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HomeMy WebLinkAboutPK18-370 - Original - All Around Fence Company - Contract - 09/18/018 T Records Management Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's Office. All portions are to be completed. If you have questions, please contact the City Clerk's Office at 253-856-5725. E] Blue/Motion Sheet Attached r] Pink Sheet Attached Vendor Name: ALL AROUND FENCE COMPANY Vendor Number (]DE): 335391 Contract Number (City Clerk): Category: Contract Agreement Sub-Category (if applicable)�° Chaw-,c Project Name: Chestnut Ridge Park Fence Installation Contract Execution Date: 9/18/2018 Termination Date: 10/31/2018 Contract Manager: Ben Levenhagen Department; Parks Contract Amount: $13.196.70 Approval Authority: XEI Director D Mayor F-1 City Council Other Details: SuDolv labor and materials to install replacement fencing at Chestnut Ridge Park, located at 9901 South 203 rd Street, Kent WA 98031. . ......... .... '"�—✓". KEN T PUBLIC WORKS AGREEMENT between City of Kent and All Around Fence Company THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and All Around Fence Company organized under the laws of the State of Washington, located and doing business at 14323 161h Street East, Sumner, WA 98390-9633, Mailing address: P.O. Box 1029, Ravensdale, WA 98051-8101. Contact: Ron Dagley, Phone: 253-863-4895, Fax: 253-863-0704 (hereinafter the "Contractor"). AGREEMENT The parties agree as follows: I. DESCRIPTION OF WORK. Contractor shall perform the following services for the City in accordance with the following described plans and/or specifications: Installation of 279 feet of replacement fencing at Chestnut Ridge Park, located at 9901 South 203r1 Street, Kent WA 98031. This is a 4 foot+- high 3 rail fence, prepainted white. To include 2 by 4 mesh galvanized wire up to the 2nd rail with 6 inch by 6 inch posts; all posts in straps - reuse and fabricate as needed. All rails are to be 2 inch by 8 inch pressure treated wood. Includes the tear-out and haul-away of materials. All work as described in Proposal/Conract dated 09/27/2017 attached and marked as Exhibit A. Contractor further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time such services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon execution of this Agreement. Upon the effective date of this Agreement, Contractor shall complete the work described in Section I by October 31, 2018. III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed THIRTEEN THOUSAND ONE HUNDRED NINETY SIX DOLLARS AND SEVENTY CENTS ($13,196.70), including any applicable Washington State Sales Tax, for the work and services contemplated in this Agreement. The City shall pay the Contractor eighty-five percent (850%) of the Contract amount upon completion and acceptance of the work by the City, or at such earlier time as the City may determine is appropriate. The City will pay the remaining Contract amount upon fulfillment of the conditions listed below and throughout this Agreement. A, No Payment and Performance Bond. Because this contract, including applicable sales tax, is $150,000 or less, and pursuant to Chapter 39.08 RCW, the Contractor, in lieu of providing the City a payment and performance bond, has elected to have the City retain the final ten percent (10%) of the Contract amount for a period of thirty (30) days after the date of final acceptance, or until receipt of all necessary releases from PUBLIC WORKS AGREEMENT - 1 ($20K or Less and No Performance Band) the State Department of Revenue, the State Department of Labor & Industries, and the State Employment Security Department, and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. B, Retainege. The City shall also hold back a retainage in the amount of five percent (5%) of any and all payments made to contractor for a period of sixty (60) days after the date of final acceptance, or until receipt of all necessary releases from the State Department of Revenue, the State Department of Labor & Industries, and the State Employment Security Department, and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. The amount retained shall be placed in a fund by the City pursuant to RCW 60.28.011(4)(a), unless otherwise instructed by the Contractor within fourteen (14) calendar days of Contractor's signature on the Agreement. C. Defective r Unauth,o orize Work The City reserves its right to withhold payment from Contractor for any defective or unauthorized work. Defective or unauthorized work includes, without limitation: work and materials that do not conform to the requirements of this Agreement; and extra work and materials furnished without the City's written approval. If Contractor is unable, for any reason, to satisfactorily complete any portion of the work, the City may complete the work by contract or otherwise, and Contractor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Contract price specified above. The City further reserves its right to deduct the cost to complete the Contract work, including any Additional Costs, from any and all amounts due or to become due the Contractor. D, Final Palm nt: Waiv r of Claims. THE CONTRACTOR'S ACCEPTANCE OF FINAL PAYMENT (EXCLUDING WITHHELD RETAINAGE) SHALL CONSTITUTE A WAIVER OF CONTRACTOR'S CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY CONTRACTOR AS UNSETTLED AT THE TIME FINAL PAYMENT IS MADE AND ACCEPTED. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Contractor has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Contractor maintains and pays for its own place of business from which Contractor's services under this Agreement will be performed. C. The Contractor has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Contractor's services and is a service other than that furnished by the City, or the Contractor is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Contractor is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Contractor has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Contractor's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. PUBLIC WORKS AGREEMENT - 2 ($20K or Less and No Performance Bond) F. The Contractor has a valid contractor registration pursuant to Ch. 18.27 RCW or an electrical contractor license pursuant to Ch. 19.28 RCW. G. The Contractor maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. The City may terminate this Agreement for good cause. "Good cause" shall include, without limitation, any one or more of the following events: A. The Contractor's refusal or failure to supply a sufficient number of properly skilled workers or proper materials for completion of the Contract work. B. The Contractor's failure to complete the work within the time specified in this Agreement. C, The Contractor's failure to make full and prompt payment to subcontractors or for material or labor. D. The Contractor's persistent disregard of federal, state or local laws, rules or regulations. E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt. F. The Contractor's breach of any portion of this Agreement. If the City terminates this Agreement for good cause, the Contractor shall not receive any further money due under this Agreement until the Contract work is completed. After termination, the City may take possession of all records and data within the Contractor's possession pertaining to this project which may be used by the City without restriction. VI. PREVAILING WAGES. Contractor shall file a "Statement of Intent to Pay Prevailing Wages," with the State of Washington Department of Labor & Industries prior to commencing the Contract work. Contractor shall pay prevailing wages in effect on the date the bid is accepted or executed by Contractor, and comply with Chapter 39.12 of the Revised Code of Washington, as well as any other applicable prevailing wage rate provisions. The latest prevailing wage rate revision issued by the Department of Labor and Industries is attached. VII. CHANGES. The City may issue a written change order for any change in the Contract work during the performance of this Agreement. If the Contractor determines, for any reason, that a change order is necessary, Contractor must submit a written change order request to the person listed in the notice provision section of this Agreement, section XV(D), within fourteen (14) calendar days of the date Contractor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Contractor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Contractor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Contractor shall proceed with the change order work upon receiving either a written change order from the City or an oral order from the City before actually receiving the written change order. If the Contractor fails to require a change order within the time specified in this paragraph, the Contractor waives its right to make any claim or submit subsequent change order requests for that portion of the contract work. If the Contractor disagrees with the equitable adjustment, the Contractor must complete the change order work; however, the Contractor may elect to protest the adjustment as provided in subsections A through E of Section VIII, Claims, below. The Contractor accepts all requirements of a change order by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. A change order that is accepted by Contractor as provided in this section shall constitute full payment and final settlement of all PUBLIC WORKS AGREEMENT - 3 ($20K or Less and No Performance Bond) claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. i VIII. CLAIMS. If the Contractor disagrees with anything required by a change order, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Contractor may file a claim as provided in this section. The Contractor shall give written notice to the City of all claims within fourteen (14) calendar days of the occurrence of the events giving rise to the claims,, or within fourteen (14) calendar days of the date the Contractor knew or should have known of the facts or events giving rise to the claim, whichever occurs first . Any claim for damages, additional payment for any reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively deemed to have been waived by the Contractor unless a timely written claim is made in strict accordance with the applicable provisions of this Agreement. At a minimum, a Contractor's written claim shall include the information set forth in subsections A, items 1 through 5 below. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. A. Notice of Cf im. Provide a signed written notice of claim that provides the following information: 1. The date of the Contractor's claim; 2. The nature and circumstances that caused the claim; 3. The provisions in this Agreement that support the claim; 4. The estimated dollar cost, if any, of the claimed work and how that estimate was determined; and 5. An analysis of the progress schedule showing the schedule change or disruption if the Contractor is asserting a schedule change or disruption. B. Rec o r s. The Contractor shall keep complete records of extra costs and time incurred as a result of the asserted events giving rise to the claim. The City shall have access to any of the Contractor's records needed for evaluating the protest. The City will evaluate all claims, provided the procedures in this section are followed. If the City determines that a claim is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. C. Contractor's Duty to Complete .Pr ted Work. In spite of any claim, the Contractor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. D. Failure to Protest Constotutes Waiver. By not protesting as this section provides, the Contractor also waives any additional entitlement and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). E. Ea11ure flow Procedures Constitutes Wauver. By failing to follow the procedures of this section, the Contractor completely waives any claims for protested work and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). IX. LIMITATION OF ACTIONS. CONTRACTOR MUST, IN ANY EVENT, FILE ANY LAWSUIT ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATE THE CONTRACT WORK IS COMPLETE OR CONTRACTOR'S ABILITY TO FILE THAT CLAIM OR SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. PUBLIC WORKS AGREEMENT - 4 ($20K or Less and No Performance Bond) X. WARRANTY. Contractor warrants that it will faithfully and satisfactorily perform all work provided under this Agreement in accordance with the provisions of this Agreement. The Contractor shall promptly correct all defects in workmanship and materials: (1) when Contractor knows or should have known of the defect, or (2) upon Contractor's receipt of notification from the City of the existence or discovery of the defect. In the event any parts are repaired or replaced, only original replacement parts shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for that portion of the work shall extend for an additional year beyond the original warranty period applicable to the overall work. The Contractor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Contractor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Contractor shall pay all costs incurred by the City in order to accomplish the correction. XI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Contractor, its sub-contractors, or any person acting on behalf of the Contractor or sub-contractor 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. Contractor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. XII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Contractor's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Contractor's work when completed shall not be grounds to avoid any of these covenants of indemnification. 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 Contractor and the City, its officers, officials, employees, agents and volunteers, the Contractor's duty to defend, indemnify, and hold the City harmless, and Contractor's liability accruing from that obligation shall be only to the extent of the Contractor's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONTRACTOR'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 Contractor refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Contractor's part, then Contractor shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Contractor's part. The provisions of this section shall survive the expiration or termination of this Agreement. XIII. INSURANCE. The Contractor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. XIV. WORK PERFORMED AT CONTRACTOR'S RISK. Contractor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the PUBLIC WORKS AGREEMENT - 5 ($20K or Less and No Performance Bond) performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Contractor's own risk, and Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XV. MISCELLANEOUS PROVISIONS. A. Recyclab[e 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. on 'Waiver caf Farah. 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 Uisputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; prov'rcled, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section XII 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. A sii amen . 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 Contractor. G. entire Agreemen . 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. ComQNance with Laws. The Contractor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Contractor's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Contractor acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Contractor in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or PUBLIC WORKS AGREEMENT - 6 ($20K or Less and No Performance Bond) possessed by the City of Kent. As such, the Contractor agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. J. Ci�usiness License Reguired. 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. K. Counterparts and Signatures .fFax 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 th e eon final signature w 9 9 e as 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. _. _. _... ..... ......... ___ _ ------- .._____— CONTRACT CITY OF KENT: By:_ ........... .. By: ! (signature) (signature) Print ,�ame ( ✓` _ I ame: Julie Parascondola, CPRE k _ Its_ _ I s: Director -Parks, Recreaction and _. irte)DATE:- Community Services Dept. -...�f��._�...L.......... DATE: mm......m — ............ _.._.._. - _ _..._...._.—.. . NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONTRACTOR: CITY OF KENT: Ron Dagley Ben Levenhagen, All Around Fence Company Support Services Field Supervisor P.O. BOx 1029 City of Kent Ravensdale, WA 98051-8101 220 Fourth Avenue South Kent, WA 98032 (253) 863-4895 (telephone) (253) 856-5133 or (telephone) (253) 863-0704 (facsimile) (253) 508-9548 (cell) (253) 856-6120 (facsimile) ATTE T: Kent City Clerk PUBLIC WORKS AGREEMENT - 7 ($20K or Less and No Performance Bond) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing be)aV, I agree o ulfill the five requirements referenced above. For:.,...,.,._. Title: " , Date: �� y ,........_ 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 I This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the I 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 BIDDER RESPONSIBILITY CRITERIA Certification of Compliance with Wage Payment Statutes I This certification is required by state law (RCW 39.04.350(2)) to be submitted to the City before the contract can be awarded. The bidder hereby certifies that, within the three-year period immediately preceding the bid solicitation date ( 09/27/2017 ), the bidder is not a "willful" violator, as defined in RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding citation and notice of assessment issued by the Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. All Around Fence Company BY ...... t Signature of Authoriial*Printed Name: Lvv'�. Title: .._........ City and State: *If a corporation, proposal must be executed in the corporate name by the president or vice- president (or any other corporate officer accompanied by evidence of authority to sign). If a co- partnership, proposal must be executed by a partner. BIDDER RESPONSIBILITY CRITERIA - 1 812812018 about:blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Washington State Prevailing Wage The PREVAILING WAGES listed here include both the hourly g Y g wage rate and the hourly rate of fringe benefits. On public works projects, worker's wage and benefit ra tes ates must add to not P J less than this g total. A brief description of overtime calculation requirements are provided on the Benefit Code Key. _... . .. . ---.. ..... Journey Level Prevailing Wage Rates for the Effective Date: 8/28/2018 ',ouai;H;ily IIa adle ....... Job Classificat n Wage Holiday Overtime Note Mng Fence Erecc F a Ura e IE:rectau $15.18 1 aboutblank 1/1 "- All-Around Fence Co. Estimate Date September 27 2017 EXHIBIT A tlicensed • Bonded . Insured Estimator: Ron a.PO Box 1029 Ravensdale,WA 98051-8101 c Ph:(253)863-4895 I Fax (253)853-0704 m w `w. ... Email:allaroundfence@msmoom FENCE COS„ www.allaroundfencewa.com PROPOSAL / CONTRACT ' ' License No.ALLARAF-839KS Customer: City of Kent —Chestnut Park Contact Name: Brian Saw Phone #1: 253 470-7083 Email: bsaw@kentwa.org Site Address. 9901 S. 203rd Street, Kent WA 98031 Billing Address: — —.�_........" — ------_.— Directions: This is a prevailing wage job. i Chain Vinyl '3 y0.L� .._.� 3--"(`wt 'w✓^". ..... Wood Link 0/1 Other - Footage see J Height POSTS; Terminal j Line Gate --... P , _.... ..-.... - Material Specs, Top Rail 'ZXHP, Middle Rail Z,f$ . . Bottom Rail Tension Wire Standard Estate ONE YEAR GUARANTEE on Workmanship & Materials Supplied by AAFCo Full Panel NOTES:_ Office Use Only r_ Picture Frame _.._.... .... .......,w® M/D Kirkland n Rambler Lattice Top _...._._ ___._ M/D/U i Horizontal ❑ Custom f WE DO NOT PAINT OR STAIN. NO EXERTIONS. GATES: 2.THIS CONTRACT IN PRINTED OR ELECTRONIC FORM IS SU EJECT TO THE TERMS AND - CONDITIONS OF WHICgA . ADE APART HEREOF BY THIS REFERENCE, Price Walk Gate 3-WE PROPOSE herebsh mate . and labor-complete in accordance with theSingle Drive above specificationsDouble Drive Authorized by: Tax .._... ............. . ._ li r APPLIT11) Hillside NOTE:This proposal may be withdrawn by AAFC 'if not accepted within thirty(30)days. Roll Gate Clearing The prices, specifications and conditions are satisfactory and are hereby accepted. XTearCut )(Haul-Away Customer Signature;. Date: TERMS: Payment due upon receipt of invoice. We accept checks, money orders and,for a fee,credit cards. NOT RESPONSIBLE FOR,SPRINKLER LINES•Customer is responsible to mark utility locations. Rev, 08/2017 I 1 d L Id ci 1 $ Y S 7 � g r r N V � \ H I Q r .. d x S r � J 4 EXHIBIT B INSURANCE REQUIREMENTS FOR CONSTRUCTION PROJECTS Insurance The Contractor 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 Contractor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Contractor shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hued and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form C.A. 00 01 or a substitute farm providing equivalent liability coverage. If necessary,the policy shall be endorsed to provide contractual liability coverage, 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. There shall be no endorsement or modification of the Commercial General Liability insurance for liability arising from explosion, collapse or underground property damage. The City shall be named as an insured under the Contractor'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. 2. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Contractor 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. Generalldahihly insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate and a$2,000,000 products- completed operations aggregate limit, I EXHIBIT B (Continued) i C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain,the following provisions for Automobile Liability, Commercial.General Liability and Builders Risk,insurance: 1. The Contractor'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 Contractor's insurance and shall not contribute with it. 2. The Contractor'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. D. Contractor's Insurance For Other Losses The Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, Contractor's employee owned tools, machinery, equipment, or motor vehicles owned or rented by the Contractor, or the Contractor's agents, suppliers or contractors as well as to any temporary structures, scaffolding and protective fences. E. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. F. Verification of Coverage Contractor 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 Automobile Liability and Commercial General Liability insurance of the Contractor before commencement of the work. Before any exposure to loss may occur, dze Contractor shall file with the City a copy of the Builders Risk insurance policy that includes all applicable conditions, exclusions, definitions, terms and endorsements related to this project. G. Subcontractors Contractor 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 Contractor. CET, � a. [GATE OF LIABILITY INSUF%—,N,E DATF'MMIDnYYYYI 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the VAINUTICAM holder is an ADDITIONAL INSURED,the policy{wi k: must t>e emdons11 If$CJBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may r0tulre an endorsement A statement on Nis certificate does not confer rights to the certificate holder In lieu o1 such endorsement{sJ. PRODUCER Carl Maciolak, ACSR Boll Anderson Agency, Inc. - (425)291 N4.E,atl _ .,. ......,,..._ 11Mr�yp)_,-(425)293 5100 600 SW 39th St, Suite 200 iUSll cari.m@hell-andarson.com '"'"' .._.,— YNSUR&RLaj AFFORDINp 00YERAdE NAK;r Renton WA 98057 ........ INSURERACORtinemtal We tern Ina. Del INSURED ._. ,. ......_..._..,, ... .__.. .. ._. ...— .__. ,.... .._.-, ....... -.._ .._.,..,., 1OB04 MS RER e A11 Around Fence Company INSURERC PC Box 1029 NUPWR 0, --- NSURER E Ravens dal! ----. . -_. RA 98051 INSURER F COVERAGES. CERTIFICATE NUMBERCL1712126259 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 CERTIFICATE MAY BE ISSUED DR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.IECT TO ALL THE TERMS TG WHICH THIS EXCLUSIONS AND CONDI NONS OF SUCH POLICIES LIMI TO SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS YN.�a' - - ...- _ --M21OL BilAA .. . ......_....._... _—_._ TYPE OF INSURANCE ....._.._.. T n POLN;YEFF POLICY EXP � ...........-.... NMMS] LTCY NUMBER LIMITS 7C COMMERCIAL pERERAI.LLABILI4Y EACH OCCAIRRLNCE ...- 1 1,000,000 A CLAWSMACE, ]ri ' GI'Cu,u.1N bA liG'E T6`SfFN'TFp _.' _......— "'-° PFdI Tx PA, t2 f 300,000 X y CPA602961222 12/l/201"I 12/1/2018 ME GYP an_ f 7. tro.me�_'a lo,0oa ... __-... -. +mmRSQNA1 d ADV INJURY y 1 000,000 GENLAGGREGATE LIMIr APPLIES PER { "- ---_>- 1 rrRC), l CENERAL ACCREIEArt 1 2,000,000 POLICY R ........_.._.." _....... .fFCT LOU PRODUCTS-COMP/aP AGG 1 2,000,000 AUYOMpBIL.E LIASLH Y' f d J ,M1 YI I 7S ANY AP,,a 1,000,000 .. _... ,.. ' - 8001LY INJURY(PeT pgT n 1 ALL OWNED SCHEDULED _ AUTOS ALTOS E Y CPA602961222 1, 12/1/201T ' J.2/1/2018 EGOILv INJURY(PV sypant) $ i THREE AUTOS NON-0WNED AUTOS R1""r nRN�Fi'CIAMAUE...._,I $ UMBRELLA LIAB 'OCCUR r AGCH EGA IURREMGC 1 2 A -_ }EXCESS LIAs �CLAJAS-WDE'. �. EACH VIC `OC.D m....mm CPA602961222 12/1/201T 12111 WORKERS COMPENSATK)N N E 10 0C16 ��`.. 9 H AND EMPLOYERS' AN rNEIY _ _�' .._ OR ...._..._.._ ' YIN °J IA1 I ;ANY PRrYMEMaI ExCTNER,FnEGL LIVE ._......___.. A l r.1Pfn;sNgIM9ER EKGLUCCO"+ ".NIA' EL EACH-- IUENT ;1 SfRIM ry{}ry OirIpVFV'dAPIQAtS below j`C�PA5602961222 � 12/1/2012 Y L2/1/201tl kL "SEA5E.d'+67L ICYLIMIT�S 1,0©�t 000 14f se L oa ,'0-Fz �F CIAP t 01"EAyL Eh EMFlLJ. f t U00 000 DIS s C coo DESC PTON OF IT The�certificateo holder LOCATIONS vadditiona �red per the attached endor w.alAr.#CL per attached endorsement RCLCGG529 0916, MCLCG2071 0916 and MCLCA0149 0215. Waiver of subrogationattached andorsamant #ICLCG0492 0915 and #ICLCA0149 0215. Primary 6 non-contributory coverage per the attached endoraemant NCLCGO529 0916 and #CLCG2071 0916, CERTIFICATE HOLDER CANCELLATION jadavis@kentwa. gov ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE FKent, ofent THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ntenance ACCORDANCE ARTH THE POLICY PROVISIONS, reation 6 Community Services Avenue South AUTHOR QED RE PRESENTATIVE 98032 Sa,on Webb/GEM ©1906-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INB026 nm an++ COMMERCIAL GENERAL LIABILITY CL CG 04 92 09 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ULTRA PLUS ENDORSEMENT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGE EXTENSIONS Provision Name Of Coverage Extension Included or-Li m i t of Insurance A. Miscellaneous Additional Insureds Included _ 8 Expected Or Intended Injury Or Damage """ ` _ . .... __... Included C. Knowledge Of Occurrence Included--- ._ D. Legal Liability Damage To Premises Rented To You Fire Li htniin Q Lightning, $300,OOD Ex Posaon Smoke,ntOr Leakage From Automatic Fire Protective Systems) E Medical Payments $10,000 _ F, Mobile Equipment Redefined """" "— """" -- __.._ Included _...._m. _.._..� .— _ _ _ G. Newy Formed Or Acquired Organization, Partnership Or LimitedmLiability Included _.. _Company And Extended Period Of Coverae H, Who Is An Insured -Am m endent F — - ncluded I. Non-Owned Watercraft (Increased to maximum length of less than 51 Included _. feet J. Supplementary Pa -_..- _....__. pp ry Payments Increased Limits — — 1. Bail Bonds $3,000 2. Loss Of Earnings -- __.._._—. . __. —.,_. — ._.._ K. ' Unintentional Omission Or Unintentional Error In Disclosure _ --- — Included L Waiver Of Transfer Of Rights Of Recovery Against Others ncluded M. Liberalization Clause Included _— N ncidental Medi_cal Malpractice — — ---� Included The above is a summary only Please consult the specific provisions that follow for complete information on the extensions provided. The provisions of the Commercial General Liability additional insured on your policy, provided Coverage Part apply except as otherwise provided in that this endorsement This endorsement applies only if such Coverage Part is Included in this policy a. The written contract or written agreement A. MISCELLANEOUS ADDITIONAL INSUREDS is. (1) Currently in effect or becoming 1. Section II - Who Is An Insured is amended effective during the term of this to include as an insured any person or policy, and organization (referred to as an additional insured below) described in Paragraphs (2) Fully executed by you and the AA.c.l through AA.c.(6) below when you additional insured prior to the "bodily and such person or organization have agreed injury", "property damage" or "per- in writing in a contract or agreement that sonal and advertising injury" such person or organization be added as an CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc Page 1 of 7 with its permission I The insurance afforded,by this provision performed by or on behalf of does not apply to any person or such additional insured organization included as an additional insured by a separate endorsement (4) Lessor Of Leased Equipment issued by us and made a part of this Any person(s) or organezation(s) policy or coverage part. from whore you lease equipment but C. Only the following persons or organi- only with respect to liability far"boni zations are additional insureds under this injury"" "property damage" or "per. provision, with coverage for such sonall and advertising injury" caused additional insureds limited as provided on whole or in part, by your herein maintenance, operation or use of equipment leased to you by such (1) Managers Or Lessors Of Premises person(s) or organizations) O A manager or lessor of premises but A person(s or organization's status only with respect to liability arising as an additional insured under this Out of the ownership, maintenance or endorsement ends when their written use of that part of the premises contract or written agreement with leased to you and subject to the you for such leased equipment ends following additional exclusions This insurance does not apply to any This insurance does not apply to 11 occurrence'' which takes place after (a) Any "occurrence" which takes the equipment lease expires place after you cease to be a (5) State, Municipality, Governmental tenant in that premises Agency Or Subdivision Or Other (b) Structural alterations, new con- Political Subdivision — Permits Or struction or demolition operations Authorizations Relating To performed by or on behalf Of Premises such additional insured. Any state, municipality, govern- (2) Mortgagee, Assignee Or Receiver mental agency or subdivision or other political subdivision subject to A mortgagee, assignee, or receiver the following additnonal provisions_ but only with respect to their liability as mortgagee, assignee, or receiver (a) This insurance applies only with and arising out of the ownership, respect to: maintenance, or use of a covered (i) The following hazards for premises by you which the state, municipality, This insurance does not apply to governmental agency or structural alterations, new con- subdivision or other political struction or demolition operations subdivision has issued a performed by or on behalf of such permit or authorization in additional insured connection with premises YOU Own, rent or control and (3) Owners Or Other Interests From to which this insurance Whom Land Has Been Leased applies. An owner or other interest from (1.1) The existence, whom land has been teased to you maintenance, repair, but only with respect to liability construction, erection arising out of the ownership, malnte- or removal of adver- nance or use of that part of the land tising signs, awnings, leased to you and subject to the canopies, cellar following additional exclusions entrances, coal holes, This insurancedoes not apply to driveways, manholes, marquees, hoist away (a) Any "occurrence" which takes openings, sidewalk place after you cease to lease vaults, street banners that land or decorations and (b) Structural alterations, new con- similar exposures, or struction or demolition operations CL CIS 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc Page 2 of 7 with its permission (1.2) The construction, erec- The insurance afforded the tion or removal of vendor does not apply tc. elevators or (i) "Bodily injury" or "property (1.3) The ownership, main- damage" for which the tenance or use of any vendor is obligated to pay elevators covered by damages by reason of the this insurance assumption of liability in a (ii) Operations performed by you written contract or written or on your behalf for which agreement This exclusion the state, municipality, does not apply to liability for governmental agency or damages that the vendor subdivision or other political would have in the absence of subdivision has issued a the written contract or written permit or authorization agreement, (b) This insurance does not apply to (ii) Any express warranty unau- "bodily injury", "property dam- thonzed by you, age"'or"personal and advertising (III) Any physical or chemical injury" arising out of operations change in the product made performed for the state, munici- intentionally by the pality, governmental agency or vendor, subdivision or other political subdivision (iv) Repackaging, except when unpacked solely for the (6) Controlling Interest purpose of inspection, Any person(s) or organization(s) with demonstration, testing, or the a controlling interest in the Named substitution of parts under Insured but only with respect to their instructions from the manu- liability arising out of facturer, and then repackaged in the original (a) Their financial control of you, or container, (bJ Premises they own, maintain or (v) Any failure to make such control while you lease or occupy inspections, adjustments, these premises tests or servicing as the This insurance does not apply to vendor has agreed to make structural alterations, new con- or normally undertakes to struction or demolition operations make in the usual course of performed by or for such person(s) business, in connection with or organizaticn(s) the distribution or sale of the (7) Co-Owner Of Insured Premises products, (vi) Demonstration, installation, A co-owner of a premises co-owned servicing or repair opera- by you and covered under this bons, except such operations insurance but only with respect to the performed at the vendor's co-owner's liability as co-owner of premises in connection with such premises the sale of the product, (8) Vendors (vii) Products which, after distri- (a) Any person(s) or organization(s) bution or sale by you, have (referred to as vendor), but only been labeled or relabeled or with respect to "bodily injury" or used as a container, part or property damage" arising out of ingredient of any other thing your products" which are or substance by or for the distributed or sold in the regular vendor, or course of the vendors business CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc, Page 3 of 7 with Its permission (viii) 'Bodilly injury" or "property 3. With respect to the insurance afforded to the damage" arising out of the additional insureds within this Provision A, sole negligence of the Miscellaneous Additional Insureds, the vendor for Us own acts or following is added to Section III -Limits of omissions or those of its Insurance employees or anyone else acting on its behalf How- The most we will pay on behalf of the ever, this exclusion does not additional insured is the amount of insurance. apply to a. Required by the written contract or (1.1) The exceptions written agreement, or contained in Sub- b. Available under the applicable Limits Of paragraphs (iv) or (vi); Insurance shown in the Declarations, or (1.2) Such inspections, ad- whichever is less justments, tests or This endorsement shall not increase the servicing as the applicable Limits Of Insurance shown In the vendor has agreed to Declarations make or normally B. EXPECTED OR INTENDED INJURY OR undertakes to make in DAMAGE the usual course of business, in con- Exclusion 2.a. Expected Or Intended Injury of nection with the Section I - Coverage A - Bodily Injury And distribution or sale of Property Damage Liability its deleted and the products_ replaced by the following (b) This insurance does not apply to a_ Expected Or Intended Injury Or Damage any insured person or organi- "Boil injury"' z t 9 y"' "property damage"expected ation, from whom you have or intended from the standpoint of the acquired products, or any insured This exclusion does not a. to ingredient, part or container, "bodilyinjury" apply entering into, accompanying or t l se or reasonable damage'' protect from ns use of reasonable force to protect containing such products. persons or property. 2. With respect to coverage provided by this C. KNOWLEDGE OF OCCURRENCE Provision A. Miscellaneous Additional Insureds, the following additional provisions Paragraph 2.a. Duties In The Event. Of apply Occurrence„ Offense, Claim Or Suit of Section IV - Commercial General Liability Conditions a. Any insurance provided to an additional is deleted and,replaced by the following insured designated under Paragraphs A.1.c.(1) through A.1.c.(8) above does a. You must see to it that we are notified as not apply soon as practicable of an "occurrence' or an offense which may result on a claim only (1) To "bodily injury" or 'property when the "occurrence` or offense is known damage" included within the to "products-completed operations hazard'', or (1) You, if you are an individual, (2) To 'Pi inJury", "property damage" (2) A partner, if you are a partnership, or "persanatl and advertising injury' arming out of the sole negligence of (3) A manager, if you are a limited liability such additional insured company; or. b. The insurance afforded to such additional (4) An "executive Officer' or the "employee" insured only applies to the extent designated by you to give such notice if permitted by law you are an organization other than a Partnership or a limited liability company c. The insurance afforded to such additional insured will not be broader than that To the extent possible, notice should include which you are required to provide by the (i) How, when and where the "occurrence" written contract or written agreement or offense took place, CL CG 04 92 09 16 Includes copyrighted matenal of Insurance Services Office, Inc , Page 4 of 7 with Is permission (ii) The names and addresses of any injured you, or in the case of damage by fore, persons and witnesses, and lighten ling explosion, "smoke", or leakage ON) The nature and location of any injury or fromi automatic fire protective systems„ damage arising out of the ''occurrence" while rented, to you or ternporarlfy or offense, occupied by you with permission of the D. LEGAL LIABILITY - DAMAGE TO PREMISES owner. RENTED TO YOU (Fire, Lightning, Explosion, This lirnit will apply to all damage y Smoke, Or Leakage From Automatic Fire Proximately caused by the same event Protective Systems) whether such damage results from fire, lightning, explosion °'smoke°' leakage If damage to premises rented to you is not from automatic fire protactve systems, or otherwise excluded from this policy or coverage other covered causes of Noss or any Part, then the following provisions apply combination thereof I. Under Section I - Coverage A - Bodily 4. Subparagraph b.(1)(a)(ii) of Paragraph 4. Injury And Property Damage Liability, the Other Insurance of Section IV last paragraph (after the exclusions) is Commercial General Liability Conditions deleted and replaced by t'he following is deleted and replaced by the following Exclusions c. through n. do not apply to dam- (ii) That is fire, lightning, explosion, "smoke" age by fire, lightning, explosion, "smoke'', or or leakage from automatic fire protective leakage from automatic fire protective systems insurance for premises rented to systems to premises while rented to you or you or temporarily occupied by you with temporarily occupied by you with the permission of the owner, permission of the owner A separate limit of insurance applies to this coverage as 5. Subparagraph a. of Definition 9. "Insured described in Section III - Limits Of contract" of Section V - Definitions is Insurance deleted and replaced by the following 2. The paragraph immediately after Sub- a. A contract for a lease of premises. paragraph j.(6) of Paragraph 2. Exclusions However, that portion of the contract for of Section I - Coverage A - Bodily Injury a lease of premises that indemnifies any And Property Damage Liability is deleted person or organization for damage by and replaced by the following fire, lightning, explosion, "smoke" or leakage from automatic fre protective Paragraphs (1), (3) and (4) of this exclusion systems to premises while rented to you do riot apply to "property damage" (other or temporarily occupied by you with than damage by fire, lightning, explosion, permission of the owner is not an smoke", or leakage from automatic fire "insured contract" Protective systems) to premises, including the contents of such premises, rented to you 6. As used in this Provision D. Legal Liability - for a period of seven or fewer consecutive Damage To Premises Rented To You days A separate limit of insurance applies to "Smoke" does not include smoke from Damage To Premises Rented To You as agricultural smudging, industrial operations described in Section III - Limits Of or"hostile fire" Insurance. 3. Paragraph 6. of Section III - Limits Of E. MEDICAL PAYMENTS Insurance is deleted and replaced by the If Coverage C - Medical Payments is not following otherwise excluded from this policy or coverage Part, the Medical Expense Limit is changed" 6. Subject to Paragraph 5. above, the subject to the terms of Section III - Limits Of greater of Insurance, to the greater of a. $300,000, or a. $10,000, or Id. The Damage To Premises Rented b. The Medical Expense Limit shown in the To You Limit shown in the Declarations. Declarations, is the mast we will pay under Coverage F. MOBILE EQUIPMENT REDEFINED A for damages because of "property Subparagraph f.(1) of Definition 12. "Mobile damage" to premises while rented to equipment" of Section V- Definitions is deleted and replaced by the following CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc Page 5 of 7 with its permission (1) Equipment with a gross vehicle weight of partnership or lirnited liabaht compan 1!,000 pounds or more and designed primanly y y for. are the same or similar to the operations of insureds already covered under this (a) Snow removal, insurance, (b) Road maintenance, but not construction Iv) Coverage only applies for those limited or resurfacing, or liability companies who have established (c) Street cleaning; a date of formation as recorded within the filed state articles of organization, G. NEWLY FORMED OR ACQUIRED ORGANI2A- certificates of formation or certificates of TION, PARTNERSHIP OR LIMITED LIABILITY organization, and COMPANY AND EXTENDED PERIOD OF (vi) Coverage only applies for those pert COVERAGE Warships who have established a date of Paragraph 3. of Section 11 - Who Is An Insured formation as recorded within a written is deleted and replaced by the following partnership agreement or partnership 3. Any organization you newly acquire or form, certificate other than a joint venture, and over which H. WHO IS AN INSURED-AMENDMENT you maintain ownership or The last paragraph of Section 11 - Who Is An a. Majority interest of more than 50% if you Insured is deleted and replaced by the foallowing. are a corporation, No person or organization is an insured with b. Majority interest of more than 50% as a respect to the conduct of any general partner of a newly acquired or a. Current partnership or limited liability formed partnership; and/or company, unless otherwise provided for c. Majority interest of more than 50% as an under Paragraph 3. of Section It - Who is owner of a newly acquired or formed An Insured, limited liability company, b. Current joint venture, or will qualify as a Named Insured if there is no c. Past partnership, joint venture or limited other similar insurance available to that liability company, organization However, for these organiza- tions that is not shown as a Named Insured in the (i) Coverage under this provision is afforded Declarations only until the next anniversary date of L NON-OWNED WATERCRAFT this policy's effective date after you Subparagraph (2) of Exclusion 2.g. Aircraft, acquire of form the organization, Auto Or Watercraft of Section f - Coverage A partnership or Pflmrted dial ity company, - Bodily Injury And Property Damage Liability or the end of the policy period, whichever is deleted and replaced by the following is earlier, (ii) Section I - Coverage A - Bodily Injury (2) A watercraft you do not own that is And Property Damage Llability does (a) Less than 51 feet long, and not apply to "bodily injury" or "property (b) Not being used to carry persons or damage" that occurred before you property for a charge. acquired or formed the organization, partnership or limited liability company; J. SUPPLEMENTARY PAYMENTS - INCREASED LIMIT'S (iii) Section I - Coverage B - Personal And Advertising Injury Liability does Section I - Supplementary Payments - not apply to "personal and advertising Coverages A And B is changed as follows injury" arising out of an offense 1. The limit shown in Paragraph 1.b. for the committed before you acquired or formed cost of bail bonds is changed^ from $250 to the organization, partnership or limited $3 000; and liability company, 2. The limit shown in Paragraph 1.d. for loss of (iv) Coverage applies only when operations earnings because of time off from work is of the newly acquired organization, changed from $250 a day to $1.000 a day CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc Page 6 of 7 with its permission i K. UNINTENTIONAL OMISSION OR UNINTEN- M. LIBERALIZATION CLAUSE TIONAL ERROR IN DISCLOSURE The fallowing provision is added to Para ra h, 6 The following is added to Section IV - g p Commercial General Liability Conditions:. Representations of Section IV - Commercial General Liability Conditions: If we adopt a Mandatory attachment form change However, the unintentional omission of or which broadens coverage under this edition of the Commercial General Liability CGO001 for no unintentional error in, any information given or additional charge, and those changes are provided by you shall not prejudice your rights intended to apply to all insureds under this edition under this insurance of CG0001, that change will automatically apply y pour insurance as of the date we im ferment This provision does not affect our right to collect to additional premium or to exercise our right of the change in your state This liberalization cancellation or non renewal clause does not apply to changes implemented L. WAIVER OF TRANSFER OF RIGHTS OF through introduction of a subsequent edition of the Commercial General Liability form CGO001 RECOVERY AGAINST OTHERS The following is added to Paragraph 9. Transfer N. INCIDENTAL MEDICAL MALPRACTICE Of Rights Of Recovery Against Others To us 1. Paragraph 2.a.j1 p(d) of Section II - Who Is of Section IV Commercial General Liability An insured does :not apply to a physician Conditions nurse practitioner, Physician assistant, nurse. We waive an right of recovery we may have emergency medical technician or paramedic y 9 ry Y employed by you if you are not in the against any person or organization because of business or occupation of providing medicaG, p yment$ we make for injury or damage arising paramedical, surgical, dental. x-ray or out of your Ongoing operations or"your work"and nursing services included in the products completed operations hazard" when you have agreed in a written 2 This provision is excess over any other valid contract or written agreement that any right of and collectible insurance whether such recovery is waived for such person or insurance is primary" excess, contingent or Organization This waiver applies only to the on any other basis Any payments by us wdf persorl or organization(s) agreed to in the follow Paragraph 4.b. of Section IV written contract or written agreement and is Commercial General Liability Conditions, subject,to those provisions This waiver does not apply unless the written contract or written agreement has been executed prior to the "bodily injury" or"property damage' However, if any person or organization is separately scheduled on a separate waiver of transfer Of rights of recovery which is attached to this policy, then this waiver does not apply CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc Page 7 of 7 with its permission COMMERCIAL GENERAL LIABILITY CL CG 05 29 10 17 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. GENERAL LIABILITY ULTRA PLATINUM ENHANCEMENT COVERA GES ES This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. The following coverage is added: paragraph 2.a. above, the words caused in ADDITIONAL INSURED , OWNERS, LESSEES whole or in part by are replaced by the OR CONTRACTORS - AUTOMATIC STATUS words ansing out of. INCLUDING PRIMARY NON-CONTRIBUTORY c. The insurance afforded to such additional 1 Section II - Who is An Insured is amended to insured only applies to the extent include as an addribonai insured any person(s) Permitted by law, and or argamzahidn(s.) for whom you are required d. If by virtue of a written contract or agreement coverage provided y the contract nil that such g insured is required ce a contract or person(s�) or organrzationQsy be agreement, the insurance afforded to such added as an additional insured on your policy. additional insured will not be broader than Z The insurance provided to the additional that which you are required by the contract insured is Umited as follows: or agreement to provide for such a- Such additional insured. person or organization is an additional insured only with respect to e. This insurance ends at the earliest of the liability for "bodily injury". "property fallowing times damage" or personal and advertising, (1) When any Named Insured(s) work J r}r' caused in whole or in part by called for in the written contract has (1) Acts or omissions of the Named been completed Insured; or (2) When all of any Named Insured(s) (2) The acts or omissions of those acting work done at a job site has been on behalf of the Named Insured, completed if the wntten contract calls in the performance of the Named Insureds for work at more than one job site walk for the additional insureds) specified (3) When that part of any Named in the waften contract provided the, Insured's work done at a job site has contract or agreement requires you to been put to I intended use by any Provide the additional insured such person or organization other than the coverage and is: Named Insured or those acting on the I. Currently in effect or becomes Named Insured(s) behalf effective during the term of this Work that may need service, maintenance, policy, and correction, repair or replacement, but is otherwise complete, will be treated as If. Was executed prior to the "bodily completed injury',pso "property damage., or f. This insurance does not a..persona and advertising injury". apply to any Id. If the written contrail specifically requires additional insured scheduled on your you to provide additional insured coverage pal°cy by separate endorsanYant, via the 10/01 edition of CG2010 (aka CG g. For purposes of paragraph A of this 20 10 10 01) or via the 1 N85 edition of endorsement the terms "'qou" and "you CG2010 (aka CG 20 10 11 85), then in refer to the Named Insured shown in the Declarations CL CG 05 29 10 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 3 3. Exclusions a, Required by the contract or agreement, or With respect to the insurance afforded to these b. Available under the applicable Limits of additional insureds, the following additional Insurance shown in the Declarations, exclusions apply to "bodily injury" "property damage" or "Personal and advertising injury" whichever is less. arising,out of [his endorsement shall not increase the a. The rendering of or failure to render any applicable Limits of Insurance shown in the professional services by you or on your Declarations. behalf, but only with respect to either or 5. Other Insurance both of the following operations. (1) Providing engineering, architectural or For purposes of this endorsement the surveying services to others in your following is added to the Section IV - capacity as an engineer, architect or Commerclai General Liability Conditions, 4, surveyor, and Other Insurance condition and sueersedes any (2) Providing, or hrinng independent provision to the contrary. professionals to provide, engineering, architectural or surveying services in This insurance is excess of all other connection with construction work you insurance available to an additional perform. Insured whelher on a pdrnary, excess. b. Subject to Paragraph C. below, Contingent or any other basis Bul, if Professional services include- required by a written contract or written agreement to be primary and (1) Preparing, approving, or failing to nonctm'tributory, this insurance will be prepare or approve, maps, strop prmary to and will not seek contribution drawings„ opinions, reports, surveys, from any insurance on which the additional field orders Change orders, or insured is a.Named Insured. drawings and specificatlons. and No other coverage or limit in the policy (2) Supervisory or inspection achvfties applies to loss or damage insured by this performed as part of any related coverage. architectural or engineering activities. H, The follovnng coverage is added: C Professional services do not include CONTRACTUAL LIABILITY - RAILROADS services within construction means, methods, techniques, sequences and 1. With respect to operations performed for a Procedures employed by you or performed Railroad within 50 feet of railroad property, the by or for the construction manager, its definition of "insured contract" In Section V - employees or its subcontractors in Definitions is replaced by the following. connection with your ongoing operations. 9. "Insured Contract"means: This exclusion applies even if the Claims against any insured allege negligence or other a. A contract for a Pease of premises wrongdoing in the supervision, hiring, However, that portion of the contract erniDdymerst training or monitdnng of others for a lease Of premises that by that. insured„ R the "Occurrence:" which " indemnifies any person or caused the "bodlfy injury" or "Property organization for damage by fire 10 damage', or the offense which caused the Premises whole rented to you or "personal and advertising injury" involved the temporarily occupied by you with rendering of, or the failure to render, any Permission of the Owner its not an Professional architectural, engineering or Insured contract", surveying Services. b. A sidetrack agreement, 4. Limits of Insurance c. Any easement or license agreement, With respect to the insurance afforded to these d. An obligation, as required by additional insureds, the following is added to Ordinance, to indemnify a municipality, Section Ill- Limits Of Insurance except in connection with work for a If coverage provided to the additional insured municipality, is required by a contract or agreement, the e. An elevator maintenance agreement. most we will pay on behalf of the additional insured is the amount of insurance:, It. That part of any other contract or agreement pertaining to your business Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc with its permission. CL CG 05 29 10 17 (including an indemnification of a C. AGGREGATE LIMITS OF INSURANCE municipality in connection with work performed for a municipality) under The General Aggregate Limit under SECTION III - whichi you assume the tort Irability of LIMITS OF INSURANCE applies separately to another party to pay for""bodify injury" each of your: or property damage" to a third person 1. Projects away from or organization. Tort liability means a t Y premises owned by or liability that would be imposed by law rented to you. in the absence of any contract or 2. "Locations" owned by or rented to you. agreement. ''Location" means premises involving the same Paragraph If. does not include that part or connecting lots, or premises whose of any contract nor agreement connection is interrupted only by a street, (1) That indemnifies an architect, roadway, waterway or right-of-way of a engineer or surveyor for injury or railroad damage arising out of: When paragraph S.Construction Project (a) Preparing, approving or failing General Aggregate Limit on form CL CG 00 20 is to prepare or approve maps, a part of this policy,then this endorsement shop drawings, opinions, CL CG 05 29 paragraph D. Aggregate Limits Of reports, surveys, field orders, Insurance does not appy. change orders or drawings and specifications, or (b) Giving directions or instructions, or failing to give them tf that is the primary cause or the injury or damage, (2) Under which the insured, if an architect, engineer or surveyor, assumes (ability for an injury or damage wising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. 2. Other Insurance For purposes of this endorsement, the following is added to the Section IV- Commercial General Liability Conditions, 4. Other Insurance condition and supersedes any provision to the contrary. This insurance is excess of all other Insurance that is Railroad Protective Liability or similar coverage for"your work" performed for a Railroad But, if required by a written contract or written agreement to be primary and noncontributory, this insurance will be primary to and will not seek contribution from any insurance on which the Railroad is a Named Insured No other coverage or limit in the policy applies to loss or damage insured by this coverage. CL CG 05 29 10 17 Includes copyrighted material of Insurance Services Office, Inc Page 3 of 3 with its permission. COMMERCIAL AUTO CL CA 01 49 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE EXPANSION ENDORSEMENT - PLATINUM This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM With respect to the coverages provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless modified by this endorsement A. NEWLY ACQUIRED OR FORMED ORGANVr4- TIONS property damage" because of the conduct of an "insured" under Paragraphs a. or I The following is added to Paragraph A.I. Who Is under Paragraph A.I. Who Is An Insured of An Insured of Section II - Covered Autos Liability Section If - Covered Autos Liability Cover- Coverage age, caused by an "accident" and resulting Any organization you newly acquire or form, oth- from the ownership, maintenance or use of a er than a partnership, joint venture or lini lia- covered "auto belity company or any organization excluded ei- 2. The written contract or agreement described Cher by this Coverage Part or by endorsement, above must have been executed prior to the and over which you maintain ownership or ma- "accident" that caused the "bodily injury" or jordy interest of more than 50 percent will qualify property damage'' and be in effect at the as a Named Insured, However time of such "accident", 1. This insurance does not apply to any newly 3. The insurance afforded to any such addition- acquired or formed organization that is an al "insured" does not apply to any "accident" 11 insured" under any other automobile policy beyond the period of time required by the or would be an "insured" under such policy written contract or agreement described but for rts termination or the exhaustion of its above, Limit of Insurance. 4. The most we will pay on behalf of such addi- 2. Coverage does not apply to "bodily injury" or tional "insured(s)" is the lesser of. "property damage" that occurred before you a. The Limits of Insurance specified in the acquired orfonmed the organization written contract or agreement described 3. Coverage under this provision is afforded on- above, or ly until the 1Mh day after you acquire or b. The Limits of Insurance shown in the form the organization or the end of the policy Declarations period, whichever is earlier This provision she not inc,ease the Limit of B. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT Insurance shown in the Declarations in this Policy or coverage part, and The following is added to Paragraph A.1., Who Is 5. The following changes are made to Para- An Insured of Section II - Covered Autos Liability graph 5. Other Insurance of B. General Con- Coverage: ditions under Section IV - Business Auto When you have agreed in a written contract or Conditions agreement to include a person or organization as an additional ''insured", such person or organiza- tion is included as an "insured" subject to the fol- If required by the written contract or lowing agreement described above, the insur- 1. Such person or organization is an additional ante afforded to the additional insured "insured" only to the extent such person or under this provision will be primary to, and will not seek contribution from, the organization is liable for "bodily injury" or additional insured's own insurance CL CA 01 49 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 5 b. Paragraph 5.c. is deleted in its entirety 1. The Limits of Insurance are increased to $75 6. Paragraph A.1.c. under Section II - Covered per day to a maximum of$2,500 Autos Liability Coverage is deleted in its en- 2. We will also pay reasonable and necessary tirety expenses to facilitate the return of the stolen 7. The definition of "insured contract" under sold"to you. Section V- Definitions is amended to add the 3, It is agreed and understood and it is our stat- following. ed intent that expenses incurred by you un- An "insured contract" does not include that der the Transportation Expenses Coverage part of any contract or agreement Extension wilP not also be covered or paid That pertains to the ownership, maintenance under the Rental Reimbursement Coverage or use pertains an "auto" and which indemnifies provided by this endorsement or any rental reimbursement coverage added by separate person or organization for other than the vi- endorsement to this policy carious liability of such person or organiza- tion for "bodily injury" or "property damage" H. EXTENDED COVERAGE - AIRBAGS caused by your operation or use of a covered The following is added to Exclusion B.3.a. of "auto" Section III - Physical Damage Coverage However, a person or organization is an ad- However, this exclusion does not apply to the un- ditional "insured" under this provision only to intended discharge of an airbag. the extent such person or organization is not named as an ''insured'' by separate en- This coverage is excess over any other collecti- dorsement to this policy ble insurance or warranty providirg such airbag C. EMPLOYEES AS INSUREDS coverage The following is added to Paragraph A.I. Who Is L AUTO LOAN/LEASE GAP COVERAGE An Insured Section II - Covered Autos Liability The following is added to Section III - Physical Coverage Damage Coverage, Paragraph C. Limits of insur- Any "employee" of yours is an "insured" while ance using a covered "auto" you don't own, hire or bor- 4. In the event of a total "loss" to a covered "au- row in your business or your personal affairs, to we will pay any unpaid amount due on D. INCREASED COVERAGE -BAIL BONDS the lease or loan for a covered"auto', less The Supplementary Payments Coverage Exten- a. The amount under the Physical Damage sion of Section II - Covered Autos Liability Cov- Coverage section of the policy, and erage is amended as follows b. Any The Limit of Insurance in paragraph A.2.a.(2) is (1) Overdue leaselloan payments at the increased to $5,000 time of the"loss" E. INCREASED COVERAGE - LOSS OF EARN- (2) Financial penalties imposed under a INGS lease for excessive use, abnormal The Supplementary Payments Coverage Exten- wear and tear or high mileage. sion of Section II - Covered Autos Liability Cov- (3) Security deposits not returned by the erage is amended as follows- lessor, The Limit of Insurance in paragraph A.2.a.(4) is (4) Costs for extended warranties, Credit increased to $1,000 Life Insurance, Heattih" Accident or F. FELLOW EMPLOYEE COVERAGE Disability Insurance purchased with the loan or lease, and The Fellow Employee Exclusion contained in Section II - Covered Autos Liability Coverage (5) Carry-over balances from previous does not apply. This coverage is excess over cans or leases any other collectable insurance J. GLASS REPAIR - NO DEDUCTIBLE G. COVERAGE EXTENSION - TRANSPORTA- The following is added to Paragraph D. Deducti- TION EXPENSES ble of Section III - Physical Damage Coverage Paragraph AA.a. Transportation Expenses of Any Comprehensive Coverage deductible shown Section III - Physical Damage Coverage is in the Declarations does not apply to "loss,, to amended as follows glass when you elect to patch or repair rather than replace the glass. Page 2 of 5 Includes copyrighted material of Insurance Services CL CA 01 49 02 15 Office, Inc , with its permission K. INCREASED COVERAGt ELECTRONIC O. HIRED AUTO rnYSICAL DAMAGE COVER- EQUIPMENT AGE The $1,000 limit indicated in Paragraph C.1.b. The following is added to Paragraph AA, Cover- under Section III - Physical Damage Coverage is age Extensions of Section III - Physical Damage increased to $2,500 Coverage: L. EXTENDED COVERAGE - PERSONAL PROP- If hired "autos" are covered "autos'" for Covered ERTY Autos Liability Coverage and if Physical Damage The following is added to Paragraph A.4. Cover- Coverage its provided for any "auto"' you own, age Extensions of Section III - Physical Damage then the Physical Damage coverages p,rovleed Coverage: are extended to "autos" you pease, rent, hire or Physical Damage Coverage on a covered "auto" borrow from someone other than your ""employ. ees", partners or members of their households may be extended to "loss" to your personal prop- subject,to the following erty or, if you are an individual, the personal property of a family member, that is in the cov- 1. The most we will pay in any one "loss" is the ered "auto" at the time of"loss" and caused by an lesser of "accident" and resulting from the ownership, a. The actual cash value of the"auto'; maintenance or use of a covered "auto" The insurance provided by this coverage exten- b or e cost to repair or replace the "auto sion is excess over any other collectible insur- ance The most we will pay for any one "loss" c. $100,000 under this coverage extension is $500 However, 2. Paragraph 1. above is subject to a deducta- our payment for "loss" to personal property will ble. The deductible shall be equal to the only be for the account of the owner of the prop- amount of the highest deductible shown for erty any owned "auto" of the same classification Under this provision, personal property does not for that coverage In the event there is no include and we will not pay for"loss" of currency, owned "auto' of the same classification, the coins, securities or contraband highest deductible for any owned 'auto"' will No deductible applies to this coverage extension apply for that coverage M. TOWING No deductible will apply to "loss" caused by fre or lightning Paragraph A.2. Towing of Section III - Physical 3. Hired Auto Physical Damage Coverage is Damage Coverage, is replaced by the following subject to the following If a private passenger type °auto" or light truck a. If symbol 8 is shown in the Covered Auto auto- (0-10,000 Los. GVW) is provided both section of the Declarations page for any Comprehensive and Collision Coverage, we will of the Physical Damage coverages, then pay up to $150 for towing and labor costs in- the Hired Auto Physical' Damage cover- curred each time such °auto' is disabled If a age described in this endorsement does medium, heavy or extra-heavy truck or extra- not apply. heavy Truck-tractor 'auto" (greater than 10,00o Lbs GVW) is provided both Comprehensive and b. Other than indicated in Paragraphs a, du". Collision Coverage, we will pay up to $250 for rectly above, coverage provided under towing and labor costs incurred each time such this provision will be excess over any auto" is disabled However, the labor must be other collectible insurance or coverage performed at the place of disablement 4. In addition to the limit set forth in Paragraph N. FIRE EXTINGUISHER RECHARGE 1- above we will pay up to $500 per day, to a The following is added to Paragraph A.4. Cover- maximum of$3,500 per"loss" for age Extensions of Section IV - Physical Damage a. Any costs or fees associated with the Coverage loss" to a hired "auto", and When fire extinguishers are kept in your covered Id. Loss of use of the hired "aato provided "auto" and any are discharged in an attempt to it is the consequence of an "accident" for extinguish a fire, we will pay the lesser of the ac- which you are legally 'liable, and as a re- tual cost of recharging or replacing such fire ex- suit of which a monetary loss is sus- tingursher(s) tarried by the leasing or rental concern No deductible applies to this coverage However Paragraph A,4.b. Loss of Use Expens- es under Section III - Physical Damage Coverage CL CA 01 49 02 15 Includes copyrighted material of Insurance Services Office, Inc with its permission Page 3 of 5 of the Business Auto Coverage Form does not (2) Your p r p apply. artners or members, if you are designated in the Declarations as a P. RENTAL REIMBURSEMENT COVERAGE partnership or joint venture, We will pay for rental reimbursement expenses (3) Your members or managers, if you incurred by you for the rental of an ''auto" be- are designated in the Declarations as cause of"loss"to a covered "auto" a limited liability company, 1. Payment applies In addition to the otherwise (4) Your executive officers if you are applicable amount of each coverage you designated in the Declarations as an have on the Covered "auto" organization other than an individual 2. No deductible applies to this coverage, partnership, joint venture or limited liability company, and 3. We will pay only for those expenses incurred Policy (5) The spouse 1. any person named in during the p y period beginning. 24 hours Paragraphs a.(1). through 1.a.(4) after the "loss" and ending, regardless of the expiration date of the policy, with the lesser white a resident of the same house- of the following number of days hold; a. The number of days when the covered Except "auto" has been repaired or replaced, or (a) Any "auto" owned by that indi- b. 45 days vidual or by any member of his or her household 4. Our payment is limited to the lesser of the fol- lowing amounts (b) Any ''auto" used by that indmdu- al or his or her spouse while a. Necessary and actual expenses incurred, working in a ousiness of selling, or servicing, repairing or parking I Not more than $75 for any one day; "autos" 5. We will pay up to an additional $300 for the 2. Changes In Auto Medical Payments And reasonable and necessa in„ Uninsured And Underinsured Motoristsry exenses you P y Coverages cur to remove your materials and equipment from the covered "auto" and replace soon The following is added to Who Is An In- materials and equipment on the rental "auto" sured 6. This coverage does not apply while there are Any individual named in 1.a above and his or spare or reserve 'autos" available to you for her "family members" are "insured" while your operations "'occupying" or while a pedestrian when being 7. If "loss" resU is from the total theft of a cov- struck by any"auto" you don't own except: ered "auto" of the "private passenger type'", Any "auto" owned by that individual or by any we will pay under this coverage only than "family member' amount of your rental reimbursement ex- 3. Changes In Physical Damage Coverage penses which is not already provided for un- der the Physical Damage Coverage Exten- Any private passenger type "auto" you don't sion of the Business Auto Coverage Form or own, hire or borrow is a covered "auto" while any endorsements thereto in the Cara custody or control of any ir ivid- 1 to the ual named in I 1.a. above or his or her However, this provision does not al spouse while a resident of the same house- extent that rental reimbursement is provided hold except- by separate endorsement to this policy a. Any "auto" owned by that individual or by Q. DRIVE OTHER CAR COVERAGE any member of his or her household; or 1. The following is added to Section II - Cov- b. An Y "auto" used by that individual or his ered Autos Liability Coverage or her spouse while working in a busi- a. Any "auto" you don't own, hire or borrow ness of selling, servicing, repairing or is a covered "auto" for Liability Coverage parking "autos" while being used by 4. The most we will pay for the total of all dam- (1) You, if you are designated in the ages under Covered Autos Liability Unin- Declarations as an individual, sured Motorists Coverage and Undennsured Motorists Coverage is the Limit Of Insurance Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc CL CA 01 49 02 15 with its permission Shown in the Declar—O, as applicable to t 3. At our re utst .!mus provide us with a co owned "autos" q p pry of the aforementioned written contract or agree- 5. Our obligation to pay for, repair, return or re- merit- place damaged or stolen property under T. UNINTENTIONAL OMISSIONS Physical damage Coverage, wit be reduced by a deductible equal to the amount of the The following is added Paragraph B.2. of Section highest deductible shown for any owned or,. IV- Business Auto Conditions vale passenger type "autoo' applicable to that If you fail to disclose any hazards existing, at the coverage If there are no owned private pas inception date Of this policy, such failure will not senger type "autos" the deductible shall be prejudice the coverage provided to you Howev- $250 for Comprehensive Coverage and $600 er, this provision does not affect our right to Col, for Collision Coverage. No deductible will lest addrfional premium or exercise Our right of apply to "lass" caused by fire or lightning cancellation or nonrenewsV 6. Additional Definition U. LIBERALIZATION As used in this DRIVE OTHER CAR Provi- If we revise this endorsement to provide greater sign coverage without additional premium charge, we "Family member' means a person related to will automatically provide the additionap Coverage the individual named in 1 a by blood, mar- to all endorsement holders as of the day the revi- page or adoption who is a resident of the in- soon is effective In your state dividual's household, including a ward or fos- ter child R. KNOWLEDGE OF AN ACCIDENT, CLAIM, SUIT OR LOSS The following is added to Paragraph A.2. of Sec- tion IV - Business Auto Conditions. Your obligation to provide prompt notice of an ",accident", claim. "Sul" Or "Voss'"is satisfied if you or a person designated by you to be responsible for insurance matters is notified of, or in any manner made aware of an "accident", claim, ",suit'." or "loss" and provides us such notice as soon as practicable S. WAIVER OF SUBROGATION BY CONTRACT OR AGREEMENT The following is added to Paragraph A.5 of Sec- tion IV- Business Auto Conditions We waive any right of recovery we may have against a person or organization because of payments we make for "bodily injury" cr "property damage" when you and such person or organiza ton have agreed in writing in a contract ar agreement to waive such right of recovery, pro- vided'. 1. Such written contract or agreement was a. Made prior to the "accident" or "loss" resulting in the covered "bodily injury" or "property damage and b. Was in effect at the time of the covered "bodily injury" or "'property damage 2. The covered "bodily injury' or "property damage" must arise out of the operations spee ied in such written contractor agreement, CL CA 01 49 02 15 Includes copyrighted material of Insurance Services Office Inc with its permission Page 5 of 5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR GENERAL LIABILITY PLATINUM ENDORSEMENT 1 This endorsement modifies insurance provided under the following: i COMMERCIAL GENERAL LIABILITY COVERAGE PART A PROPERTY DAMAGE TO BORROWED EQUIPMENT 1. Paragraph 2„1. of SECTION I • COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perfomn operations at the time of loss. 2. SECTION III—LIMITS OF INSURANCE is deleted and replaced by the following. The most we will pay in any one 'occurrence" for "property damage" to borrowed equipment is $15,000 This limit of insurance is the most we will pay regardless of the ni,urnt-x.r of- a. Insureds, b. Claims made or"suits" brought, or c. Persons or organizations making claims or bunging "suits". 3. Deductible a. Our Obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as applicable to `property damage" as the resut of any one "occurrence', regardless of the number of persons or arganiizatici who sustain damages bec:MriSe of that'Oecurrane,". b. The terms of this insurance including those with respect to our right and duty to defend the insured against any 'Suits* seeking those damages; and your duties in the event of an "occurrence', claim, or"suq' apply irrespective of the eppjication of the deductible amount. c We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notrFcation of the action taken; you shall promptly reimburse us for such part of the deductible amount as we have paid.. B. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT I. For all sums which the Insurerl becomes legally obligated to pay as damages caused by "occurrences' under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C(SECTION I,), which can be attributed Only to ongoing operations at a single construction project away from prenrises owned by or rented to the insured a. A Single Construction Project General Aggregate Lmit applies to each construction project away from promises Owned by or rented to the insures}', and that limit is equal to the amount of the General Aggregate Limit shown In the Declarations b. The Single C:onstruidbon Project General Aggregate Limit Is the roost we will pay for the surn Of all damages under' COVERAGE A, except damages because of"bodily injury^or"property damage` included In the 'products-COMPlsted operations hazard", and for medical expenses under COVERAGE C regardless of the number of (1) Insureds; (2) Claims made or'suits" brought, or (3) Persons or organizations making claims or bringing 'suts", c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Aggregate L'innit for that construction project away from promises owned by or rented to the insured Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate constnuclion project away from premases owned by or rented to the iinsured. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Office, Inc with Its Page 1 of 4 permLysion� d The fimPts shown in the Declarations for Each Oocurmnce j: ire Damage and Mecioal Exp*,ose continue hr appry. However, instead Of being SlubjcCr to the General Aggregate Limit shown ire tr10 Declarations, such imijS will be rubject la VIL Constrocion Project General Aggregate L.rrrll Cs Single 2 For all sums WIlch the insured becomes legally obfiqated to Pay as darnages caused by "occurrences"' under COVERAGE A (SECTION I) and for all medical expenses caused by arcicenis Linder COVERAGE C (SECTION 1), Airich cannot be, aftnbuied only to ongoing operations at a single designated coinslru�o the insured tiOn PrRJ8,Ct away from prarnses owrlep by or rented to a- Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall, reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate 1, it, whichever is aphicable, and b. Such payments shad not reduce any Single Construction Project General Aggregate Limit 3. When coverage for liab0ty arising out of the 'producls.-complet p tionhazard" Prov d, any payments for damages at'a era sis 1 ed PrOducts-GOMPleted operations Of "Oridly MJLY of 'property damage' included m the hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit or the Single Col General Aggregate brnrt. nstructilon Project 4. ff the applicable codstr=Ion project away from PrOnUSOS Owned by or rented to Vie Maired has been abandoned deiayeci, or abandoned and then restarted, or if the, authorized corirracting parties deviate from plans, blueprints, designs, specifications or timetables, the projec(wfli still be deefrad to be the same COnstruction project, 5. The provisions of Limits Of Insurance (SECTION 111) not otherwise endorsement shall continue to apply as stipulated rnod�fied by this C. LIMITED JOB SITE POLLUTION 1, Exclusion f. under Section I— Coverage A is replaced by the following: 2. Exclusions This insurance does not apply to: It. Pollution (1) '19odily injury" or "property damage,, ansfrig out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants' (s) At or From any premises, site or location on which any insured or any contractors or suldicbritractors working directly or ino 'rectlY On any insured's behalf are performing operations if the operations are to test for, moritior, clean up remove," contain, treat. detoxify Or neutralize, or in any Way respond to, or as the effects of, *pollutair or (b) At or from a storage tank or other container, ducts, or piping which a below or partuilly below the Surface Of the ground or water or which, at any time has s been buried under the surface of the ground or water and then subsequismu'y exposed by erosion, excavation or any other means If the actual, allayed or threatened discharge, dispersal, seepage, migration, release or escape of Pollutants" arises at or from any premises, site or location wilich any lrisured or any contractors or subcontractors workmy directly or indirectly on any insured's behalf are performing operations if the "pollutants"'are brought On or to the Premises, site Or hocation in connection wqh SUIrciontractor, such Operations by such insured, contractor or Subparagraph (b) does not apply to *bodily injury or "property damage' arising out of heat, smoke or fumes from a"hostile fire". (2) Any loss, cost or expense arising but Of any- (a) Request, demand, order or statutory or regulatory requirement issued or "lade Pursuant to any environmental protection or environmental liability statutes or regulatons that any hnsured test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, pollutants or CIL CG 00 20 01 12 Includes copyrighted material of Imuranyce Services Page 2 of 4 ice, Inc with its permission (b) Claim Or suit by or on behalf of'a governmentatl authority for damages(because:of tBaling for, rnC itonng, dashing up removing containing, 'treating, detoxifying, or neutralizing or in any way responding to or asseiierig the effects of, "pollutants". However„ the ,paragraph does not apply to liability for those sums the insured becomes legaily Obligated to pay as damages because of"property damage"III the tnsured would have In the absence Of such request, derrand, order or statutory or regulatory requirenoent, or such daim or "suit" by or on behalf of a tgovernmerniaR authority 2. With respect to 'bcrdipy injury or "property damage" arising out of the actual, alleged or threatener)discharge,dispersal, seepage, migration,9 9 iOn, release or escape of"pollutants` a. The "Each Occurrence Limit"shown in the Declarations does not apply b. Paragraph 7. of Limits Of Insurance(Section III)does not apply. c. Paragraph 1. of Section III-Limits Of Insurance is replaced by the following: The Limits Of Insurance shown in this end)rsarnent, or in the Declarations and the rules below fix the most we will pay regardless of the number of'. (1) Insureds, (2) Claims made or "suits"brought, or (3) Persons or organizations making claims or bringing "suits'_ d. The following are added to Section III- Limits Of Insurance: 8. Subject to 2,or 3. above, whichever applies, the most we will pay for the sum of. a. Damages under Coverage A; and b. Medical expenses under Coverage C because o "beadily injury' or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants' is $100,000 aggregate. 9. Subject to 8.above the Mer @c-al Expense Umit is the most we win pay under Coverage C for all medicaB expenses because of "beadre,y injury" sustained by any one person arising out of the actual, alleged or threatened discharge,dispersal, seepage, migration, release or escape of'prrll'utants". D. VOLUNTARY PROPERTY DAMAGE 1. The following is added to Section 1 - COVERAGES: We will pay, at your request for "property damage"to that part of any property. a. Which you or any subcontractors working directly or indirectly on your behalf are performing operations; or b. That must be restored, repaired or replaced because 'your work" was incorrectly performed on it This insurance applies only to "property damage" to property of others while in your care, ctystotty, or Control, and arising out of operations away from your insured prem ses and incidental to your business_ Exclusions j.(3),(4),(5) and (6) do not apply to this coverage, This insurance does not apply to 'property damage' included ,within the "explosion hazard', the"collapse hazard"or the "underground property damage hazard'". 2, For the purposes of the Coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION III-LIMITS OF INSURANCE is replaced by the following A. Limits of Insurance 1. Unless a highrer limit Is shown in the Declarations, the most we will pay In any one "occurrence'for"property damage" under this endorsement is $15,000. 2. Unless a higher limit is shown in the Declarations, the most we will pay for all Covered "occurrences" during any one policy period is $r15,000 Aggregate Limit of Insurance. CL CG 00 20 01 12 includes copyrighted material of Irs.urance Services Page 3 of 4 Office, Inc with its perm ston the Limits Of Insurance of this endorsement; apply separately to each consecutive annr..ed period and to any remaining perbrxy of less than 12 months. starting with the beginning of the policy Period Shci in the Declarations, uNess the policy period is extended after Issuance for an additional period of less than 12 rnonths. In that cease, the additional penod will be deemed pant of the last preceding period for purposes Of determining the Limits of insurance 3. Deductible a. Our obllgatlon to pay damages on bel of the insured applies only to the amount of damages in excess of $250 as the result of any one "occurrence"„ regardless of the number of persons or Organizations who sustain damages because of that'occurrence". b. The terms of this Insurance, including those with respect to our right and duty to defend the insured against any"suits"seeking those damages, and your duties in,the event of an "occurrence", claim, or "suit" apply Iriespec:Pive of the application of the deductible amount. C. We may pay any part or all of the deductible amount to effect settlemtent,of any claim or suit and upon notifiicat'ion, of the action taken, you shall promptly re,mburse us for such part of the deductible amount as we nave paid. 4. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is a hended as follows a. The following is added to paragraph 2. Duties In The Event Of Occurrence, offense, Claim or Suit: In the event of loss covered by this endorsement, the irmsured shall„ if requested by us, replace the property or furnish the labor and materials necessary for repairs at actual cost to the insured, excluding prospective profit or Overhead changes of any nature. A,ny Property so paid for or replaced shall, at our option, became our property Any payment made by us shall not constitute an admission of inability by On insured, or by us. b. Paragraph 4. Other Insurance is amended as follows: (1) Paragraph 4.a. Primary Insurance is deleted, (2) Subparagraphs (1) and (2) of paragraph 4.b. Excess Insurance are deleted and replaced with the following: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis All other provisions that apply to paragraph 4. Other Insurance contained in the Commercial General Liability Coverage Form are applicable 5. For the purposes of the c-average provided by D. VOLUNTARY PROPERTY DAMAGE, the following definitions are added to SECTION V— DEFINITIONS; a. "Collapse hazard" includes 'structural property damage" and any resulting 'property damage" to any other property at any time. b. "Explosion hazard" indludes "property damage" arising out of blasimy or explosion. The "explosion hazard" does not include "property damage" amsing out of the explosion or air Or steam vessels. Piping under pressure, prime movers, machinery or power transmitting equipment C. 'Structural property damage" means the collapse of or structural injury to any building or structure due to: (1) Grading of land, excavating, borrowing, filling, back-filling, tunneling, pile driving, cofferdam work or caisson work; or (2) Moving, shoring, underpinning, raising or demolit,on of any building or structure or removal Or rebuilding of any structural support of that building or stricture. d. "Underground properly damage hazard" includes "underground property damage" and any resulting 'property damage'to any other property at any time. e. "Underground property damage" means 'property damage" to wires, cordults, pipes, mains, sewers. tanks tunnels, any similar property, and any apparatus used wool them beneath the surface of the ground Or water, nausea by and occurring during the use of mechanical equipment for the purpose of grading, land, paving, excavating, drilling, borrowing„ filling, bactr-filling or pile driuing. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Office Inc wits its Page 4 of 4 permission COMMERCIAL GENERAL LIABILITY CL CG 20 71 09 16 THIS ENDORSEMENT CHANGES THE POLICY.. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS OR OTHERS - COMPLETED OPERATIONS - AUTOMATIC STATUS, INCLUDING PRIMARY NONCONTRIBUTORY N O NTRIBUTORY This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO 15 AN INSURED is amended to include as an additional insured an the purposes of this ''Youand "endorsement,throughout y person(s) the policy, the terms "you" and "YOU' refer to or organizations) when you are obligated by virtue of a written contract or agreement that he Named Insured shown in the Declarations such person or organization(s) be added as an B. Exclusions additional insured to your policy With respect to the insurance afforded to these Such person(s) or organization(s) is an additionat additional insureds, the following additional insured Only with respect to liability for "bodily exclusions apply to "bodily injury" and ''property injury" or "'property damage" or "personal and damage" arising out of advertising injury"caused, in whole or in part by 1. The rendering of or failure to render an (1) Acts or omissions of the Named Insured, professional services by you oron your behalf or but only with respect to either or both of the (2) The acts or omissions of those acting on following operations behalf of the Named Insured, a. Providing engineering, architectural or and included in the "products-completed surveying services to others in your operations hazard" capacity as an engineer, architect or surveyor, and This insurance applies only when you are required to add the additional insured by virtue of a written b. Providing, or hiring independent contract or agreement, provided the contract or professionals to provide, engineering, agreement is architectural or surveying services in connection with construction work you 1. Currently in effect or becomes effective during perform the term of this policy, and This exclusion applies even if the claims against 2. Was executed prior to the "bodily injury" or any insured allege negligence or other "property damage' or "personal and wrongdoing in the supervision, hiring advertising injury" employment, training or monitoring of others However that insured, if the 'occurrence'which caused the "bodily injury"or"property damage",or the offense a. The insurance afforded to such additional which caused the "personal and advertising insured only applies to the extent permitted by injury", involved the rendering of, or the failure to law, and render, any professional architectural, engineering It. If coverage provided to the additional insured or surveying services is required by a contract or agreement, the 2. Subject to Paragraph 3, below, professional Insurance afforded to such additional insured services include will not be broader than that which you are a. Preparing, approving, or failing to prepare required by the contract or agreement to or approve, maps, shop drawings, provide for such additional insured, opinions, reports, surveys, field orders, change orders, or drawings and CL CG 20 71 09 16 specifications; and Includes copyrighted material of Insurance Services Office, Inc with its permission Page 1 of 2 b. Supervisory or ction activities D. Otherinsuran,,� ' Performed as part of any related architectural or engineering activities For purposes of this endorsement, the following is 3. Professional services do not rrtncPuCle sarviCes added to the Section IV - Commercial General wrote LiabiVrty Conditions, 4. Other Insurance construction means, methods, condition and supersedes any provision to the techniques, sequences and procedures contrary employed by you or performed by or for the construdtion manager, its employees or its This insurance is excess of all other insurance sUbcOntraliti in connection with your available to an additional insured whether on a ongoing operations primary, excess, contingent or any other basis C. Limits of Insurance But, if required by a written contract or written agreement to be primary and noncontributory, this Wirth respect to the insurance afforded to these insurance will be primary to and will not seek additional insureds, the following is added to contribution from any insurance on which the Section Ilt-Limits Of Insurance, additional insured is a Named Insured If coverage provided to the additional insured is No other coverage or limit in the policy applies to required by a contract or agreement, the most we loss or damage insured by this coverage will pay on behalf of the additional insured is the amount Of insurance: 1. Required by the contract or agreement, or 2. Available under the applicable Lim Rs of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applGcable Limits of Insurance shown in the Declarations. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc „ with its permission CL CG 20 71 09 16 ti 0 CV g S S` LC) o c A .r 0 w N i � a N o ti W N O rl n '1 N V J m v C y QJ 0 U N m C N } O 3 N p m � �p N � V O m b Z d 4 N m � C E u U Y J o_ w � C g C A N � Gl } C G J W c Z � E _O � y d V 3 yb C m V L D Y O O m C wy C � C CIT`I OF K[- "le f n Iny So acxe4sn BL�t i5SL[CEVSF. NOTICE ,,- eatile Wa gal no b965 1fEM7 (zss(escszia For LicensingPenod cnsrnrnersermcaLHeniwAgo, January 1, 2018 - December31, 201E j )ate Due January 01, 2018 Amount Due S101.00 Business License No. BLOC-2171028 i Check each box as appropriate: _j' New Owner Kent Relocation J Out of Business BUSINESS NAME- MAILING ADDRESS (revise Wow as needed) LOCATION ADDRESS OF DIFFERENT) Al AROUND F6NGE CDMPAN'Y ALL AR - - PO BOX 7034 AROUND H,Nt;L. CONMANY 14323 16T14 ST E RAVFNSDALF, WA 9yMI SUWNER, l,iA )U90 I. Business Phone: 253 863-4895 Email: - 2. Business Owners: Ill new 01`1 ,please check [he'Nt,, 0,,, r hox uyn,'e Iha matlmg aUUre s mid refer q occr inner 4 nfonnaciao Name: RONALD & ROCHELLE DAGLEY Hm Address: 29032 SE 226TH ST - ------ City: MAPLE VALLEY State: WA Zip Code: 9803E Him Phone: 253-863-4895 3. Business and Occupation Tax Is your business registered and filing City of Kent B&O tax? YES ISO Please enter your Estimated Annual Gross Receipts? S .� 00o OLb B&O tax registration is completed online at"Taxflle.KentWA.GOV", More information can be found at"KentWA.GOVYdoing•businesslcity-taxes/6-O-lax... 4. Emergencv Contacts for Business located in Kent: ---�� 253-863 4895 Permit (Item 824) ml oil III Tech Fee (?hem 1473) Permit# 2171028 t Customer(Item 754) � Permit ID: 195589 -. Description of Business: FENCE CONTRACTOR 6. Employees at Kent Location as of 10/31/2017: Full Time: __.... `� Part Time —�' 7. TRNN: __......_..`..._.__. ._ S. UBI#: 604 100 765 9. SIC Code: 10. NAICS Code: 11. Floor Space Used I01— S Ft � 12. Mark if any of the followiag are on the premises: 'LI Amusement Uevlces - Ganrblrn g' 7 Kaan,FeiCahaY[ -Put!Tabs,Punch Boards,Card Rooms f hereby cenity[hat the statements and nie on this appharnlication ed by re on ibis eppllca[ioo arc min and complete to the best of my knowledge.t also ackno,oi that the 42 17 r60 and iuhxmation furnished by me on[his application are public records and are available for pabtln inspection pursuant I0State of Washington RCW 4217 J60 . Signature -� _ Date _-7 sed Mail in the enclo envelope with Checkl ... ._ _ .. rint Name ,e� Money Order Payable to: CITY OF KENT ..._ r n r, ... Job Title ��. .1�`1.:�-,-.�''w4nr _. Email Please make a carrjr o([he com7aleted peorm for your records