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PW17-405 - Original - GeoEngineers, Inc. - Linda Heights Pump Station - 07/21/2017
"'�� Of�r/��/' /rg/ " r�ag'/'X,"% �9/ Records M An,'', q / iy%�'/'l�/off✓/!a %i� G %j�%�5ig " fff f ii ��r/� /�na r���g`tF Vie,/ -,, ifoad �P KENT Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prier to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: CeoEn ineers, Inc, Vendor Number: JD Edwards Number Contract Number: 2W 1 This is assigned by City Clerk's Office Project Name: Linda Heights Pump Station Description: ❑ Interlocal Agreement El Change Order r-1 Amendment ® Contract E! Other: Contract Effective Date: Date of the Mayor's signature Termination Date: 7/1/18 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Thomas Le rer Department: Engineering Contract Amount: $34,260.00 Approval Authority: (CIRCLE E ONE) Department Director May City Council 9, Detail: (i.e. address, location, parcel number, taxi~ id, etc.): Investigate site conditions as a basis for developing geotechnical design ___..._._ __.._._... _ .. recommendations for the proposed Linda Heights Pump Station Replacement project, As of: 08/27/14 e KENT CONSULTANT SERVICES AGREEMENT between the City of Kent and GeoEngineers, Inc. THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and GeoEngineers, Inc. organized under the laws of the State of Washington, located and doing business at 1101 S. Fawcett Ave., Suite 200, Tacoma, WA 98402, Phone: (253) 383- 4940, Contact: Lyle Stone (hereinafter the "Consultant"). •I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: The Consultant shall investigate site conditions as a basis for developing geotechnical design recommendations for the proposed Linda Heights Pump Station Replacement project. For a description, see the Consultant's Scope of Work which is attached as Exhibit A and -incorporated by this reference. Consultant 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. Consultant shall complete the work described in Section I by July 1, 2018. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed Thirty Four Thousand, Two Hundred Sixty Dollars ($34,260.00), for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit B. B. The Consultant shall submit monthly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. 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: CONSULTANT SERVICES AGREEMENT - 1 (Over$20,000) A. The Consultant 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 Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant 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 thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant 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. Consultant 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 Consultant'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 Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's duty to defend, indemnify, and hold the City harmless, and Consultant's liability accruing from that obligation shall be only to the extent of the Consultant's negligence. CONSULTANT SERVICES AGREEMENT - 2 (Over$20,000) IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Consultant 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 Consultant's part, then Consultant 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 Consultant's part. The provisions of this section shall survive the expiration or termination of this Agreement. VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit C attached and incorporated by this reference. IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work under this Agreement. X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the Consultant. Consultant shall make such data, documents, and files available to the City upon the City's request. The Consultant 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. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. The City's use or reuse of any of the documents, data, and files created by Consultant for this project by anyone other than Consultant on any other project shall be without liability or legal exposure to Consultant. XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor with the authority to control and direct the performance and details of the work authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant 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. XIII. 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. 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 CONSULTANT SERVICES AGREEMENT - 3 (Over$20,000) 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. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. 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 Consultant. 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. All of the above documents are hereby made a part of this Agreement. However, 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. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Consultant 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 Consultant 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 Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. J. 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. CONSULTANT SERVICES AGREEMENT - 4 (Over$20,000) K. Counterparts and Si natures 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. CONSULTANT: CITY OF KENT, oe By: By: (sigriature) J �signature) 4��p- Print Name:- 5 - M Pri Na e: u, zette Cooke Its Avisaaq!i&� It� Ma or DATE: -711 Z//7 (title) DATE: 71" z 77 NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Lyle Stone Timothy J. LaPorte, P.E. GeoEngineers, Inc. City of Kent 1101 S. Fawcett Ave., Suite 200 220 Fourth Avenue South Tacoma, WA 98402 Kent, WA 98032 (253) 383-4940 (telephone) (253) 856-5500 (telephone) (253) 383-4923 (facsimile) (253) 856-6500 (facsimile) APPROVED AS TO FORM: Kent Law Department Ge.aFn9ineers-Linda Heights/Leyrer CONSULTANT SERVICES AGREEMENT 5 (Over$20,000) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. 1 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. B y For: 6-9V1 Oh�al aWtS Title: &5'drckg-La- Date: 7/11/0 EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity -policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 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. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 EXHIBIT A SCOPE OF SERVICES GEOENGINEERS,INC. PROPOSED LINDA HEIGHTS PUMP STATION REPLACEMENT KENT,WASHINGTON FILE NO.0410-20100 SCOPE OF SERVICES The purpose of our services is to investigate site conditions as a basis for developing geotechnical design recommendations related to the design and construction of the proposed Linda Heights Pump Station Replacement in Kent, Washington. We understand that a wastewater pump station will be constructed at Linda Heights located on South 248(h Street near 35th Avenue South.The site is located on the Kent west hill. A small (about 20-foot tall)forested slope is located to the west of the site. Interstate 5 is located at the base of the slope about 200 feet from the park. We understand that a wetland is mapped on Washington State Department of Transportation (WSDOT)right-of-way(ROW). The current preferred location of the pump station is at the north end of the park.The details of the pump station layout have not yet been developed, but are expected to include above-ground elements including a pump house and backup generator and below-ground vaults.The vaults are expected to be constructed about 15 feet below existing site grades. There is an existing depression in the park that is used as a basketball court.We understand that this area might be filled and used as an underground stormwater detention area. Our services will include both geotechnical engineering and biological science services.We have organized our services into three tasks as shown below. Task 100- Biological Site Evaluation 1. Review and summarize existing wetland databases that may identify the location, extent,and type of wetland occurring within the WSDOT ROW. 2. Coordinate with City of Kent personnel to obtain right-of-entry onto WSDOT ROW to perform a field assessment and delineation of the wetland. 3. Complete a site visit to delineate and assess the wetland. Field methods will follow established protocols for wetland delineation as identified by the U.S. Army Corps of Engineers (USACE) and incorporated by reference into Washington State planning regulations as well as local (City of Kent) critical areas ordinance. 4. Rate the wetland according to the Washington State Department of Ecology wetland rating system. 5. Identify anticipated critical area buffer regulations that may apply to the wetland based on City of Kent regulatory code and the wetland rating system results. City of Kent June 22,2017 Page 2 6. Document the results of our work in a brief report accompanied by appropriate graphics, illustrations, and appendices. This will include a site plan with the location of the site, wetland delineation extents, and anticipated buffer extents. Our scope of services does not include other fish and wildlife habitat areas. We assume that professional land survey of the wetland boundary will be provided by City of Kent. If the proposed project cannot avoid impacts to the critical area buffer,a Habitat Management Plan,Wetiand Mitigation Plan,or other planning and permitting documents may be required.These services are not included in this scope.We can provide these additional services at your request subject to a future scope amendment. Task 200 -Geotechnical Slope Evaluation 1. Review existing soil and groundwater information, including select in-house reports and published geologic maps. 2. Perform a geologic reconnaissance of the slope.We will look for landslide hazard indicators including seeps and springs, leaning or pistol-butted trees, and surface cracking or hummocky ground. 3. Provide our opinion on the stability of the slope.We will also provide our opinion on critical areas slope buffers and setbacks that could be required under City of Kent or King County Critical Areas Ordinances relating to steep slope,erosion, or landslide hazards. 4. Provide our opinion on the feasibility of locating stormwater detention facilities on site and near site slopes. 5. Present the results of our geologic reconnaissance and slope evaluation in a brief letter report. Task 300 -Geotechnlcal Design Recommendations Once the proposed location of the pump station structure has been determined based, in part, on slope and wetland buffer and setback criteria, we will perform a more detailed site assessment.We will require topographic survey of the site and the slope to perform our analysis. 1. Conduct a site visit prior to subsurface explorations to coordinate exploration locations and site safety issues. 2. Coordinate clearance and location of existing underground utilities in the project area.We will contact the Washington Utilities Coordinating Council "One Call"service prior to beginning explorations.We will also retain a private utility locate service to check for underground utilities at the site. 3. Drill a boring to about 60 feet below ground surface(bgs) using hollow-stem auger drilling techniques. We will install a monitoring well in the exploration. We will also install an electronic piezometer in the well.The electronic piezometer will collect and store groundwater level data from multiple readings per day. 4. Complete laboratory analysis of select soil samples. We anticipate that our laboratory program will consist of grain-size analyses and moisture content determinations. 5. Provide at least two rounds of groundwater monitoring.We will measure groundwater levels in the well during installation to provide data for our design report. We will also retrieve groundwater data from the electronic piezometer and measure levels again prior to construction bidding to provide more up- to-date groundwater information for contractors. GWENGINEERS File No.0410-201-00 City of Kent June 22,2017 Page 3 6. Provide recommendations for shallow foundations for support of equipment pads and equipment buildings. We will recommend bearing surface preparation and provide design criteria, including allowable soil bearing pressures and allowable lateral resistance values for the design of foundation elements. 7. Perform a slope stability analysis to evaluate the current stability of site slopes and to evaluate how that stability could change with the proposed site improvements.We will provide recommendations for maintaining or improving slope stability as appropriate. S. Provide a discussion of temporary shoring and dewatering for the pump station construction. We are assuming that the dewatering and shoring system will be designed by the contractor.We will provide a general discussion of shoring and dewatering issues at the site and comment on the feasibility of different shoring and dewatering methods.We will also provide preliminary lateral earth pressures for the design of shoring systems and an order of magnitude estimate of dewatering quantities. 9. Provide recommendations for utility pipe bedding, pipe support and excavation backfill.We will provide recommendations for imported fill, reuse of on-site soil as appropriate and compaction requirements. 10. Provide recommendations for fill placement and compaction on the surface of the site.We will include recommendations for imported fill and compaction requirements. 11. Prepare a geotechnical design report presenting the results of our explorations and summarizing our findings and recommendations. We will also prepare a brief technical memorandum presenting the second round of groundwater monitoring data and revising our recommendations if appropriate. 12. Provide additional consultation as required and requested. We anticipate that this could include meetings or plan review.We have budgeted 6 hours each for a project engineer and associate engineer to cover this contingency. Our scope and budget does not include any construction management, monitoring or inspections. We will provide a scope and budget for these services upon request. Dc:us:tt Attachment: Exhibit B-1.Fee Estimate Disclaimer:Any electronic form,facsimile or hard copyof the original document(email,text,table,and/or figure),if provided,and any attachments are only a copy of the original document.The original document is stored by GeoEngineers,Inc.and will serve as the official document of record. GMENGINEERS� He No.0410-201-00 J / � - - � ; I � !� ■ � \ � � \ � � � . LU � . om� � ■_ � � � � � |I23 . 00 � a£ ji fa ` f\ /� (Ult21 \ » � 0T ® ; ' ƒ\) ! {\ § %>\E /\ 7 {\ §� ' )k 2t !§ EXHIBIT C 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 Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. 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 $3,000,000 each occurrence, $3,000,000 general aggregate. EXHIBIT C (Continued) 3. Professional Liability insurance shall be written with limits no less than $3,000,000 per claim and $3,000,000 policy aggregate limit. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant 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. v Client#: 326119 GEOENINC2 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 7/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Please send all requests by USI Kibble&Prentice PHONE fax or email FAX 61 601 Union Street,Suite 1000 MAIL°.E"t: AIC,No): 0-362-8518 Seattle,WA 98101 ADDREss: CLCertRequest@usi.com INSURER(S)AFFORDING COVERAGE NAIC# 206-441-6300 INSURER A:Continental Insurance Company 35289 INSURED GeoEngineers,Inc. INSURER B:Liberty Insurance Corporation 42404 8410154th Ave NE INSURERC:Valley Forge Insurance Company 20508 Redmond,WA 98052 INSURER D:Natl Fire Ins Co of Hartford 20478 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: K2 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDNYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY X X 6023113030 D313112017 03/31/2018.EACH OCCURRENCE $1,000,000 CLAIMS-MADE �X OCCUR D PREMISESAMAGETO Ea occurrRENTEDence $500 OOO X WA&ND Stop Gap MED EXP(Any one person) $15 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY 51 ECOT O LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Stop Ga IEL $1,000,000 D AUTOMOBILE LIABILITY X X 6023117823 3/31/2017 03/31/201 COMBINED S[NGLE LIMIT Ea accident 1,000r000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAVTOS N NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident B X UMBRELLA LIAB X OCCUR X X TH7661066735017 3/31/2017 0313112018 EACH OCCURRENCE s2,000,000 EXCESS LIAB CLAIMS-MADE XS of GL,Auto& AGGREGATE s2,000,000 DED I X RETENTION$1O 000 Employers Liab. $ C WORKERS COMPENSATION X WC6045639429 3131/2017 03/31/201 X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y1-1 ID LA MO NC NY OR UT USL&H/Mlikl.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? L N I A D (Mandatory in NH) X WC6045838328 3/3112017 03131/2018 E.L.DISEASE-EA EMPLOYEE $1,000,000 tfyos,describe under DESCRIPTION OF OPERATIONS below CA incl USL&H/MEL *incl WA E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 0410-201-00-Linda Height Pump Station Replacement, Kent,Washington. City of Kent is Additional Insured and coverage is primary and non-contributory as respects General Liability and Automobile Liability policies if required by written contract per attached endorsement(s). CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 4th Ave.S. ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S21123203/M20200757 SZYZP CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows; I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization's liability for: A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's ongoing operations as specified in such written contract;or 2. bodily injury or property damage caused in whole or in part by your work and included in the products- completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage;and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard;and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. It. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide ti such additional insured with: A. coverage broader than required by the written contract;or M B. a higher limit of insurance than required by the written contract. Q $ III. The insurance ranted b this endorsement to the additional insured does not apply to bodily injury, property g 9 Y PP Y Y � 1 rY, P p rtY damage,or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and i� 2. supervisory, inspection,architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written CNA75079XX(1-15) Policy No: 6023113030 Page 1 of 2 Endorsement No: 9 The Continental Insurance Co. Effective Date: 03/31/2017 Insured Name: GEOENGINEERS, INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its pemtission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence,Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim,or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation,defense,or settlement of the claim;and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph (4) does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part,provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy;and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX(1-15) Policy No: 6023113030 Page 2 of 2 Endorsement No: 9 The Continental Insurance Co. Effective Date: 03/31/2017 Insured Name: GEOENGINEERS, INC. Copyright CNA AH Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its pennission. eNA CNA63359XX (Ed.04/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILITY COVERAGE name, with your permission, while performing A. Who Is An Insured duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An The following is added to Section II, Paragraph Insured, includes those policies that were in force A.1.,Who Is An Insured: on the inception date of this Coverage Form but: 1. a. Any incorporated entity of which the 1. Which are no longer in force;or Named Insured owns a majority of the 2, Whose limits have been exhausted. voting stock on the date of inception of this Coverage Form; provided that, B. Bail Bonds and Loss of Earnings b. The insurance afforded by this provision Section 11, Paragraphs A.2. (2) and A.2. (4) are A.1. does not apply to any such entity revised as follows: that is an "insured" under any other liability"policy"providing"auto"coverage. 1. In a.(2), the limit for the cost of bail bonds is 2. Any organization you newly acquire or form, changed from$2,000 to$5,000; and other than a limited liability company, 2• In a.(4), the limit for the loss of earnings is partnership or joint venture, and over which changed from$250 to$500 a day. you maintain majority ownership interest C. Fellow Employee The insurance afforded by this provision A.2.: Section II,Paragraph B.5 does not apply. a. Is effective on the acquisition or formation Such coverage as is afforded by this provision C. date, and is afforded only until the end of is excess over any other collectible insurance. the policy period of this Coverage Form, or the next anniversary of its inception It. PHYSICAL DAMAGE COVERAGE date,whichever is earlier. A. Glass Breakage — Hitting A Bird Or Animal — m b. Does not apply to: Falling Objects Or Missiles (1) "Bodily injury" or "property damage" The following is added to Section III, Paragraph caused by an "accident" that A.3.: occurred before you acquired or With respect to any covered"auto,"any deductible s formed the organization;or shown in the Declarations will not apply to glass s (2) Any such organization that is an breakage if such glass is repaired, in a manner "insured" under any other liability acceptable to us,rather than replaced. "policy"providing"auto"coverage. B. Transportation Expenses 3. Any person or organization that you are Section III, Paragraph AA.a. is revised, with required by a written contract to name as an additional insured is an"insured" but only with respect to transportation expense incurred by you, respect to their legal liability for acts or to provide: omissions of a person, who qualifies as an a. $60 per day,in lieu of$20;subject to "insured" under Section II — Who Is An b, $1,800 maximum, in lieu of$600. Insured and for whom Liability Coverage is afforded under this policy. If required by C. Loss of Use Expenses written contract, this insurance will be primary and non-contributory to insurance on which Section III, Paragraph A.4.b. is revised, with the additional insured is a Named Insured. respect to loss of use expenses incurred by you, 4. An "employee" of yours is an "insured" while to provide: operating an "auto" hired or rented under a a. $1,000 maximum, in lieu of$600. contract or agreement in that "employee's" CNA63359XX CDWdgK,CNA corporation,2000. Page 1 of 3 (Ed.04/12) Includes copyrighted material of the Insurance Services Office used with its permission. CNA63359XX (Ed.04/12) D. Hired"Autos" d. A $100 per occurrence deductible applies to The following is added to Section III. Paragraph the coverage provided by this provision. A.: G. Diminution In Value 5. Hired"Autos" The following is added to Section III, Paragraph If Physical Damage coverage is provided under B.6.. this policy,and such coverage does not extend to Subject to the following, the "diminution in value" Hired Autos, then Physical Damage coverage is exclusion does not apply to: extended to: a. Any covered "auto" of the private a. Any covered "auto" you lease, hire, rent passenger type you lease, hire, rent or or borrow without a driver; and borrow, without a driver for a period of 30 b. Any covered "auto" hired or rented by days or less, while performing duties your"employee"without a driver, under a related to the conduct of your business; contract in that individual "employee's" and name, with your permission, while b. Any covered "auto" of the private performing duties related to the conduct passenger type hired or rented by your of your business. "employee"without a driver for a period of c. The most we will pay for any one 30 days on less, under a contract in that "accident" or "loss" is the actual cash individual employees name, with your value, cost of repair, cost of replacement permission, while performing duties or $75,000, whichever is less, minus a related to the conduct of your business. $500 deductible for each covered auto. c. Such coverage as is provided by this No deductible applies to "loss"caused by provision is limited to a "diminution in fire or lightning. value" loss arising directly out of d. The physical damage coverage as is accidental damage and not as a result of provided by this provision is equal to the the failure to make repairs; faulty or physical damage coverage(s) provided on incomplete maintenance or repairs; or the your owned "autos." installation of substandard parts. e. Such physical damage coverage for hired d• The most we will pay for "loss" to a "autos"will; covered "auto" in any one accident is the lesser of: (1) Include loss of use, provided it is the consequence of an "accident" for (1) $5,000;or which the Named Insured is legally (2) 20% of the "auto's" actual cash value liable, and as a result of which a (ACV). monetary loss is sustained by the III. Drive Other Car Coverage—Executive Officers leasing or rental concern. (2) Such coverage as is provided by this The following is added to Sections II and III: provision will be subject to a limit of 1. Any "auto" you don't own, hire or borrow is a $750 per"accident." covered "auto" for Liability Coverage while being E. Airbag Coverage used by, and for Physical Damage Coverage while in the care,custody or control of, any of your The following is added to Section III, Paragraph "executive officers,"except: B.3.. a. An "auto"owned by that "executive officer" or The accidental discharge of an airbag shall not be a member of that person's household;or considered mechanical breakdown. b. An "auto" used by that "executive officer" F. Electronic Equipment while working in a business of selling, Section III, Paragraphs BA.c and B.4.d. are servicing, repairing or parking"autos." deleted and replaced by the following: Such Liability and/or Physical Damage Coverage c. Physical Damage Coverage on a covered as is afforded by this provision. "auto" also applies to "loss" to any (1) Equal to the greatest of those coverages permanently installed electronic equipment afforded any covered"auto'; and including its antennas and other accessories. CNA63359XX Copyright,CNA Corporation,2000. Page 2 of 3 (Ed.04/12) Includes copyrighted material of the Insurance Services Office used with its permission. ' CNA63359XX (Ed.04/12) (2) Excess over any other collectible damage, against any person or organization for insurance. whom or which you are required by written 2. For purposes of this provision, "executive officer" contract or agreement to obtain this waiver from means a person holding any of the officer us. positions created by your charter, constitution, by- This injury or damage must arise out of your laws or any other similar governing document, activities under a contract with that person or and, while a resident of the same household, organization. includes that person's spouse. You must agree to that requirement prior to an Such "executive officers" are "insureds" while "accident"or"loss" using a covered"auto"described in this provision. C. Concealment, Misrepresentation or Fraud IV. BUSINESS AUTO CONDITIONS The following is added to Section N, Paragraph A. Duties In The Event Of Accident, Claim,Suit Or B.2.: Loss Your failure to disclose all hazards existing on the date The following is added to Section N, Paragraph of inception of this Coverage Form shall not prejudice A.2.a.: you with respect to the coverage afforded provided (4) Your "employees" may know of an such failure or omission is not intentional. "accident" or "loss." This will not mean D. Other Insurance that you have such knowledge, unless The following is added to Section N, Paragraph such "accident" or"loss" is known to you or if you are not an individual, to any of B'S' your executive officers or partners or your Regardless of the provisions of Paragraphs 5.a. insurance manager. and 5.d. above, the coverage provided by this The following is added to Section N, Paragraph policy shall be on a primary non-contributory A 2 b : basis. This provision is applicable only when required by a written contract. That written (6) Your "employees" may know of contract must have been entered into prior to documents received concerning a claim "Accident"or"Loss." or"suit"This will not mean that you have E. Policy Period,Coverage Territory such knowledge, unless receipt of such documents is known to you or if you are Section N, Paragraph B. 7.(5).(a). is revised to not an individual,to any of your executive provide: officers or partners or your insurance m manager. a. 45 days of coverage in lieu of 30 days. B. Transfer Of Rights Of Recovery Against Others V. DEFINITIONS To Us Section V. Paragraph C. is deleted and replaced by The following is added to Section IV, Paragraph the following: A.5. Transfer Of Rights Of Recovery Against "Bodily injury"means bodily injury,sickness or disease Others To Us: sustained by a person, including mental anguish, We waive any right of recovery we may have, mental injury or death resulting from any of these. because of payments we make for injury or CNA63359XX copyright,CNA corporation,2000. Page 3 of 3 (Ed.04112) Includes copyrighted material of the Insurance Services Office used with its permission. TERRA INSURANCE COMPANY Terra Insurance Company (A Risk Retention Group) TERRA Two Fifer Avenue, Suite 100 Corte Madera, CA 94925 INSURANCE COMPANY CERTIFICATE OF INSURANCE DATE 07/14/17 NAME AND ADDRESS OF INSURED Cieo.Engincers,Inc. 1101 Fawcett.Avenue, Suite 200 Tacoma, WA 98402 This certifies that the"claims made" insurance policy(described below by policy number)written on forms in use by the Company has been issued. This certificate is not a policy or a binder of insurance and is issued as a matter of information only,and confers no rights upon the certificate holder. This certificate does not alter, amend or extend the coverage afforded by this policy. The policy of insurance listed below has 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 policy described herein is subject to all the terms,exclusions and conditions of such policy. Aggregate limits shown may have been reduced by paid claims. TYPE OF INSURANCE Professional Liability POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 217019 01/01/17 1.2/31/17 LIMITS OF LIABILITY $3,000,000 EACH CLAIM $3,000,000 ANNUAL AGGREGATE PROJECT DESCRIPTION City of Dent, Linda Heights Pump Station Replacement. GeoEngineers No. 0410-201-00 CANCELLATION: If the described policy is cancelled by the Company before its expiration date, the Company will mail written notice to the certificate holder thirty (30) days in advance, or ten (10) days in advance for non-payment of premium. If the described policy is cancelled by the insured before its expiration date, the Company will mail written notice to the certificate holder within thirty(30) days of the notice to the Company from the insured. ISSUING COMPANY: CERTIFICATE HOLDER TERRA INSURANCE COMPANY City of Kent (A Risk Retention Group) Attn: Nancy Yoshitake 220 4th Ave S Kent, Washington 98032 President V C:"llly VV U11VC.1b %,Ulltp YIVillIUlll 3LdLUS - L'111P10yC:l. I-IdUlllLy l..0 I LIIludLC Y'd�"v 1 CUl l Washington State Department of Employer Liability Jr " Labor and Industries Certificate Z, tax,°.r '.'" Department of Labor and Industries Employer Liability Certificate Date: 07/13/2017 UBI##: 600 375 010 Legal Business Name: Account##: 429,351-00 'Doing Business As'Name: GEOENGINEERS INC Estimated Workers Reported: Quarter 1 of Year 2017 "Greater than 1.00 Workers" (See :Description Below) Workers' Comp Premium. Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? Yes License: GEOEN1*11 OJE Expire Date: 5/9/2019 Account Representative: T3 /KAYLENE 1'4'ONIER (360)902-6627 - Email: BRKB235@lni.wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be tilled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, Limitations of coverage or waiver of subrogation (See RC W 51,12.050 and,51,16.190 ). l�ttr�c•1f rtrrcc xxra 711' /N)11 REQUEST FOR MIXYOR591G ' URE neauezn rnusin minim a�xem�� (� /�/� wv+m w NMI��o- 1 °`: Thomas Leyrer �e (dr <or� SSfiz: s c� Remnsiynea �me�rt ro. Nanry. vpsM1-rake r cenoete��/1/1$ tlnxWpn[ -na - ao�re �a.�s N 6/26/17 v.N. � o ou�� ry ee. 52004Z n 9 act n o Flp evg F esgn re tlat ons be [ 4L� ea v�r c�r �a �e �m�a or°m Mom,