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HomeMy WebLinkAboutPW16-014 - Amendment - #4 - HDR Engineering Inc - S 228th St UPRR Grade Separation - 01/11/2016 ' - �* 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. Vendor Name: HDR Engineering, Inc.. Vendor Number (]DE): Contract Number (City Clerk): RN I`,P — Old — Category: Contract Agreement Sub-Category (if applicable): Amendment LI Project Name: S. 228th St. UPRR Grade Separation Contract Execution Date: Mayor's signature Termination Date. PW: Engineering Contract Manager: Mark Madfai Department: g g Contract Amount: $17,644.04 Budgeted: ❑✓ Grant? Part of NEW Budget: Local ❑ State: El Federal: Related to a New Position: Basis for Selection of Contractor? Other Approval Authority: ❑ Director 0 Mayor City Council Other Details: Assist with the completion of the bid documents for the project. `� ✓ K E +1 T AMENDMENT NO. 4 NAME OF CONSULTANT OR VENDOR: HDR Enguneering. Ing. CONTRACT NAME & PROJECT NUMBER: 228th Street PRR Grade 5gggration ORIGINAL AGREEMENT DATE: ]anuary 11, 2016 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: Provide additional services to complete the bid documents for the project. For a description, see the Consultant's Scope of Work which is attached as Exhibit A and incorporated by this reference. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: ......._........ ... ------- _._.... ...-- Original Contract Sum, $605,264.91 including applicable WSST .............. .................. _...... ........_. _.... Net Change by Previous Amendments $198,817.51 including applicable WSST _ _. - - .._....._ _..-.. _ ... .... C_urr r ent Co-ntract Amount $804,082A2. ._. including all previous amendments _............ _. - _._..__ �.._.-...._ Current A m endment Sum $17,644.04 _..m._. �..._...- .. _. ...... ...... ......-. Applicable WSST Tax on this $0 Amendment ._.... ...... ....-.. .........., ...... _....-... ..... Revised Contract Sum $821,726.46 AMENDMENT - 1 OF 2 ...... _....... Original Time for Completion 12/31/16 (insert date) Revised Time for Completion under 12/31/18 prior Amendments (insert date) Add'I Days Required (t) for this 365 calendar days Amendment RevisedTime for _..._.Completio.�n, __................ .. .... . ........_ 12/31/19 ..... .... ......,_,_... .._..._._.. ., (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. ............ CON+ TJANT/VENDOR: CITY OF KENT: E y: Y: ,f (signature signatur ) Print Name: Print Name: Dana Ralph Its V1 C& Its Mavor DATE: 12 ZG (title)........ .... DATE: l Oiritte _.. _ _ ......... ATTEST: APPROV D-1S TO FORM: (applicable ' Mayer°s 7,t9ture required) i �f f Kent City Clerk Kefit Law apartment xoa-zze'"UP Grade Sep z-amd 4/MadM AMENDMENT - 2 OF 2 EXHIBIT A City of Kent, Washington South 228t" Street/UPRR Grade Separation Structural Engineering Services Amendment - Scope of Services December 11, 2018 r° 929 108th Avenue NE oil Suite 1300 �� , 0 Bellevue, WA 98004-5549 (425) 450-6200 Table of Contents Background....................................................................................................................1 Revisions to the Scope of Services .............................................................................1 General Project Assumptions............................. ... ..........................1 Items and Services to be Furnished by the City, the City's Geotechrical Engineer, and other Consultants......... ....... .............................._.,.,.........1 Schedule. .... .. ., ..,, . .,.. .................,....,.....................,.,,..............2 WorkElements ...................................................................................................... .„..-2 Work Element 1. Contract/Task Management.......................................... .........2 Work Element 2. Coordination with City and Other Consultants............. _.__.....3 Work Element 3. Structural Design .......I................... _................... ......3 3A. 100% Structural Design.... ............. ......................... .................................3 City of Kent South 226'h UPRR Grade Separation " 7, 2018 P Revisions to Scope of Services Nov 7, 2018 `M1 EXHIBIT A REVISIONS TO SCOPE OF SERVICES The City has requested that additional work by HDR Engineering, Inc., (Consultant) be performed to complete the Bid [Documents for the South 228th Street / UPRR Grade Separation Project (Project). The City has requested the previously prepared bid documents (sealed April 4, 2018) be separated into two phases. Phase 4 will include the Pier 1 and Pier 3 drilled shafts and walls NVV2, VVA, SVV2, NE1, EA, and SE1 Phase 5 will include all other items included within the previously prepared bid documents. levisaons to Scope of Se .�' General Project Assumptions General assumptions from prior Amendments are assumed to remain in effect unless modified herein. 1. No new design details or construction elements will be detailed as part of this effort. 2. Dual stamps where previously required will be in effect for the Phase 4 and Phase 5 plans 3, Phase 4 will be constructed prior to Phase 5. 4. Elements in Phase 5 wT be shown as future work in the Phase 4 drawings. 5 Elements in Phase 4 will be shown as existing in the Phase 5 drawings. 6 Construction cost estimates, bid items, and quantities will not be revised as part of this effort. 7. Consultant will assist by reviewing the Specifications but will not be responsible for development of the Specifications. Items and Services to be Furnished by the City, the City's Geotechnical Engineer, and other Consultants The following items are repeated from the previous Amendment, except that revisions, or clarification, are indicated by strikethrough text and text in italics. 1. Extents of the geofoam fill, including transitions to conventional backfill will be determined by the Geotechnical Engineer and/or the City. This includes the seeped geofoarrr dotrails. 2. The design parameters for structural earth wall backfill, which will be incorporated into the Specifications for the Project, will be provided by the Geotechnical Engineer. 3. Stone column design and details, including interface details between the stone columns and wall backfill above the stone columns will be by the Geotechnical Engireer and/or the City. City of Kent South 22W" UPRR Grade SeparationRevisions ry P � to Scope of Services Nov 7. 2018 Y) 4. The backfill for the approach walls will be surcharged to achieve settlement of the underlying soils. Surcharge plan extents, height and weight, and duration will be determined by the Geotechnical Engineer, 5. Roadway pavement sections will be detailed and determined by the City and /or the Geotechnical Engineer. This includes sections ror temporary construction. 6. Typical Section (pavement or concrete) at the Access Ramp (Interurban Trail ramp along the south face of Wall SW2) will be determined by the City and coordinated with the Consultant's curb concrete harrier design for the Access Ramp railing. 7. The City will develop selected electronic (CADD) Plan sheets for the Retaining Walls as described in the Assumptions section above and the list of Sheets below, The City will perform checking of the horizontal and vertical geometry provided in the Plan and Profile sheets for the walls. 8. As discussed in the General Project Assumptions section above, the City will generate the quantities for the Retaining Walls, including all materials and bid items for fill, geofoam, wall facings, barriers, railings, etc. The City will compile the Construction Cost Estimate for the Project. 9 Project construction sequence and schedule will be developed by the City. The City's Geotechnical Engineer will provide input and review of the technical special provisions for geofoam construction. Schedule The proposed schedule below is based on the assumption that the City finalizes issued for construction plans for Phase 4 for by January 15, 2019 and advertises Phase 5 for bid by December 30, 2018. Consultant will coordinate with the City and GecEngineers on the design elements in this scope of work. Date Deliverable January 15, Final issued for construction plans for Phase 4 2019 December 30, Final submittal for Phase 5 2018 Work Elements Work Element 1. ContracVTask Management This amendment will extend the overall contract through May 31, 2019 to support finalizing the construction bid documents. Deliverables: • Monthly invoices, progress reports. Services City of Ken( South 228 UPRR Grade Separation 2 Revisions to Scope of Services Nov 7, 2018 Work Element 2. Coordination with City and Other Consultants • Coordination with the City and the City's Geotechnical Engineer will be by phone and email. Deliverables: • Emails, PDFs No formal documents or submittals will be prepared. Work Element 6. Structural Design No revisions to Work Elements 3.1, 3.2, or 3.3, The following items were added to Work Element 3.4 of the Consultant's Scope of Work. 3.4. 100% Structural Design 3.4.D. The Consultant will revise previously prepared bridge plan drawings for walls NW2, WA, SW2, NE1, EA, and SE1 and for Pier 1 and Pier 3 shafts to show all otherwork elements as future work for use in the Phase 4 Bid Documents, The Consultant will assist the City with the Specifications for these revisions. Assunlfrti2ri No new details or construction elements are to be added to the drawings. Deliverables: Sealed drawings on 22x24 Bond. 3.4,E The consultant will revise previously prepared bridge plan drawings to show portions of walls NW2, SW2, NE1, and SE1; all of walls WA and EA', and the Pier 1 and Pier 3 shafts to show as existing elements and not to be constructed In the Phase 5 Bid Documents. The Consultant will assist the City with the Specifications for these revisions, Assumptions: No additional Plans sheets will be prepared by the Consultant. Modifications to the Walls Sheets includes the Wall Elevation sheet for Wall NW2, the Wall Layout sheet(s), and the Wall Sections sheet for the structural earth walls. Civil Plans by the City will be used for the majority of the details. Deliverables: Sealed drawings on 22x34 Bond _._.. ... _Ke _ ____- —.. _ —ation 3 Rewsions to Scope of Services Nov 7, 2018 LABOR ESTIMLA�TFHDRLNGINIERING STAFF City of Kent: City of Kent-S 228th UPRR Grade Separation ......... ... ..... .......... .................... 14 I i feR Wk, v r Q....... I nl;filr itN YI. I Contract/Task Management Lt of 2 6 0 19 "905 95 1 Ll fl,v, 6 448 RG U 2 2 396�11 S 1,327.65 Co'6w"t II p r $ 336.60 PIC1111, ,rspuIt 2 3%.42 2 Coordination with City and Other Consultants A 0 0 0 0 4 792,94 11.2 Cnnrdutat on 4 4 S 70244 3 Structural Design 32 24 30 0 0 6 H S ,34 3.6A 100%Str.ctu rd I Desip n 32 24 30 :6 ............ ....... ............ Task 79WH9mrs 47 00 2UD 32.00 6.00 0.00 Task Tatal Fee S _9,315.87 3,043.12 $ 4,428.40 448.86 ......—--— ---— ----- -- EXPENSES City of Kent: City of Kent-S 22Zi UPRR Grade Separation Expense Summary Conbact7mk Mana0amaa, Caerdinadon with Ely rad ONm SOudural Oerl" Consultants OTHER DIRECT COSTS (fia t.....t Per Urdt(w.hrn CI and then tit,for each'Feskl (?, AfAfelD boctiCin )rover. nrnnan ri,Offirag Rat imisrom "RiPa.�l P�,Q,r>,n$ ib' 1 SaBal!�115rktir 4W'b)Y.v.x!.ruYYiS.�IaJls�kT!adt,t!at!E,1 -11 c I A k l,rt l ci I Ll' Alr o o u o A III aav !D IriY i Y n rats . �. ,�..- ..,,..... . F fi e S Sr]YUI�M V 20(l) 0 y(h o I v I[a L O 0 R!I k 0 J 1411 4 (lq f.YJ r � 9 UI 0 I IItY E So,oa ford r l0ud PoI, nrrraped 4VaItalilt II $131NV U Ski loft 0 U) B .+ir9 Wan!'Itod k 4YAS tk4 k NhNo 0 rpU p Y 0 1)r Ilu k(t IIMVI Qna;IJ VdW II yll fPl f !d a]4+eIt) rr $%Qu 11 oo') on u _ COUMS M r;lalnfrlrr -. $71ott � 1! SOV0 0 ,to ft 1t0 0 'Tmi fasJlu a 19 n(j ❑ Ill o0 0 St)00 11 l la UU 0 SO idDAUrrr, v-Ft 11 F41pngi JniilR 40?SY ..1 . _ 1 0,UIv D "aghdlPi 0 .(,00 V [ r P'UY MlitrwMntiu 9u°aS5 .......ton 954Wi _.1) $(?.tlf1 O $P/;10� A{yp >54,to D`Kr DI$Er!_TEy3yyy_I,f,4t!1fR W13 TstS!S,iL SSA`n!Y 4sY Te'Ilrtk I l wlgw�, 0 DID a Pc oirr[WMI 21w1a t, aaaulc ra ror tr�a f (ia.V w..�, ,a�:o or [Ig B G�`,,. r yor)tat n .. in�G l.�.,.. il 11 U nl 11 :to.�� i0 U w to TRAVEL EXPENSES TOTAL $54.50 $0.00 $0.00 154.50 (dLS1Ttrilpnr^Ivi,[{uey¢t rynggl 5....RD'KI U+ PII,P„rJrdRlf, Cu tp ti a. tlo, X I �. All, P PY-=.al Qt I .kTnUVX H9V V Y kloa.d �,...... mnu imxmwwwwwu....m...,.�..... vim.. . d......�.,..$, ..Mmn 1 do r iSe/Lir $i (all it Orkaon li Sir¢roil 11 ki aba7 ti m_ tl;cldd itl lU k"nothInnewi zror) ( '01 IA U o Ill 0f 4 11O D n O $an.l q l G[ oU 1 fl di rU f'a I u: ci �uav0 as $uoa rr pW,I itYcie not) u ° OU 0 SU pY' .. p,00 _..Q 1 SOorD.... Mot 5,T,,,tf 'tg011 ( SD On Ul $tOkrYJ n 1 .UOn l+u,rO er h,nob •,.00 On idEYJftl 1p "ho So I, SU,UXIi _.. p {hrhnl rPi i L,%, tuorID 0 S CYCt So 0a PP D 0a 0 0 (I Pdd14PY lV' 4` ;"rAl Ar u .pfb U I (I in 04101tf Inal1vwraA .l= OO o $000 w $IiriYu o ( ..Oo Itoni I4prbiv llhto 41.1 L(Dina h l 4hlXdaY S2;art 0 'iU,US �G4 `,tYJN 0 Ipp p 'O f'r _. ,....... .._.� It Sal 4+I FIELD 6'(p4}1rPAfi $0.00 SO,W Syf OEM -�� $0.00 OIFlce FmgNnSl, - Y.k I' tl liYy I ,kTrAtal NI, IA9cTml91 fsM1Vtl XI II 4a4ry^ To< I tpryy mwnun rwun, S11Sn1 . .. U oo .w. w.....4 „ r ) D U MY tUJ C4P Y/P Ir 16(r rot Soo) WD O( ti Sr 0 n I4.g0 ., sur noa Sol Ex.rori... ) r 1 u I I6 ir,l h+rd cv do ( a rnu Ytl + 1r r.Ir P a Y Y11enu o n IG 1 r ry .I on r.nv dtli ll 1=UCW o01 rDl hll V97 0 „6'0 1W0 r1T(M) Wil I lu it d .I Y + Xu(IQ 25U 1541 VI S + 1 SIV d!`U 15 II@ O 6(V¢ 0 YC ^^Y ',fo it 4lM 1 a41Vtl�, i0 "a'i ( .00X�__. rOPli 11p.W a,r d9y 5q 13 2`0 {ry 1 54100 t Do Go 0 ul Mp1 f tx [On'r ur iti i10D 0 nr) Y 5r1 rN1 rf bxu^om 5('1 ( ialftl Wool, lf(h Y I!P Y CfF-11I'D SHO )i"art hyy+do 1 . n01 Coet" n"c dR p,Per oa e. DJ• 9 W 8B G0 D yvd thr o-- is np" IX Strap c91Peu xYfi aM't.Ilxi tl .atel QA4@0 U 00( It °6 Ut I it l)to "ol G_.... lop.�,. ,......._...,. ........ ._......... ..... ..._.. ..... ._...._....,.... ..._... ._�.�.,..,......... ........._._..._�..........W, .. ...._...__._—__OFFICE SUPPLIED TOTAL $67.00 $250 $000 $645U Miss II nco Expenses C.p rU c Qo' i<l l [Aty 1 T.t C v r hi_I-i_� n. ❑ly � L uEo 0 �Uf IX 1nO a ucir r IrrP it r D 900 tl n.Or d � 00 U SG qP 0 004B . 9( W r IO 4 aPU{) C _.... .... ...........__ ..,_A _ ........ ..<.._ _.... ......._ �_._,..._._0,0 xU UU ...,. MISCELLANEOUS E%PENSE$TOTAI,. 50.00 $O,OO 50.U0 $O,OO RIInRpBuy+6Ud�exT rERPpttSMA�65tIYYiMCCIE asa eof Labor ry Q[ PT-t Qt I ;k! tl pay . 4 ( rot I w . w«..n..m, .. u 1 CONTINGENCY BUDGET FORE ....._ ,,.... �. ___— ,_ v t q i l I I I ¢ Cx'P n f� �U . EXPENSES TOTAL $000 $000 SO 00 $U 00 TOTAL-OTHER DIRECTCOSTS $T, 5zso 50.00 5u9,Do aA3(=10ar&utu(i iarkop s. i red on Vr r) rf Into tool Ufi:, � ^DU.OU u1 � (u(1 pY, ��� tp0 ii4. � 5fU u0 TOTAL OTHER DIRECT COSTS+MARKUP $12150 $2.5U $o OD $uvao .. r FEE ESTIMATE City of Kent: City of Kent-S 228th UPRR Grade Separation n,or,I.b o,en duet"wL Ponm"[nuensci'iah Taskq Task Description Billable Labor Billable Expenses Total From Total For Proposal ..............._.......... ............... 1 Contract/Task Management $ 2,90�9r $ 2.SU $2,908.45 .......................,............_ ................... �. ._._.v� .........._.... 2 Coordination with Cltyand Other Consultants $ 797.84 $ $792.84 _. _...m._.... ._.......... _......., 3 Structural Dentin $ 13,538.44 $ 119M $13,657,34 $17,358.63 $0.00 Escaladon $0,0111 $Q_00 ,tw�,ortmr�,,.gaossros�lmot_s amn uvxesms.,Psm.�am.m c_esnMmexem Pe961 Page 1 of 2 �t`C"J CERTIFICATE OF LIABILITY INSURANCE D05/1 IUDYYY , 05/18/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS "ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ;'LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED rtEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: II[he certificate holder Is an ADDITIONAL INSURER the policy(ies) must havo ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the farms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate tloes not confer d h[s to the certificate holder In lieu of such endorsemeRtQs,). PRODUCER INTACT Willis of Minnesota, Inc. NAN1 PHONE _.,,, ..... 1-877 945 7378 FAN -- c/O 26 Century Blvd IEV Nk.E%II< IAIO Nb)111.1-8 8.8 467 23]B P.O. Be. 305191 ADDRESS, ADOR@$$ certificates@willis,com . _ ... _.. Nashville, TN 372305191 USA lNSURER(Sf AFFORDING COVERAGE NAICC _.. VNSURERA Liberty Mutual Fire Insurance Company 23035 INSURED INSURERS Liberty Insurance corporation RDx Engineering, Inc. � 42404 8494 Indian Hills Drive INSURER 0 Omaha, NE 68114 _ .. _.... ..,..."..... ..... .............. aNsuRER D I (wrsuN�g E. INSPIRER F COVERAGES CERTIFICATE NUMBER:W6237527 REVISION NUMBER',: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSRY ..... _..__ <. .. US L iRI TYPE OF INSURANCE AD V POLICYNUMBER MAIDDNYYY ( MMYOOYYYY " LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000 000 ( CLAIM MADE X OCCUR NAMrtCLT'Ij,l Harm •.. . V>n[MII$,E.§.1G$c�,LEloruJey $ 11000,000 A X Contract 1 L abiliky PER MED EXP(1my.0na(�arop) t 10,000 Y Y TB2-641-444950-038 06/01/2018 06/01/2019 N 2 TONAL&AOVINJURY s 2 000,000 GEW LAGGREGATE LIMITAPPL IES PER f uENEraALA(GRFGAIE $ 41000,00C POLICY X PRO x LOC Ca i'ktlk':Ifi. L PROUdGC„rti, COMPIOPACG $ ........ 4,000 000 AUTOMOa1LELIABILITY COVERS OSIN(y'LI"LIMIT iEa,sl;c4devill $ 2 000,000 X ANY AUTO BODILY INJURY(PS Pa n) $A "" AUTOSOME -'yyy AUTOSSCHED LED AUTOS ONLv AUTOS Y Y A52-641-444950-048 06/01/2018 '06/01/2019 SODILY INJURY(Per accident){ $ HIRED "'" NON OWNED AUTOS GNLY ,AUTOS ONLY PROPERTY AG! —I DIj, B X UMBRELLALIAB X OCCUR $ EACH OCCURRENCE § 5,000,000 E%CESS LIAR CLAIMS,MADE Y Y TE7-641-444950-06B 06/01/2010 06/01/2019 _ A6tl Pl 'AT g 5,000,000 W ORRERS COMPENSATION $ AND EMPLOYERS LIABILITY YIN I X PER 9fATUTE EN'H S k,NYPIfEi7J'NIEPORfPAIdTNFRAEXECU USE No NIA Y I EI EACH q LIOENT g 1,000,000 47E ndgtofMIF:MHF.ui E%OLL U4MErl? f WA]-64D-444950-01B 06/O1/2018 O6/OS/2019 k. IMmxd4rory in NHI .. ... ._. _ __.. .. If ss IAmaenbe under EL QSLAS, EAEMP OYFE $ 11000,000 U:BCIRiry rVOluB Of OPhRATYfJNIR'bvlfaw ­11EL DISEASE,POLICY LIMIT000" $ 1, ,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORDiD1,Addltlonal Remarks schod'e,meybeaMachenlrm...apace is m,.I1.dN Certificate Bolder is named as Additional Insured an General Liability, Automobile Liability and Umbrella. Liabilit on a primary, non-contributory basis where required by written contract, Waiver of Subrogation applies on General y Liability, Automobile Liability, Umbrella Liability and Worker. Compensation where required by written contract, Umbrella policy follows form of the underlying General Liability, Automobile Liability, Employers Liability, Employers Liability for the Monopolistic States of ND, OS, WA, 6 WY is provided in the Worker's Compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE BE IN CITY OF SENT ACCORDANCE WITH THE POLICY PROVISIONS. 'FNTION: NANCY YOSBITAI(F, ,?Y OF 1( HT ENGINEERING AUTHORIZED REPRESENTATIVE 400 WEST GOWE �,y , I SENT, WA 98032 y� q_ ©1988-2015 ACORD CORPORATION„ All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR m: 16178775 AATCH: 715012 AGENCY CUSTOMER ID: LOC#: ACC ADDITIONAL REMARKS SCHEDULE Page 2 Df, ` AGENCY NAMED INSURED SIR Inc. Willie of Minnesota, Inc, Engineering, E404 Indian Hills Drive POLICY NUMBER Omaha, NE 65114 See Page 1 CARRIER NAIC CODE , .— �.._,�.._._._ m_....... ... See Pdge 1 See Page 1 EFFECTIVE DD ATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance _ RE: LOWER LOWEST RUSSELL ROAD LEVEE PROJECT. REVIEWING THE RELOCATION BENEFIT EFIT CALCULATION AND PAYMENT APPROVAL FORMS USED TO IDENTIFY ANY POTENTIAL ISSUES FOUND IN THE RELOCATION BENEFIT CALCULATIONS, ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are regpistered marks of ACORO 3 SR ID: 16178775 TcH: 7NO12 CeaT: W6237527 Policy Number: T62-641.444950-038 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following, COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE FDesignated Locationi cations owned by or rented to the Named Insured ation re uired to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally b. Claims made or"suits" brought; or obligated to pay as damages caused by "occur- c. Persons or organizations making claims or rences"' under Section 1 — Coverage A, and for all bringing medical expenses caused by accidents under 9 g "suits". Section I — Coverage C, which can be attributed 3. Any payments made under Coverage A for only to operations at a single designated "loca- damages or under Coverage C for medical tion"shown in the Schedule above: expenses shall reduce the Designated Loca- 1. A separate Designated Location General tion General Aggregate Limit for that desig- Aggregate Limit applies to each designated nated "location". Such payments shall not re- "location", and that limit is equal to the duce the General Aggregate Limit shown in amount of the General Aggregate Limit, the Declarations nor shall they reduce any shown in the Declarations. other Designated Location General Aggre- gate2, The Designated Location General Aggregate hown inithfe or Schedule otherany oeegnatetl "location" Limit is the most we will pay for the sum of all damages under Coverage A, except damag- 4. The limits shown in the Declarations for Each es because of "bodily injury" or "property Occurrence. Damage To Premises Rented To damage" included in the "products-completed You and Medical Expense continue to apply. operations hazard' and for medical expenses However, instead of being subject to the under Coverage C regardless of the number General Aggregate Limit shown in the Decla- Of: rations, such limits will be subject.to the appid- cable Designated Location General Aggre- a. Insureds, gate Limit. CG 25 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by 'occur- "products-completed operations hazard" is pro- rences" under Section I — Coverage A, and for all vided, any payments for damages because at medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be at- the "products-completed operations hazard" will tributed only to operations at a single designated reduce the Products-completed Operations Ag- "location" shown in the Schedule above. gregate Limit, and not reduce the General Ag- 1. Any payments made under Coverage A for gregate Limit nor the Designated Location Gen- damages or under Coverage C for medical eral Aggregate Limit, expenses shall reduce the amount available D. For the purposes of this endorsement, the Defi- under the General Aggregate Limit or the nitions Section is amended by the addition of Products-completed Operations Aggregate the following definition: Limit, whichever is applicable, and "Location" means premises involving the same or 2. Such payments shall not reduce any Desig- connecting lots, or premises whose connection is nated Location General Aggregate Limit. interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 04 05 09 Policy Number: TB2-641-444950-038 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the followirg: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE [Designa:tedConstruc:com;nretethis Project(s): l conction pro not located at premises owned, leased or rented by a Named Insured ormate uired to Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by „occur- damages or under Coverage C for medical rences" under Section I — Coverage A„ and for all expenses shalt reduce the Designated Can- medical expenses caused by accidents under structioan Project General Aggregate Limit for Section I -- Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- t. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4, The limits, shown in the Declarations for Each Limit shown In the Declarations, Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply, Aggregate Limit is the most we will pay for the However" instead of being subject to the SLIM of all damages under Coverage A, ex. General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen- completed operations hazard", and for medi_ eraR Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds, b. Claims made or"suits" brought, or c. Parsons or organizations making claims or bringing"suits". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ B. For all sums which the Insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products-completed operations hazard"' is pro- rences" under Section I — Coverage A, and for all vided„ any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be at- the "products-completed operations hazard" wili tributed only to ongoing operations at a single reduce the Products-completed Operations Ag- designated construction project shown in the gregate Limit, and not reduce the General Ag- Schedule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit, damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract- Products-completed Operations Aggregate ing parties deviate from plans, blueprints, de- Limit, whichever is applicable; and signs, specifications or timetables, the project will 2. Such payments shall not reduce any Desig- still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. gate Limit. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 POLICY NUMBER: T132-641-444950-038 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWVNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the Person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only work, on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or damage' or "personal and advertising injury" on behalf of the additional insured(s) at the caused, in whole or in part, by: location of the covered operations has been 1. Your acts or omissions; or completed; or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf, injury or damage arises has been p ut to its in the performance of your ongoing operations for intended use by any person or organization the additional insured(s) at the location(s) other than another contractor or subcontractor designated above, engaged in performing operations for a However: principal as a part of the same project. C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III— Limits Of Insurance: law; and 2. If coverage provided to the additional insured is If coverage provided to the additional insured is equired by a contract or agreement, the most we required by a c ontract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured amount of insurance: will not be broader than that which you are required by the contract or agreement to provide 1. Required by the contract or agreement; or for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the "property damage" occurring after: Declarations. CG 20 10 04 13 C ISO Properties, Inc., 2012 Page 1 of 2 ❑ SCHEDULE =cchjs itional Insured Persons) Organization(s) L ocation(s) Operations Any peization with whom you have agreed, Or oontract,agreement or permit tditional insured coverage. informato ccm fete this Schedule if not shownns, CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: TB2-641-444950-038 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSJCOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Descri flan Of Com feted O +stations Any person or organization to whom or to which Any location where you have agreed,through you are required to provide additional insured written,contract,agreement or permft,to provide status in a written contract, agreement or permit additional insured coverage for completed except where such contract or agreement is operations.. rohibited,. Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds,the following is added to Section organization(s) shown in the Schedule, but only III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is Property damage"caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement, or hazard" 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by lawn and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not bebroader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number TB2-641-444950-038 Issued by THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT—SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: Where required by written contract. If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV - Conditions will not apply. If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV - Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same"occurrence",claim or"suit'. LC 24 20 0213 ©2013 Liberty Mutual Insurance„All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission, POLICY NUMBER: AS2-641-444950-048 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following, AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form, SCHEDULE Name Of Person(s)Or Organization(s): As required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifles as an "ensured" under the Who Is An Insured provision contained in Paragraph A.I. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2, of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form, CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Polley N l In=thfl AS2-641-444950-048 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED a NONCONTRIBUTING Thds M'ogmnanI rnndl9ei 111`ru1.r0r1 µm.ndeu wider nip fllfo- ing_ PUBI1`4EE8 AU1`0 COVERACF FORM GARAUL bOVLRAGC f UPM MOTOR CARRIERS COVERAGE FORM MUCKCR6C0Vf,dAG'F f OlVA 'F1'1In rasped to Coverage pfoVvded by ihs uvldOfW- w9 nt, Shu prLvillons of fro C%0'veffldv` Form clrnhi UI'lltmt mo.0"by Thle ondoraan.w This andprnwore Idomi los porson;sl or orgairamont6i who era "n�surads" order thra VVIto is All Insurod ProV13IOh c,rw,L19Yd'i a rp fplArl,Tnoj meorgemonr/,Ioryy nutalter covpr'ne proticoll In the Gaf Mae fom- Schedule (Name of Person(sj or Orgaxllrxuans(et nn} pe i ,o, I,Irtsn,.i r, T,y>:c tiv I lI e ftn' rQa 1...) rc''cIr ul "Ir;d.ce,n rr4 rr w r, '.> L' 41d. i4u.-kr f r Wkl .II r I ry -..ioo Regarding Designated Contract or Proler:t; An Coo vnrsrour or Pro}...vr1on ot©wn bvprp$.C,nESrlhlh OfINA Yfndru rn nt,.gan in:iroq'fordalallty Commlo ew niby In Ina tnitont Mar piewn or orhy,ni Arwiml Llrrvb I I S as au+ Inv-arrx.1"unow tyro Who is. An Inn irn 0 ll,irvieurr wntwrreb in onct"R1 i otr1R Lole'dgn r0n➢ I lie Inl wymruj is added in IN,Other Iranian"Condition: It yrau nDwo agroadn In o wial.r,nglrrnnuonl pha#lr'le pGllo')<wlll bo prhr my anr?will Celt r lthr of a;oT#Ilun6f.n Irnnr any nauranan in force for an hddibmal Ineur and Far IYnaAdy o k,ng oul of yaps OV01 ttl00M U1Id the .lgfpdin".11 WAS exke ulwj wean:[ to Iola'bod ly rn'Vrp' of "plro peft)*rtanvrj'e, then,thoG in&4XrxY'rtAfl, °trvll IY pdrr.-y ilnd we u,411 not seek rwntrOuhnn from such Irisuranco. AC 8423 08 11 20 ftl.Uhcro/PAutoal Group of Companies, All tlgh[a unrnamb, Pngc i of i Inolq.lc:e.a�pya'q;hlnd rrmoterinl of I nsui.,f .Senylce•r Olk,,, Inc.. w,115 is p9RIk1551nfL POLICY NUMBER: TB2-641-444950-038 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract or agreement Information re aired to com lete this Schedule, if not shown above„ will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: AS2-641-444950-048 COMMERCIALAUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following. AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization for whom you perform work under a written contract of the contract requires you to obtain this agreement from us but only If the contract is executed prior to the injury or damage occurring. Information require to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 5 Insurance Services Office, Inc„ 2011 Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. ('This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Where required by contract or written agreement prior to loss, Issued by: For attachment to Policy No WA7-64D-444950-018 Effective Date 6/0 112 01 8 Premium Issued to, i WC 00 03 13 © 1983 National Council on Compensation Insurance, Inc. Page 1 of 1 Ed. 4/1/1984 Policy Number TB2-641-444950-038 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY—UMBRELLA COVERAGE FORM Schedule Name of Other Person(s)! Email Address or mailing address. Number Days Notice:. Or�anization(s): Per Schedule on File 30 A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 04 03 14 ©2014 Liberty Mutual Insurance., All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission,. Policy Number AS2-641-444950-048 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM Schedule Name of Other Persons)! Email Address or mailing address: Number Days Notice: Ocganizallan s Per Schedule on File 30 A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged, .. LIM 99 04 03 14 ©2014 Liberty Mutual Insurance. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF MATERIAL CHANGE We will not make changes that reduce the insurance afforded by this policy until written notice of such reduction has been delivered to those scheduled below at least 30 days before the effective date of the material change to the insurance afforded by this policy. Our failure to provide notice under this endorsement will not affect the validity of the changes except as it relates to the person or organization listed below. NAME ADDRESS Per Schedule on file. In no event will the notification be less than the minimum days required for notification by state statute, Notification will be provided to all parties in a manner as required by state statute, if any. This endorsement is executed by the Liberty Insurance Corporation Premium, Effective Date:611/2018 Expiration Date:6/112019 For attachment to Policy No:WA7-64D-144 9 5 0-01 8 Countersigned by -.......... Authorized Representative End. Serial No. WC992016 Page 1 of 1 Ed, 09/01/2010 Copyright 2010 Liberty Mutual Group of Companies„ All Rights Reserved WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 20 74 (Ed. 12-16) NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below by email as soon as practical after notifying the first Named Insured. B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) / Organization(s); Per Schedule on file with Company 30 Days All other terms and conditions of this policy remain unchanged. Issued by For attachment to Policy No. WA7-64D-444950-018 Effective Date 6/01/2018 Premium $ Issued to DATE IMMIDDIYYYV CERTIFICATE OF LIABILITY INSURANCE 6/1I2019 1 5/18/2018 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS "'-ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen. s). PRODUCER Lookton Companies d5a 444 W.47th Street,Suite 900 PHONE - Kansas City MO 64 1 12-1 9 0 6 €CINIExit.--.. . .... _ UN09,RmJ�.. .. MA (816)960-9000 Ap,P39§s°. ......... _ YN URER(Si AFFORDINGC OVERAGE NAICA .. . INSU Lexington InStlraB ( a11111 SU HE RERA RED HER ENGINEERING,INC wsuRERe 29590 .. .. .__ �... ,.. _ .. IND[AN HILLS DRIVE INSURER c _ OMAHA NE 68114-4049 . INSURER D: INSURER E. INSURER F COVERAGES; *HDRINOI CERTIFICATE NUMBER: 14730903 REVISION NUMBER: xxxxxxx THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS„ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR .. . .......... ,,,, .... _..... ,,,,,.. ..... TYPE OF INSURANCE Ab94$UAR POLICY NUMBER I MMMDYYFM MMtpp Ye YYYV LIMITS COMMERCIAL GENERAL LIABILITY NOT APPLICABLE' EACH OCCURRENCE s �`h`K�,,;'r,XX Y CLAIMS MADE OCCUR DAJXXOE YO'RENl FD . I .. .,.... ... Y A P J RADIFS c LB ADA INJURY $ .rTixxxxxx s _ : _ _ ate PRODUCTS-COMPIOPAGc..l.s XXXxxxh GEN L ..... AGGREGATE LIMIT APPLIES PER .A.�,. POLICY� — � � _ � LOC AUTOMOBILE LIABILITY NO] APPLICABLE, Bld^:4,'(7,INCk.EIMIT i Daan.annrl_ 1 xxxxxxx ANYAUTO BODILY INJURY(Pelper.1. $ OWNED SCHEDULED Xh.`iXX>XX AUTDsoNLY _I AUTOS BODILY INJURY(Per dccldenl) $ XJxxxx"x .. ... HIRED NON-OWNED PRO4"{°RTY OAMhEnR —. AUTOS ONLY _. AUTosoNLv 01ofor..eruWmo $ xxxxxxX UMBRELLA IA $ XXXXxXX OCCURLNN APP5CABLI, -- rAo„IaoccuRRENCE $ xXKKXXx EXCESS LIAR CLAIMS MAD $ xxx Kxxx WORKERS ACri ISTAT VTE RED "COMPENSATION y,. . _ s XXkXXXX AND EMPLovoERsL AelurY APPLICABLE ��I""""""` j j' II y ry I II ..L FR ANY PERIME 1OR'IPXCLUEReO.'EI,LY rN l" YIN EL EACH ACCIDENT -$ xxxxxxx ...Ci'PY ICPRIMCMHEn C.rCL41U�EJN � _.... ..__...... (mandatory In NH EL DISEASE-EA(MPLOYEE $ XXAXXXX UF.4CRIPOON OF OPERABONSbelow EL DIS EASE.POI.IG Y 4.I MI r Sh"X.Y.XxX.YiA ARCH&ENG J3691 6/I/2018 6/I Y1019 PER CLAIM. $S,OOQ000 PROFESSIONAL ACGREGATF,`. $5000,000 LIABILITY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD I01,AddlUI Ramarpe Uhaulu,may Be aM&.c!if more apace le requlred) CITY OF KENT SOUGH 228"rH IIPRR(-rlthf)F SI'.FARAITON,IIDR(!ON"r12ACT d CON0104334,PROJP_CI 9272159 30 DAYS NOTICE OP CANCELLNNON APPLTFS, 10 DAYS NOTICE FOR NON-PAYMEN r OF PRF;MIUM_ CERTIFICATE HOLDER CANCELLATION 14730903 CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: NIAPK MADF:AI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 FOURTH AVENUE SOUTH ACCORDANCE WITH THE POLICY PROVISIONS. ,KENT WA 98032 C AUTHORIZED REPRESENTA TIV r ©15158 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD of I V aw m w . ua �,w IIa't m a �" a Iw � ." .,. rtu e oa' ��"�a• � .'. � ' � r r ty n Ill G III W nm uu ao m pN—n V Y I I m � I �Ilm I I AN m a m m m. IPoI� wli f, � •®m� �a uu � ®N ml II•. i 1 r i i w