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HomeMy WebLinkAboutPW16-312 - Original - Integra Washington Inc - Mill Creek Reestablishment - 08/08/2016 t a r ,�" r s n "� e e`n , N = K�IrIT Document WASHtNOTOH ry*(n v 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: Integra Washington, Inc. Vendor Number: JD Edwards Number Contract Number: po 's This is assigned by City Clerk's Office Project Name: Mill Creek Reestablishment Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment M Contract ❑ Other: Contract Effective Date: 8/8/16 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: $3,500.00 Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Provide valuation services for the Barber properties. As of: 08/Z7/14 f' KENT PROFESSIONAL SERVICES AGREEMENT between the City of Kent and Integra Washington, Inc. THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Integra Washington, Inc. organized under the laws of the State of Washington, located and doing business at 600 University St., Suite 310, Seattle, WA 98101, Phone (206) 903-6700/Fax: (206) 623-5731, Contact: Lori Safer (hereinafter the "Contractor"). I. DESCRIPTION OF WORK. Contractor shall perform the following services for the City: The Contractor shall provide valuation services for the Mill Creek Reestablishment Project - Barber Properties. 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 Three Thousand, Five Hundred Dollars ($3,500.00) 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 Contractor- 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. 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. PROFESSIONAL SERVICES AGREEMENT - 1 ($20,000 or Less) 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 I 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 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. PROFESSIONAL SERVICES AGREEMENT - 2 ($20,000 or Less) r 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. CONTRACTOR: CITY OF KENT: By: By. (signature) (signature Print Nam a Print Name; Ken Langho z Its: ps a Its: Interim Design Engineering Manager DATE: DATE: I NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONTRACTOR: CITY OF KENT: Lori Safer Timothy J. LaPorte, P.E. Integra Washington, Inc. City of Kent 600 University St., Suite 310 220 Fourth Avenue South Seattle, WA 98101 Kent, WA 98032 (206) 903-6700 (telephone) (253) 856-5500 (telephone) (206) 623-5731 (facsimile) (253) 856-6500 (facsimile) PROFESSIONAL SERVICES AGREEMENT - 4 ($20,000 or Less) f' 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 �buen4 20_� By: For: '"'i' c _ ' Title: /� > ° Date: / 2—�` 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. EEO COMPLIANCE DOCUMENTS - 2 i 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 Kent. 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 I i EXHIBIT A Integra Realty Resources 600 University Street T 206.9016700 Seattle suite 310 F 206.623.5731 Seattle,WA 98101 www.Irr.com Lr® July 28, 2016 Ingrid Willms-Dixon,RWA Project Analyst City of Kent Public Works Engineering 400 West Bowe Kent,WA98032-5895 SUBJECT: Proposal for Valuation Services Mill Creek Reestablishment Project—Barber Properties Tax Parcels 312205-9001&312205-9012 Dear Ms.Willms-Dixon: Integra Realty Resources—Seattle appreciates the opportunity to provide this proposal for valuation services for the above-captioned project. It is my understanding that the project will involve full acquisition of both tax parcels. It appears from King County mapping that tax parcel312205-9012 is encumbered by steep slopes and is likely not developable.As such, we will combine it with tax parcel 312205-9001 for the appraisal. We will provide a summary appraisal report in compliance with current WSDOT standards.Our fee for this assignment is$3,500 for one appraisal of both properties. The appraisal and reports will be prepared in conformance with and subject to,the Code of Professional Ethics and Standards of Professional Appraisal Practice of the Appraisal Institute and the Uniform Standards of Professional Appralsal Practice(USPAP) developed by the Appraisal Standards Board of the Appraisal Foundation.The Ethics Rule of USPAP requires us to disclose to you any prior services we have performed regarding the subject property within a three year period Immediately preceding the acceptance of this assignment,either as an appraiser or in any other capacity.We represent that we have not performed any services that require disclosure under this rule. We will submit an electronic copy of the report via our PRP site for initial review and we will work with the reviewer to provide additional Information or make corrections as specified by the reviewer.Two hard copies of the reports will be provided; additional copies of the report(s) I City of Kent July 18,2016 Page 2 are available at an additional cast. The current minimum cost for each additional copy is$100 per copy. The report(s)will be completed and delivered to you within 30 days once we are authorized to begin the appraisal of each parcel. In order to complete this assignment in the designated time,we will need access to pertinent documents, materials,facilities and or/personnel.Any delays in the receipt of this information or in the access to the property will automatically extend the final delivery date of the report(s) as proposed. Furthermore,the appraisal report and conclusions therein will be predicated upon the accuracy and completeness of the information provided by the Client. in the absence of some of this information,the appraisers will attempt to obtain this information from other sources and/or may require the use of Extraordinary Limiting Conditions and Assumptions within the appraisal report. Please let me know if you have any questions about this response. I look forward to your favorable consideration. Sincerely, INTEGRA REALTY RESOURCES—SEATTLE 'i Lori Safer,MAI,MRICS Managing Director 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. 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. 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 liability assumed under an insured contract. The City shall be named as 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 11 85 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. B. Minimum Amounts of Insurance Consultant shall maintain the following 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 $2,000,000 each occurrence, $2,000,000 general aggregate and a $1,000,000 products-completed operations aggregate limit. EXHIBIT B (Continued) 3. Professional Liability insurance shall be written with limits no less than $2,000,000 per claim and $2,000,000 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 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 (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 limits 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 ANII. E. 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 additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. 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. I' ® DATE(MMIDDIYYYY) ® CERTIFICATE OF LIABILITY INSURANCE 3/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the POlicy(IOS) 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). CONTACT Carrie Ovrid PRODUCER NAME, - -- PHONE (425)455-SDOO ''.NC NoI•(425)454-5550 COROV,x Insurance IC - 155 108th Avenue NE, Suite 725 E-M11- — _ -_.- C e.rrieO�COIIOVerinBllranCe.Com ADDRESS_ P.O. Box 90007 INSURER(SI AFFORDING COVERAGE _ _ NAICA Bellevue WA 98004 INSURERAMutual of Enumclaw Insurance 14761 INSURED INSURER,: Integra Washington, Inc., DBA: Integra Realty INSVRERC: 600 University Street INSURERD:.,-_ - Suite 310 INSURER E: Seattle WA 98101 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AO R POLICY NUMBER IA WODY� MMIODIYYYY LIMITS LTRINM X COMMERC IAL GENERAL LIABILITY EACH OCCURRENCE $ _--- 2.000,000 - ...__ DA D R ETENTEU 100,000 A CLAIM S-MADE OCCUR PREMISES Enocconepc' $ X HOP000138305 3/14/2D16 3/14/2017 MED FXP(Any one ers,,n) $ 10,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- LOC PRODUCTS-COMPIOP AGO $ 2,000,000 JECT - -- -- OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Eaaccldanl $ 2,DD0,000 ANY AUTO BODILY INJURY(Pafparsoo) $ A AI(.OWNED SCHEDULED BOP000138305 3/11/2016 3/14/2017 BOOILV INJURY(Pereccldenl) $ AUTOS _- AUTOS X _- PROPERTY DAMAGE X X NON-OWNED Psv Axltlentl $ - HIREDAUT06 AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE_- $ 11000,000 A EXCESS LIAB_ I I CLAIMS-MADE AGGREGATE _E 1,00 D,000 DED I RETENTIONS X nMC0000555 3/14/2016 3/14/2017 $ WORKERS COMPENSATION I STATUTE X ORn - ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOWPAIRTNEWEXECIJUVE WA Stop bap E,L.EACH ACCIDENT $ 2,000,ODO OFFICERIMEMSER EXCLUDED? NIA A (Mandateryln NH) e0P000138305 3/14/2916 3/14/2017 FL.DISEASE-LA EMPLOYE E 1.,000,ODD_ If ,,6dosctlbeundor E,L.DISEASE-POLICYIIMIT $ 2,000 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addllional Remarks Schedule,may he affached if more space is remrad) City of Rent are included as Additional Insured, per form BP 04 48 07 13 attached. Umbrella policy is following form over the GL and Auto. i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City o£ Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 220 Bourth Avenue South Kent, WA 96032 AUTHORIZED REPRESENTATIVE Deanna Wilson/CRU)EN ©1988-2014 ACORD CORPORATION. All rlghts reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 owAn11 POLICY NUMBER: BOP 0001383 05 BUSINESSOWNERS BP 04 48 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): CITY OF KENT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II—Liability is amended as follows: B. With respect to the insurance afforded to these A. The following is added to Paragraph C.Who Is An additional insureds, the following is added to Insured: Paragraph D. Liability And Medical Expenses Limits Of Insurance: 3. Any person(s) or organization(s) shown in the If coverage provided to the additional insured is Schedule is also an additional insured, but only required by a contract or agreement, the most we with respect to liability for "bodily injury", will pay on behalf of the additional insured is the "property damage"or'personal and advertising amount of insurance: injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those 1. Required by the contract or agreement: or acting on your behalf in the performance of 2. Available under the applicable Limits Of your ongoing operations or in connection with Insurance shown in the Declarations; your premises owned by or rented to you. whichever is less. However: This endorsement shall not increase the a. The insurance afforded to such additional applicable Limits Of Insurance shown in the insured only applies to the extent permitted Declarations. by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. BP 04 48 07 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 PAS 1 MAIL MCH-M-I Y1392 MARCH 29. 2016 us ® AUTOMOBILE POLICY PACKET ALLEN N SAFER 5221 PULLMAN AVE NE SEATTLE WA 98105-2139 USAA 00140 78 56 7102 2 POLICY PERIOD: EFFECTIVE MAY 01 2016 TO NOV 01 2016 IMPORTANT MESSAGES Refer to your Declarations Page and endorsements to verify that coverages, limits, deductibles and other policy details are correct and meet your insurance needs. Required information forms are also enclosed for your review. Your Underinsured Motorists Coverage (UIM) and Underinsured Motorists Property Damage (LIMPID) selection/rejection remains in effect You may quote different coverage limits and make changes at any time to your policy on usaa.com. Or you may call us at 1-800-531—USAA (8722), TEXTING & DRIVING ... It Can Wait! Join USAA in the movement against distracted driving by going to http://Itcanwait.usaa.com to watch powerful videos and take the pledge to not text and drive! Coverage exclusions apply when your vehicle is used in ride sharing. If you need coverage for ride sharing activities, we're pleased to offer Ride Share Gap Protection. Please contact us for more information or to obtain a quote. USAA considers many factors when determining your premium. Maintaining safe driving habits is one of the most Important steps you can take in keeping your premium as low as possible. A history of claim or driving activity and your USAA payment history may affect your policy premium. We have provided your ID cards in this packet. You can use the cards to show proof of insurance, if necessary. This is not a bill. Any premium charge or change for this policy will be reflected on your next regular monthly statement. Your current billing statement should still be paid by the due date indicated. To receive this document and others electronically, or manage your Auto Policy online, go to usaa.com. For U.S. calls: Policy Service (800) 531-8111. Claims (800) 531-8222. AC51 49708-0406 PAGE 2 THIS PAGE INTENTIONALLY LEFT BLANK 1 4 UNITED SERVICES AUTOMOBILE ASSOCIATION A-DDL INFO ON NEXT PAGE MAIL MCH-M-1 RENEWAL OF �® (A RECIPROCAL IMERINSURANCE EXCHANGE) State 13 14 15 Ud, RBI-K.Y N.1v R USj 9800 Fredericksburg Road -San Antonio.Texas 78288 WA 62 622 62 Te„ 00140 78 56U 7102 2 WASHINGTON AUTO POLICY POIJCYPERIOD: (12:01 A.M. standard time RENEWAL DECLARATIONS EFFECTIVE MAY 01 2016 TO NOV 01 2016 ATTACH TO PREVIOUS POLICY OPERATORS Named Insured and Address 01 ALLEN N SAFER 04 LORI E SAFER 08 MARTIN T SAFER ALLEN N SAFER !. 5221 PULLMAN AVE NE !, SEATTLE WA 98105-2139 Description of Vehic e s VEH USE VS} TRACE NAME 21 BODYTYPE .I UAL M e IDENTIFICATION NUMBER SYM l 13 10 TOYOTA PRIUS HYB 41) 14 DOOR 10000 JTDKN3DU8A0041.891 P 14 06 SUBARU OUTBACK SW 6000 4S4BPGIC367319002 P 15 08 SUBARU B9 TRIBECA 4 DOOR 6000 4S4WX90D584411357 P The Vehicles) described herein is principally garaged at the above address unless otherwise stated, wic=wI B=Baines VEH 13 SEATTLE WA 98105-2139 VEH 15 SEATTLE WA 98105-2139 VEH 14 SEATTLE WA 98105-2139 is o cy prove es ose coverages w ere a premium is show below. a Imt s s own may be redLced y policy provisions and may not be combined regardless of the number of vehicles for which a remium is listed unless s eclficall authorized elsewhere in this pollcv. VEH VEH VEH VEH COVERAGES LIMITS OF LIABILITY 13 6-MONTH 14 6-MONTH 15 6-MONTH ("ACV"MEANS ACTUAL CASH VALUE) D=DED PREMIUM D=DED PREMIUM ❑=DED PREMIUM D=DED PREMIUM AMOUNT MOUNT MOUNT $ MOUNi $ `ART A - LIABILITY BODILY INJURY EA PER $ 500 , 00 EA ACC $1, 000 , 00C 108 . 12 82 . 44 91 . 2 PROPERTY DAMAGE EA ACC $ 100, OOC 64 .76 50 . 47 55 . 31 PART B - PERSONAL INJURY PROTECTIO1, MEDICAL BENEFITS - EA PER $ 10, 00 INCOME CONTINUATION - $200 PER WEEK LOSS OF SERVICES BENEFITS - $40/DAY MAX, $200/WK MAX, $5, 000 MAXIMUM TOTAL FUNERAL EXPENSE - $2 , 000 14 . 96 11 . 04 9 . 8 PART C - UNDERINSURED MOTORISTS BODILY INJURY EA PER $ 500 , 00 EA ACC $1, OOD, 00 40 . 54 37. 70 38 . 1 TOTAL PRE I NUM - SEE FO7,LOWI G PAGE(S) VEH 13 ADDNL INTEREST - PERSONAL CORP INTEGRA WASHINGTON INC, SEATTLE, WA ! LOSS PAYEE VEH 15 USAA FEDERAL SAVINGS BANK, LE14IGH VALLEY PA 1074231315 ENDORSEMENTS : ADDED 05-01-16 - A074WA(01) REMAIN IN EFFECT (REFER TO PREVIOUS POLICY) - ACCFOR (01) A099 (01) RSGPWA(01) 5100WA(02) INFORMATION FORMS: 663WA(06) 999TWA(24) „ 13 RSM23 00 0 4 RMM64 00 0 5 RMF58 00 0 n TNESS WHEREOF,the Subscribers at NITED SERVICES AU TO OB SSOC ATION have causod hese presents to be signed by their Attorney-in-Fact on this date MARCH 29, 2016 Laura Bishop President, USAA Reciprocal Attorney-in-Fact, Inc. soon U 07-11 53461-07-11 PACE 5 UNITED SERVICES AUTOMOBILE ASSOCIATION 1 I (A RECIPROCAL INTERINSURANCE EXCHANGE) State 113 14 15 Vh POUCYNUMBER USW 9800 Fredericksburg Road-San Antonio,Texas 78288 WA P62 212621 1 Terrj 00140 78 56U 7102 2 WASHINGTON AUTO POLICY POUCYPEWOD (12:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE MAY 01 2016 TO NOV 01 2016 ATTACH TO PREVIOUS POLICY Named Insured and Address ALLEN N SAFER 5221 PULLMAN AVE NE SEATTLE WA 98105-2139 BS Cr rptlon o e IC es VENUSE' es VB-IYE TRADENAME MODEL BODYTYPE ILFAGE IDENFIRCA-FON NJMBER SYM bloc 13 10 TOYOTA PRIUS HYB 41) 4 DOOR 10000 JTDKN3D-J8A0041891 F 14 06 SUBARU OUTBACK SW 6000 4S4BP61C367319002 P 15 08 SUBARU B9 TRIBECA 4 DOOR 6000 4S4WX90D584411357 P The Vehicle(s)described herein is principally garaged at the above address un ess otherwise stated. wr�we,ws `a=ens.:E=Fa rP P VEH 13 SEATTLE WA 98105-2139 VEH 15 SEATTLE WA 98105-2139 VEH 14 SEAT'I'LE WA 98105-2139 This o icy prove es NL those, coverages w ere a premium is shown a ow. a rmr s shown may be reduced by policy provisions and may ,not be combined regardless t the number of vehicles for which a remium is listed unless s ecificall authorized elsewhere in this olic . VEH V COVERAGES LIMITS OF LIABILITY 13 6-MONTH 14 6-MONTH 15 6-MONTH ("ACV"MEANS ACTUAL CASH VALUE) D=DEU PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $ MOUNT $ MOUNT $ MOUNT $ PART C - UNDERINSURED MOTORISTS PROPERTY DAMAGE EA ACC $ 10, 00 4 . 90 4 .55 4 . 60 PART D - PHYSICAL DAMAGE COVERAGE .COMPREHENSIVE LOSS ACV LESS D 300 52 . 71 300 29 . 23 300 30 . 5 COLLISION LOSS ACV LESS D 500 150 . 33 SOO 65 . 02 500 84 . 2 RENTAL REIMBURSEMENT $ 30 A DAY/$ 900 MAXIM 13 . 87 13 . 8 EHICLE TOTAL PREMIUM 450 . 19 300 . 45 327 . 6E 6 MONTH PREMIUM $ 1078 .30 PREMIUM DUE AT INCEPTION. THIS IE NOT A BILL, STAT MENT TO FOLLOW. EARNED ACCIDENT FORGIVENESS APPL ES WITH FIVE YEARS CLEAN DRI ING WI H US . THE PREMIUM ON YOUR RENEWING POLIC IS $ 20 . 94 LESS THAN YO EY.PI ING OLICY. THE FOLLOWING COVERAGE (S) DEFINED N THIS POLIC P.RE NOT P VID ",OR; VEH 13 - TOWING AND LABOR VEH 14 - RENTAL REIMBURSEMENT, T WING AND LAB R VEH 15 - TOWING AND LABOR N1131 RSM23 00J0 4 RMM64 00 0 5 RMF58 00 0 In WITNIL6S WHEREOF,the Subscribers at UNITED SERVI S AUTOMOBILE SO(-IA I UN have caused these presents to ee signed by their Attorney-in-Fact on this date MARCH 29, 2016 � -�- Laum Bishop President, USAA Reciprocal Attorney-in-Fact, Inc. 5000 U 07-11 53461-07-11 PAGE 6 USAA 00140 78 56 7102 INN SUPPLEMENTAL INFORMATION USAX EFFECTIVE MAY 01 2016 TO NOV 01 2016 The following approximate premium discounts or credits have already been applied to reduce your policy premium costs. NOTE: Age or senior citizen status, if allowed by your state/location, was taken into consideration when your rates were set and your premiums have already been adjusted. VEHICLE 13 DAYTIME RUNNING LIGHTS DISCOUNT -$ 4 . 27 MULTI-CAR DISCOUNT -$ 70 . 72 OCCASIONAL OPERATOR ➢ISCOUNT -$ 62 . 71 '.. OPERATOR OB PASSIVL; RESTRAINT DISCOUNT -$ 2 .20 PREMIER DRIVER DISCOUNT -$ 30 . 18 VEHICLE 14 '.. ANNUAL MILEAGE DISCOUNT -$ 19 . 94 DAYTIME RUNNING LIGHTS DISCOUNT -$ 2 .25 ', MULTI-CAR DISCOUNT -$ 46 . 75 PASSIVE RESTRAINT DISCOUNT -$ 1 . 51 PREMIER DRIVER DISCOUNT -$ 19 . 94 VEHICLE 15 ANNUAL MILEAGE DISCOUNT -$ 17 . 76 DAYTIME RUNNING LIGHTS DISCOUNp -$ 2 .23 MULTI-CAR DISCOUNT -$ 49 . 11 PASSIVE RESTRAINT DISCOUNT -$ 1 .29 PREMIER DRIVER DISCOUNT -$ 20 . 95 SUPDECCW Rev. 7-95 MARCH 29, 2016 PAGE 7 USAA 0014C 78 56 7102 PERSONAL CORPORATION ENDORSEMENT - WASHINGTON The coverage provided by this Endorsement is subject to all the provisions of the policy and amendments except as they are modified in this Endorsement. This endorsement is added at the request of This Endorsement applies only to a Personal the named insured. It forms a part of the auto Corporation the stock of which is wholly policy to which it is attached. It is effective owned by: from the policy effective date or from the date shown on the amended Declarations. 1. You; or We agree that the Personal Corporation shown 2. You and family members; or on the Declarations is a covered person under Part A — Liability Coverage of this policy. 3. You and other persons, all of whom are However, this applies only to the extent that eligible for auto insurance with USAA, the Personal Corporation qualifies as a covered USAA—CIC, USAA—GIC, or Garrison person under Paragraph 3. of the definition of insurance. covered person in Part A of this policy. If any stock of the Personal Corporation is Our inclusion of the Personal Corporation does issued or transferred to persons other than not operate to increase the limits shown on the those listed above, the coverage afforded by Declarations. this Endorsement shall cease automatically as of the date of such change. The Personal Corporation is not responsible for the payment of any premiums. Any premiums The named insured is authorized to act for the returned and any dividend we may declare will Personal Corporation in all matters pertaining to be paid to the named insured. this insurance. Coverage under this policy does not apply to BI We will not provide any written notice of: or PD sustained by any person arising out of or in the course of that person's employment by 1. Cancellation initiated by the named the Personal Corporation. insured; 2. Nonrenewal; or 3. Policy changes: to the Personal Corporation. If we decide to cancel the policy, we will give the same advance notice of cancellation to the Personal Corporation as we give to the named insured shown in the Declarations. Copyright, USAA, 2014. All rights reserved. Includes copyrighted material of Insurance Services Office, used with permission. 128794-0814_01 A074WA(01) 10-14 Page 1 of 1 PAGE 8 US AA 00140 78 56 7102 Personal Injury Protection Coverage in Washington Below, you will find a brief explanation of Personal Injury Protection coverage. Please remember that I this is designed to be a simple overview. Coverage is subject to all the provisions and exclusions described in your insurance policy. The decision you make regarding the level of coverage in this area may affect your insurance premium. When purchasing this coverage, it is important to understand that you will be reimbursed only for reasonable and necessary medical expenses. Bills are audited, and amounts charged which are not reasonable, or charges incurred for treatment which is not necessary, will not be reimbursed. Any amounts not qualifying for reimbursement are your responsibility. Please see your policy for details. If you have further questions, feel free to contact a member service representative by calling (800) 531-8111. Coverage Description Personal Injury Protection Coverage (PIP): • Is optional. • Written rejection is required. If rejected, future renewals will remain the same. • Provides a death benefit. • Provides an income continuation benefit, for up to one year, beginning 14 days from the date of the automobile accident, subject to the lesser of 851/. of the actual income lost or the limit selected. • Provides Loss of Services Disability Benefits of $40 per day, subject to the limit selected. 52 1 1 2--1 006 663WA(06) Rev. 10-06 .�' Page 1 of 4 PS,001407856.663WA.07102 PAGE 9 USAA 00140 76 56 7102 THIS PAGE INTENTIONALLY LEFT BLANK 663WA(06) Rev. 10-06 Page 2 of 4 PS.001407656.663WA,07102 PAGE 10 U8AF. 00140 78 56 7102 Rejection/Selection Form If you do not wish to make any changes to your current policy, no action is required. If you would like to make changes to your policy, please complete, sign and return the form below. The premiums below reflect the total premium for this coverage for all vehicles insured on your policy. The coverage—limit combinations displayed in this form are examples. You can create other combinations of the coverage limits displayed in this example. PERSONAL INJURY PROTECTION COVERAGE Semi—annual premiums per policy Medical & Income Loss of Funeral Hospital Expenses Continuation Services Expenses Premium ❑ s 10,000 $200 wk./$10,0O0 max. $200 wk.155,000 max. $2,000 $ 35.81 ❑ s 10,000 $2O0 wk./$l0,0O0 max. $280 wk./s14,600 max. $2,000 s 36.80 ❑ $ 10,000 $200 wk./$l0,0O0 max. $200 wk./$5,O00 max. $5,000 $ 37.79 ❑ $ 25,000 $200 wk./510,000 max. $280 wk./$14,6O0 max. s5,000 s 57,s5 ❑ $ 35,000 $700 wk./$35,000 max. $2O0 wk./$5,00O max. $2,0O0 $ 65.95 ❑ s 50,000 $700 wk./s35,000 max. $280 wk./s14,600 max. $2,0O0 $ 75.91 ❑ $ 75,000 $70O wk./s35,000 max. $2O0 wk./$5,0O0 max, $5,000 $ 85.92 ❑ $10O,00O $700 wk./s35,00O max. $280 wk./$14,600 max. $5,O0O $ 98.93 Loss of Services: $ 5,000 has a $40 per day, $2O0 per week maximum s 14,600 has a $40 per day, one year maximum Note: Your current limit selection is: Medical & Income Loss of Funeral Hospital Expenses Continuation Services Expenses Premium ❑ I reject Personal Injury Protection Coverages for this policy and all subsequent renewals, supplemental policies or replacement policies. USAA Number Signature of Named Insured Home Phone Alternate Phone Date Please fax your completed form to (800) 531-8877 or mail it to the following address: USAA, 9800 Fredericksburg Road, San Antonio, Texas 78288 If this form is sent by facsimile machine (fax), the sender adopts the document received by USAA as a duplicate original and adopts the signature produced by the receiving fax machine as the sender's original signature. 663WA(06) Rev. 10-06 M Page 3 of 4 Ps.001407856.663WA,07102 PAGE 11 USAA 00140 78 56 7102 THIS PAGE INTENTIONALLY LEFT BLANK 663WA(06) Rev, 10-06 Page 4 of 4 PS.001407856.663WA.07102 PAGE 12 USAA 00140 78 56 7102 Underinsured Motorists Coverage in Washington Below, you will find a brief explanation of Underinsured Motorists coverage. Please remember that this explanation is only an overview, and it does not replace or supplement any of the provisions of your policy. Please see your policy for details because the policy controls all issues of coverage. The decisions you make regarding the amount of coverage will affect your insurance premium. If you have questions, please call Policy Service at 1-800-531-USAA (8722). You may complete this form online at usaa.com. Coverage Descriptions Underinsured Motorists (UIM) Coverage: • Protects you and your family if injured in a motor vehicle accident caused by an undarinsured or hit—and—run motorist who is at—fault. • Pays if you are injured by an at—fault motorist whose Bodily injury (BI) Liability limits are less than the amount of damages you are legally entitled to recover from the at—fault motorist. The at—fault motorist's policy pays its BI Liability limits first, then your UIM Coverage pays the lesser of: • any remaining loss, or • your UIM Coverage limits. • Must be issued with UIM Coverage limits equal to your BI Liability limits unless you reject UIM Coverage or select lower UIM Coverage limits by completing, signing and returning the Rejection/Selection Form by mail or at usaa.com. • Your rejection of UIM Coverage or selection of lower UIM Coverage limits will remain in effect on this policy and on future renewals until you request otherwise in writing. Underinsured Motorists Property Damage (UIMPD) Coverage: • Pays for damage to your vehicle that you are legally entitled to recover from an at—fault underinsured motorist or hit—and—run motor vehicle because of property damage (including loss of use) sustained in an auto accident. • Is issued with UIMPD Coverage limits equal to the minimum limits required by Washington unless you reject UIMPD Coverage for one or more vehicles by completing, signing, and returning the Rejection/Selection Form by mail or at usaa.com. • You may select higher UIMPD Coverage limits for one or more vehicles by completing, signing, and returning the Rejection/Selection Form by mail or at usaa.com. • Your rejection of UIMPD Coverage will remain in effect on this policy and on future renewals until you request otherwise in writing. • Vehicle damage is subject to a $100 deductible. However, vehicle damage caused by a hit—and—run or phantom vehicle is subject to a $300 deductible. 53652-0612_01 999WA(24) Rev. 2-08 Page 1 of 4 Ps.001407856.999WA.07102 PAGE 13 USAA 0014C 78 56 7102 THIS PACE INTENTIONALLY LEFT BLANK i I� 999WA(24) Rev. 2-08 Page 2 of 4 PS.001407856.999WA.07102