined single
limit for bodily injury and property damage of$1,000,000 per
accident.
2. Commercial Genera Liability Insurance shall be written with limits
no less than $1,000,000 each occurrence, $2,000,000 general
aggregate and a $1,000,000 products-completed operations
aggregate limit.
EXHIBIT B (Continued)
3, Professional LIabllity Insurance shall be written with limits no less
than $1,000,000 per claim and $1,000,000 policy aggregate limit.
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
insurance:
1. The consultant's Insurance coverage shall be primary Insurance as
respect the City. Any insurance, self-insurance, or Insurance pool
coverage maintained by the City shall be excess of the Consultant's
Insurance and shall not contribute with it.
2. The consultant's Insurance shall be endorsed to state that coverage
shall not be cancelled by either party, except after thirty (30) days
Erlor written notice by certified mall, return receipt requested, has
been given to the city,
3. The city of Kent shall be named as an additional Insured on all
pollcles'(except Professional Liability) as respects work performed
by or on behalf of the Consultant 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. The Consultant'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
Ilmlts of the Insurer's liability.
D. Acceptability of Insurers
Insurance Is to be placed with insurers with a current A.M. Best rating of not
less than ANIL
B. Verification of Coverage
Consultant shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
addltional Insured endorsement, evidencing the Insurance requirements of
the Contractor before commencement of the work,
r=. Subcontractors
Consultant 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 the Consultant,
ACOIaC�® DATE IMM0DrN l
`..�� CERTIFICATE OF LIABILITY INSURANCE 6/12/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
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BELOW, THIS CERTIFICATE OF INSURANCE D098 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,'
MPORTANTI, If the oats loato holder is an ADDITIONAL INSURED,the polloy(lEa)must he endorsed. If SUBROGATION S WAIVED,aub)eot to
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the terms and conditions of tho-polloy,oertaln poilDlee may require an endosem6nt. A etetementan this certlfloate does not venter rights to the
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C Don Filer Agency t 4,1,(9061E4S-de40
4201 Roosevelt Way Nl4 slof4auist$fi0.erinsurance.com
INSU ER 8)AFFORD11111 COVERAGE N
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INSURED INSURER
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0206 38th Ave HE INSURER 01
[INSURERS, . .
Seattle WA 90115
COVERAGES a TIPICA f NUMBER:Master GL 2015-18 REVISIONNUMBER:
THIS 18 TO CERTIFY THAT THE POLI0119S OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDIOATED. 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 SUBJEOT TO ALL THE TERMS,
EXOLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
rYPEOPINJOftwE AC.D.IJUIJ POLIOYNUMBRRLIMM3
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A OWMews ®000UR a a • CT^ 0., 300,000
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PI! e0 ALEAO IN RY 4 2,000,000
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AUTOMOEILEMABILRY _ J 2,000 000
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DtlaCRIPTION or OPaRATIONNILOOATIONSIVERIOLES(ACORD t41,Addllland Rem4n4 801144t6t MIVEe RUe0114d Ilmare epees a NgUiad)
Certificate holder in hereby named additional insured.
CERTIFICATE HOLDER _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLI018S SS CANCELLED BEFORE
City of Kent, Dept, of THE EXPIRATION DATE THEREOF, NOTION WILL BE DELIVERED IN
Engineering ACCORDANCE WITH THE POLICY PROVISIONS.
Attnt Nancy Yoehitake
220 4th Ave B AUTHORI19D REPAUS94TATIVE
Kent:, WA 98032-3994
Shari Lofqutat/SHARX
0 1088-2014 ACORD CORPORATION, All rights reserved.
ACORD 26(2014I01) The ACORO name and logo ere registered marks of ACORD ',
INS026(201401)
Policy k 600-7R721900-15-42 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY,
BLANKET ADDITIONAL INSURED -- OWNERS, LESSEES
OR CONTRACTORS
This endorsement modifies insurance provided under the following,
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROVISIONS;
1. WHO IS AN INSURED(SEOTION II)is amended In a written contract for this Insurance to
to Include as an Insured in y person or organize• apply on a primer or contributory basis,
Ilan (called hereafter"eddit onet Insured")whom S, This insurance does not apply.,
you hava'agreed in a written contract, executed a. on any basis to any person or organization
prior to lose,to name as additional Insured, but for wham you have purchased an Owners
only with respect to liability arising out or"your end Contractors protective Poll*
work" or your ongoing operations for that addle b. to "bodily Injury," "property dams par-e;' "
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liability apply: 1, The proparing, approving or falling to
1. The limits which you agreed to provide; propars or approve maps, drawings,
or opinions, reports, survegga, change or•
2. The limits shown on the deoiarallons, ders,designs orspeclfications;and
whichever is tees, 2, supervisory, inspection or engineering
b. This insurance Is excess over any valid and services,
collectible Insurance unless you have agreed
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CERTIFICATE OF LIABILITY INSURANCExzi3iizoi4)
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•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 $SURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT., If the certificate holder Is an ADDITIONAL INSURED,the polloy tes 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
oadingate holder In Hou of such ondoreement(s). _
PRODUCER CO Shari LOfquiet
C bon Miler Agency a (206)545-4800 1 ika,°Not,(204)543-4ee0
4201 Roosevelt Way NE AObmpAgLusu�xlofquist@filerinsurance.com
INBUREfla APFORDINOCOVEPACE NAIL#
Seattle WA 98105-6608 INUMERAgontInanxtal CasualtV Company
INSURED INRuae ee ,,
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6206 35th Ave NE INS east ._
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COVE,RAQES CERTIFICATE NUMBER;Erofessionel 2015 -- RE
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NUMBER.
T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEOB6LOW HAVE BEEN ISSUED TO THE INSURED MED 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 i3 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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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.
Evidence of Insurance
AUTHORIZED REPRESENTATIVE
Sheri Lofquist/SBAAI "'4' —
ACORD 25(2010105) ®1Bfl8.2010 ACORD CORPORATION. All rights reserved.
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