HomeMy WebLinkAboutCAG2020-090 - Original - Traffic Control Plan Co. of Washington, LLC - Lower Russell Levee - Traffic Control Plans - 03/11/2020 Agreement Routing Form
• For Approvals,Signatures and Records Management
KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms.
w A s�I N c T o N (Print on pink or cherry colored paper)
Originator: Department:
Nancy Yoshitake for Toby Hallock Public Works
Date Sent: Date Required:
> 3/11/20 3/13/20
0
QAuthorized to Sign: Date of Council Approval:
Q 0 Director or Designee ❑ Mayor N/A
Budget Account Number: Grant? ❑Yes El No
D20079
Budget? 0 Yes ❑ No Type:
Vendor Name: Category:
Traffic Control Plan Co. of Washington, LLC Contract
Vendor Number: Sub-Category:
1688086
0
Project Name: Lower Russell Levee
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0
Project Details:Prepare traffic control plans.
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a�
E Agreement Amount: $1,750 Basis for Selection of Contractor:
a)
Start Date: 3/11/20 Termination Date: 6/30/20
Q
Local Business? ❑Yes O No*
*If meets requirements per KCC 3.10.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspoce.
Notice required prior to disclosure? Contract Number:
❑Yes ❑ No CAEn202-0 0 D
Date Received by City Attorney: Comments:
C1
C
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3
3 0
a,
GJ �
� a+
f0
p� Date Routed to the Mayor's Office:
Date Routed to the City Clerk's Office:
ad«w22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements
KENT
W-1 1-N
GOODS & SERVICES AGREEMENT
between the City of Kent and
Traffic Control Plan Co. of Washington, LLC
THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Traffic Control Plan Co. of Washington, LLC organized under the laws of the
State of Washington, located and doing business at 1245 Auburn Way N. #315, Auburn, WA 98002,
Phone: (253) 258-1419, Contact: Christopher Grose (hereinafter the "Vendor").
AGREEMENT
I. DESCRIPTION OF WORK.
Vendor shall provide the following goods and materials and/or perform the following services for
the City:
The Vendor shall prepare traffic control plans for the Lower Russell Levee Project. For a
description, see the Vendor's Scope of Work which is attached as Exhibit A and incorporated
by this reference.
Vendor acknowledges and understands that it is not the City's exclusive provider of these goods,
materials, or services and that the City maintains its unqualified right to obtain these goods, materials,
and services through other sources.
II. TIME OF COMPLETION. Upon the effective date of this Agreement, Vendor shall complete
the work and provide all goods, materials, and services by June 30, 2020.
III. COMPENSATION. The City shall pay the Vendor an amount not to exceed One Thousand,
Seven Hundred Fifty Dollars ($1,750), including applicable Washington State Sales Tax, for the goods,
materials, and services contemplated in this Agreement. The City shall pay the Vendor the following
amounts according to the following schedule:
The Vendor shall be paid after traffic control plans have been prepared, delivered, and
submittal of invoice.
If the City objects to all or any portion of an invoice, it shall notify Vendor and reserves the option
to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make
every effort to settle the disputed portion.
GOODS & SERVICES AGREEMENT - 1
($20,000 or Less, ind. WSST)
A. Defective or Unauthorized Work. The City reserves its right to withhold payment from
Vendor for any defective or unauthorized goods, materials or services. If Vendor is unable,
for any reason, to complete any part of this Agreement, the City may obtain the goods,
materials or services from other sources, and Vendor 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
Agreement price specified above. The City further reserves its right to deduct these
additional costs incurred to complete this Agreement with other sources, from any and all
amounts due or to become due the Vendor.
B. Final Payment: Waiver of Claims. VENDOR'S ACCEPTANCE OF FINAL PAYMENT SHALL
CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE
AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT
IS MADE.
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 Vendor 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 Vendor maintains and pays for its own place of business from which Vendor's
services under this Agreement will be performed.
C. The Vendor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Vendor's services, or the Vendor is engaged in an independently established
trade, occupation, profession, or business of the same nature as that involved under
this Agreement.
D. The Vendor 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 Vendor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Vendor's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
F. The Vendor maintains a set of books dedicated to the expenses and earnings of its
business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of
this Agreement.
VI. CHANGES. The City may issue a written amendment for any change in the goods,
materials or services to be provided during the performance of this Agreement. If the Vendor determines,
for any reason, that an amendment is necessary, Vendor must submit a written amendment request to
the person listed in the notice provision section of this Agreement, section XIV(D), within fourteen (14)
calendar days of the date Vendor 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 Vendor'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 Vendor on all equitable adjustments. However, if the parties are unable to
agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall
proceed with the amended work upon receiving either a written amendment from the City or an oral order
from the City before actually receiving the written amendment. If the Vendor fails to require an
GOODS & SERVICES AGREEMENT - 2
($20,000 or Less, including WSST)
amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent
amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable
adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the
adjustment as provided in subsections A through E of Section VII, Claims, below.
The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate
acceptance, or (3) not protesting in the way this section provides. An amendment that is accepted by
Vendor 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.
VII. CLAIMS. If the Vendor disagrees with anything required by an amendment, another
written order, or an oral order from the City, including any direction, instruction, interpretation, or
determination by the City, the Vendor may file a claim as provided in this section. The Vendor 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 Vendor 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 Vendor unless a timely written claim
is made in strict accordance with the applicable provisions of this Agreement.
At a minimum, a Vendor'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 Vendor'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 Vendor is asserting a schedule change or disruption.
B. Records. The Vendor 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 Vendor'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. Vendor's Duty to Complete Protested Work. In spite of any claim, the Vendor 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 Vendor
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 Vendor completely waives any claims for protested work and accepts from the
GOODS & SERVICES AGREEMENT - 3
($20,000 or Less, including WSST)
City any written or oral order (including directions, instructions, interpretations, and
determination).
VIII. LIMITATION OF ACTIONS. VENDOR 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 VENDOR'S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED.
THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD.
IX. WARRANTY. Vendor warrants that it will faithfully and satisfactorily perform all work
provided under this Agreement in accordance with the provisions of this Agreement. In addition to any
other warranty provided for at law or herein, this Agreement is additionally subject to all warranty
provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington.
Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained,
and will perform in accordance with their specifications and Vendor's representations to City. The Vendor
shall promptly correct all defects in workmanship and materials: (1) when Vendor knows or should have
known of the defect, or (2) upon Vendor's receipt of notification from the City of the existence or
discovery of the defect. In the event any part of the goods are repaired, 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 Vendor shall begin to correct any defects within seven (7) calendar days of its
receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a
reasonable time as determined by the City, the City may complete the corrections and the Vendor shall
pay all costs incurred by the City in order to accomplish the correction.
X. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the
Vendor 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.
Vendor 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.
XI. INDEMNIFICATION. Vendor 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 Vendor'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 Vendor's work when completed shall not be grounds
to avoid any of these covenants of indemnification.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION
PROVIDED HEREIN CONSTITUTES THE VENDOR'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 Vendor 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 Vendor's part, then Vendor
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
Vendor's part.
The provisions of this section shall survive the expiration or termination of this Agreement.
GOODS & SERVICES AGREEMENT - 4
($20,000 or Less, including WSST)
XII. INSURANCE. The Vendor 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.
XIII. WORK PERFORMED AT VENDOR'S RISK. Vendor 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
Vendor's own risk, and Vendor 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.
XIV. 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 XI 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 Vendor.
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 Vendor agrees to comply with all federal, state, and municipal
laws, rules, and regulations that are now effective or in the future become applicable to Vendor's business,
equipment, and personnel engaged in operations covered by this Agreement or accruing out of the
performance of those operations.
GOODS & SERVICES AGREEMENT - 5
($20,000 or Less, including WSST)
Public ReCarcls Act, The VQndor acknowledgQs that the City Is a pLjbl;c agency sLi4jed to the
Public Records Act codified irl Chapter 42.5-6, (if the Revised Code o( Washington and documents,ts, notes,
emalls, and other records prepared or garhurud by the Consultant in its jo�erforrnance of this Agreement
MaY tag si,hiect to public neview and disclosure, even if those r�trjrds are not produced to or possessed by
tht City of Kent, As such, the Vendor agrees to cooperate fully with the City In satisfying the City's duti-es
anc obligations under the flubdc Records Act.
31 Crty Buskles.s--Lk&n _RetUlred, Prior to commencing the tasks described in Section 1,
Contractor agrees to provide proof of a current city of Kent busines,& license Pursuant to Chapter 5.01 or
the Kcr!, City Code.
K, Lau�zM and Signatures by Fox or Email.. This Agreement rray to executed in any
numbar of cmincerparts, each of which sWall 6�nstltute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreernentr either party may deliver the 5ignature paget
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the oh�gjnal 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 acre ratifi ed and affirmed, and the terms of the Agreement shall be deemed
to have applied.
VENDOR,. CM OF KENT;
BY: By:
PrInLName.- (L2�- r,i` Print: Name- Nlichai,-,l Mactutis, P,E,
its: Its: Environmental Engineering Manager
ATE: 31) X9
DATE: D
r4—rkii, 0' BE SEAT T- 00 NOTICES TO BE SENT TO: ...........
VENDOR- CITY OF KENT:
Christopher Grose Timothy J. LaPorte, P.E.
Traft Control Plan Ccj,, i�! Washington City of ye"If
1245 Auburn Way N, #315 220 fourth Avenue South
Auburn, WA 96002 Kert, WA 98032
(253) 258-1419 i,,Le°epnone) f253) 856-5500 (telephone)
(253) 270-2250 (facsimile) 1253) 856-6500 (facsimile)
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Trw%-C.airza Pw r.0*k-L.—Wsmf
GOODS &SERVTCf 5 AGREEMErlr' 6
($2010M or Lesr', MPOUding W-SET)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
'T'he City of Kent is committed to confonm to Federal and SL@Le, 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 too be valid and binding,
If any contractor, subcontractor or supplier wififuily 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 queSLlons areas follows:
I. 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 wili 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,
1; 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,
q
For:
Title.
Date:
EEO COMPUANCE DOCUMEN7S - 1 of 3
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 of 3
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 of 3
rrrafflic Control. Plan Co. '
Washington, LIX
raff
on s
o
City of Kent 02/24/2020
400 W Gowe St uG
Kent, Wa 98032
ATTN: Tobias Hallock
Project ob`eci tive: To provide all traffic control plans (TCP) for the Lower Russell
Levee Green River Trail to South 212th St Detour Route Project.
Key points that Traffic Control Plan Co. of WA, LLC will provide
° Work on Proposed TCP's will not commence until contract has been signed and
delivered via email to TCP Co. of WA. LLC. Verbal noticewill not be acce_pteci
No charge will be applied to any in-house consultations or pre-cons that are
requested.
Payment terms for providing TCP's for this project shall be NET 30,
Task 1: Proposal for Lower Russell Levee Green River Trail to South 212th
St Detour Route Project.
Cost for each plan sheet shall be $175.00 Per sheet.
10 Sheets X $175.00 per sheet= $ 1,750.00
NOTE: final cost of package will be determined by the final number of TCP's prepared.
REVISIONS: No additional charge (whether customer needs revisions or approving
authority).
We do not charge sales tax
Christopher D. Grose v.
' Plan engineer/Owner
Traffic Control Plan CO. of WA, LLC
Traffic Control Plan Co of WA,LLC O:253-258-1419 email:chris@trafficcontrolplan net
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/1YYY)
a9F26/2o19
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Tt*JS
;RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
_LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZr
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
"ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject It
.e 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 endorsements .
PRODUCER AC
NAME:
PHONE FAx
NATIONWIDE SALES SOLUTIONS INC EMAIL No:
ADDRESS:
1200 LOCUST ST DEPT 2010
INSURERS AFFORDIN=E-GEA
DES MOINES IA 50391-2010 INSURERA: DEPOSITORS INSURAINSURED
INSURER B:
INSURER C
TRAFFIC CONTROL PLAN CO.OF WASHINGTON, LLC INSURERD:
1339 42ND ST NE IN
E
AUBURN WA 98002-7036 IN
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 L POLICY EFF POLICY EXP
TYPE OF INSURANCE POLICY NUMBER
XLIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
2,000.000
CLAIMS-MADE X OCCUR AMA
PR MI S rare S 100,000
MED EXP(Any one person) S 5,000
A ACP GLDO 3028459207 09/25/2019 09/25/2020 PERSONAL dADV INJURY s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY E PE 4 ❑LOC GENERAL AGGREGATE S 4,000,000
OTHER:
PRODUCTS-COMP/OP AGG S 4,000.000
S
'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO
a c nt S
BODILY INJURY Per
ALL OWNED SCHEDULED O $
AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNED
AUTOS PROPERTY DAMAGE
P $
UMBRELLA LIAR pOCUR $
EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE
AGGREGATE $
DIEDRETENTION S
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY OTH-
ANYPROPRIETOR/PARTNERIEXECUTIVE Y/N PEAT T R
OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $
(Mandatory in NH)
If yes describe under E.L.DISEASE-EA EMPLOYE $
DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The above mentioned general liability policy includes data compromise coverage with a response expense limit of$50,000 and defense and liability limit of
$50,000.The above mentioned general liability policy includes computer attack coverage with a limit of$50,000.The above mentioned general liability policy
includes identity recovery coverage with a limit of$25,000.
CERTIFICATE HOLDER CANCELLATION
:FRESENTATIVE
Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
E WITH THE POLICY PROVISIONS.
lKent
t AUTHORIZED
WA, 98032
4CORD 25(2014101) 01988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
CG72881216
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS ENHANCEMENT ENDORSEMENT
INCLUDING MEDICAL PAYMENTS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Lost Key Coverage C. Non-Owned Watercraft
1. Under Section I — Coverages, Coverage A Under Section I — Coverages, Coverage A
Bodily Injury And Property Damage Bodily Injury And Property Damage Liability,
Liability, coverage is extended to include 2. Exclusions Exclusion g. Aircraft, Auto Or
the following: Watercraft Paragraph (2) (a) is replaced with:
If a customer's master or grand key, (a) Less than 51 feet long; and
excluding electronic key card, is lost,
damaged or stolen while in your care, D. Expanded Property Damage Coverage
custody or control we will pay the cost of 1• For the purposes of this endorsement only:
replacing the keys, including the master lock Section I — Coverages, Coverage A
and all keys used in the same lock, the cost Bodily Injury And Property Damage
of adjusting locks to accept the new keys, or Liability, 2. Exclusions, Exclusion j.
the cost to replace the locks, whichever is Damage To Property is amended as
less. follows:
2. Limit of Insurance— For the purpose of this a. Paragraphs (3), (5), and (6) are deleted
coverage, the most we will pay is $10,000 in their entirety.
per"occurrence". b. Paragraph (4) is deleted in its entirety
B. Voluntary Property Damage and replaced with:
1. Under Section I — Coverages, COVerage A (4) Personal property in the care
Bodily Injury And Property Damage Liability, custody, or control of the insured:
coverage is extended to include the following:
(a) For storage or sale at premises
At your request, we will pay for "property you own, rent or occupy;or
damage" to property of others caused by you (b) While beingtransported b an" Y Y
and while in your possession, arising out of your
business aircraft, "auto , or watercraft
operations and occurring during thepolicy period- owned or operated by or rented
to or loaned to any insured.
2. Limit of Insurance— For the purpose of this
coverage the most we will pay is $1,500 per C. The coverage provided by this
endorsement does not apply to
"occurrence". "property damage":
C. Non-Owned Watercraft
Under Section I — Coverages, Coverage A (1) osslo9 use ofng out f the personal disappearance
(2) Included in the
Bodily Injury And Property Damage Liability, property;pl
2. Exclusions Exclusion g. Aircraft, Auto Or "products-completed
Watercraft Paragraph (2)(a) is replaced with: operations hazard".
(a) Less than 51 feet long;and
CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc.,
Page 1 of 5
with its permission.
ACP 3028459207 - TRAFFIC CONTROL PLAN CO. OF WASHINGTON, LLC
CG72881216
b. Managers or Lessors of Premises d. Owners, Lessees, or Contractors with
with respect to liability arising out of the respect to liability for "bodily injury",
ownership, maintenance, or use of that "property damage", or "personal and
part of the premises you own, rent, advertising injury" caused, in whole or in
lease, or occupy. part, by:
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;
that premises. in the 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
cease to be a tenant of such premises. (1) "Bodily injury", "property damage",
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
connection with premises you own, rent (a) The preparing, approving, or
or control and to which this insurance failing to prepare or approve
applies: maps, shop drawings, opinions,
reports, survey, field orders,
(1) The existence, maintenance, repair, change orders, or drawings and
construction, erection, or removal of specifications: or
advertising signs, awnings,
canopies, cellar entrances, coal (b) Supervisory, inspection, archi-
tectural, or engineering activ
holes, driveways, manholes,
marquees, hoist away openings, ities.
sidewalk vaults, street banners, or (2) "Bodily injury" or "property damage"
decorations and similar exposures; occurring after:
or (a) All work, including materials,
(2) The construction, erection, or parts, or equipment furnished in
removal of elevators; or connection with such work, on
The ownership, maintenance, or use of the project (other than service,
any elevators covered by this insurance. maintenance or repairs) f be
o
This insurance does not apply to: Performed by or on behalf of the
additional insured(s) at the
(1) "Bodily injury" or "property damage" location of the covered
or "personal or advertising injury" operations has been completed;
arising out of operations performed or
for the state or municipality;or (b) That portion of "your work" out
(2) "Bodily injury" or "property damage" of which the injury or damage
included within the "products- arises has been put to its
completed operations hazard". intended use by any person or
However, such state or political organization other than another
subdivision's status as additional contractor or subcontractor
engaged in performing
insured under this policy ends when the
operations for a principal as a
permit ends. part of the same project.
CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc.,
Page 3 of 5
with its permission.
ACP 3028459207 - TRAFFIC CONTROL PLAN CO. OF WASHINGTON, LLC
CG72881216
N. Liberalization O. Broadened Bodily Injury Definition (Mental
Under Section IV — Commercial General Anguish)
Liability Conditions, the following condition is Under Section V — Definitions Definition 3.
added: "Bodily Injury" is replaced with:
10. Liberalization 3. "Bodily injury" means physical injury,
If we revise this coverage form to provide sickness, or disease to a person and if
more coverage without additional premium arising out of the foregoing, mental anguish,
charge, your policy will automatically provide mental injury, shock, or humiliation,
the additional coverage as of the day the including death at any time resulting
revision is effective in your state. therefrom.
All terms and conditions of this policy apply unless modified by this endorsement.
CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc.,
Page 5 of 5
with its permission.
ACP 3028459207 - TRAFFIC CONTROL PLAN CO. OF WASHINGTON, LLC
Wakefield,Wendy
From: Christopher Grose echris@trafficcontrolplan.net>
Sent: Thursday, December 14, 2017 4:14 PM
To: Wakefield,Wendy
Subject: RE:Your Nationwide Commercial Insurance
Attachments: image001.em2;Contractor's Enhancement.pdf
Wendy-
Attached is the CG7288 form. If this is not what you need, let me know and I will call my agent
fielow is an email& link f)ertaining to the L& I requirements for the State of Washington, As a sole Proprietor,I am not
required to carry Workman's Compensation, I received this reply on 6/1(i/17 from Lila Allenton. See below between
red brackets.
[Hello Chris,
Below is a link to Labor and industries Limited Liability Companies.
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All managers who are also members to the LLC are excluded
Iron)coverage.
Thank you
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P: 360-00248i3l
As for the Automobile insurance requirements....my business does not have any vehicles listed or registered as company
assets. lily work is done using phone&email. I do not visit any jobsites nor do I provide labor,equipment or onsite job
consults.
Feel free to contact me with any other questions.
Thank you.