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HomeMy WebLinkAboutCAG2019-124 - Original - Evergreen Asphalt & Concrete, Inc. - Springwood Park Asphalt Patching - 03/06/2019 KEN,- 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: Evergreen Asphalt & Concrete, Inc. Vendor Number (JDE): 213355 Contract Number (City Clerk): Cq('IZO�� ��2.C{ Category: _Contract Agreement Sub-Category (if applicable): None Project Name: Asphalt Patching at Springwood Park Contract Execution Date: 03/06/2019 Termination Date: 05/31/2019 Contract Manager: Andy Martin Department: Parks Contract Amount: $6435.00 Budgeted: FVI Grant? Part of NEW Budget: ❑ Local: State: Federal: ❑ Related to a New Position: Notice required prior to public disclosure? Basis for Selection of Contractor? Other Approval Authority: Dt�tter Mayor ❑ City Council Su PER-1 rl rCn1 DEnT Other Details: Asphalt patching at Springwood Park, located at 12700 S.E. 274th Street, Kent WA 98031. KENT wAs , ,oI PUBLIC WORKS AGREEMENT between City of Kent and Evergreen Asphalt & Concrete, Inc. THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Evergreen Asphalt & Concrete, Inc. organized under the laws of the State of Washington, located and doing business at 27204 SE Kent-Kangley Road, Ravensdale WA 98051; Mailing address P.O. Box 867, Ravensdale WA 98051. Contact: Shane Gilbertson, Phone: 425-584-7890, Cell: 253- 670-9072 (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: Asphalt patching at Springwood Park, located at 12700 S.E. 2741h Street, Kent WA 98031. Includes 1300 square feet new asphalt trail patching in one location, 3 inches thick and removal of existing asphalt, tree roots and new grade by owner, approximately 26 tons as described in Proposal #7438 dated 2/4/19 attached as Exhibit A. it i 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 May 31, 2019. III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed SIX THOUSAND FOUR HUNDRED THIRTY FIVE DOLLARS AND NO CENTS ($6,435.00), 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 (85%) 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 the State Department of Revenue, the State Department of Labor & Industries, and PUBLIC WORKS AGREEMENT - 1 ($20K or Less and No Performance Bond) the State Employment Security Department, and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. B. Retainaae. 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 or Unauthorized 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 Payment: Waiver 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 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. PUBLIC WORKS AGREEMENT - 3 ($20K or Less and No Performance Bond) 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 Claim. 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. Records. 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 Protested 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 Constitutes 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. Failure to Follow Procedures Constitutes Waiver. 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. 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 PUBLIC WORKS AGREEMENT - 4 ($20K or Less and No Performance Bond) 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 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. PUBLIC WORKS AGREEMENT - 5 ($20K or Less and No Performance Bond) XV. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section 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. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Contractor. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The 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 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. PUBLIC WORKS AGREEMENT - 6 ($20K or Less and No Performance Bond) J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. All acts consistent with the authority of this Agreement and prior to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. CONTRACTOR: CITY OF ENT: By: R-11:::? By: \(signature) (signature) Print Name: Print ame: Garin Lee, Its Its: Parks Operations Superintendent � e) DATE: 2 ' 9 DATE: 4 Z 15 NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONTRACTOR: CITY OF KENT: Shane Gilbertson Andy Martin, Construction Crew Lead MWIV Evergreen Asphalt & Concrete, Inc. City of Kent P.O. Box 867 220 Fourth Avenue South Ravensdale, WA 98051 Kent, WA 98032 (253) 670-9072 (cell) or (253) 569-6940 (cell) or (425) 584-7890 (telephone) (facsimile) (253) 856-5124 (telephone) (253) 856-6120 (facsimile) ATTEST: 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 below, I agree to fulfill the five requirements referenced above. By: For: C-- Tit I e: �-�-- Date: -15 EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 BIDDER RESPONSIBILITY CRITERIA Certification of Compliance with Wage Payment Statutes 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 (02/04/2019), 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. Evergreen Asphalt & Concrete, Inc. By: Signature of Au hoorrized Official* Printed Name: c\ � G• � . Title:Date: City City and State: A�e-�— �i1✓� *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 2/26/2019 abouttlank 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 wage rate and the hourly rate of fringe benefits. On public works projects, worker's wage and benefit rates must add to not less than this total. A brief description of overtime calculation requirements are provided on the Benefit Code Key. Journey Level Prevailing Wage Rates for the Effective Date: 2/26/2019 County_ Trade Job Classification Wage Holiday Overtime Note King Laborers Air, Gas Or Electric Vibrating $48.90 7A 31 Screed King Laborers Airtrac Drill Operator $50.42 7A 31 King Laborers Ballast Regular Machine $48.90 7A 31 King Laborers Batch Weighman $41.45 7A 31 King Laborers Brick Pavers $48.90 7A 31 King Laborers Brush Cutter $48.90 7A 31 King Laborers Brush Hog Feeder $48.90 7A 31 King Laborers Burner $48.90 7A 31 King Laborers Caisson Worker $50.42 7A 31 King Laborers Carpenter Tender $48.90 7A 31 King Laborers Caulker $48.90 7A 31 King Laborers Cement Dumper-paving $49.81 7A 31 King Laborers Cement Finisher Tender $48.90 7A 31 King Laborers Change House Or Dry Shack $48.90 7A 31 King Laborers Chipping Gun (under 30 Lbs.) $48.90 7A 31 King Laborers Chipping Gun(30 Lbs. And Over) $49.81 7A 31 King Laborers Choker Setter $48.90 7A 31 King Laborers Chuck Tender $48.90 7A 31 King Laborers Clary Power Spreader $49.81 7A 31 King Laborers Clean-up Laborer $48.90 7A 31 King Laborers Concrete Dumper/chute Operator $49.81 7A 31 King Laborers Concrete Form Stripper $48.90 7A 31 King Laborers Concrete Placement Crew $49.81 7A 31 King Laborers Concrete Saw Operator/core $49.81 7A 31 Driller King Laborers Crusher Feeder $41.45 7A 31 King Laborers Curing Laborer $48.90 7A 31 King Laborers Demolition: Wrecking 8t Moving $48.90 7A 31 (incl. Charred Material) King Laborers Ditch Digger $48.90 7A 31 King Laborers Diver $50.42 7A 31 abouttlank 1/4 2/26/2019 aboutbiank King Laborers Drill Operator $49.81 7A 31 (hydrau tic,diamond) King Laborers Dry Stack Walls $48.90 7A 31 King Laborers Dump Person $48.90 7A 31 King Laborers Epoxy Technician $48.90 7A 31 King Laborers Erosion Control Worker $48.90 7A 31 King Laborers Falter Et Bucker Chain Saw $49.81 7A 31 King Laborers Fine Graders $48.90 7A 31 King Laborers Firewatch $41.45 7A 31 King Laborers Form Setter $48.90 7A 31 King Laborers Gabian Basket Builders $48.90 7A 31 King Laborers General Laborer $48.90 7A 31 King Laborers Grade Checker Et Transit Person $50.42 7A 31 King Laborers Grinders $48.90 7A 31 King Laborers Grout Machine Tender $48.90 7A 31 King Laborers Groutmen (pressure)including $49.81 7A 31 Post Tension Beams King Laborers Guardrail Erector $48.90 7A 31 King Laborers Hazardous Waste Worker (level A) $50.42 7A 31 King Laborers Hazardous Waste Worker (level B) $49.81 7A 31 King Laborers Hazardous Waste Worker (level C) $48.90 7A 31 King Laborers High Scaler $50.42 7A 31 King Laborers Jackhammer $49.81 7A 31 King Laborers Laserbeam Operator $49.81 7A 31 King Laborers Maintenance Person $48.90 7A 31 King Laborers Manhole Builder-mudman $49.81 7A 31 King Laborers Material Yard Person $48.90 7A 31 King Laborers Motorman-dinky Locomotive $49.81 7A 31 King Laborers Nozzleman (concrete Pump, $49.81 7A 31 Green Cutter When Using Combination Of High Pressure Air Et Water On Concrete Et Rock, Sandblast, Gunite, Shotcrete, Water Bla King Laborers Pavement Breaker $49.81 7A 31 King Laborers Pilot Car $41.45 7A 31 King Laborers Pipe Layer Lead $50.42 7A 31 King Laborers Pipe Layer/tailor $49.81 7A 31 King Laborers Pipe Pot Tender $49.81 7A 31 King Laborers Pipe Reliner $49.81 7A 31 King Laborers Pipe Wrapper $49.81 7A 31 King Laborers Pot Tender $48.90 7A 31 King Laborers Powderman $50.42 7A 31 King Laborers Powderman's Helper $48.90 7A 31 King Laborers Power Jacks $49.81 7A 31 King Laborers Railroad Spike Puller - Power $49.81 7A 31 King Laborers Raker - Asphalt $50.42 7A 31 King Laborers Re-timberman $50.42 7A 31 abouttlank 2/4 2/26/2019 abouttlank King Laborers Remote Equipment Operator $49.81 7A 31 King Laborers Rigger/signal Person $49.81 7A 31 King Laborers Rip Rap Person $48.90 7A 31 King Laborers Rivet Buster $49.81 7A 31 King Laborers Rodder $49.81 7A 31 King Laborers Scaffold Erector $48.90 7A 31 King Laborers Scale Person $48.90 7A 31 King Laborers Sloper (over 20") $49.81 7A 31 King Laborers Sloper Sprayer $48.90 7A 31 King Laborers Spreader (concrete) $49.81 7A 31 King Laborers Stake Hopper $48.90 7A 31 King Laborers Stock Piler $48.90 7A 31 King Laborers Tamper Et Similar Electric, Air Et $49.81 7A 31 Gas Operated Tools King Laborers Tamper (multiple Et Self- $49.81 7A 31 propelled) King Laborers Timber Person - Sewer (lagger, $49.81 7A 31 Shorer Et Cribber) King Laborers Toolroom Person (at Jobsite) $48.90 7A 31 King Laborers Topper $48.90 7A 31 King Laborers Track Laborer $48.90 7A 31 King Laborers Track Liner (power) $49.81 7A 31 King Laborers Traffic Control Laborer $44.33 7A 31 8R King Laborers Traffic Control Supervisor $44.33 7A 31 8R King Laborers Truck Spotter $48.90 7A 31 King Laborers Tugger Operator $49.81 7A 31 King Laborers Tunnel Work-Compressed Air $107.60 7A 31 8Q Worker 0-30 psi King Laborers Tunnel Work-Compressed Air $112.63 7A 31 8Q Worker 30.01-44.00 psi King Laborers Tunnel Work-Compressed Air $116.31 7A 31 80 Worker 44.01-54.00 psi King Laborers Tunnel Work-Compressed Air $122.01 7A 31 8Q Worker 54.01-60.00 psi King Laborers Tunnel Work-Compressed Air $124.13 7A 31 80 Worker 60.01-64.00 psi King Laborers Tunnel Work-Compressed Air $129.23 7A 31 80 Worker 64.01-68.00 psi King Laborers Tunnel Work-Compressed Air $131.13 7A 31 80 Worker 68.01-70.00 psi King Laborers Tunnel Work-Compressed Air $133.13 7A 31 80 Worker 70.01-72.00 psi King Laborers Tunnel Work-Compressed Air $135.13 7A 31 8Q Worker 72.01-74.00 psi King Laborers Tunnel Work-Guage and Lock $50.52 7A 31 8Q Tender King Laborers Tunnel Work-Miner $50.52 7A 31 8Q King Laborers Vibrator $49.81 7A 31 King Laborers Vinyl Seamer $48.90 7A 31 King Laborers Watchman $37.67 7A 31 abouttlank 3/4 2/26/2019 abouttlank King Laborers Welder $49.81 7A 31 King Laborers Well Point Laborer $49.81 7A 31 King Laborers Window Washer/cleaner $37.67 7A 31 abouttlank 4/4 EXHIBIT A Evergreen Asphalt& PROPOSAL Concrete, Inc. Date Proposal# ,9 P.O. Box 867 �T& Ravensdale, WA 98051 2/4/2019 7438 Ph/Fax: 425 584-7890 PROPOSAL SUBMITTED TO: City of Kent 220 Fourth Avenue Kent,WA 98032 Attn Andy Martin TERMS SUBMITTE... JOB ADDRESS Due on receipt SG Qty Description Rate Total Springwood Park Asphalt Patching 1,300 Sq Ft new asphalt trail patching in 1 location 3"thick. Removal of existing asphalt,tree roots,and 4.50 5,850.00T new grade by owner Approximately 26 tons Prevailing wage Sales Tax (10.0%) $585.00 The above prices,specifications and conditions are satisfactory and are herby accepted. You are authorized to do the work as specified. 50%Payment is due within 30 days. 1.5%PER Total $6,435.00 MONTH SERVICE CHARGE ON ALL PAST DUE ACCOUNTS. IN THE EVENT LEGAL ACTION IS TAKEN TO COLLECT ANY AMOUNTS DUE,YOU AGREE TO PAY ALL LEGAL FEES&EXPENSES. THIS QUOTATION IS ONLY VALID FOR Signature THIRTY(30)DAYS. E-mail: Web Site: evergreen.dirk@comcast.net Evergreenasphalt.com 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. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 or its equivalent, with minimum limits of $3,000,000 per occurrence and in the aggregate for each 1 year policy period. This coverage may be any combination of primary, umbrella or excess liability coverage affording total liability limits of not less than $3,000,000 per occurrence and in the aggregate. Products and Completed Operations coverage shall be provided for a period of 3 years following Substantial Completion of the work. The Commercial General Liability insurance shall be endorsed to provide the Aggregate per Project Endorsement ISO form CG 25 03 11 85. The City shall be named as an Additional Insured under the Contactor's Commercial General Liability insurance policy with respect to the work performed for the City. All endorsements adding Additional Insureds shall be issued on form CG 20 10 11 85 or a form deemed equivalent, providing the Additional Insureds with all policies and endorsements set forth in this section. 2. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 3. 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. Commercial General Liability insurance shall be written with minimum limits of $,3,000,000 per occurrence and in the aggregate for each 1 year policy period. This coverage may be any EXHIBIT B (Continued) combination of primary, umbrella or excess liability coverage affording total liability limits of not less than $3,000,000 per occurrence and in the aggregate. Products and Completed Operations coverage shall be provided for a period of 3 years following Substantial Completion of the work. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability: 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. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. 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. EXHIBIT B (Continued) E. Waiver of Subrogation The Contractor and the City waive all rights against each other any of their Subcontractors, Sub-subcontractors, agents and employees, each of the other, for damages caused by fire or other perils to the extend covered by Builders Risk insurance or other property insurance obtained pursuant to the Insurance Requirements Section of this Contract or other property insurance applicable to the work. The policies shall provide such waivers by endorsement or otherwise. F. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. G. 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. H. 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. EVEPASP-02 LBUISCIO ,acoRo CERTIFICATE OF LIABILITY INSURANCE DATE F / �-� o2/27z7/2o1 019Y) s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Laura Buscio NAME: Hub International Northwest LLC PHONE FAX 200 1st Avenue West,Suite 500 (A/C,No,Ext):(206)838-1015 (A/C,No): Seattle,WA 98119 E-MAIL DRESS:laura.buscio@hubinternational.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Depositors Insurance Company 42587 INSURED INSURER B:AMCO Insurance Company 19100 Evergreen Asphalt 8r Concrete,Inc. INSURER C: P O Box 1567 INSURER D: Kent,WA 98035 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X GLD03037050259 04/30/2018 04/30/2019 DAMAGE PRE SE T0 RENTED 100,000 (Ea occurrence) _$ ME EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) _$ _ X ANY AUTO X X BAPD3037050259 04/30/2018 04/30/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS SSWry BODILY INJURY CPer accident) $ AUTS ONLY AUOTOS ONLDY PROPERTY accident DAMAGE $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LAB CLAIMS-MADE CAA3037050259 04/30/2018 04/30/2019 AGGREGATE _$ 2,000,000 DIED X RETENTION$ 10,000 $ A WORKERS AND EMPLOYERCOMPENSATION N ATIOI N Y/N STATUTE X OTRH- ANYPROPRIETOR/PARTNER/EXECUTIVE GLD03037050259 04/3012018 04/30/2019 1,000,000 gFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Springwood Park Asphalt Patching The City of Kent,its officials,employees and volunteers are additional insured for general liability,but only if required by written contract or written agreement per the attached. Insurance is primary and non-contributory per the attached.Waiver of subrogation applies per the attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 220 4th Ave South Kent,WA 98032 AUTHORIZED REPRESENTATIVE v' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy#GLD03037050259 COMMERCIAL GENERAL LIABILITY CG 73 23 12 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Lost Key Coverage D. Expanded Property Damage Coverage 1. Under Section I — Coverages, Coverage A 1. For the purposes of this endorsement only: Bodily Injury And Property Damage Section I — Coverages, Coverage A Liability, coverage is extended to include Bodily Injury And Property Damage the following: Liability, 2. Exclusions, Exclusion j. If a customer's master or grand key, Damage To Property is amended as follows: excluding electronic key card, is lost, a. Paragraphs(3), (5), and(6) are deleted damaged or stolen while in your care, in their entirety. custody or control we will pay the cost of b. Paragraph (4) is deleted in its entirety replacing the keys, including the master lock and replaced with: and all keys used in the same lock, the cost (4) Personal property in the care, of adjusting locks to accept the new keys, or custody, or control of the insured: the cost to replace the locks, whichever is less. (a) for storage or sale at premises 2. Limit of Insurance—For the purpose of this you own, rent or occupy; or coverage the most we will pay is $ 10,000 (b) while being transported by any per"occurrence". aircraft, "auto" or watercraft B. Voluntary Property Damage owned or operated by or rented 1. Section I — Coverages,Coverage Bodily to or loaned to any insured. Injury And Property Damage Liability c. The coverage provided by this coverages extendedo includethefollowing: endorsement does not apply to At our request, we will "property damage": y q pay for "property damage"to propertyof others caused by you (1) Arising out of the disappearance or and while in yourpossession,risingout of your loss of use of personal property;or business operationsand occurring during the (2) Included in the "products-completed policyperiod. operations hazard". 2. Limit of Insurance—For the purpose of this 2. Limit of Insurance - The most we will pay coverage the most we will pay is$1,500 per for loss arising out of any one "occurrence" "occurrence". is$5,000. C. Non-Owned Watercraft 3. Deductible - Our obligation to pay for a Under Section I — Coverages, Coverage A covered loss applies only to the amount of Bodily Injury And Property Damage Liability, loss in excess of$250. 2. Exclusions, Exclusion g. Aircraft, Auto Or We will pay the deductible amount to effect Watercraft Paragraph(2)(a) is replaced with: settlement of any claim or "suit" and, upon (a) Less than 51 feet long; and notification of this action having been taken, you shall promptly reimburse us for the deductible as has been paid by us. CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 5 with its permission. ACP GLD03027050259 51BE 17128 INSURED COPY 47 0018262 CG 73 23 12 16 This insurance is primary to any expanded d. All reasonable expenses incurred by the property damage coverage provided by a insured at our request to assist us in the separate endorsement attached to this investigation or defense of the claim or policy, and it will supplant any deductible in "suit", including actual loss of earnings up to said endorsement $500 a day because of time off from work. E. Damage To Premises Rented To You G. Newly Formed And Acquired Organizations 1. Under Section I —Coverages, Coverage A Under SECTION II — WHO IS AN INSURED Bodily Injury And Property Damage Paragraph 3.a.is replaced with: Liability, the last paragraph of 2. a. Coverage under this provision is afforded Exclusions is replaced with: only until the 1801' day after you acquire or If Damage To Premises Rented To You is form the organization or the end of the policy not otherwise excluded, Exclusions c. period,whichever is earlier; through n. do not apply to damage by fire, H. Additional Insured — Automatic Status When lightning, explosion, smoke, or sprinkler Required In An Agreement Or Contract With leakage to premises while rented to you or You temporarily occupied by you with permission Section II —Who Is An Insured is amended to of the owner. include: 2. Under Section III — Limits Of Insurance, 1. Any person(s)or organization(s)described Paragraph 6 is replaced with: in Paragraph a.—d. below with whom you 6. Subject to 5. above, the Damage To have agreed in writing in a contract or Premises Rented To You Limit is the written agreement that such person or most we will pay under Coverage A for organization be added as an additional damages because of"property damage" insured on your policy during the policy to any one premises, while rented to period shown in the Declarations. you, or in the case of damage by fire, 2. Any other person or organization you are lightning, explosion, smoke or sprinkler required to add as an additional insured leakage, while rented to you or under the contract or agreement described temporarily occupied by you with in Paragraph 1. above. permission of the owner. The limit is The person or organization added as an increased to$1,000,000. insured s this endorsement is an insured 3. Under Section IV — Commercial General only for liability due to: Liability Conditions, 4. Other Insurance, b. a. Lessors of Leased Equipment — with Excess Insurance (1) (a) (ii) is replaced with: respect to their liability for"bodily injury", "property damage", or "personal and (ii) That is Fire, Lightning, Explosion, Smoke advertising injury", caused in whole or in or Sprinkler leakage insurance for part by your maintenance, operation, or premises rented to you or temporarily use of equipment leased to you by such occupied by you with permission of the person(s) or organization(s). This owner. insurance does not apply to any F. Supplementary Payments "occurrence"which takes place after the Under Section I — Coverages, Supplementary equipment lease expires. Payments — Coverages A and B Paragraphs However, their status as additional 1.b and 1.d. are replaced with: insured under this policy ends when b. Up to $2,500 for cost of bail bonds required their lease, contract, or agreement with because of accidents or traffic law violations you for such leased equipment expires. arising out of the use of any vehicle to which b. Managers or Lessors of Premises — the Bodily Injury Liability Coverage applies. with respect to liability arising out of the We do not have to furnish these bonds. ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. ACP GLD03027050259 51BE 17128 INSURED COPY 47 0018263 CG73231216 This insurance does not apply to: (1) Your acts or omissions; or (1) Any "occurrence"which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; in the that premises. performance of your ongoing (2) Structural alterations, new con- operations performed for that struction, or demolition operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage", cease to be a tenant of such premises. or "personal and advertising injury" c. State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises — with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services,including.- has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own, rent, failing to prepare or approve or control and to which this insurance maps, shop drawings, opinions, applies. reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection, or removal of specifications;or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural or engineering activities. holes, driveways, manholes, This exclusion applies even if marquees, hoist away openings, the claims against any insured sidewalk vaults, street banners, or allege negligence or other decorations and similar exposures; wrongdoing in the supervision, or hiring, employment, training or (2) The construction, erection, or monitoring of others by that removal of elevators;or insured, if the "occurrence" (3) The ownership maintenance or use which caused the "bodily injury" or "property damage", or the of any elevators covered by this offense which caused the insurance. "personal and advertising This insurance does not apply to: injury", involved the rendering (1) "Bodily injury" or "property damage" of, or failure to render, any or "personal or advertising injury" professional, architectural, arising out of operations performed engineering, or surveying for the state or municipality; or services. (2) "Bodily injury" or "property damage" (2) "Bodily injury" or "property damage" included within the "products- occurring after: completed operations hazard". (a) All work, including materials, However, such state or political parts, or equipment furnished in subdivision's status as additional connection with such work, on insured under this policy ends when the the project (other than service, permit ends. maintenance, or repairs) to be d. Owners, Lessees, or Contractors — performed by or on behalf of the with respect to liability for"bodily injury", additional insured(s) at the location of the covered "property damage", or "personal and operations has been completed; advertising injury" caused in whole or in or part, by: CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission. ACP GLD03027050259 51BE 17128 INSURED COPY 47 0018264 CIS 73 23 12 16 (b) That portion of "your work" out b. You have agreed in writing in a contract of which the injury or damage or agreement that this insurance would arises has been put to its be primary and would not seek intended use by any person or contribution from any other insurance organization other than another available to the additional insured. contractor or subcontractor I. Employee Bodily Injury To Another Employee engaged in performing Under Section II — Who Is An Insured The operations for a principal as a part of the same project. following is added to Paragraph 2.a.(1): However, a person or organization's Paragraphs 2.a.(1) (a), (b) and (c) do not apply status as additional insured under to "bodily injury" to a co-"employee" in the this policy ends when your course of the co-"employee's" employment by operations for that additional insured you, or to "bodily injury" to a co-"volunteer are completed. worker" while performing duties related to the With respect to the insurance afforded to conduct of your business. such additional insureds a. — d. described J. Broad Form Named Insured above, the following is added to Section III Under Section II — Who Is An Insured The —Limits Of Insurance: following is added to Paragraph 2.: If coverage provided to the additional e. Any business entity incorporated or insured is required by a contract or organized under the laws of the United State agreement,the most we will pay on behalf of of America (including any State thereof), its the additional insured is the amount of territories or possessions, or Canada insurance: (including any Province thereof)in which the 1. Required by the contract or agreement; Named Insured shown in the Declarations or owns,during the policy period, an interest of 2. Available under the applicable Limits of more than fifty percent. If other valid Insurance shown in the Declarations: collectible insurance is available to any whichever is less. business entity covered by this solely by This endorsement shall not increase the reason of ownership by the Named Insured applicable Limits of Insurance shown in the shown in the Declarations in excess of fifty Declarations. percent, this insurance is excess over the However, the insurance afforded to such other insurance, whether primary, excess, additional insureds a.—d. described above: contingent,or on any other basis. 1. Only applies to the extent permitted by K. Aggregate Limit Per Location law; and Under Section III — Limits Of Insurance the 2. Will not be broader than that which you following is added to Paragraph 2: are required by the contract or The General Aggregate Limit under Section III agreement to provide for such additional Limits Of Insurance applies separately to each insured. of your locations owned by or rented to you or 3. Primary and Noncontributory — Other temporarily occupied by you with the permission Insurance Conditions of the owner. For the purposes of this provision, The following is added to the Other location means premises involving the same or Insurance Condition and supersedes any connecting lots, or premises whose connection provisions to the contrary: is interrupted only by a public street, roadway, Primary and Noncontributory Insurance waterway or railroad right-of-way. This insurance is primary to and will not L. Aggregate Limit Per Project seek contribution from any other insurance Under Section III — Limits Of Insurance The available to an additional insured under your following paragraph is added to Paragraph 2: policy provided that: The General Aggregate Limit under Section III a. The additional insured is a Named Limits Of Insurance applies separately to each Insured under such other insurance;and of your construction projects away from premises owned by or rented to you. Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. ACP GLD03027050259 51BE 17128 INSURED COPY 47 0018265 CG 73 23 12 16 M. Medical Payments inception date of the policy shall not Under Section III — Limits Of Insurance, prejudice the coverage afforded by this Paragraph 7. is replaced with: policy provided such failure to disclose all 7. Subject to 5. above,the higher of: hazards or prior"occurrences"or offenses is not intentional. This provision does not a. $10,000;or affect our right to collect additional premium b. The amount shown in the Declarations or exercise our right of cancellation or non- for Medical Expense Limit is the most renewal. we will pay under Coverage C for all P. Waiver Of Subrogation medical expenses because of "bodily Under Section IV — Commercial General injury"sustained by one person. Liability Conditions, 8. Transfer Of Rights Of This coverage does not apply if Coverage C Recovery Against Others To Us the following — Medical Payments is excluded either by paragraph is added: the provisions of any coverage forms If required by a written contract executed prior to attached to the policy or by endorsement. loss, we waive any right of subrogation we may N. Knowledge Of An Occurrence have against the contracting person or Under Section IV — Commercial General organization because of payments we make for Liability Conditions, the following is added to injury or damage arising out of your ongoing 2. Duties In The Event Of Occurrence, operations or"your work" done under a contract Offense,Claim Or Suit: with that person or organization and included in e. Knowledge of an occurrence, offense, claim the"products-completed operations hazard". or suit by an agent or employee of any Q. Liberalization insured shall not in itself constitute Under Section IV — Commercial General knowledge of the insured unless you, a LiabilityConditions, the following partner, if g paragraph is p you are a partnership; or an added: executive officer or insurance manager, if 10. Liberalization you are a corporation receives such notice of an occurrence, offense, claim or suit from If we revise this coverage form to provide more the agent or employee. coverage without additional premium charge, f. The requirements in Paragraph b. will not your policy will automatically provide the be considered breached unless there is additional coverage as of the day the revision is knowledge of occurrence as outlined in effective in your state. Paragraph e. above. R. Broadened Bodily Injury Definition (Mental O. Unintentional Failure To Disclose Hazard Anguish) Under Section IV — Commercial General Under Section V — Definitions Definition 3. Liability Conditions, Condition 6. "Bodily Injury"is replaced with: Representations the following paragraph is 3. "Bodily injury" means physical injury, added: sickness, or disease to a person and if d. Your failure to disclose all hazards or prior arising out of the foregoing, mental anguish, "occurrences"or offenses existing as of the mental injury, shock, or humiliation, including death at any time resulting therefrom. All terms and conditions of this policy apply unless modified by this endorsement. CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5 with its permission. ACP GLD03027050259 51BE 17128 INSURED COPY 47 0018266 POLICY NUMBER: GLD03037050259 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s) Location and Description Of Completed Operations ALL LOCATIONS AT WHICH COMPLETED OPERATIONS HAVE BEEN PERFORMED FOR THE ADDITIONAL PERSON(S) OR ORGANIZATION(S) 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 required by the contract or agreement to provide include as an additional insured the person(s) or for such additional insured. organization(s) shown in the Schedule. but only B. With respect to the insurance afforded to these with respect to liability for "bodily injury" or additional insureds. the following is added to "property damage"caused, in whole or in part, by Section III- Limits Of Insurance: "your work" at the location designated and If coverage provided to the additional insured is described in the Schedule of this endorsement required by a contract or agreement, the most we performed for that additional insured and will pay on behalf of the additional insured is the included in the "products-completed operations amount of insurance: hazard". However: 1. Required by the contract or agreement: or 1. The insurance afforded to such additional 2. Available under the applicable Limits of insured only applies to the extent permitted Insurance shown in the Declarations; by law, and whichever is less. 2. If coverage provided to the additional insured This endorsement shall not increase the applicable is required by a contract or agreement, the Limits of Insurance shown in the Declarations. insurance afforded to such additional insured will not be broader than that which you are All terms and conditions apply unless modified by this endorsement. CG 20 37 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 ACP GLD03037050259 L7C8 18108 INSURED COPY 47 0020160 Policy# BAPD3037050259 COMMERCIAL AUTO AC 70 05 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO PROTECTION - GOLD This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGES A. Effect of This Endorsement B. Newly Acquired or Formed Entities C. Employees as Insureds— Nonowned Autos D. Additional Insured by Contract, Permit or Agreement E. Supplementary Payments— Bail Bonds F. Supplementary Payments— Loss of Earnings G. Personal Effects and Property of Others Extension H. Prejudgment Interest Coverage I. Fellow Employee—Officer, Managers and Supervisors J. Hired Auto Physical Damage K. Temporary Substitute Autos— Physical Damage Coverage L. Expanded Towing Coverage M. Auto Loan or Lease Coverage N. Original Equipment Manufacturer Parts— Leased Private Passenger Types 0. Deductible Amendments P. Rental Reimbursement Coverage Q. Expanded Transportation Expense R. Extra Expense— Stolen Autos S. Physical Damage Limit of Insurance T. New Vehicle Replacement Cost U. Physical Damage Coverage Extension V. Transfer of Rights of Recovery Against Others To Us W. Section IV— Business Auto Conditions— Notice of and Knowledge of Occurrence X. Hired Car Coverage Territory Y. Emergency Lock Out Z. Cancellation Condition AC 70 05 03 16 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 7 with its permission ACP BA 30-3.7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020224 COMMERCIAL AUTO AC 70 05 03 16 A. EFFECT OF THIS ENDORSEMENT If specifically required by the written contract or Coverage provided under this policy is modified agreement referenced in the paragraph above, by the provisions of this endorsement. If there any coverage provided by this endorsement to is any conflict between the provisions of this an additional insured shall be primary and endorsement and the provision(s)of any state- any other valid and collectible insurance avail- specific endorsement also attached to this poli- able to the additional insured shall be non- cy, then the provision(s) of the state-specific contributory with this insurance. If the written endorsement shall apply instead of the provi- contract does not require this coverage to be sions of this endorsement that are in conflict, primary and the additional insured's coverage to but only to the extent of the conflict, and only to be non-contributory, then this insurance will be the extent necessary to bring such provisions excess over any other valid and collectible insur- into conformance with the state requirement(s) ance available to the additional insured. contained in the provision(s)of the state-specific endorsement. E. SUPPLEMENTARY PAYMENTS — BAIL B. NEWLY ACQUIRED OR FORMED ENTITIES BONDS The Named Insured shown in the Declarations is Supplementary Payments of SECTION II — amended to include any organization you newly COVERED AUTOS LIABILITY COVERAGE is acquire or form, other than a partnership, joint revised as follows: venture, or limited liability company, and over (2) Up to $2,500 for cost of bail bonds(including which you maintain ownership or majority (more bonds for related traffic law violations) than 50%) interest; if there is no other similar in- required because of an "accident"we cover. surance available to that organization. Coverage We do not have to furnish these bonds. under this provision is afforded until the 180`h F. SUPPLEMENTARY PAYMENTS — LOSS OF day after you acquire or form the organization or EARNINGS the end of the policy period, whichever is later. C. EMPLOYEES AS INSUREDS — NONOWNED Supplementary Payments of the SECTION II — AUTOS COVERED AUTOS LIABILITY COVERAGE is revised as follows: The following is added to paragraph A.1. Who Is (4) All reasonable expenses incurred by the "in- An Insured of SECTION II — COVERED AUTOS sured" at our request, including actual loss LIABILITY COVERAGE: of earnings up to $500 a day because of d. Any "employee" of yours is an "insured" time off from work. while using a covered "auto" you don't own, G. PERSONAL EFFECTS AND PROPERTY OF hire or borrow in your business or your per- OTHERS EXTENSION sonal affairs. D. ADDITIONAL INSURED BY CONTRACT, 1. The. Care, Custody or Control Exclusion of PERMIT OR AGREEMENT SECTION II — COVERED AUTOS LIABILITY COVERAGE, does not apply to The following is added to A.1. Who Is An In- "property damage" to property, other than sured of SECTION II — COVERED AUTOS your property, up to an amount not exceed- LIABILITY COVERAGE: ing $250 in any one "accident". Coverage Any person or organization that you are re- is excess over any other valid and collectible quired to name as an additional insured in a insurance. written contract or agreement that is executed 2. The following paragraph is added to A.4. or signed by you prior to a "bodily injury" or Coverage Extensions of SECTION III — "property damage" occurrence is an "insured" PHYSICAL DAMAGE COVERAGE: for Covered Auto Liability coverage. How- c. We will pay up to $500 for your property ever, with respect to covered "autos", such that is lost or damaged as a result of a person or organization is an insured only to covered "loss", without applying a de- the extent that person or organization qualifies ductible. Coverage is excess over any as an "insured" under A.1. Who is an Insured of other valid and collectible insurance. SECTION II — COVERED AUTOS LIABILITY COVERAGE: Page 2 of 7 Includes copyrighted material of Insurance Services Office, Inc. AC 70 05 03 16 with its permission ACP BA 30.3-7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020225 COMMERCIAL AUTO AC 70 05 03 16 H. PREJUDGMENT INTEREST COVERAGE substitute for a covered "auto" you own that The following paragraph is added to SECTION II is out of service because of its: — COVERED AUTOS LIABILITY COVERAGE, a. Breakdown; 2. Coverage Extensions, a. Supplementary b. Repair; Payments: c. Servicing; (7) Prejudgment interest awarded against the "insured" on that part of the judgment we d. "Loss";or pay. If we make an offer to pay the appli- e. Destruction cable limit of insurance, we will not pay The coverage that applies is the same as any prejudgment interest based on that the coverage provided for the vehicle being period of time after the offer. replaced. I. FELLOW EMPLOYEE — OFFICERS, MANAGERS, AND SUPERVISORS L. EXPANDED TOWING COVERAGE The Fellow Employee Exclusion in SECTION II 1. We will pay up to: — COVERED AUTOS LIABILITY COVERAGE is a. $100 for a covered "auto" you own of replaced as follows; the private passengertype, or A. "Bodily injury" to any fellow "employee" of b the "insured"arising out of and in the course . $500 for a covered "auto" you own that of the fellow "employee's" employment or is not of the private passengertype, while performing duties related to the con- for towing and labor costs incurred each duct of your business. This exclusion does time the covered "auto" is disabled. Howev- not apply to an "insured" who occupies a er, the labor must be performed at the place position as an officer, manager, or supervi- of disablement. sor. 2. This coverage applies only for an "auto" J. HIRED AUTO PHYSICAL DAMAGE covered on this policy for Comprehensive or If covered "auto" designation symbols 1 or 8 ap- Specified Causes of Loss Coverage and ply to Liability Coverage and if at least one "au- Collision Coverages. to" you own is covered by this policy for Com- 3. Payment applies in addition to the otherwise prehensive, Specified Causes of Loss, or Colli- applicable amount of each coverage you sion coverages, then the Physical Damage have on a covered"auto". coverages provided are extended to "autos" you M. AUTO LOAN OR LEASE COVERAGE lease, hire, rent or borrow without a driver; and 1. In the event of a total "loss" to a covered provisions in the Business Auto Coverage Form "auto", we will pay any unpaid amount due applicable to Hired Auto Physical Damage apply on the loan or lease, including up to a max- up to a limit of $100,000. The deductible will be imum of $500 for early termination fees or equal to the largest deductible applicable to any penalties, for your covered"auto"less: owned "auto" for that coverage. Any Compre ve deductible does not apply to fire or a. The amount paid under SECTION III — hensi ensi PHYSICAL DAMAGE COVERAGE of lightning. K. TEMPORARY SUBSTITUTE AUTOS — this policy; and PHYSICAL DAMAGE COVERAGE b. Any: The following is added to paragraph C. Certain 1) Overdue lease/loan payments at the Trailers, Mobile Equipment And Temporary time of the"loss", Substitute Autos of SECTION I - COVERED 2) Financial penalties imposed under a AUTOS: lease for excessive use, abnormal If Physical Damage Coverage is provided by wear and tear or high mileage; this Coverage Form, the following types of 3) Security deposits not refunded by a vehicles are also covered "autos" for Physi- lessor; cal Damage Coverage: 4) Costs of extended warranties, Credit Any "auto" you do not own while used with Life insurance, Health, Accident, or the permission of its owner as a temporary Disability insurance purchased with the lease; and AC 70 05 03 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 7 with its permission ACP BA 30-3-7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020226 COMMERCIAL AUTO AC 70 05 03 16 5) Carry-over balances from previous No deductible applies to glass if the glass is re- leases. paired, in a manner acceptable to us, rather than 2. This coverage only applies to a "loss" which replaced. is also covered under this policy for Com- P. RENTAL REIMBURSEMENT COVERAGE prehensive, Specified Causes of Loss, or 1. This coverage applies only to a covered"au- Collision coverage. to" for which Physical Damage Coverage is 3. Coverage does not apply to any unpaid provided on this policy. amount due on a loan for which the covered 2. We will pay for rental reimbursement ex- "auto" is not the sole collateral. penses incurred by you for the rental of an N. ORIGINAL EQUIPMENT MANUFACTURER "auto"because of"loss"to a covered "auto". PARTS — LEASED PRIVATE PASSENGER Payment applies in addition to the otherwise TYPES applicable amount of each coverage you Under Paragraph C. Limit of Insurance of have on a covered "auto." No deductibles SECTION III — PHYSICAL DAMAGE apply to this coverage. COVERAGE, Section 4 is added as follows: 3. We will pay only for those expenses incurred 4. We will use new original equipment vehicle during the policy period beginning 24 hours manufacturer parts for any private passen- after the "loss" and ending, regardless of the ger type covered "auto" where required by policy's expiration, with the lesser of the the lease agreement which has a term of at following number of days: least six months. If a new original equip- a. The number of days reasonably ment vehicle manufacturer part is not in pro- required to repair or replace the covered duction or distribution we may use a like, "auto". If "loss" is caused by theft, this kind and quality replacement part. number of days is added to the number O. DEDUCTIBLE AMENDMENTS of days it takes to locate the covered The following are added to the Deductible provi- "auto" and return it to you. sion of SECTION III — PHYSICAL DAMAGE b. The number of days shown in the COVERAGE: Schedule. If another policy or coverage form that is not an 4. Our payment is limited to the lesser of the automobile policy or coverage form issued by following amounts: this company applies to the same"accident",the a. Necessary and actual expenses following applies: incurred. 1. If the deductible under this coverage is the b. $75 for any one day or for a maximum smaller (or smallest) deductible, it will be of 30 days. waived: 5. This coverage does not apply while there 2. If the deductible under this coverage is not are spare or reserve"autos"available to you the smaller (or smallest) deductible, it will be for your operations, reduced by the amount of the smaller (or 6. If "loss" results from the total theft of a cov- smallest)deductible. ered "auto" of the private passenger type, If a Comprehensive or Specified Causes of Loss we will pay under this coverage only that Coverage "loss" from one "accident" involves amount of your rental reimbursement ex- two or more covered "autos", only the highest penses which is not already provided for un- deductible applicable to those coverages will be der SECTION III — PHYSICAL DAMAGE applied to the "accident," if the cause of the loss COVERAGE Coverage Extension. is covered for those vehicles. This provision only Q. EXPANDED TRANSPORTATION EXPENSE applies if you carry Comprehensive or Specified Paragraph AA.a. of SECTION III — PHYSICAL Causes of Loss Coverage for those vehicles, DAMAGE COVERAGE is replaced by the follow- and does not extend coverage to any covered "autos" for which you do not carry such ing: coverage. We will pay up to $50 per day to a maximum of $1500 for temporary transportation expense in- curred by you because of the total theft of a Page 4 of 7 Includes copyrighted material of Insurance Services Office, Inc AC 70 05 03 16 with its permission. ACP BA 30-3-7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020227 COMMERCIAL AUTO AC 70 05 03 16 covered "auto" of the private passenger type. ment manufacturer or other sources in- We will only pay for those covered "autos" for cluding non-original equipment manu- which you carry Comprehensive or Specified facturers and Causes of Loss Coverage. We will pay for tem- b. If a repair or replacement results in bet- porary transportation expenses incurred during ter than like kind or quality, we will not the period beginning 24 hours after the theft and pay for the amount of the net improve- ending, regardless of the policy's expiration, ment. when the covered"auto" is returned to use or we 5. If we offer to pay the actual cash value of pay for its "loss". the damaged or stolen property, we will R. EXTRA EXPENSE—STOLEN AUTOS value auto advertising wraps, paint customi- The following paragraph is added to Coverage zation, and similar business related advertis- Extensions of SECTION III — PHYSICAL ing modifications, in addition to the actual DAMAGE COVERAGE: cash value of the property. Auto advertising c. We will pay for up to $5,000 for the expense wraps, paint customization, and similar of returning a stolen covered "auto" to you. business related advertising modifications We will pay only for those covered "autos" will be valued at the cost to replace them for which you carry Comprehensive or Spec- with an adjustment made for depreciation ified Causes of Loss Coverage and physical condition. S. PHYSICAL DAMAGE LIMIT OF INSURANCE T. NEW VEHICLE REPLACEMENT COST Under SECTION III — PHYSICAL DAMAGE The following is added to the Limit of Insurance COVERAGE, Paragraph C., Limit of Insurance provision of SECTION III — PHYSICAL is replaced by the following: DAMAGE COVERAGE: C. Limit Of Insurance 5. The provisions of paragraphs 1. and 3. do 1. The most we will pay for "loss" in any one not apply to a covered "auto" of the private "accident" is the lesser of: passenger type or a vehicle with a gross vehicle weight rating of 20,000 pounds or a. The actual cash value of the damaged less which is a"new vehicle." or stolen property as of the time of the In the event of a total "loss" to your new ve- "loss", or hicle to which this coverage applies, we will b. The cost of repairing or replacing the pay at your option: damaged or stolen property. a. The verifiable "new vehicle" purchase 2. $1500 is the most we will pay for "loss" in price you paid for your damaged vehi- any one "accident" to all electronic equip- cle, not including any insurance or war- ment that reproduces, receives or transmits ranties purchased; audio, visual or data signals which, at the b. If it is available, the purchase price, as time of"loss", is: negotiated by us, of a "new vehicle" of a. Permanently installed in or upon the the same make, model, and equipment covered "auto" in a housing, opening or or the most similar model available, not other location that is not normally used including any furnishings, parts, or by the "auto" manufacturer for the in- equipment not installed by the manufac- stallation of such equipment. turer or manufacturers'dealership;or . b. Removable from a permanently installed c. The market value of your damaged ve- housing unit as described in Paragraph hicle, not including any furnishings, 2.a. above or is an integral part of that parts, or equipment not installed by the equipment;or manufacturer or manufacturer's dealer- c. An integral part of such equipment. ship. 3. An adjustment for depreciation and physical We will not pay for initiation or set up costs condition will be made in determining actual associated with loans or leases cash value in the event of a total "loss". As used in this endorsement, a "new 4. The cost of repairing or replacing may: vehicle" means an "auto" of which you are a. Be based on an estimate which includes the original owner that has not been previ- parts furnished by the original equip- AC 70 05 03 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 7 with its permission ACP BA 30.3-7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020228 COMMERCIAL AUTO AC 70 05 03 16 ously titled and which you purchased less a. Your obligation in the Duties in the Event than 365 days before the date of the"loss". of Accident, Claim, Suit or Loss Condi- tion relative to notification requirements U. PHYSICAL DAMAGE COVERAGE applies only when the "accident' or EXTENSIONS "loss"is known to: Under SECTION III — PHYSICAL DAMAGE (1) You, if you are an individual; COVERAGE, A. Coverage, Coverage Exten- (2) A partner, if you are a partnership; sions, b. Loss of Use Expenses is replaced by (3) A member, if you are a limited liability the following: company;or b. Loss of Use Expenses (4) An executive officer or insurance For Hired Auto Physical Damage, we will manager, if you are a corporation. pay expenses for which an "insured" be- b. Your obligation in the. Duties in the Event comes legally responsible to pay for loss of of Accident,Claim, Suit or Loss Condition use of a vehicle rented or hired without a relative to providing us with documents driver, under a written rental contract or concerning a claim or "suit' will not be agreement. We will pay for loss of use ex- considered breached unless the breach penses if caused by: occurs after such claim or"suit' is known (1) Other than collision if the Declarations to: indicate that Comprehensive Coverage (1) You, if you are an individual; is provided for any covered"auto"; (2) A partner, if you are a partnership; (2) Specified Causes of Loss only if the (3) A member, if you are a limited Declarations indicate that Specified liability company;or Causes of Loss Coverage is provided (4) An executive officer or insurance for any covered"auto";or manager,if you are a corporation. (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered"auto." X. HIRED CAR—COVERAGE TERRITORY However, the most we will pay for any Item (5) of the Policy Period, Coverage Territory expenses for loss of use is $50 per day, to a GeneralConditionss replaced by the following: maximum of$1,500.The insurance provided (5)Anywheren theworldif a covered"auto" is by this provision is excess over any other leased, hired, rented or borrowed without a collectible insurance. driverfor a period of 30 days or less;and V. TRANSFER OF RIGHTS OF RECOVERY Y. EMERGENCY LOCKOUT AGAINST OTHERS TO US We will reimburse you up to $100 for reasonable The following is added to the Transfer Of Rights expense incurred for the services of a locksmith Of Recovery Against Others To Us Condition: to gain entry into your covered "auto" subject to We waive any right of recovery we may these provisions: have against any person or organization to 1. Your door key, electronic key or key entry the extent required of you by a written con- pad has been lost, stolen or locked in your tract executed prior to any "accident' be- covered "auto" and you are unable to enter cause of payments we make for damages such "auto" , or under this coverage form. 2. Your keyless entry device battery dies and W. NOTICE OF AND KNOWLEDGE OF you are unable to enter such "auto"as a re- OCCURRENCE sult, SECTION IV— BUSINESS AUTO 3. Your key, electronic key or key entry pad CONDITIONS, Paragraph A is amended as has been lost or stolen and you have follows: changed the lock to prevent an unauthorized 6. NOTICE OF AND KNOWLEDGE OF entry; and OCCURRENCE Page 6 of 7 Includes copyrighted material of Insurance Services Office, Inc AC 70 05 03 16 with its permission. ACP BA 30-3-7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020229 COMMERCIAL AUTO AC 70 05 03 16 4. Original copies of receipts for services of a If we cancel for any reason other than non- locksmith must be provided before reim- payment of premium, we will mail or deliver bursement is payable. to the First Named Insured written notice of Z. CANCELLATION CONDITION cancellation at least 60 days before the ef- fective date of cancellation. This provision Paragraph A.2. of the COMMON POLICY does not apply in those states that require CONDITION — CANCELLATION applies more than 60 days prior notice of cancella- except as follows: tion. AC 70 05 03 16 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 7 with its permission ACP BA 30.3-7050259 L7C8 18107 INSURED COPY AC7005031600 0001 47 0020230 Policy#BAPD3037050259 COMMERCIAL AUTO AC 0102WA 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT- WASHINGTON This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM A. CHANGES FOR TRAILERS AND FARM C. BLANKET ADDITIONAL INSURED EQUIPMENT Any person or organization which you have 1. Under the COVERED AUTOS Section, agreed to name as an additional insured in a the following are added to Paragraph C. written contract, executed prior to an acci- Certain Trailers, Mobile Equipment and dent, other than a contract for the lease or Temporary Substitute Autos: rental of a vehicle is an "insured"for Liability 4. "Trailers" designed to be towed by a Coverage,but only to the extent that person private passenger type "auto" or a or organization qualifies as an "insured" pickup,panel truck or van if not used under the Who Is An Insured Provision con- for business purposes, other than tained in the LIABILITY COVERAGE farming or ranching. SECTION of the Coverage Form 5. Farm wagons or farm implements D. REPLACED EXCLUSIONS while being towed by a covered "au- The Expected or Intended Injury Exclusion to". in the LIABILITY COVERAGE SECTION is B. CHANGES FOR ADDITIONAL NEWLY replaced by the following: ACQUIRED VEHICLES Expected or Intended Injury 2. Paragraph B.2 of the COVERED AUTOS "Bodily injury"or"property damage"which is SECTION is replaced by the following: expected or intended by the "insured".This 2. If Symbol(s)Tor 67 is entered next to exclusion applies even if the resulting "bodi- a coverage in Item Two of the Decla- ly injury"or"property damage": rations, an "auto"you acquire will be a. is of a different kind, quality or degree a covered "auto" for that coverage than initially expected or intended,or only if: b. is sustained by a different person,entity, a. We already cover at least one real property, or personal property than "auto" you own for that coverage that initially expected or intended. or it replaces an "auto" you pre- E. ADDITIONAL EXCLUSIONS viously era e; d owned that had that cov- erage; The following exclusions are added to the b. You tell us within 30 days after LIABILITY COVERAGE SECTION: you acquire it that you want us to Damage to Named Insured's Property cover it for that coverage. Any claim or"suit" for"property damage"by The most we will pay for Physical Dam- you or on your behalf against any other per- age Coverage for "loss" under this Cov- son or entity that is also a Named Insured erage Extension is $100,000 per "auto", under this policy. subject to the largest deductible applica- Abuse or Molestation ble to any"auto"for that Coverage. AC 01 02WA 03 10 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 1 of 4 ACP BAPD30-0-7050259 ME 15135 INSURED COPY AC01020310DO 0001 75 0023682 AC 01 02WA 03 10 "Bodily injury" or"property damage"aris- b. Resulting from food or drink furnished ing out of: with these services. a. The actual or threatened abuse or "Bodily injury" or "property damage" result- molestation by anyone or any person ing from the handling of corpses. while in the care, custody or control F. MOTOR HOME CONTENTS COVERAGE of any"insured",or 1. For a covered "auto" that is a motor home b. The negligent: the following exclusions are added to the 1) Employment; PHYSICAL DAMAGE COVERAGE 2) Investigation; SECTION: 3) Supervision; Motor Home Contents 4) Reporting to the proper authori- This insurance does not apply to: ties,or failure to so report;or a. "Loss" to the covered"auto's"contents, 5) Retention; except equipment usual to trucks or pri- vate passenger"autos". of a person for whom any"insured"is or ever was legally responsible and b. "Loss" to TV antennas, awnings or ca- whose conduct would be excluded by banas. Paragraph a.above. c. "Loss" to equipment designed to create Abuse means an act which is committed added living facilities. with the intent to cause harm. However, these exclusions do not apply if Explosives Miscellaneous Personal Property Coverage is provided by endorsement to this policy. caused by the explosion of explosives "Bodily injury" "property damage" G. ACCIDENTAL AIRBAG DISCHARGE you make,sell or transport. -COVERAGE Rolling Stores Under Paragraph B.3.a. of the PHYSICAL. DAMAGE COVERAGE SECTION, the following If a covered"auto" is a rolling store, "bo- is added: dily injury"or"property damage"resulting Mechanical breakdown does not include the ac- from the handling,use or condition of any cidental discharge of an airbag. item the "insured" makes, sells or distri- butes if the injury or damage occurs after H. PHYSICAL DAMAGE LIMIT OF INSURANCE the "insured" has given up possession of Under PHYSICAL DAMAGE COVERAGE the item. SECTION, Paragraph C, Limit of Insurance is Wrong Delivery of Liquid Products replaced by the following: "Bodily injury" or "property damage" re- C. Limit Of Insurance sulting from the delivery of any liquid into 1. The most we will pay for "loss" in any the wrong receptacle or to the wrong ad- one"accident"is the lesser of: dress, or from the delivery of one liquid a. The actual cash value of the dam- for another,if the "bodily injury" or"prop- aged or stolen property as of the erty damage" occurs after the delivery time of the "loss";or has been completed. b. The cost of repairing or replacing Delivery is considered completed even if the damaged or stolen property. further service or maintenance work, or 2. $1,000 is the most we will ay for"loss" correction, repair or replacement is re- in an one "accident" to all electronic quired because of wrong delivery. equipment that reproduces,receives or Professional Services "Bodily injury": a. Resulting from the providing or the failure to provide any medical or oth- er professional services. Page 2 of 4 Includes copyrighted material of Insurance Services Office,Inc.,with its permission AC 01 02WA 03 10 ACP BAPD30-0-7050259 ME 15135 INSURED COPY AC0102031000 0001 75 0023683 AC 01 02WA 03 10 transmits audio, visual or data signals I. GLASS REPAIR WAIVER OF DEDUCTIBLE which,at the time of"loss",is: Under Paragraph D. Deductible of the a. Permanently installed in or upon PHYSICAL DAMAGE COVERAGE SECTION, the covered "auto" in a housing, the following is added: opening or other location that is No deductible applies to glass damage if the not normally used by the "auto' glass is repaired rather than replaced. manufacturer for the installation J. AMENDED DUTIES IN EVENT OF ACCIDENT, of such equipment. CLAIM,SUIT, OR LOSS b. Removable from a permanently The requirement in Loss Condition 2.a. Duties In installed housing unit as de- The Event Of Accident, Claim, Suit Or Loss—of scribed in Paragraph 2.a. above the BUSINESS AUTO CONDITIONS SECTION or is an integral part of that and the MOTOR CARRIER CONDITIONS equipment;or SECTION that you must notify us of an "acci- c. An integral part of such equip- dent", "claim", "suit", or"loss" applies only when ment. the "accident", "claim", "suit", or "loss" is known 3. An adjustment for depreciation and to : physical condition will be made in de- 1. You,if you are an individual termining actual cash value in the 2. A partner,if you are a partnership; event of total"loss". 4. The cost of repairing or replacing 3• An executive officer or the employee desig- nated by you to give such notice if you are a may: corporation;or a. Be based on an estimate which 4. A member, if you are a limited liability com- includes parts fumished .by the original equipment manufacturer pay' or other sources including non- K. UNINTENTIONAL FAILURE TO DISCLOSE original* equipment manufactur- HAZARDS ers and The BUSINESS AUTO CONDITIONS SECTION b. Include a deduction for better- and MOTOR CARRIER CONDITIONS ment for a part or parts that are SECTION-6.2. are amended by the addition of normally subject to repair or re- the following: placement during the useful life If you unintentionally fail to disclose any hazards of the "auto" such as, but not li- existing at the inception date of your policy, we mited to tires and batteries, will not deny coverage under this Coverage Betterment means the difference Form because of such failure. However, this between the actual cash value of provision does not affect our right to collect addi- a part immediately before the tional premium or exercise our right of cancella- "loss" and the cost to replace tion or nonrenewal. that part with a new part. L AUTOS HIRED OR RENTED BY EMPLOYEES . 5. If we offer to pay the actual cash val- If hired or rented"autos"are covered"autos"on ue of the damaged or stolen proper- this policy,the following provisions apply: ty, we will value auto advertising A. Changes In Liability Coverage wraps, paint customization,and simi- lar business related advertising mod- The following is added to the Who Is An In- ifications, in addition to the actual sured Provision in the LIABILITY cash value of the property. Auto ad- COVERAGE SECTION: vertising wraps, paint customization, An "employee" of yours is an "insured"while and similar business related advertis- operating an "auto" hired or rented under a ing modifications will be valued at the contract or agreement in that "employee's" cost to replace them with an adjust- ment made for depreciation and physical condition. AC 01 02WA 03 10 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 3 of 4 ACP BAPD30-0-7060259 ME 15135 INSURED COPY AC0102031000 0001 75 0023684 AC 01 02WA 03 10 name, with your permission, while per- M. EMERGENCY LOCKOUT- PRIVATE forming duties related to the conduct of PASSENGER VEHICLES your business. We will reimburse you up to $50 for reasonable B. Changes In General Conditions expense incurred for the services of a locksmith Paragraph 5.b. of file Other Insurance to gain entry into your covered"auto"of the pri- Condition and Paragraph 5.f. of the vate passenger type subject to these provisions: Other Insurance Condition in the Motor 1. Your door'key or key entry pad has been Carrier Coverage Form is replaced by the lost, stolen or locked in your covered "auto" following: and you are unable to enter such`auto",or For Hired Auto Physical Damage Cover- 2. . Your key or key entry pad has been lost or age, the following are deemed to be cov- stolen and you have changed the lock to ered"autos"you own: prevent an unauthorized entry;and 1. Any covered "auto" you lease, hire, 3. Original copies of receipts for services of a rent or borrow;and locksmith must be provided before reim- 2. . Any covered"auto"hired or rented by bursement is payable. your "employee" under a contract in N. LIBERALIZATION that individual "employee's" name, Paragraph 3.of the Other Insurance Condition in with your permission, while perform- the Business Auto Coverage Form is replaced by ing duties related to the conduct of the following:If we adopt any revision that would your business. broaden the coverage under this policy without However,any"auto" that is leased,hired, additional premium within 60 days prior to or dur- rented or borrowed with a driver is not a ing the policy period,the broadened coverage will covered"auto". immediately apply to this policy. All terms and conditions of this policy apply unless modified by this endorsement. Page 4 of 4 Includes copyrighted material of Insurance Services Office,Inc.,with its permission AC 01 02WA 03 10 ACP BAPD30-0-7050259 ME 15135 INSURED COPY AC0102031000 0001 75 0023685 City of Kent Business License EVERGREEN ASPHALT&CONCRETE INC PO BOX 1567 KENT,WA 98035 Please tear at perforation ------------------------------------------------ BUSINESS LICENSE Per RCW 82. local sales and use tax must t be coded LICENSE MUST BE PAID ANNUALLY BY No. 1715 for all qualified JANUARY 1st TO AVOID PENALTY sales within the city of Issuance of License Does Not Imply Licensee's Kent. Compliance with State and Local Laws THIS LICENSE MUST BE POSTED IN A CONSPICUOUS 2019 PLACE.NOT TRANSFERABLE OR ASSIGNABLE NAME AND ADDRESS OF BUSINESS BLOC-2140738 �¢ EVERGREEN ASPHALT&CONCRETE INC MAYOR 18744 SE 282ND ST Tax Registration The City of Kent KENT,WA 98042 Endorsement At 2204TH AVE SO KENT,WASHINGTON 98032