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PW16-429 - Original - Integra Washington, Inc. - Contract - 12/13/16
a Records ICEIV�f g6mefft-, Document WASHINOTON >?''n4y o F 3 t 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: This is assigned by City Clerk's Office Project Name: Mill Creek Reestablishment - Johnsen Property Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 12/13/16 Termination Date: 6/30/17 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 project. _ As of: 08/27/14 l 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, 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 Johnsen Property. 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 June 30, 2017. 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 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) 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. All acts consistent with the authority of this Agreement and prior to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. CONTRACTOR , CITY OF,; TENT By f. � e j. j � / By:� a t -r 1 (signatuC. (signature) Print Name: L r' Print Name: Carla Maloney, P. Its. 1" t. ._ " ` Its: Design Engineering Manager DATE t UI" 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) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY j 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 �-J - rtrJ 20�Y t f By: z % r For: v - Title: 1 _I � x - . Date: 1' EEO COMPLIANCE DOCUMENTS - 1 E 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 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 EXHIBIT A Integra Realty Resources 6p0 University Street T 206,903,6700 Seattle Suite 310 F 206.623,5731 Seattle,WA 98101 www.Irr.com Llirro November 16,2016 Ingrid Willms-Dixon, RWA Project Analyst City of Kent Public Works Engineering 400 West Gowe Kent,WA 98032-5895 SUBJECT: Proposal for Valuation Services PW2015-078-Walter I, Johnsen &Cheryl Sealy Johnsen Tax Parcel312205-9010 Dear Ms.Wlllms-Dixon: Integra Realty Resources—Seattle appreciates the opportunity to provide this proposal for valuation services forthe above-captioned project. It is my understanding that the project will involve full acquisition of the property. We will provide a summary appraisal report In compliance with current WSDOT standards.Our fee for this assignment is $3,500, 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 Appraisal 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 FRP 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) are available at an additional cost. The current minimum cost for each additional copy is$100 i EXHIBIT A City of Kent November 16,2016 Page 2 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 �.11 > � i Lori Safer, MAI, MRICS Managing Director i 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. 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 $1,000,000 each occurrence, $2,000,000general EXHIBIT B (Continued) aggregate and a $1,000,000 products-completed operations aggregate limit. 3. Professional Liability 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 I 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 HIMIODIYYYY) CERTIFIGATE OF LIABILITY INSURANCE 3/1I/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 pollcy(les) must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditIDCS 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 Cz2rrie OS^_'id PRODUCER E PHONE (A25)455-50DD WX (425)454-5550 Conover In611I'anCO o. IC 155 108th Avenue NE, Suite 725 ADDRESS' P.O. Box 90007 INSL'AERfs AFFORDING C04ERAGE NATO# Bellevue WA 98004 INSURERA:NI1tual OS Enwnclaw InBllYdnCB 147GI INSURED INSURER a Integra Washington, Inc. , )BA: Integra Realty INSURER C: 600 University.Street INSURER D: Suite 310 INSURERS: Seattle WA 98101 IIleURERF: COVERAGES CERTIFICATE NUMBER:l6-3.7 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, NOTWTHSTANDING 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 DL SUER POLICY EFF POLICY EXP LIMITS LTR TYPEOFINSURANCE POLICY HUMEEA MI✓JDD 11A1dIDD, X I COMMERCIAL GENERAL UABILFY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RE 100,000 A CLAIMS-MADE 5-1 OCCUR PR DAMAGE owUOe $ X 80800013 a305 3/14/2016 3/14/2017 [AM EXP(Any one person) S 10,000 PERSONAL&ACV INJURY S / GENE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 4,000,000 POLICY�PRD- LOG PRODUCTS-COMPIOPABC S 2,000,000 Y JEOT S OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIAEILIN aaccitlanl S 2,000,000 BODILY INJURY(Pe,Person) S A ANY AUTO ALL DWNEDLANTOS X 8oP00D136305 3/lt/2016 3/1412117 BODILY INJURY IPet aedden:) S AUTOS PROPERTY—DAMAGE Perax,tlsM $ X HIRED AUTOSX UIdBRELTA LIAe EACH OCCURRENCE $ 1 COO,OOD AEXCESS LIAR AGGREGATE 5 1,00 a,00a DED RETX UMC0000555 3/14/2015 3/14/2017 F PER X OTH WORKERS COMPENSATION S A MUTE ER _ AND EMPLOYERS'LIABILITY YIN ANY PRDPRIETORIPARTNERIEXECUTIVE ❑ WA 6top Gan EL EACH ACCIDENT Is 2,OOD D00 OFFICERREMBER EXCLUDED? NIA 3/1n/2016 EL.DISEASE-EAEIAPLCY 3 14 2017 E 000,000 A (My.ndo(ory In NH) AOPDDD136305 / / $ 21 '., DESCRIPTIONOF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION of OPERATIONS I LOCATIONS I VEHICLES (AGORD tOt,fitltlitlonal Remarks Schedule,maybe aaached if more space is requrred) City of Rent are included as Additional Insureds Per form BP 04 48 07 13 attached. Umbrella Policy is fallowing form over the CL and Auto. i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFF HE ABOVE DESC RIB EO POLIG)ES BE CANCELLED BEFORE ( City Of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i ACCORDANCE WITH THE POLICY PRDVISIDNS, 22D Fourth Avenue South Kent, WA 98D32 AUTHORIZED REPRESENTATIVE Deanna Wilson/CRUDEIQ ' ©1988-2014ACORD CORPORATION, All rights reserved ACORD 25(2014/01) The ACORD name and logo are regis[ered marks Of ACORD INS02512wou ® . ► ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 2/24/2016 3 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS tT1FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 2EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, MPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to :he terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not Confer rights to the ;ertificate holder to lieu of such endorsements. CON DODDER NAN,CT LARealEstateCerts J .corn hur J. Gallagher&Co. PHOC. NE .818-539-1247 FAX .818-539-1804 urance Brokers of CA. Inc LIC#0726293 E-MAIL i N. Brand Boulevard, Suite 600 .LARealEstateCerts@ajg.com Indale CA 91203 INSURERS)AFFORDING COVERAGE NAICH INSURER A:LLOYD'S OF LONDON SYNDICATE 3624 URED INTEREA-03 -INSURER B:APPRAISAL GUARDIAN SERIES OF FORTRE Dgra Washington, Inc. INSURBRC: ,gra Realty Resources Inc. 1133 Ave of Americas INSURER❑: :h Floor 600 University Street, Suite 310 attle WA 98101 INSURERS: INSURER F )VERAGES CERTIFICATE NUMBER:612604032 REVISION NUMBER: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS IERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, :XCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. TYPE OF INSURANCE A ft POLICY EFF POLICY E%P INSD WVD POUCYNUMBER MMIDD(YYYY fMM1DDNYyY LIMITS COMMERCIAL GENERAL LIASILITY EACH OCCURRENCE $ DANTAGE O R D ClAlldS-MADE ❑OCCUR PREMISES Es or.unence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E _ POLICY❑JET LOD PRODUCTS-CONFIDE AGO $ OTHER: COBI $ AUTOMOBILE LIABILITY Be seede0 N L L .I $ ANY AUTO BODILY INJURY(Par person) $ AU.OS NED SSCHHEEDDULED BODILY INJURY(Par acddenl) $ NON-0C"ED OS PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CIAIMSMADE AGGREGATE S D.D RETENTION$ $ WORKERS COMPENSATION _ MR STA II E RH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEAECUTIVE O WA In NH) ELFACHACCIDENT E OFFICERMEMBER EXCLUDED? E.L,DISEASE-EA EMPLOYE $ If yes,dasgibe under E.L DISEASE-POLICY UMIT $ DESCRIPTION OF OPERATIONS below Errors if Omisslans MPL1531199.16 3114/2015 3/14/2017 Each Claim $2,DDD,000 Errors&Omissions MPLi531199,16 3/14/2018 3JJ412017 Aggregate Limit $10,000,000 `E&O Deductible Reimbursement `PRFDR46APP200306522D15TC 3/14/2016 3/14l2017 Ea Claim/Aggregata` $150,000 DRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he mdached If mom space is required) ation:600 University Street, Ste 310, Seattle,WA 98101 lence only. icy is subject to$25,o0D Self Insured Rentention/Deductible payable by local office. certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, nd or alter the coverage afforded by the policy to which the certificate of insurance makes reference. 4TIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Certificate As Evidence ACCORDANCE WITH THE POLICY PROVISIONS. '.. I I ' AUTHORIZED REPRESENTATIVE 001988-2014 ACORD CORPORATION. All rights reserved, I JRD 25(2014101) The ACORD name and logo are registered marks of ACORD 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 additional insureds, the following is added to A. The following is added to Paragraph C.Who Is An paragraph D. Liability And Medical Expenses Insured: 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. I Office Inc. 2012 Page 1 of 1 BP 04 48 07 13 © Insurance Services , PAS 1 ® /[ MAIL MCH-M-1 Y1392 SEPUIEE t 24, 2016 .,SAW AUTOMOBILE POLICY PACKET ALLEN N SAFER 5221 PULLMAN AVE NE SEATTLE WA 98105-2139 USAA 00140 78 56 7102 2 POLICY PERIOD: EFFECTIVE NOV 01 2016 TO MAY 01 2017 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. Check your vehicle for a safety recall today! Visit www.usaa.com/autorecall to learn more. Your Rental Reimbursement Coverage has changed. Please see your Declarations, Amendatory Endorsement A402, and the form "New Features are Now Available" for information about this change. With this renewal, your premium has increased due to a rate change in your state or because of your policy's individual risk characteristics. See your Declarations for the new premium. Contact us if you have any questions. Your Underinsured Motorists Coverage (LIM) and Underinsured Motorists Property Damage (UIMPD) 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://itcanwalt.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. 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 ACS1 49708-0406 PALE 3 USAF. 00140 78 56 7102 2 AUTOMOBILE POLICY PACKET CONTINUED 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. I ACS2 PAGE 4 WASHINGTON INSURANCE IDENTIFICATION CARD i WASHINGTON INSURANCE IDENTIFICATION CARD UNITED SAS AUTOMOBILE ASSN I UNITED SAS AUTOMOBILE ASSN NAMEOFINSURED LORI E SAFER i NAMEOFINSURED A11EN N S6F$2 INTEGRA WASHINGTON INC ; MARTIN T SAFER POLICYNUMBER 00140 78 56IJ 7102 2 PUJYNUMBER 00140 78 55U 7102 2 EFFECTNEDAIE 11/01/16 EVIRAIIONDATE 05/01/17 EFFECTMEDATE 11/01/16 EXPIRATIONDATE 05/01/17 VEHICLEDESCRIPTON i VEHcLEDEscRFrioN YEAR MAVI7MODEL t YEAR MAKEMODEL 2010 TOYOTA PRIUS FhB 4D 2OD6 SUBARU CUTBACK VEHICLE IDENTIFICATION NUMBER VEHICLE IDENTIFICAMON NUMBER JTDIQN3DU840041891 4S4BP61C367319002 9800 Fredericksburg Road San Antonio,Texas 78288 i 9800 Fredericksburg Road San Antonio,Texas 78288 Additional copies available at usaa.com Additional copies available at usaa.com CONTACT US: 210-531-USAA(8722) I CONTACT US: 210-531-USAA(8722) OR 800-531-USAA I OR 800-531-USAA - - -- - - -- --- - - - - - - - ----- - - --- - ----- - -- -- - - - - - - - --- - - -- -- - - - - - - -- -- - - - - - - - - - -- - 09/24/16 Automobile Insurance Identification Card We've issued an identification card as evidence of liability insurance for your vehicle(s). This card is valid only as long as liability insurance remains in force. You may be required to produce your identification card at vehicle registration or inspection, when applying for a driver's license, following an accident or upon a law enforcement officer's request Keep a copy of the ID card in your vehicle at all times. For your convenience, additional copies are available on usaa.com. 53WA3 Rev. 6-13 55084-0513_01 - - - - - - --- -- - - - -- - - -- - - - -- - -- - - - --- - - - - WASHINGTON INSURANCE IDENTIFICATION CARD UNITED SERVICES AUTOMOBILE ASSN NAME OF INSURED ALLEN N SAFER LOPJ E SAFER i POLICYNUMBER 00140 78 56U 7102 2 EFFECTMEDATE 11/01/16 E)FIRATIONDATE 05/01/17 VEHICLE DESCRFTION YEAR MAKEMIODEL t 2008 SUB°RU B9 TRIBECA VEHICLE IDENTIFICATION NUMBER 4S4WX90D584411357 9800 Fredericksburg Road San Antonio,Texas 78288 Additional copies available at usaa.com CONTACT US: 210.531-USAA(8722) OR 800-531-USAA 4- I PACE 5 UNITED SERVICES AUTOMOBILE ASSOCIATION ADDL INFO ON RENEW IN X OF GE MAIL MCH-M-1 O. (ARECIPROCALINTERINSURANCEEXCHMGE) State 13 14 15 Vdi POLICY DUMBER u 9800 Fredericksburg Road-San Antonio,Texas 78288 WA P62P621262 Teff 00140 78 56U 7102 2 WASHINGTON AUTO POLICY PCUCYPEROD: (12:01 A.M. standard time RENEWAL DECLARATIONS EFFECTIVE NOV 01 2016 TO MAY 01 20i7 (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 PULLMtAN AVE NE SEATTLE WA 98105-2139 escr p on o e Ic e s VEHUSE' VEH TRADE NAME MODEL BODYTYPE ANNUAL MILEAGE IDEMIFICAMON NUMBER S11N es 13 10 TOYOTA PRIUS HYB 4D 4 DOOR 10000 JTDKN3DUSA0041891 P 14 06 SUBARU OUTBACK SW 6000 4S4BP61C367319002 P 15 08 SUBARU B9 TRIBECA 4 DOOR 6000 4S4WX9OD584411357 P The Vehicle(s)described herein is principally garaged at the above address unless otherwise stated.*wiawoNseaotB=Business;F=F=,P-HI su VEH 13 SEATTLE WA 98105-2139 VEH 15 SEATTLE WA 98105-2139 VEH 14 SEATTLE WA 981OS-2139 Is o Icy provides those coverages where a premium Is shown below. a limits s own may a reduced by policy provisions and may not be combined regardless of the number of vehicles for which a remlum Is 11 ted unless specifically authorized elsewhere in this policy. VEH H VEH VEH COVERAGES LIMITS OF LIABILITY 13 6-MONTH [JVE 4 6-MONTH 15 6-MONTH ("ACV"MEANS ACTUAL CASH VALUE) D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $ mour 11MOUNT1 $ PART A - LIABILITY r ILY INJURY EA PER $ 500, 00 EA ACC $1, 000, 000 117 . 56 89 . 67 78 . E PROPERTY DAMAGE EA ACC $ 100, OOC 73 . 10 65 .43 63 . 7 PART B - PERSONAL INJURY PROTECTIO 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 15 . 02 11 . 5E 9 . 52 ?ART C - UNDERINSURED MOTORISTS BODILY INJURY EA PER $ 500, 00 EA ACC $1, 000, 00 36 . 89 34 . E 34 . 6 TOTAL PRE IUM - SEE FO LOWI G PAGE(S) 1EH 13 A➢DNL INTEREST - PERSONAL CORP INTEGRA WASHINGTON INC, SEATTLE, WA ,OSS PAYEE JEH 15 USAA FEDERAL SAVINGS BANK, LEHIGH VALLEY PA 1074231315 ENDORSEMENTS: ADDED 11-01-16 - A402 (02) 2EMAIN IN EFFECT (REFER TO PREVIOUS POLICY) - ACCFOR (01) A074WA (01) A099 (01) RSGPWA(01) 5100WA(02) ENF'"MATION FORMS : FEAFLRR (02) 663WA(06) 2 ---T- v1131 RSM23pobpbl I I I I I JIV41RMM6SP00P0j I I I I I 11k5lRMF59 00 0 In WITNESS WHEREOF,the Subscribers at UNITED SERVICES AUTOMOBILE ASSOCIATION have caused these presents to be signed by their Attorney-in-Fact on this date SEPTEMSER 24, 2016 �°-u G NaA Laura Bishop President, USAA Reciprocal Attorney-in-Fact, Inc. 5000 U 07-11 53461-07-11 PP42E 6 1� UNITED SERVICES AUTOMOBILE ASSOCIATION (A RECIPROCAL INTERINSURPNCE EXCHANGE) State 113 14 15 Ue1 POLICY NUMBER USAW 9800 Fredericksburg Road-San Antonio,Texas 78288 WA P62P 212621 1 Terl 00140 78 56U 7102 -2 WASHINGTON AUTO POLICY POUCYPERIOD (12:01A.M.standardtime) RENEWAL DECLARATIONS EFFECTIVE NOV 01 2016 TO MAY 01 2017 ATTACH TO PREVIOUS POLICY Named Insured and Address ALLEN N SAFER 5221 PULLMAN AVE NE SEATTLE WA 98105-2139 escri tion of Vehicle s AN VEH USE' fly VEH TRADE NAME MCDEI- BODYTYPE MILFgGE IDENTIFICATION NUMBER SYM 13 10 TOYOTA PRIUS HYB 4D 4 DOOR 10000 JTDKN3DU8AO041891 P 14 06 SUBARU OUTBACK SW 6000 4S4BP61C367319002 P 15 OB SUBARU B9 TRIBECA 4 DOOR 6000 4S4WX9OD584411357 P The Vehicle(s)described herein is principally garaged at the above address unless otherwise stated. tA F=:P=PIa m VEH 13 SEATTLE WA 98105-2139 VEH 15 SEATTLE WA 98105-2139 VEH 14 SEATTLE WA 98105-2139 Is olicy provi es ONLY those coverages where a premium Is shown below. he limits shown may pe reduced by policy provisions and may ,not be combined regardless of the number of vehicles for which a premium is listed unless specifically authorized elsewhere in this polIc . COVERAGES LIMITS OF LIABILITY 13 6-MONTH F[, DED 6-MONTH 15 6-MONTH (°ACV"MEANS ACTUAL CASH VALUE) D=DED PREMIUM PREMIUM D=DED PREMIUM D=DED PREMIUM MOUNT $ OUNT $ MOUNT $ MOUNT $ PART C - UNDERINSURED MOTORISTS PROPERTY DAMAGE EA ACC $ 10, OOC 4 .43 4 . 12 4 .1 PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 30C 52 . 71D 300 23 .46D 30C 24 . 2 COLLISION LOSS ACV LESS D 50C 137 . 92D 500 89 . 52D 50C 89 . 6 RENTAL REIMBURSEMENT STANDARD CLASS 12 . 50 12 . 5 VEHICLE TOTAL PREMIUM 450 . 13 318 . 09 316 . 8 6 MONTH PREMIUM $ 1085 . 07 PREMIUM DUE AT INCEPTION. THIS IE NOT A BILL, STATEMENT FOLLOW. EARNED ACCIDENT FORGIVENESS APPLIES WITH FIVE YEA CLE DRIVING WITH US . THE PREMIUM ON YOUR RENEWING POLIO IS 6 . 77 MORE THAN YO EXPI ING OLICY. THE FOLLOWING COVERAGE (S) DEFINED N TH S POLIO ARE NOT PROVIDED FOR: VEH 13 - TOWING AND LABOR VEH 14 - RENTAL REIMBURSEMENT, T WING LAB R VEH 15 - TOWING AND LABOR w1131 RSM23 00 0 41-KMM65POOPOJ I I 111 JV51RMF59 DO D ; In WITNESS WHEREOF,the Subscribers at UNITED SERVICES AUTOMOBILE ASSOCIATION have caused these presents to be signed by their Attorney-in-Fact on this date SEPTEMBER 24, 2016 �� � U aura Bishop President, USAA Reciprocal Attomey-in-Fact, Inc. 5000 U 07-11 53461-07-11 i PAGE 7 '. USAA 00140 78 56 7102 '.., SUPPLEMENTAL INFORMATION ` SAX EFFECTIVE NOV 01 2016 TO MAY 01 2017 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 -$ 3 . 89 MULTI-CAR DISCOUNT -$ 71. 08 OCCASIONAL OPERATOR DISCOUNT -$ 63 . 79 OPERATOR OS PASSIVE RESTRAINT DISCOUNT -$ 2 .21 PREMIER DRIVER LEVEL DISCOUNT -$ 71 . 08 VEHICLE 14 ANNUAL MILEAGE DISCOUNT -$ 21 . 30 DAYTIME RUNNING LIGHTS DISCOUNT -$ 2 .40 MULTI-CAR DISCOUNT -$ 49 . 97 PASSIVE RESTRAINT DISCOUNT -$ 1 . 60 PREMIER DRIVER LEVEL DISCOUNT -$ 49 . 97 VEHICLE 15 ANNUAL MILEAGE DISCOUNT -$ 17 .20 DAYTIME RUNNING LIGHTS DISCOUNT -$ 2 .40 MULTI-CAR DISCOUNT -$ 47 .55 PASSIVE RESTRAINT DISCOUNT -$ 1 .24 PREMIER DRIVER LEVEL DISCOUNT -$ 47 . 55 r SUPOECCW Rev. 7-95 SEPTEMBER 24 , 2016 PAGE 8 USAA 00140 78 56 7102 AMENDATORY ENDORSEMENT The coverage provided by this Endorsement is subject to all the provisions of the policy and amendments except as they are modified as follows. PART D - PHYSICAL DAMAGE COVERAGE INSURING AGREEMENT b. If Rental Reimbursement Coverage is afforded, the vehicle class for Paragraph A. is replaced in its entirety by the transportation expenses is the following: vehicle class shown on the Declarations for Rental A Comprehensive Coverage (excluding Reimbursement for that vehicle. collision). Paragraph C. is replaced in its entirety by the 1. Physical damage. We will pay for loss following: caused by other than collision to your covered auto, including its equipment, C. Rental Reimbursement Coverage (for loss and personal property contained in your other than total theft). covered auto, minus any applicable deductible shown on the Declarations. 1. We will reimburse you for expenses The deductible will be waived for loss you or any family member incurs to to window glass that can be repaired rent a substitute for your covered rather than replaced. In cases where the auto. This coverage applies only if: repair proves unsuccessful and the window glass must be replaced, the full a. Your covered auto is withdrawn amount of the deductible, if any, must from use due to a loss, other than a be paid. total theft, to that auto; and 2. Transportation expenses. We will also b. The loss is covered under pay: Comprehensive Coverage or caused by collision, and the cause of loss a. The reasonable amount for is not otherwise excluded under Part transportation expenses incurred by D of this policy. you or any family member, but no more than the cost of renting an 2. We will reimburse you only for that Economy Class vehicle, as defined period of time reasonably required to under Rental Reimbursement repair or replace your covered auto. If Coverage. This applies only in the we determine your covered auto is a event of a total theft of your total loss, the rental period will end no covered auto. We will pay only later than seven days after we have transportation expenses incurred made a settlement offer. during the period beginning 48 hours after the theft and ending LIMIT OF LIABILITY when your covered auto is returned to use or, if not recovered Paragraph A. of the Limit of Liability section is or not repairable, up to seven days replaced in its entirety b the following: after we have made a settlement p y y offer. I 126836-0314_02 A402(02) Rev. 05-14 Page 1 of 3 PAGE 9 USAA 00140 78 56 7102 A. Total loss to your covered auto. Our limit D. Under Rental Reimbursement Coverage, our of liability under Comprehensive Coverage maximum limit of liability is the reasonable and Collision Coverage is the actual cash amount necessary to reimburse you for value of the vehicle, inclusive of any expenses incurred to rent a vehicle in the custom equipment, and the cost to applicable class shown on the Declarations: transfer or replace any equipment, furnishings or parts designed to assist 1. Economy Class. For purposes of this disabled persons. endorsement, Economy Class means "mini," small or compact 2— and 4—door 1. The maximum amount we will include cars that are not considered sports or for loss to custom equipment in or on luxury vehicles and are not the station your covered auto is $5,000. wagon type. 2. We will declare your covered auto to 2. Standard Class. For purposes of this be a total loss if, in our judgment, the endorsement, Standard Class means cost to repair it_would be greater than standard and full size 2— and 4—door its actual cash value minus its salvage cars that are not considered sports or value after the loss. luxury vehicles and are not the station wagon type. 3. If Car Replacement Assistance is shown on the Features Declarations for this 3. Multi passenger/Truck Class. For your covered auto, we will pay an purposes of this endorsement, additional 20% of the actual cash Multipassenger/Truck Class means: value of the vehicle at the time of a total loss. This additional amount: a. Sports, convertible and luxury cars � of any size; a. Is separate from the limit available for loss to your covered auto b. Station wagons; under Comprehensive Coverage or Collision Coverage; and c. Minivans; b. Is available if the total loss is paid: d. Mid—size cargo and passenger vans; (1) Under this policy's e. Pickup trucks; and Comprehensive Coverage or Collision Coverage; or f. "Mini" small and midsize sport utility (2) Because of the PD by or on vehicles (SUVs) that are not behalf of persons or considered luxury SUVs. organizations who may be legally responsible. 4. Large SUV Class. For purposes of this endorsement, Large SUV Class means However, Car Replacement Assistance luxury SUVs of any size, large SUVs, does not apply to total loss to any any private passenger vehicle equipped nonowned vehicle. to assist the disabled (when available) and large cargo or passenger vans, Paragraph D. is replaced in its entirety by the following: A402(02) Rev. 05-14 Page 2 of 3 PAGE 10 USAA 00140 78 56 7102 PART E - GENERAL PROVISIONS OUR RIGHT TO RECOVER PAYMENT The Our Right to Recover Payment section is amended to add the following: Our rights in this section do not apply with respect to amounts paid in excess of the actual cash value of your covered auto because of Car Replacement Assistance. Copyright, USAA, 2013. All rights reserved. A402(02) Rev. 05-14 Page 3 of 3 PAGE 11 USAA 00140 78 56 7102 9800 Fredericksburg Road � /� San Antonio,Texas 78288 -SAX New Auto Policy Features Available for Purchase At USAA, we continuously look for ways to improve features and benefits of your insurance policy. We're pleased to let you know about two new auto policy features that can help you if you're involved in an accident: 1) Rental Reimbursement Coverage by vehicle class and 2) Car Replacement Assistance. • Rental Reimbursement Coverage Rental Reimbursement Coverage has changed. The current option of dollar limits per day for Rental Reimbursement Coverage is being replaced by vehicle class. The vehicle-class choices are: • Economy • Standard • Multipassenger/Truck • Large SUV How this change affects your current Rental Reimbursement Coverage Effective with this renewal, the Rental Reimbursement Coverage applicable to each vehicle on your policy has been converted as follows: • $30 per day to a maximum of $900 - Standard Class • $50 per day to a maximum of $1,500 - Multipassenger/Truck Class Please see your Declarations for the vehicle class that applies to your Rental Reimbursement Coverage. You may change the vehicle class at any time. • Car Replacement Assistance Regardless of the year and model of your car, Car Replacement Assistance will pay an additional 20% of the actual cash value of your vehicle at the time of a total loss. Please read the Amendatory Endorsement included with this renewal for more details about Rental Reimbursement Coverage and Car Replacement Assistance. Change the Rental Reimbursement Coverage vehicle class or purchase Car Replacement Assistance on usaa.com using the Change Coverage option once your renewal is in effect. If you prefer, you can make these changes to your policy by calling 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722. It's our pleasure to help you with all your financial needs. i 127562-0215 01 FEAFLRR(02) Rev. 04-15 PAGE 12 USAA 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 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 85% of the actual income lost or the limit selected. • Provides Loss of Services Disability Benefits of $40 per day, subject to the limit selected. 52112-1006 663WA(66) Rev. 10-06 a Page 1 of 4 Ps.00l407856.663WA.07102 PAGE 13 USAA 00140 78 56 7102 THIS PAGE INTENTIONALLY LEFT BLANK I I 663WA(06) Rev. 10-06 .�� Page 2 of 4 PS.001407856.663WA.07102 PAGE 14 USAA 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./$10,000 max. $200 wk./$5,000 max. $2,000 $ 36.12 ❑ S 10,000 $200 wk./510,000 max. $280 wk./$14,600 max. $2,000 $ 37.12 ❑ $ 10,000 $200 wk./$10,000 max. $200 wk./$5,000 max. $5,000 $ 38.12 ❑ S 25,000 $200 wk./$10,000 max. $280 wk./$14,600 max. $5,000 $ 58.41 ❑ S 35,000 $700 wk./$35,000 max. $200 wk./$5,000 max. $2,000 $ 66.60 ❑ S 50,000 $700 wk./$35,000 max. $280 wk./$14,600 max. $2,000 $ 76.66 ❑ $ 75,000 $700 wk./$35,000 max. $200 wk.155,000 max. $5,000 $ 86.77 ❑ 510Q000 $700 wk./$35,000 max. $280 wk.1514,600 max. $5,000 $ 99,94 Loss of Services: $ 5,000 has a $40 per day, $200 per week maximum $ 14,600 has a S40 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 Page 3 of 4 PS.001407856.663WA.07102 LAST PAGE 15 USAA 00140 78 56 7102 THIS PAGE INTENTIONALLY LEFT BLANK i 663WA(06) Rev. 10-06 Page 4 of 4 PS.001407856.663wn.07102