HomeMy WebLinkAboutPW18-464 - Amendment - #3 - Skillings Connolly, Inc. - Shops Fuel Tank Replacement - 07/30/2019 CITY CLERK
berley A n Forffi
A.
Cityy Clerk Clerk
® 220 4th Avenue South
T For Approvals,Signatures and Records Management Kent, WA 98032
KT T O N This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. Fax: 253-856-6725
WASHINGTON (Print on pink or cherry colored paper)
Originator: Nancy for Bryan Bond Department: Public
Date Sent: 7/26/19 Date Required: 7/30/19
i�
Authorized Director or Designee Date of
® N/A
a. to Sign: Council
QMayor Approval:
Budget Grant? ❑ Yes W1 No
Account E20018
Number. Type: N/A
Vendor
Name: Skillings Connolly, Inc. Category: Contract
= Vendor 177599 Sub-Category Amendment
o Number:
E Namet Fuel Tank Replacement
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� Project
Z Details: Provide soils and water analysis investigation.
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E Agreement 29 322 Basis for
40 Amount: Selection of
y Contractor:
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Start Date: Mayor's signature Termination Date: 12 31 19
Notice required prior to a Yes No Contract Number:
disclosure? f v v tv— "(Lr L
loll if
Date Received by City Attorney: Comments:
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RECEIVED
Im Date Routed to the Mayor's Office:
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•_d Date Routed to the City Clerk's Office:
City of Kent
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GoOfficee of the N!
Cr. Dote Sent to Originator:
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C Visit Documents.KentWA.gov to obtain copies of all agreements
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Mayor Dana Ralph,
City of Kent Administration
Derek M. Matheson, CAO
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•
KEN T CITY CLERK
A 5 N I N G T O N Kimberley A. Komoto
City Clerk
220 4th Avenue South
• AMENDMENT NO. 3 Kent, WA 98032
KEN T Fax: 253-856-6725
NAME WbW ULTANT OR VENDOR: Sky iinas G�!J*jnc
CONTRACT NAME & PROJECT NUMBER: Fuel Tank Replacement
ORIGINAL AGREEMENT DATE: December 18, 2018
This Amendment is made between the City and the above-referenced Consultant or
Vendor and amends the original Agreement and all prior Amendments. All other provisions of
the original Agreement or prior Amendments not inconsistent with this Amendment shall remain
in full force and effect. For valuable consideration and by mutual consent of the parties,
Consultant or Vendor's work is modified as follows:
1. Section I of the Agreement, entitled "Description of Work," is hereby modified to
add additional work or revise existing work as follows:
In addition to work required under the original Agreement and any
prior Amendments, the Consultant or Vendor shall:
Provide soils and water analysis investigation. For a
description, see the Consultant's Scope of Work which is
attached as Exhibit A and incorporated by this reference.
2. The contract amount and time for performance provisions of Section II "Time of
Completion," and Section III, "Compensation," are modified as follows:
Original Contract Sum, $119,999.85
including applicable WSST
Net Change by Previous Amendments $26,090.49
including applicable WSST
Current Contract Amount $146,090.34
including all previous amendments
Current Amendment Sum - $29,322.00
Applicable WSST Tax on this $0
Amendment
Revised Contract Sum $175,412.34
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• Mayor Dana Ralph
City of Kent Administration
AMENDMENT - 1 OF 2 Derek M. Matheson, CAO
Original Time for Completion 12/31/19
(insert date) CITY CLERK
Revised Time for Completion under n/a to
for Amendments City Clerk
ert date) 2204th Avenue So th
KE Kent, WA 98032
'I Days Required (f) for this 0 calendar days Fax: 253-856-6 25
WASHI GTON
Amendment
PHONE: 253-856-5 28
Revised Time for Completion 12/31/19
(insert date) 7
The Consultant or Vendor accepts all requirements of this Amendment by signing below,
by its signature waives any protest or claim it may have regarding this Amendment, and
acknowledges and accepts that this Amendment constitutes full payment and final settlement of
all claims of any kind or nature arising from or connected with any work either covered or
affected by this Amendment, including, without limitation, claims related to contract time,
contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless
otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the
guarantee and warranty provisions of the original Agreement.
All acts consistent with the authority of the Agreement, previous Amendments (if any),
and this Amendment, prior to the effective date of this Amendment, are hereby ratified and
affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment
shall be deemed to have applied.
The parties whose names appear below swear under penalty of perjury that they are
authorized to enter into this Amendment, which is binding on the parties of this contract.
IN WITNESS, the parties below have executed this Amendment, which will
become effective on the last date written below.
CONSULTANT/VENDOR: CITY OF KENT:
P�lrlBy: BY�
(signature) (signat e)
Print Name:Patrick E.Skillings,PMP Print Name: Dana Ralph
Its Vice President Its Mayor
(title) title)
DATE: July25,2019 DATE:
ATTEST: APPROVED AS TO FORM:
(applicable if Mayor's signature required)
Kent City Clerk Kent Law Department
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3i11ings Connolly-Fuel Tank Replacement Amd 3/Bond
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• Mayor Dana Ralph �®
AMENDMENT - 2 OF 2 City of Kent Administration
Derek M. Matheson, CAO
CITY CLERK
Kimberley A. Komoto
City Clerk
•
EXHIBIT A 220 4th Avenue South
KENT SCOPE OF WORK Kent, WA 98032
WASHINOTON
Fax: 253-856-6725
Prepared for:
PHONE: 253-856-5728
CITY OF KENT
SOILS AND WATER ANALYSIS INVESTIGATION SUPPLEMENT 3
July 25,2019
Background:
The project site is the City of Kent's Maintenance Shops located at 5821 S. 240`h St. Kent, WA, immediately
east of Russell Road and south of S. 2401h St. The project entails the preparation of the design documents
for a new fueling station and the abandonment (decommissioning) of the existing fueling station after the
new fueling station is operational. Recent additional sampling associated with the YST decommissioning
uncovered previously and unidentified petroleum contaminants. This scope is to complete additional
testing to determine the extent of the contamination.
Skillings Connolly, Inc. (CONSULTANT) will be the prime CONSULTANT for the project.
Assumptions:
• The CONSULTANT's anticipated SUBCONSULTANTs for the project will include:
o ESN Northwest-Vendor
• Vendors will be used to supply a drill rig and equipment needed to collect soil samples and a
certified lab will be used for soil and water testing for contaminants as part of the abandonment of
the existing fuel tanks.
• CONSULTANT will utilize all existing AutoCAD base topographical base maps illustrating all pertinent
site features both above and below grade in the area of the proposed work.
• All meetings and work required by CITY that is not listed herein will be considered extra work.
• For purposes of this Agreement,the overall duration of the Project will take place within one
months from date of Notice to Proceed.
• The contract may be supplemented to extend time and add budget for any unintended findings
upon the outcomes of the soils investigation.
• CITY will provide the CONSULTANT's project manager a written request for any extra work not
specifically included herein.
• Deliverables will be a fully executed report with all soils analysis results from the onsite
investigation.
• CONSULTANT's assumed total hours for attendance at project meetings are shown on the Fee
spreadsheet.
CITY Will Provide the Following:
1. Utility locates as needed prior to soil testing and drilling.
Change Management:
This is a time and materials contract with a not to exceed maximum without a supplement to the contract.
The level of effort for various tasks listed in the budgeted hours spreadsheet is an estimate and actual
hours may vary for each line item. The contract will be managed to the contract maximum, not the task
> level budgets.
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Y Skillings Connolly,Inc. Page 1 of 7
g Project No 18184 Supplement-03
! Mayor Dana Ralph
Soil andQ1AkcgfAKgi9J~ ,tration
Derek M. Matheson, CAO
CITY CLERK
Kimberley A. Komoto
City Clerk
o be Provided by CONSULTANT: 220 4th Avenue South
KT N1wing tasks are anticipated as part of the CONSULTANT's work for the project. Kent, WA 98032
" ■ Fax: 253-856-6725
WASHINGTON
Task 1 Project Management and Coordination PHONE: 253-856-5728
The CONSULTANT will:
1. Provide overall project coordination and project management throughout the duration of the
onsite investigation and report generation process.
2. Set up and manage project files.
3. Prepare up to two (2) monthly invoices along with progress summary reports.
Deliverables:
• Meeting Minutes
• Monthly Invoices accompanied by a progress report. It is anticipated the monthly progress report
will address:
o Scope,Schedule and Budget status;
o Work that was completed during the last month;
o Discuss issues that have arisen that may require additional work due to soils sample findings;
o Discuss any unresolved issues, or outstanding questions awaiting response;
o Provide an anticipated 30-day look-ahead of anticipated work or issues to resolve.
Task 2 Soil Sampling and Soils Analysis
Introduction
CITY, pursuant to the direction received from ongoing meetings, desires additional testing for tank
decommissioning to be conducted and added to the existing soils investigation already performed. The
work includes additional sample locations for soils testing and analysis for potential contaminated
materials, which includes analysis of both soils and groundwater samples taken at the existing UST location.
A comparison of the containment levels to MTCA Method A Cleanup Standards will be made and required
permitting for decommissioning through the Department of Ecology(ECY) will be provided.
Plan and Coordinate Field Work: ESN Northwest will coordinate with the CONSULTANT to determine the
appropriate field exploration locations for soils testing. This will include reviewing existing information to
evaluate where additional data is needed.
Conduct Site Reconnaissance and Utility Locates:Prior to conducting field exploration program, ESN
Northwest will conduct a reconnaissance of the site.This reconnaissance will be focused on identifying
critical surface features of the site and identifying the best exploration locations. During our site
reconnaissance, CONSULTANT and CITY will mark proposed boring locations and utility locates for the
boring locations.
Conduct Field Exploration: CONSULTANT and ESN Northwest proposes to drill twelve (12)geotechnical
borings in support of the proposed developments.This will include twelve (12) 20-foot borings to be
advanced in the area of the location of the fuel tanks. All exploration activities will be monitored full time
by a qualified Biologist provided by CONSULTANT and the ESN Northwest field crew. We expect that drilling
0 of the proposed twelve (12) borings will take approximately two (2)working day.
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Project No 18184 Supplement-03
• Mayor Dana Ralph
Soil ancIG1 ta9f\Ka§V$s^dffl1rgiakrotion
Derek M. Matheson, CAC)
CITY CLERK
Kimberley A. Komoto
City Clerk
220 4th avenue Sou h
Boring Logs and Assign Laboratory Testing:Soil samples retrieved from the borings ill b e
�Ieiv� t�-bags and taken to the laboratory for further examination and testing. Selected soil1 dent, �/� �}e,0�2
Fa� s8�� t3PL5
w-Aes,,,IX
determine if contaminants exist.These tests will include NWTPH-Dx+x (diesel range-extended)
and BTEXEPA 8021 (unleaded). Soil information will be presented in a summary rep0RH*NiE:Cc25P %SffhW28
the testing by the laboratory.
Assumptions:
• Site access will be provided to CONSULTANT and their subcontractors.
• Identification of potentially contaminated soils is not anticipated. If contaminated soils are
encountered the CITY will be contacted for direction.
• Work by ESN Northwest will include identification or evaluation of contaminants that may be
present in the soil or groundwater.
• CITY will call for utility locates prior to soil investigation.
• Soil and groundwater samples will be collected using a geoprobe with use of an air-knife to avoid
utility impacts.
• Collected samples will be analyzed for NWTPH-Dx+x (diesel range-extended) and BTEXEPA 8021
(unleaded).
• Laboratory analytical results will be compared to the Model Toxics Control Act (MTCA) "Method A
Cleanup".
Sample Collection and Reporting
Assumptions:
• Geoprobe borings will be advanced at twelve(12) distinct locations.
• Discreet soil sample and groundwater samples will be collected from each boring.
• Groundwater samples will be collected at the groundwater interface.
• ESN Northwest will conduct each boring. ESN Northwest will utilize an air-knife in order to avoid
impacts to encountered utilities.
• Each boring will be decommissioned and sealed using clay bentonite as per ECY guidelines.
• Collected samples will be maintained on ice through delivery to the laboratory.
• CITY will conduct all coordination and correspondence with ECY regarding the results of laboratory
analysis.
• CONSULTANT will provide oversight and review of field sample collection and comparison of results
to cleanup standards.
• If contaminants are present within the soils and exceed MTCA cleanup levels, an additional
supplement for a cleanup plan and associated work for cleanup for contaminated soils will be
provided in a new scope and budget.
• Sampling results will be added to the final report under Supplement 2 Scope of Work.
Task Description:
1. Provide coordination with the CITY and SUBCONSULTANT.
2. Review utility locates and generate a Sample Analysis Plan for onsite investigation work.
3. CONSULTANT will develop a Sample Analysis Plan (SAP)which will include logistics for site
preparation, planning, scheduling and procedures.
4. CONSULTANT will collect soil and groundwater samples from twelve (12) distinct borings. Collected
samples will be delivered to ESN Northwest's laboratory for analysis,following method NWTPH-
rn Dx+x (Diesel range-extended) and BTEXEPA(unleaded). A Chain-of-Custody will be completed for
Q all collected samples,from point of collection to laboratory delivery.
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Y Skillings Connolly,Inc. Page 3 of 7 Project No 18184 Supplement-03
• Mayor Dana Ralph
Soil and@ftyeoAVA"k l4t*gj tion
Derek M. Matheson, CAO
CITY CLERK
Kimberley A. Komoto
City Clerk
NSULTANT will prepare a conceptual site model. 2204th Avenue South
K �+ Ir Kent, WA 98032
W d E aTie: Fax: 253-856-6725
• Twelve (12) discreet soil samples. PHONE: 253-856-5728
• Twelve (12) discreet groundwater samples.
• Chain-of-Custody Record.
• Memo detailing sampling collection.
• Conceptual site model.
Deliverables:
• CONSULTANT will provide CITY with a digital and hard copy of the Draft and Final Soils Investigation
Report.
Task 3 Plans,Specifications and Estimate (PSE) Engineering Support
Introduction
Additional contaminated soils have been identified after the original SOW was released. As a result of this
finding, extra engineering effort is foreseeable for the PSE engineering documents.
Assumptions:
• The added engineering work is assuming the project will be broken into two projects (Schedule A
and B) and will be reflected as such on the Plans, Specifications and Estimate.
• The Plans, Specifications and Estimate will need to be revised per the outcome of the additional soil
contamination tests proposed cleanup efforts.
Deliverables:
• Updated cost estimate to incorporate hauling away of contaminated soils
• Updated plan set to account for contaminated soil areas
• Updated specifications
• Break all PSE documents into two separate bid advertisement contracts (Schedule A and B)
END SCOPE OF WORK
Prepared by: Grant Gilmore 07/25/2019
Reviewed by: Patrick E.Skilline PMP 07/25/2019
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g Project No 18184 Supplement-03
• Mayor Dana Ralph
Soil and V&VQfrMIilIat AdmigOrAmation
Derek M. Matheson, CAO
CITY CLERK
Kimberley A. Komoto
City Clerk
EXHIBIT B-1 220 4th Avenue South
4 Kent, WA 98032
KEN T CONSULTANT COST COMPUTATION—MAN-HOURS Fax: 253-856-6725
WA5HINGTON
PHONE: 253-856-5728
PROJECT NO. 18184 Supplement 03
CITY OF KENT
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FUEL TANK REPLACEMENT z m
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TASK# TASK DESCRIPTION
1 Project Management&Coordination
Provide overall project management and coordination 1 2
Conduct periodic, minimum of bi-weekly phone
conferences with Client to discuss work progress and 1
status.
Provide coordination with other team members
(subconsultants), including phone coordination, 4
meetings and emails.
Prepare up to one(1) monthly invoice along with
progress summary report. 1
2 Soil Sample&Soils Analysis
Develop a sample analysis plan (SAP)which will include
logistics for site planning for site preparation, planning, 2 8
scheduling and procedures.
Collect soil and groundwater samples from up to twelve
(12)distinct boring locations. 18 18
Data analysis 8
Concept site model 2 8
3 PSE Engineering Support
Incorporate contaminated soils into cost estimate 9
Revise drawings to reflect contaminated areas 9
Update Specifications 18
Break PSE documents into two separate projects 40
HOURS PER DISCIPLINE 24 48 76 1
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Page S of 7 Project No 18184 Supplement-03
Mayor Dana Ralph
Soil and' r4fnKgp�I4%egpioWation
Derek M. Matheson, CAO
CITY CLERK
Kimberley A. Komoto
City Clerk
EXHIBIT B-2 2204th Avenue South
KE Kent, WA 98032
NT CONSULTANT COST COMPUTATION—SUMMARY Fax: 253-856-6725
WASHINGTON
NEGOTIATED HOURLY RATE(NHR): PHONE: 253-856-572
Man
Classification Hours X Rate =
Cost
ENVIRONMENTAL MANAGER 24 x $188.59 = $4,526.16
SR ENVIRONMENTAL SCIENTIST 48 X $108.52 = $5,208.96
ENGINEER 76 X $102.46
$7,786.96
PROJECT ADMINISTRATOR 1 X $110.63 = $110.63
Total Hours= 149 Total NHR= $17,632.71
REIMBURSABLES:
Mileage 172 X $0.580 = $99_76
Miscellaneous Expenses $100.00 X 10% _ $110.00
Total Expenses= $209.76`
SUBCONSULTANT COST(See Exhibit E):
ESN Northwest $11,480.00 X 0% _
$11,480.00
Total Subconsultants= $11,480.00
SUB-TOTAL(NHR+REIMBURSABLES+SUBCONSULTANTS):
Sub Total= $29,322.47
GRAND TOTAL
GRAND TOTAL = $29,322
PREPARED BY: Grant Gilmore DATE: 07/25/2019
REVIEWED BY: Patrick E.Skillings, PE DATE: 07/25/2019
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Skillings Connolly,Inc. Page 6 of 7
Y Project No 18184 Supplement-03
• Mayor Dana Ralphµ :
Soil and C4004pnt IAdmkr6*pation
Derek M. Matheson, CAO
CITY CLERK
Kimberley A. Komoto
City Clerk
EXHIBIT B-3 220 4th Avenue South
4 Kent, WA 98032
KEN T CONSULTANT COST COMPUTATION—EXPENSES Fax: 2 t, WA 8032
WASHINGTON6725
PHONE: 253-856-5728
Item Description Basis Quantity Rate Total
1 Telephone Month $0.00
2 Auto Rental Each $0.00
3 Lodging Day $0.00
4 Per Diem-Meal Day $0.00
5 Photo Copies-Blk&White Each $0.10 $0.00
6 Photo Copies-Color Each $0.35 $0.00
7 Half Sized Prints Each $0.50 $0.00
8 Full Sized Prints Each $6.00 $0.00
9 Postage Month $0.00
10 Shipping Month $0.00
11 FAXs Each $0.00
12 Miscellaneous Project Costs Month 1 $100. 00 $100.00
13 Miscellaneous Survey Costs Estimated $0.00
14 Traffic Control I Estimated $0.00
Total Miscellaneous Expenses $100.00
Mileage Per Mile 172 0.580 $99.76
Total Expenses $199.76
Assumptions
1 Telephone Estimated
2 Auto Rental Estimated trips
3 Mileage Estimated miles
4 Lodging
5 Per Diem-Meal
6 Photo Copies-Blk&White Estimated
7 Photo Copies-Colored Estimated
8 Half Sized Prints
9 Full Sized Prints
10 Postage Estimated
11 Shipping Estimated
12 FAXs Estimated
13 Miscellaneous Project Costs Estimated
14 Miscellaneous Survey Costs Estimated
15 Purchase Order Estimated
Prepared by: Grant Gilmore July 24, 2019LE�Ej
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Page 7 of 7 Project No 18184 Supplement-03
• Mayor Dana Ralph ,
Soil and\it-okfi tiA4gVjWgVation
Derek M. Matheson, CAO
MA C ORD SKILLCON
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIQN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H DATE(MAA ODrYYYYI
CERTIFICATE DOES Np7 AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORTI 8Y TH 12/C/2018
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REVISION NUMBER:
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY
CERTIFICATE MAY 3E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE P
CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
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l Liability policy includes an automatic Additional Insured endorsement that provides
nsured status to the Certificate Holder, only when there is a written Contract that requires
, and only with regard to work performed on behalf of the named insured.
CERTIFICATE HOLDER
CANCELLATION
I City of Kent SHOULD ANY OF 1 HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
220 Fourth Avenue South THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Kent, WA 98032
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ACORt?�25(1016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
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• Mayor Dana Ralph
City of Kent Administration
Derek M. Matheson, CAO
Policy Number 6805H560029
GENERALPURPOSEENDORSEMENT
CITY CLERK
OFFICE PAC Kimberley A. Komoto
City Clerk
IS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREEN y
220 4th Avenue South
KEN• CGD361 (03-05) - ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRALTOnt, WA 98032
T SCHEDULED PERSON OR ORGANIZATION �:&.-253-856-6725
WAS H Tf?'i 'dndorsement modifies insurance provided under the following:
PHONE: 253-856-5728
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
SCHEDULED PERSON OR ORGANIZATION
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
NAMES OF ADDITIONAL INSURED PERSON(S) OR ORGANIZATION(S):
Any person or organization that you agree in a written contract to
include as an additional insured on this Coverage Part, provided that
such written contract was signed and executed by you before,and is in
effect when, the "bodily injury" or "property damage" occurs or the
"personal injury" or "advertising injury" offense is committed.
LOCATION OF COVERED OPERATIONS:
Any project to which a written contract with the Additional Insured
Person(s) or Organization(s) in the Schedule applies.
(INFORMATION REQUIRED TO COMPLETE THIS SCHEDULE, IF NOT SHOWN ABOVE, WILL
BE SHOWN IN THE DECLARATIONS.)
A. SECTION it - WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN
ADDITIONALINSURED THE PERSON(S) OR ORGANIZATION(S) SHOWN IN THE SCHEDULE,
BUT ONLY WITH RESPECT TO LIABILITY FOR 'BODILY INJURY", "PROPERTY
DAMAGE", PERSONAL INJURY OR "ADVERTISING INJURY"CAUSED, IN WHOLE OR 1N
PART, BY:
1. YOUR ACTS OR OMISSIONS; OR
2. THE ACTS OR OMISSIONS OF THOSE ACTING ON YOUR BEHALF; IN THE
PERFORMANCE OF YOUR ONGOING OPERATIONS FOR THE ADDITIONAL INSURED(S)AT
THE LOCATION(S) DESIGNATED ABOVE.
B. WITH RESPECT TO THE INSURANCE AFFORDED TO THESE ADDITIONAL INSURED,
O CG T8 04 12 18
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• Mayor Dana Ralph 4
City of Kent Administration
Derek M. Matheson, CAO
Policy Number 6805H560029
GENERAL PURPOSE ENDORSEMENT
OFFICE PAC
CITY CLERK
Kimberley A. Komoto
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFt�L�Y,
City Clerk
CGD361 (03-05) - ADDITIONAL INSURED - OWNSRS, LSSSSSS OR CONTRACTORt venue South
SCHEDULED PMRSON OR ORGANIZATION �ent, WA 98032
KEItTendor5ement modifies insurance provided under the following:
.TON Fax: 253-856-6725
WASHIN
THE FOLLOWING ADDITIONAL EXCLUSIONS APPLY: PHONE: 253-856-5728
THIS INSURED DOES NOT APPLY TO "BODILY INJURY" OR "PROPERTY DAMAGE"
OCCURRING, OR "PERSONAL INJURY"OR "ADVERTISING INJURY" ARISING OUT OF AN
OFFENSE COMMITTED, AFTER:
7. ALL WORK, INCLUDING MATERIALS, PARTS OR EQUIPMENT FURNISHED IN
CONNECTION WITH SUCH WORK, ON THE PROJECT(OTHER THAN SERVICE,
MAINTENANCE OR REPAIRS) TO BE PERFORMED BY OR ON BEHALF OF THE ADDITIONAL
WSURED(S) AT THE LOCATION OF THE COVERED OPERATIONS HAS BEEN COMPLETED;
OR
2. THAT PORTION OF"YOUR WORK"OUT OF WHICH THE INJURY OR DAMAGE ARISES
HAS BEEN PUT TO ITS INTENDED USE BY ANY PERSON OR ORGANIZATION OTHER THAN
ANOTHER CONTRACTOR OR SUBCONTRACTOR ENGAGED IN PERFORMING OPERATIONS FOR
A PRINCIPAL AS A PART OF THE SAME PROJECT.
CG D3 61 03 05
Copyright 2005 The St. Paul Travelers Companies,reserved_ Inc. Ail rights
Includes copyrighted material of Insurance Services Office, Inc_ with its
permission.
CG T8 04 12 18
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• Mayor Dana Ralph „*yE
City of Kent Administration
Derek M. Matheson, CAO