HomeMy WebLinkAboutPW18-066 - Amendment - #2 - JECB LLC - 2018 Traffic Sign Replacement - 07/03/2018 I
ANT Records Management Document
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to the City Clerk's Office. AU portions are to be completed,
1f you have gUestiorns, pspease contact the City Cllerk's Office at 25 3-fl,56-572.5.
❑ Blue/Motion Sheet Attached
❑ Pink Sheet Attached
Vendor Name: JECB, LLC
Vendor Number (JDE):
Contract Number (City Clerk):
Category: Contract Aqreement
Sub-Category (if applicable): Amendment_.____.
Project Name: 2018 Traffic Siqn Replacement
Contract Execution Date: 7/3/18 Termination Date: 12/31/19
Contract Manager: Paul Kuehne Department: PW: Engineering
Contract Amount: $12,000.00
Approval Authority: ® Director ❑ Mayor ❑ City Council
Other Details: Provide additional construction and Droiect management services for the
project.
`�✓ K1 T
AMENDMENT' NO. 2
NAME OF CONSULTANT OR VENDOR: JECB LLC
CONTRACT NAME & PROJECT NUMBER: 2018 Traffic Sion Replacement
ORIGINAL AGREEMENT DATE: February 15, 2018
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:
Provide additional construction and project management
services for the project. For a description, see Exhibit A which
is attached and incorporated by this reference.
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, $24,820.00
including applicable WSST
Net Change b Previous Amendments
g y $14,875.00
including applicable WSST
_..... _
Current Contract Amount $39,695.1111
including all previous amendments
...................._
Current Amendment Sum 12,000.00
_.._....... ..
...................
Applicable WSST Tax on this $0
Amendment
R -. __._
evised Contract Sum $51 695.00
AMENDMENT - 1 OF 2
Original Time For Completion
(insert date)
Revised Time for Completion under 13/
prior Amendments
(insert date)
Add'I Days Required (f) for this 0 alendar days
Amendment
_ .....�
Revised Time for Completion 12 it/19
(insert date)
The Consultant or Vendor accepts all requiremen s 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 ccnstit tes full payment and final settlement of
all claims of any kind or nature arising from or cone cted 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 the Amendment, are hereby ratified and
affirmed, and the terms of the Agreement, previous Am ndments (if any), and this Amendment
shall be deemed to have applied.
The parties whose names appear below swear tinder penalty of perjury that they are
authorized to enter into this Amendment, which is bindin I on the parties of this contract,
IN WITNESS, the parties below have execute this Amendment, which will
become effective on the last date written below.
.......-- .......
CONSULTANT VENDOR. —_ ... - ._ -- — —_...... ..
� CITY F KENT: ...
an ature)
Print ame:,, llrah .- Print N me: Timothy J. LaPorte P.E.
Its �� Its Put li wtl arksk CJirector
(title)
_ __.._
DATE: I 1.11 DATE: Mrl
ATTEST: — __. __. _ __ _ _. .. .. ...
APPRO ED AS TO FORM:
(apra!lcr�hfr If Mayor's signature requlredJ
Kent City Clerk
Kent La N Department
JECB-Trnl 5'�yn 0.epl Amtl 2/KueM1 is
AMENDMENT- - 2 OF 2
EXHIBIT A
PUBLIC WORKS CONSTRUCTION ENGINEERING
Paul Kuehne
Construction Engineering Supervisor
400 West Gowe
Kent, WA 98032
Fax: 253-856-6500
PHONE: 253-856-5543
June 4, 2018
RE: JECB Consulting Contract, Change Order Two, Description and Reasoning
2018 Traffic Sign Replacement Project
To the Project File:
The scope of the JECB consulting contract expanded greatly after the agreement was formed.
2018 Traffic Sign Replacement Project, plans and specifications provided a general geographic
area but did not provide information sufficient to determine which specific street segments were
included, specific sign locations, type of sign for a specific location, or signs to be excluded from
replacement. The added effort to provide crucial information for the contractor after the project
commenced was not accounted for in the original consulting contract and accounts for more
than half of the total construction management effort for this project.
Paul Kuehne,
Construction Engineering Supervisor
City of Kent Public Works Department
Timothy J. LaPorte, P.E. Public Works Director
JECB
Marketing Proposal
Estimated Additional Services - Construction Management
Price Hours"
PROFESSIONAL SERVICES
Administrative Services $50.00 pet hour to MOM
Construction/Project Mgr $115.00 Perham 100 $11,500,00
ESTMIATED PROJECT TOTAL TOTAL* $12,000,00
Total is an estimate only for the project since contractor's work dictates schedule
"Hours quoted are for reference only
PO Box 832 Auburn, WA. 98071
Ph- (253)405-4654
Email:jecboffice@gmail.com
J EC BLLC-02
ACORN DATEiMMrDD Yl
CERTIFICATE OF LIABILITY INSURANCE 08/22d2018
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 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 riohts to the certificate holder in lieu of such endorsernent(s(
PRODUCER CONTACT _......... ..._.__— ....... ................
N ME
Griffin MacLean Inc PHONE FAX
2340 130th Ave NE D150 (AIC Na EO) (425)822 1368 INC.Nal(425)822-2737
Bellevue,WA 98005 I tcR.i.Ls3s info f@,!If'ifflnrnac(eanI com
INSURERISI AFFORDING COVERAGE NAIC N
INSURER A.IOhiaY,Security Insurance Co �24082
INSURED ........ _.. _._.. _.. INSURERe:
JECB, LLC
Jamie Hicks INSURER C.
PO BOX 832 INSURER D
Auburn,WA 98092 INSURER E
............ ... .... INSURER F I
COVERAGES ..... ..�CERTIFICATE NUMBER _ ..._ _... ......... 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
INDICATE❑. NOTVNTHSTANDING 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.
IN5Ri TYPE OF INSURANCE 7ADOLJSUBRl POLICY NUMBER I POLICYEFF I POHCYEXP LIMITS a,fB ..__ —;' vrwvp. _ mNm�rrYvi,{anu eY�c�l
A Xl COMMERCIAL GENERAL LIABILITY 1 2,000,000
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CLAIM„MADE I X� oc�ua ; X X BZS56778701 0612612018 0612612019 i DAMACF 10Rl Naar 21000,000
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ATIONS
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GartiPieato holder is named as addltioaral insured as respects work performed by the named Insured
cEraTtFrcraL.h9 E — CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Kent Public Works Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS,
Kent,WA 98032 _—...._ .. ........�......_..... _____,,,,.... .._......_
AUTHORIZED REPRESENTATIVE
C--
ACORD 25(2016103) _ ...—...... ..._..._. ...,......_......., _ _. ..�..,.
1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER : BZS56778701
6USINESSOWNERS
13P 79 96 67 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
BU SINE SSOWNE RS LIABILITY EXTENSION ENDORSEMENT
This endorsement modlnes Insurance provided under the following
BUSWESSOWNERS COVERAGEFORM
SUBJECT
PAGE
AGGREGATE LIMITS OF INSURANCE 3
AMENDMENT OF INSURED CONTRACT DEFINITION 4
BLANKET ADDITIONAL INSURED (OWNERS, CONTRACTORS OR LESSORS) 2
BODILY INJURY 4
BROADENED COVERAGE FOR DAMAGE TO PREMISES RENTED TO YOU 2
DUTIES IN THE EVENT OF OCCURRENCE,OFFENSE,CLAIM OR SUIT 4
INCIDENTAL MEDICAL MALPRACTICE 2
MOBILE EQUIPMENT 2
NEWLY FORMED OR ACQUIRED ORGANIZATIONS 3
PERSONAL AND ADVERTISING INJURY 4
SUPPLEMENTARY PAYMENTS 2
Ball Bonds
Loss Of Eamings
e
9
G
DP 79 96 07 13 ® 2013 Liberty Mutual Insurance,All rights reserved.
Includes wpyrtghted ere191121 of Inaurerrca Services Office,!aria.,with Its permission, Page 1 014 y
i
u
.. .......... .......__, .. ... .__._ __.. ........_..__..... ......... . __ _... ,. __
Secton 11 -Llablllty Is amended as follows:
I. SUPPLEMENTARY PAYMENTS
Paragraph L(t)(b) of A Coverages Is replaced by the following;
(b) Up to $3000 for cost of ball bond required because of accidents or traffic law violations arising out of
the use of any vehlple to which Business Liability Coverage for "bodily Injury" applies. We do not have
to furnish the bonds.
Paragraph 1.f.(1)(d) of A Coverages Is replaced by the following;
(d) All reasonable expenses Incurred by the Insured at our request to assist us In the Invastgatlan or
defense of the claim or "suit", Including actual loss of earnings. up to tpS0 a day because of Nlrine off
from work,
11. BROADENED COVERAGE FOR DAMAGE TO PREMISES RENTED TO YOU
With respect to the coverage provided under this endorsement, Section II •Liability Is amended as follows,
1. The final paragraph of B.A. Exclusions - Applicable To Business Liability Coverage Is deleted and
MEW replaced by the following:
r With respeol to the premises which are rented to you or temporarily occupied by you with the permis- J
sloe of the owner, Exclusions c., d„ e„ g„ In., k., I., m., n. and o. do not apply to "property damage".
2. Paragraph 0.2, Liability And Medical Expenses Llmlts Of Insurance Is deleted and replaced by the
g sm following,
The most we will pay under this endorsement for the sum of all damages because of all "property
damage" to premises while rented to you or temporally occupied by you with the permission of the
owner Is the Limit of Insurance shown In the Declaration.
3. Paragraph D.3. Liability And Madlcal Expenses Llmlts Of Insurance Is deleted.
III. INCIDENTAL MEDICAL MALPRACTICE
Exclusion 1.J.(4) does not apply to Incidental Medical Malpractice Injury coverage,
The following Is added to F.LIABILITY AND MEDICAL EXPENSES DEFINITIONS:
23. "Incidental Medical Malpractice Injury" means bodily Injury arising out of the rendering of or failure
to render, during the policy period, the following services;
a, medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or dev-
erages In connection therewith; or
Is. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances.
This coverage does not apply to:
1. expenses Incurred by the Insured for first- aid to others at the time of an accident and the DutiesIn
the Event of Occurrence, Claim or Suit Condltlon Is amended accordingly;
2. any Insured engaged in the business or occupation of providing any of the services described
x under a, and b, above;
a 3. Injury caused by any Indemnitee If such Indemnitan Is engaged In the business or occupatlon of
providing any of the services described under a,and b. above,
IV. MOBILE EQUIPMENT -
1. Section C.Who is An Insured Is amended to Include any person driving "mobile equipment" with your
permission,
V. BLANKET ADDITIONAL INSURED (OWNERS, CONTRACTORS OR LESSORS)
I. Sartori C. Who Is An Insured Is amended to Include as an Insured any person or organization whom
you are required to name as an addltlonal Insured on this policy under a written contract or written
agreement, The written contract or agreement must be:
a. currently In effect or becoming effective during the term of this policy; and
Is. executed prior to the "bodily Injury", "property damage", "ponsonal and advertising Injury",
I�
® 2013 Liberty Mutual Insurance.All dghls reserved.
SP 79 96 07 13 Includes copyrighted material of Insurance Services Offlca,Inc„with Its permisslon. Page 2 of 4
j
2. The Insurance provided the additional Insured Is limited as follows:
a. The person or organization Is only an additional Insured with ,respect to liability arlsing out of
(1) Real property, as described In a written contract or written agreement, you own, rant, lease,
maintain or occupy;
(2) Caused In whole or In part by your ongoing operations performed for that insured.
b. The limits of insurance applicable to the additional Insured are those specified in the written
contract or written agreement or the limits available under this policy, as stated In the Declara-
Ilona, whichever are less. These limits are Inclusive of and not In addition to the limits of insurance
available under this policy.
c. The Insurance provided the additional Insured does not apply to:
(1) Liability arising out of the sole negligence of the additional insured;
(2) "Badfly Injury", 'proporty damage" "personal and advertising Injury"; or defense coverage
under the Supplementary Payments section of the policy arising out of art arctiiteot's, en-
9 tears or surveyor's rendering of or faiEuro to render any professional services including:
(a) The Preparing, approving wraps, shop drawings, opinions, reports, surveys, fleld orders, i
change orders, or drawings and spsciflcefions; and
(b) Supervisory, ,Inspection, architectural or engineering activities,
(3) Any "occurrence" that takes place after you cease to be a tenant In the premises described In
the Declarations; or
(4) Structural alterations, new construction or demolition operations performed by or for the
person or organization designated in the Declarations.
3. Any coverage provided hereunder shall be excess over any other,valid and collectible Insurance avall-
able to the additional Insured whether primary, excess, contingcrid or on any other basis unless a
contract specifically requires that this Insurance be phinary or you request that It apply on a primary
basis.
VI. NEWLY FORMED OR ACQUIRED ORGANIZATIONS
The following Is added to C.Who Is An Insured:
3. Any business entity acquired by you or Inocrpurated or organized by you under the laws of any
Individual state of the United States of America over which you maintain majority ownership Interest
exceeding fifty percent, Such acquired or newly formed organization will qualify as a Named Insured If
there Is no similar Insurance available to that unity, However,
a. Coverage_under this provision is afforded only until the 150th day .after the entity was acquired or
Incorporated or organized by you or Ilia end of Ina policy period, whichaver Is earfler,
b. Coverages A. Paragraph 1, Business Liability, does not apply to:
(1) "Bodlly Injury" or "property damage" that occurred before the entity was acquired or Incor-
porated or organized by you; and
ro (2) "Personal and advertising Injury" arising out of an offense committed before the entity was
acquired or Incorporated or organized by you; and
c, Records and descriptions of operations must be maintained by the first Named Insured.
No person or organization Is an insured with respect to the conduct of an current y Or past partnership,
Joint venture or limited lability company that Is not shown as a Named Insured In the Declarations.
VII. AGGREGATE LIMITS f
The following Is added to Aggregate Limits Paragraph 4. of D. Liability and Medical Expenses Limits of
Insurance:
The Aggregate Limits apply separately to each of"locations" owned by or rented to you or temporally
occupied by you with the permission of the owner,
The Aggregate Limits also apply separately to each of your projects away from premises owned by or
rented to you.
For the purpose or this aridorsement only, "location" means premises Involving the same or connect-
Irng lots, or premises whose connection is Interreplad only by a street, roadway, waterway or right- J
of-way of a railroad.
® 2013 t-Mbaaty Mutual Insurance.All rights reserved.
3P 79 96 07 13 includes copyrighted material of Insurance Sale lnaa offlce,Ino.,with Its permission, Page 3 of 4
Vfll. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE,CLAIM OR SUIT
1. The requirement In E. Liability And Medical Expenses General Conditlons paragraph 2.a, that you must
see to If that we are notified of an "acconence" or offense which may result In a claim applies only
when the "Occurrence" Is known to any Insured listed In Paragraph C.1, Who Is An Insured or any
"amyoloyee" authorized by you to give or recelve notice of an "accurrence" or claim. p
2. The requirements In E. Liability And Medical Expenses General Conditions paragraph 2.b, that you
must see to It that we receive notice of a claim or "suit" will not be considered breached unless the
breach occurs after such claim or"suit" Is known to any Insured listed under Paragraph C.I. Who Is An
insured or any "employee',. authorized by you to give or receive notice of an"occurrence" or claim,
IX. BODILY INJURY
Paragraph 3, of F Liability And Medical Expenses Definitions is replaced by the following:
3. 'Bodily Injury" means:
a. Bodily Injury, sickness, disease, or Incidental medical malpractice Injury sustained by a person,
e' and includes mental anguish resulting from any of these; and Including death resulting from any
of these at any time.
X. AMENDMENT OF INSURED CONTRACT DEFINITIDN
iEM Paragraph 9, of F.Liability And Medical Expenses Deflnitlons Is replaced by the following.
9. "Insured contract" means:
_ a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that Indemnlfles any person or organization for damage by flre to premises while rented to you or
temporarily occupied by you with parmisslon of the owner Is not an "Insured contract
to A sidetrack agreement;
c, Any easement or license agreement, except In connection with construction or demolition oper-
ation on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to Indemnify a municipality, except in connection with
work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement pertaining to your business (Including an Indem-
niflcation of a municipality In connection with work performed for a municipality) under which you
assume the tort liability of another parry to pay for 'bodily Injury" or "property damage" to a third
person or organization, provided the "bodily Injury" or "property damage" Is caused, in whole or
in part, by you or by those acting on your behalf, However, such part of a contract or agreement
shall only be considered an "Insured contract" to the extent your assumption of the tort liability is
permitted by law. Tort Ilabllity means a liability that would be Imposed by law In the absence of
any contract or agreement,
Paragraph f. does not Include that part of any contract or agreement:
(1) That Indemnities a railroad for "bodily Injury" or "property damage" arising out of coralmo-
e lion or demolition operations, within 50 feet of any railroad property and effecting any railroad
bridge or trestle, tracks, road-beds, tunnel, underpass or crossing;
(2) That Indemnities an architect, engineer or surveyor for Injury or damage arising out of:
(a) Preparing, approving, or falling to prepare or approve, maps. shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications: or
bJ Glving directions or Instructions, or falling to give them, If that Is the primary cause of the
Injury or damage; or
(3) Under which Vie Insured, If an nrchlteet, engineer or surveyor, assumes liability for an Injury
Or darnage arising out of the Insured's rendering or failure to render professional services,
Including those Isted In (2) above and supervisory, Inspection, architectural or engineering '
activities.
XI. PERSONAL AND ADVERTISING INJURY
Paragraph 14. to of F, Liability And Medical Expenses Detlnlllons is replaced by the following:
b. Malicious Prosecution or abuse of process
0 2013 Liberty Mutual Insurance,All rights reserved.
BP 79 96 07 13 Includes copyrighted materiel of Insurance Services Office,Inc.,with Its permisabn. Page 4 of 4
CERTIFICATE OF LIABILITY INSURANCE IMhV0D11Y"'I
-. 1212'81 ol7
THI3 CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTt-`"ATE HOLDER.THIS
CERTIFICATE DOES NOTAE OFIN IVELYINSURANCE
E NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDEI BY THE POLICIES
BELOW. THIS CERTIFICATE UC INSURANCE DOES NOT CONSTITUTEA CONTRACT BETWEEN THE ISSUING INSUR aRIS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT! Iflhe corlificato holdor is an AODITTONA,L gNSURED,MO pollCy(fea)must be endorsed, If SUBREIGATCON,15 WAIVED,SB7jO'Ct to
-
the the forms and conditions of the policy,cif pollcles may require an endorsement. A statement on this certificate% a;,i
certificate holder In Ilou of such endorsement(s), not confer rights to the
PRODUCER
Stanford Insurance Inc NAME: •
905 S 336Ih St Sle 102 r - °---�J .No
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INSIaRER S aFFDRDaNcoauERd c. - MAW ifFederal Wsy WA 98003 INSURERA; CDotinontel O'aSuatry 20443
INSURED
INSURER a.;
JECB-Jason Engineering&Consulting Business iNSURERC;. _ —'--
DO Box 832 INSUR.ERO; ° .
YNSGJRER E
Auburn' WA g8071 SURER F
- YN '
COVERAGES . .CERTIFICATE NUMBER,: REVISION NUMBER.
THIS IS TO CERTJFYT14AT THE POLICIES OF INSURANCE LISTED BELOW HAV€BEEN ISSUED TO THE INSURED NAM ED ABOVE FOR THE POLICY PERIOD
INDICATED_ NOTWITHSTANOINGANY 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,
LTR TYPSOFINSURANCE na A -
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DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES IACORO 101,Addl(laml Rem vMA Schedule,M W M lithe Md If mom specs 4 ndulr.d)
Evidence OF Insurance
C Ti . OLD' Gd ANOELUATION'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL E'DELIVERED IN
City of Kent Public Woks ACCORDANCE WITH THE POLICYpROVISIONS.
2200 AID Ave So
AUTHORIZED REPRESENTATIVE
Kent WA 98032 /rry.
- ®'1888.2014ACOROCORPCrIATION. Allrlghtareserved.
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