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HomeMy WebLinkAboutPW16-244 - Amendment - #2 - Integra Realty Resources - S 228th St UPRR Grade Separation - 05/04/2017 Records � rrr '1711 ENT Document WASHIWGT k CONTRACT COVER SHEET This its 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 Dumber:. JD Edwards Number Contract Number: V l - q — 007, This is assigned by City Clerk's Office Project Name: S. 224th 2281h St. Phase II Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 5/4/17 Termination date: 9/30/17 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Dee Martindale Department: Engineering Contract Amount: $0.00 v Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to September 30 2017 due to a delay with permitting. As of: 08/27/14 1 KENT w.s-0- AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Integra Washington, Inc. CONTRACT NAME & PROJECT NUMBER: S. 224th/2281h St. Phase II ORIGINAL AGREEMENT DATE: dune 14, 2016 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: No change to the scope of work, however an amendment is needed to extend the time of completion to September 30, 2017 because the project has been delayed due to permitting issues. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $30,500.00 including applicable WSST Net Change by Previous Amendments $0 T! including applicable WSST Current Contract Amount $30,500.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $30,500.00 AMENDMENT- 1 OF 2 Original Time for Completion 5/15/17 (insert date) Revised Time for Completion under ndaa prior Amendments (insert date) ............. ........... Ad'd'l Days Required (±) for this 138 calendar days Amendment Revised Time for Completion 9/30/17 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims, of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed', and the terms of the Agreement, previous Amendments (if any), and this Amendment shail be deemed to have applied, The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. XN WXTNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULT V E:D 10 ,�V CIT��KENT: L By By:ZL�Ze� 'gliR—Ure) 'grgture) Print --)Xl r�nt Fame: I Z I Print Name: Timothy 3. LaPorte, P.E. P)dblic Works its dn Its Director e) DATE: DATE: APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department V4`2 AI'd I/K10,1.1dale AMENDMENT - 2 OF 2 ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYWI t-- � 1 3/29/2017 F71THIS 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Co NT T Carrie Ovrid A NA Conover Insurance PHONE (425)455-5000 FAX .Extl: , (425)454-5550 155 108th Avenue NE, Suite 725 -MAIL ADDRESS:carrieot;slcoaoveriasuraace.cam P.O. Box 90007 INSURERS AFFORDING COVERAGE NAIC0 Bellevue WA 98004 _ INSURERAMutual of Enumclaw Insurance 14761 INSURED INSURER S: Integra Washington, Inc. , DBA: Integra Realty INSURERC: 600 University Street INSURERD: _ Suite 310 INSURER E: Seattle WA 98101 INSURERF: COVERAGES CERTIFICATE NUMBER:17-18 Master OL 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. INTR TYPE OF INSURANCE I wvn L POLICY NUMBER MIUD0Y EFF M Dpr yy LIMITS $ �COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 �� A i ;CLAIMS-MADE X OCCUR i PREMISES A A N rcren $ 100,000 X BOP0001383 3/14/2017 13/14/2018 MEDEXP(Any one person) $ 10,000 PERSONAL d ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER. I GENERAL AGGREGATE $ 4,000,000 X POLICY❑ JECT LOC PRODUCTS-COMP/OPAGO $ 2,000,000 OTHER; Non-owned $ 2,000,000 AUTOMOBILE LIABILITY a Bcciden SINGLE LI IT $ 2,000,000 A ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS X BOP0001383 3/14/2017 3/14/2018 BODILY INJURY(Per accident) $ X HIREOAUTOSPROPERTY DAMAGE PX NON-OWNED PRO j ` I Per accident) $ S X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIA6 HCLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION UNC0000555 3/14/2017 3/14/2018 $ WORKERS COMPENSATION YIN IS' R H- AND EMPLOYERS'LIABILITY STATUTE I IER ANY PROPRIETOR/PARTNER/EXECUTIVE �Nlj WA Stop Gap E L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? A (Mandatory In NH) BOP0001383 3/14/2017 31/14/2018 E.L DISEASE-EA EMPLOYE S 2,000,000 if yes,describe under DESCRIPTION OF OPERATIONS below !I i E.L.DISEASE-POLICY LIMIT S 2,000 000 I DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) City of Kent are included as Additional Insureds. The following attached form applies: Additional Insured per form BP 0448 0713. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent, WA 98032 AUTHORIZED REPRESENTATIVE p Carrie Ovrid/COVRID �GLLttit_���f d:52,_-t Cry' 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 omami POLICY NUMBER: BOP 0001383 06 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 Persons Or Organ Ization 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 Schedule is also an additional insured, but only If coverage provided to the additional insured is with respect to liability for "bodily injury", required by a contract or agreement, the most we "property damage"or"personal and advertising will pay on behalf of the additional insured is the injury"caused, in whole or in part, by your acts amount of insurance: 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 © Insurance Services Office, Inc., 2012 Page 1 of 1 PPC� 1 MAIL MCH-M-I Y1392 SEI`76VEER 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.usaacom/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 (UIM) 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 usaacom. 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://itcanwaitusaa.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) 531-81 1 1. Claims (800) 531-8222. ACS1 49708-0406 PKE. 4'. THIS PAGE INTENTIONALLY LEFT BLANK PPG£ 3 USAA 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. ACS2 F'AGE' 4 WASHINGTON INSURANCE IDENTIFICATION CARD WASHINGTON INSURANCE IDENTIFICATION CARD UNRID SERdICJ=B ALMMOBU ASSN UN(TED SERNAMS AUTOMCEILE ASSN NAME OF INSURED LCRI E SAFER i NAME OF INSURED ALEN N SAFE IMEGRA WASI-INT'ON NC i MARTIN T SAFER POLICY NUMBER 00140 78 56U 7102 2 POLICY Nl mem 00140 78 56U 7102 2 EFFECTIVEDATE 11/01/16 E>FIRATKIDATE 05/01/17 &TE' VEDATE 11/01/16 E*tRATMDATE 05/01/17 VEHICLE DESCRIPTION i VEHICLE DESCRIPTION YEAR MAID IMODEL i YEAR MAKEMODEL 2010 TOYOTA PRLIS MB 4D 2006 SL1BAFd1 OUTB4(X VEHICLE IDENTIFICATION NUMBER VEHICLE IDENTIFICATION NUMBER JTDKN3DU8A"1891 4S4BP61 C36731 M 9800 Fredericksburg Road San Antonio,Texas 78288 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) CONTACT US: 210-531-USAA(8722) OR 800.531-USAA OR 800-531 -USAA i -------- -- - --- - - ---- -- - - ---- - - ---- - -- - - - --- - - --- - - - - - - -- - - -- - - -- - - - - - - - - - - - - - 09/24/16 Automobile Insurance Identification Card We've issued an identification card as evidence of liability insurance for your vehicie(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 1D 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 i LNTED Sff?v� AUTOMOBILE ASSN i NAME OF ENSURED Ai 1JEN N SAFER i LCRI E SAFER ' POUCYNUMBER 00140 78 56U 7102 2 El ESE DATE 11/01/16 EXPIRATION DATE 05/01/17 VB-KIE DESCRIPnON ' YEAR MAKEMODEL 2008 SUBARIJ 139 TR[BECA ' VEHICLE IDENTIFICATION NUMBER 4S4WX90D584411357 9800 Fredericksburg Road San Antonio,Texas 78288 i Additional copies available at usaa.com i CONTACT US: 210.531-USAA(8722) OR 800-531-USAA PPCE 5 UNITED SERVICES AUTOMOBILE ASSOCIATION ADDL INFO ON NEXT PAGE MAIL MCH-M-1 RENEWAL OF (AREOPROCA.INTER24SUROCE EXCHANGE) VA te 13 14 15 �, POLICY Nl USAX 9800 Fredericksburg Road-San Antonio,Texas 78288 1262129212621 Terr 00140 78 5 6 U 7102 2 WASHINGTON AUTO POLICY POLICYPERIOD: (12:01 AM. slandard time) RENEWAL DECLARATIONS EFFECTIVE NOV 01 2016 TO MAY 01 2017 TO PREVIOUS C 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 e cription of Vehicle(s) VEH USE* W I YEA4 TRADE NAME MODEL BODYT`P% IDENTIFICATION NUMBER SW 13 10 TOYOTA PRIUS HYB 4D 4 DOOR 10000 JTDKN3DU8AO041891 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. w F P-PIemm VEH 13 SEATTLE WA 98105-2139 VEH 15 SEATTLE WA 98105-2139 VEH 14 SEATTLE WA 98105-2139 This o cy rov es those coverage w ere a premium s shown below. a limits s ow mayy a re y policy provisions an may not be combined regardless of the number 07 veh-Icies for which a nremium is listed unless sbecifically authorized elsewhere in this policy. VEH VEH VEH VEH COVERAGES LIMITS OF LIABILITY 13 6-MONTH 14 6-MONTH 15 6-MONTH ("ACV"MEANS ACTUAL CASH VALUE) D=DEDd PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM PART A - LIABILITY MOUN $ NMOUNT AMOUN MOUNT $ P"-"ILY INJURY EA PER $ 500, 00 EA ACC $1, 000, OOC 117 . 56 89 . 6 78 . 3 PROPERTY DAMAGE EA ACC $ 100, OOC 73 . 10 65 .43 63 . 7 PART B - PERSONAL INJURY PROTECTIOIN 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 .5 PART C - UNDERINSURED MOTORISTS BODILY INJURY EA PER $ 500, 00 EA ACC $1, 000, OOC 36 . 89 34 .31 34 . 6 TOTAL PREMIUM - SEE F LOWI G PAG (S) VEH 13 ADDNL INTEREST - PERSONAL CORP INTEGRA WASHINGTON INC, SEATTLE, WA LOSS PAYEE VEH 15 USAA FEDERAL SAVINGS BANK, LEHIGH VALLEY PA 1074231315 ENDORSEMENTS: ADDED 11-01-16 - A402 (02) REMAIN IN EFFECT(REFER TO PREVIOUS POLICY) - ACCFOR(01) A074WA(01) A099 (01) RSGPWA(01) 5100WA(02) INFORMATION FORMS: FEAFLRR(02) 663WA(06) F2 N 1 -ftSM23 00 0 41 RMM65 00 01 11111 1,,,'�51 RMF59 00 0 N n WITNESS WHEREObubscribers athave caused,.J^ is to signed y their Attorney-in-Fact on this date sEPTEMBER 24, 2016 �/�.`""" Laura Bishop 5000 U 07-11 President, USAA Reciprocal Attorney-in-Fact, Inc. 53461-07-11 PPGE 6 UNITED SERVICES AUTOMOBILE ASSOCIATION (ARECIPROCALINTEV49-RANOEDC uvvcE) slate 13 14 15 ve, POLICYNUMBFR 11S/4A® 9800 Fredericksburg Road-San Antonio,Texas 78288 IWA t2621262i2621 I Teff 00140 78 5 6U 710` 2 WASHINGTON AUTO POLICY POLICYPERIOD: (12:01 A.M. standard time RENEWAL DECLARATIONS EFFECTIVE NOV 01 2016 TO MAY 01 20 7 (ATTACH TO PREVIOPOLICY) Named Insured and Address ALLEN N SAFER 5221 PULLMAN AVE NE SEATTLE WA 98105-2139 escription of Vehicle(s) VFHUSrz" \,si I YEM TRADE NAME MODEL BODY TYPE fDEN FICATION NUMBER SYM 13 10 TOYOTA PRIUS HYB 4D 4 DOOR 10000 JTDKN3DU8A0041891 P 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 unless otherwise stated. wic-w«I�saro�o�s-a s •F� P � VEH 13 SEATTLE WA 98105-2139 VEH 15 SEATTLE WA 98105-2139 VEH 14 SEATTLE WA 98105-2139 This maY po I those coverages were a pream bm is shown below. a limits s owfbe reduced by policy provisions and may not combined regardless of the number o veh-icles for which a remium is listed unless specifically sp6cifically authorized elsewhere In this policy. VEH VEH VEH vtm COVERAGES LIMITS OF LIABILITY 13 6-MONTH 14 6-MONTH 15 6-MONTH (''ACV-MEANS ACTUAL CASH VALUE) D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM MOUN $ 04MOUNT $ 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 300 52 . 71D 300 23 .46D 300 24 .2 COLLISION LOSS ACV LESS D 500 137 . 92D 500 89 . S2D 500 89 . 6 RENTAL REIMBURSEMENT STANDARD CLASS 12 . 50 12 . 5 EHICLE TOTAL PREMIUM 450 . 13 318 . 09 316 . 8 6 MONTH PREMIUM $ 1085 . 07 PREMIUM DUE AT INCEPTION. THIS IE NOT A BILL, STATEMENT 10 FOLLOW. EARNED ACCIDENT FORGIVENESS APPLIES WITH FIVE YEARS CLEM DRIVING WIqH US PA. THE PREMIUM ON YOUR RENEWING POLIO IS 6 .77 MORE THAN CN YOUR EXPI ING FOLICY. THE FOLLOWING COVERAGE (S) DEFINED IN THIS POLICY AR NOT PFOVIDED FOR: VEH 13 - TOWING AND LABOR VEH 14 - RENTAL REIMBURSEMENT, TqWING JAND LABPR VEH 15 - TOWING AND LABOR F13 RSM23 00 0 E 4 RMM65 00 0 x f 5 RMF59 00 D E x n N E Subscribers at R T S A have caused these presents to be signed by their Attorney-in-Fact on this date SEPTEMBER 24, 2016 - U ura Bishop President, USAA Reciprocal Attorney-in-Fact, Inc. 5000 U 07-11 53461-07-11 PAGE 7 USAA 00140 78 56 - 7102 SUPPLEMENTAL INFORMATION U5�0 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 08 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 SUPDECCW 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 or not repairable, up to seven days Paragraph A of the Limit of Liability section is after we have made a settlement replaced in its entirety by the following: offer. 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. Multipassenger/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 78283 SW 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. 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) 531-81 1 1. 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. 52 1 1 2-1 006 663WA(06) Rev. 10-06 Page 1 of 4 Ps.001407856.663wA.07102 PAGE 13 USAA 00140 78 56 7102 THIS PAGE INTENTIONALLY LEFT BLANK 1 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./S 10,000 max. $280 wk./$14,600 max. $2,000 $ 37.12 ❑ S 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./S35,000 max. $280 wk./S14,600 max. $2,000 $ 76 .66 ❑ $ 75,000 $700 wk./$35,000 max. $200 wk./$5,000 max. $5,000 $ 86 .77 ❑ $100,000 $700 wk./$35,000 max. $280 wk./$14,600 max. $5,000 $ 99.94 Loss of Services: $ 5,000 has a $40 per day, $200 per week maximum $ 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 Page 3 of 4 Ps.0014O7856.663WA.07102 LAST PAGE 15 USAA 00140 78 56 7102 1 THIS PAGE INTENTIONALLY LEFT BLANK 663WA(06) Rev. 10-06 �'�k 9 Pa e 4 of 4 PS.001407856.663wA.07102 A`oRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 2/21/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 'RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 'LOW. 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(les)must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER CON TACT Arthur J. Gallagher 8 Co. PH LARealEstateCerts@a g.com FAx Insurance Brokers of CA. Inc LIC#0726293 818-539-1247 (arc., Nal:818-539-1804__ E MaIL . _ 505 N. Brand Boulevard, Suite 600 LARealEstateCerts@ajg.com Glendale CA 91203 INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Underwriters at Lloyd's London 15792 INSURED INTEREA-03 INSURERB:APPRAISAL GUARDIAN SERIES OF FORTRE Integra Washington, Inc. INSURERC: 600 University Street#310 INSURER D: Seattle,WA 98101 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1182069887 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 77POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR iNSD WVD POLICY NUMBER WOD1YYYY MMO'La 1'W LIMITS F, COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S UAMIAGE TED CLAIMS-MADE C OCCUR PREMISES(Eat occurrence)� S MED EXP(Any one person) S PERSONAL&ADV INJURY S I GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE _ $ I r— PRO- POLICY JECT L� ! ;PRODUCTS-COMPlOPAGG S OTHER: $ AUTOMOBILE LIABILITY -� Ea aCCidenl ANY AUTO S BODILY INJURY(Per person) S OWNED SCHEDULED C i AUTOS ONLY AUTOS I BODILY INJURY(Per accident)I S HIRED NON-OWNED AUTOS ONLY AUTOS ONLY $ I IROPERTY DAMAGE Per accident I $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE' AGGREGATE S DED RETENTIONS � $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'UABIUTY YIN ! TAT ER ANY PROPRIETOR/PARTNER/EXECUTIVE LAI E.L.EACH ACCIDENT S I OFFICER/MEMBER EXCLUDED? �1 I(Mandatory d ory In NH)and E L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below i I I E.L.DISEASE-POLICY LIMIT S A Errors&Omissions MPL1531199.17 3/14/2017 3/14/2018 1 Each Claim $2.000,000 A Errors&Omissions MPL1531199.17 !3/14/2017 3/14/2018 1Aggg agate Limit $10.000,000 B 'E&O Deductible Reimbursement 'PRFDR46APP200306922015TC 13114/2017 3/14/2018 IEaClaim/Aggregate' $150.000 I l DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached B more space Is requlred) Location:600 University Street, Ste 310, Seattle, WA 98101 Evidence only. "Policy is subject to$25,000 Self Insured Rentention/Deductible payable by local office. This certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy to which the certificate of insurance makes reference. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityy Of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2211 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Kent WA 98032 USA AUTHORIZED/ D REPRESENTATIVE i 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD May 2017 June 2017 May 04, 2017 S,uMo TuWe Th F-r Sa SuMo TUWe Th Fr Sa 1 2 3 4 5 6 1 2 3 Thursday 7 8 9 10 11 12 13 4 5 6 7 8 910 14 15 16 17 18 19 20 11 12 13 14 15 16 17 21 22 23 24 25 26 27 18 19 20 21. 22 23 24 1 28 29 30 31 25 26 27 28 29 30 4 Thursday Notes 7 am Survey Department Meeting Engineering Conference Room 2A Knowles, Eric 800 9 O'D 1000 132nd status meeting;Engineering Conference Room 2A; Holcomb, Drew 00 Set up Time for Luncheon; Engineering Conference Room,2A; Engineering CorIference -1st I-&-I2ncIl-Quarter Luncheon Engineering Conference Roorn 2A&2B 12 Pm Engineering Conference Room 2B 1 00 2 00 Council Workshop for Tue 5/16-Drainage District#1 of King County Mill Creek F Engineering Conference Room 3 Murillo,AUex .............. 3 00 P4 Action Team Meeting Engineering Conference Room 2A Engineering Conference Room 2A 4 00 Soo 6 00 Engineering Conference Room 2A 1 5/4/2017 11:28 AM