Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
CAG2021-371 - Original - Eagle Asphalt Sealcoating Company, LLC -Glenn Nelson Park Sealcoating & Striping - 08/23/2021
8/17/2021 OK to sign, 8/18/2021, TW. PUBLIC WORKS AGREEMENT - 1 (Over $20K and No Performance Bond) PUBLIC WORKS AGREEMENT between City of Kent and Eagle Asphalt Sealcoating Company, LLC THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Eagle Asphalt Sealcoating Company, LLC organized under the laws of the State of Washington, located and doing business at 11219 Benston Drive East, Puyallup WA 98372, Mailing Address: P.O. Box 1564, Sumner WA 98390-0330. Contact: Bryce Wilson, Phone (253) 862-9554, Cell (253) 266-5996 (hereinafter the "Contractor"). AGREEMENT The parties agree as follows: I. DESCRIPTION OF WORK. The Contractor shall perform the following services for the City in accordance with the following described plans and/or specifications: Contractor to furnish all materials and necessary equipment and perform all labor necessary to sealcoat and stripe the parking lot at Glenn Nelson Park, located at 3216 South 268th Street, Kent WA 98032, per quote dated July 20, 2021 attached and marked as Exhibit A. The 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 within 75 calendar days after the City issues its Notice to Proceed. Upon the effective date of this Agreement, all physical work shall thereafter be completed by October 31, 2021. The term of this Agreement shall continue until all work has been completed, final acceptance has occurred, and all Contractor obligations have been fulfilled. III. COMPENSATION. The City shall pay the Contractor a total amount not to exceed THIRTY FOUR THOUSAND FOUR HUNDRED SEVENTEEN DOLLARS AND TWENTY SIX CENTS ($34,417.26), 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. Card Payment Program. The Contractor may elect to participate in automated credit card payments provided for by the City and its financial institution. This Program is provided as an alternative to payment by check and is available for the convenience of the Contractor. If the Contractor voluntarily participates in this Program, the Contractor will be solely responsible for any fees imposed by financial institutions or credit card companies. The Contractor shall not charge those fees back to the City. PUBLIC WORKS AGREEMENT - 2 (Over $20K and No Performance Bond) A. No Payment and Performance Bond. Because this contract, including applicable sales tax, is less than $150,000, 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 the State Employment Security Department, and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. B. Retainage. The City shall also hold back a retainage in the amount of five percent (5%) of any and all payments made to the 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 the e Agreement. C. Defective or Unauthorized Work. The City reserves its right to withhold payment from the 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 the 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 the Contractor shall be liable to the City for any additional costs 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 CONTRA PAYMENT (EXCLUDING WITHHELD RETAINAGE) SHALL CONSTITUTE A WAIVER OF 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 the 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 the ervices 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. PUBLIC WORKS AGREEMENT - 3 (Over $20K and No Performance Bond) 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 the from the State of Washington. 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. include, without limitation, any one or more of the following events: A. workers or proper materials for completion of the Contract work. B. Agreement. C. material or labor. D. The Con regulations. E. F. 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 this project which may be used by the City without restriction. VI. PREVAILING WAGES. The ct work. The Contractor shall pay prevailing wages in effect on the date the bid is accepted or executed by the 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, the Contractor must submit a written change order request to the person listed in the notice provision section of this Agreement, Section XVI(D), within fourteen (14) calendar days of the date the 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 PUBLIC WORKS AGREEMENT - 4 (Over $20K and No Performance Bond) 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 IX, 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 the 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. VIII. FORCE MAJEURE. Neither party shall be liable to the other for breach due to delay or failure in performance resulting from acts of God, acts of war or of the public enemy, riots, pandemic, fire, flood, or other natural disaster or acts of government . Performance that is prevented or delayed due to a force majeure event shall not result in liability to the delayed party. Both parties represent to the other that at the time of signing this Agreement, they are able to perform as required and their performance will not be prevented, hindered, or delayed by the current COVID-19 pandemic, any existing state or national declarations of emergency, or any current social distancing restrictions or personal protective equipment requirements that may be required under federal, state, or local law in response to the current pandemic. If any future performance is prevented or delayed by a force majeure event, the party whose performance is prevented or delayed shall promptly notify the other party of the existence and nature of the force majeure event causing the prevention or delay in performance. Any excuse from liability shall be effective only to the extent and duration of the force majeure event causing the prevention or delay in performance and, provided, that the party prevented or delayed has not caused such event to occur and continues to use diligent, good faith efforts to avoid the effects of such event and to perform the obligation. Notwithstanding other provisions of this section, the Contractor shall not be entitled to, and the City shall not be liable for, the payment of any part of the contract price during a force majeure event, or any costs, losses, expenses, damages, or delay costs incurred by the Contractor due to a force majeure event. Performance that is more costly due to a force majeure event is not included within the scope of this Force Majeure provision. If a force majeure event occurs, the City may direct the Contractor to restart any work or performance that may have ceased, to change the work, or to take other action to secure the work or the project site during the force majeure event. The cost to restart, change, or secure the work or project site arising from a direction by the City under this clause will be dealt with as a change order, except to the extent that the loss or damage has been caused or exacerbated by the failure of the Contractor to fulfill its obligations under this Agreement. Except as expressly contemplated by this section, all other costs will be borne by the Contractor. IX. 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 PUBLIC WORKS AGREEMENT - 5 (Over $20K and No Performance Bond) 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). X. 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 FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. XI. WARRANTY. The Contractor warrants that it will faithfully and satisfactorily perform all work provided under this Agreement in accordance with the provisions of this Agreement. The Contractor shall promptly correct all defects in workmanship and materials: (1) when the Contractor knows or should have known of the defect, or (2) upon the 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. XII. 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. PUBLIC WORKS AGREEMENT - 6 (Over $20K and No Performance Bond) The 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. XIII. INDEMNIFICATION. The 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 the 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 the 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 the 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 the The provisions of this section shall survive the expiration or termination of this Agreement. XIV. 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. XV. WORK PERFORMED AT CONTRACTOR'S RISK. The 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 the Contractor's own risk, and the 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. XVI. 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 PUBLIC WORKS AGREEMENT - 7 (Over $20K and No Performance Bond) 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 XIII 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 the 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 the 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 and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, the 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 PUBLIC WORKS AGREEMENT - 8 (Over $20K and No Performance Bond) to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. CONTRACTOR: By: Print Name: Its DATE: CITY OF KENT: By: Print Name: Dana Ralph Its Mayor DATE: NOTICES TO BE SENT TO: CONTRACTOR: Bryce Wilson Eagle Asphalt Sealcoating Company, LLC 14017 16th Street East P.O. Box 1564 Sumner, WA 98390-0330 (253) 266-5996 (cell) or (253) 862-9554 (telephone) (253) 862-3855 (facsimile) NOTICES TO BE SENT TO: CITY OF KENT: Ben Levenhagen, Support Services Field Supervisor City of Kent 220 Fourth Avenue South Kent, WA 98032 (253) 508-9548 (Cell) or (253) 856-5133 (telephone) (253) 856-6120 (facsimile) APPROVED AS TO FORM: Kent Law Department ATTEST: Kent City Clerk 08/23/2021 PUBLIC WORKS AGREEMENT - 9 (Over $20K 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 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 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: _________________________________________ Title: ________________________________________ Date: ________________________________________ PUBLIC WORKS AGREEMENT - 10 (Over $20K and No Performance Bond) 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 su 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 policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. PUBLIC WORKS AGREEMENT - 11 (Over $20K and No Performance Bond) 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: ________________________________________ PUBLIC WORKS AGREEMENT - 12 (Over $20K and No Performance Bond) 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 (July 13, 2021 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. Eagle Asphalt Sealcoating Company, LLC By:__________________________________________ Signature of Authorized Official* Printed Name: _________________________________ Title: ________________________________________ Date: ________________________________________ City and State: _________________________________ *If a corporation, proposal must be executed in the corporate name by the president or vice- president (or any other corporate officer accompanied by evidence of authority to sign). If a co- partnership, proposal must be executed by a partner. 8/11/2021 about:blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Washington State Prevailing Wage The PREVAILING WAGES listed here include both the hourly 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: 8/11/2021 *Risk County_ Trade Job Classification Wage Holiday Overtime Note Class King Laborers Air, Gas Or Electric Vibrating $52.39 7A 4V 8Y View Screed King Laborers Airtrac Drill Operator $54.01 7A 4V 8Y View King Laborers Ballast Regular Machine $52.39 7A 4V 8Y View King Laborers Batch Weighman $44.40 7A 4V 8Y View King Laborers Brick Pavers $52.39 7A 4V 8Y View King Laborers Brush Cutter $52.39 7A 4V 8Y View King Laborers Brush Hog Feeder $52.39 7A 4V 8Y View King Laborers Burner $52.39 7A 4V 8Y View King Laborers Caisson Worker $54.01 7A 4V 8Y View King Laborers Carpenter Tender $52.39 7A 4V 8Y View King Laborers Cement Dumper -paving $53.35 7A 4V 8Y View King Laborers Cement Finisher Tender $52.39 7A 4V 8Y View King Laborers Change House Or Dry Shack $52.39 7A 4V 8Y View King Laborers Chipping Gun (30 Lbs. And $53.35 7A 4V 8Y View Over) King Laborers Chipping Gun (Under 30 Lbs.) $52.39 7A 4V 8Y View King Laborers Choker Setter $52.39 7A 4V 8Y View King Laborers Chuck Tender $52.39 7A 4V 8Y View King Laborers Clary Power Spreader $53.35 7A 4V 8Y View King Laborers Clean-up Laborer $52.39 7A 4V 8Y View King Laborers Concrete Dumper/Chute $53.35 7A 4V 8Y View Operator King Laborers Concrete Form Stripper $52.39 7A 4V 8Y View King Laborers Concrete Placement Crew $53.35 7A 4V 8Y View King Laborers Concrete Saw Operator/Core $53.35 7A 4V 8Y View Driller King Laborers Crusher Feeder $44.40 7A 4V 8Y View King Laborers Curing Laborer $52.39 7A 4V 8Y View King Laborers Demolition: Wrecking 8t Moving $52.39 7A 4V 8Y View (Incl. Charred Material) about:blank 1 /4 8/11 /2021 about:blank King Laborers Ditch Digger $52.39 7A 4V 8Y View King Laborers Diver $54.01 7A 4V 8Y View King Laborers Drill Operator (Hydraulic, $53.35 7A 4V 8Y View Diamond) King Laborers Dry Stack Walls $52.39 7A 4V 8Y View King Laborers Dump Person $52.39 7A 4V 8Y View King Laborers Epoxy Technician $52.39 7A 4V 8Y View King Laborers Erosion Control Worker $52.39 7A 4V 8Y View King Laborers Faller Et Bucker Chain Saw $53.35 7A 4V 8Y View King Laborers Fine Graders $52.39 7A 4V 8Y View King Laborers Firewatch $44.40 7A 4V 8Y View King Laborers Form Setter $52.39 7A 4V 8Y View King Laborers Gabian Basket Builders $52.39 7A 4V 8Y View King Laborers General Laborer $52.39 7A 4V 8Y View King Laborers Grade Checker Et Transit Person $54.01 7A 4V 8Y View King Laborers Grinders $52.39 7A 4V 8Y View King Laborers Grout Machine Tender $52.39 7A 4V 8Y View King Laborers Groutmen (Pressure) Including $53.35 7A 4V 8Y View Post Tension Beams King Laborers Guardrail Erector $52.39 7A 4V 8Y View King Laborers Hazardous Waste Worker (Level $54.01 7A 4V 8Y View A) King Laborers Hazardous Waste Worker (Level $53.35 7A 4V 8Y View B) King Laborers Hazardous Waste Worker (Level $52.39 7A 4V 8Y View C) King Laborers High Scaler $54.01 7A 4V 8Y View King Laborers Jackhammer $53.35 7A 4V 8Y View King Laborers Laserbeam Operator $53.35 7A 4V 8Y View King Laborers Maintenance Person $52.39 7A 4V 8Y View King Laborers Manhole Builder-Mudman $53.35 7A 4V 8Y View King Laborers Material Yard Person $52.39 7A 4V 8Y View King Laborers Motorman -Dinky Locomotive $53.35 7A 4V 8Y View King Laborers Nozzleman (Concrete Pump, $53.35 7A 4V 8Y View Green Cutter When Using Combination Of High Pressure Air Et Water On Concrete Et Rock, Sandblast, Gunite, Shotcrete, Water Blaster, Vacuum Blaster) King Laborers Pavement Breaker $53.35 7A 4V 8Y View King Laborers Pilot Car $44.40 7A 4V 8Y View King Laborers Pipe Layer Lead $54.01 7A 4V 8Y View King Laborers Pipe Layer/Tailor $53.35 7A 4V 8Y View King Laborers Pipe Pot Tender $53.35 7A 4V 8Y View King Laborers Pipe Reliner $53.35 7A 4V 8Y View King Laborers Pipe Wrapper $53.35 7A 4V 8Y View King Laborers Pot Tender $52.39 7A 4V 8Y View King Laborers Powderman $54.01 7A 4V 8Y View about:blank 2/4 8/11 /2021 abouttlank King Laborers Powderman's Helper $52.39 7A 4V 8Y View King Laborers Power Jacks $53.35 7A 4V 8Y View King Laborers Railroad Spike Puller - Power $53.35 7A 4V 8Y View King Laborers Raker - Asphalt $54.01 7A 4V 8Y View King Laborers Re-timberman $54.01 7A 4V 8Y View King Laborers Remote Equipment Operator $53.35 7A 4V 8Y View King Laborers Rigger/Signal Person $53.35 7A 4V 8Y View King Laborers Rip Rap Person $52.39 7A 4V 8Y View King Laborers Rivet Buster $53.35 7A 4V 8Y View King Laborers Rodder $53.35 7A 4V 8Y View King Laborers Scaffold Erector $52.39 7A 4V 8Y View King Laborers Scale Person $52.39 7A 4V 8Y View King Laborers Sloper (Over 20") $53.35 7A 4V 8Y View King Laborers Sloper Sprayer $52.39 7A 4V 8Y View King Laborers Spreader (Concrete) $53.35 7A 4V 8Y View King Laborers Stake Hopper $52.39 7A 4V 8Y View King Laborers Stock Piler $52.39 7A 4V 8Y View King Laborers Swinging Stage/Boatswain $44.40 7A 4V 8Y View Chair King Laborers Tamper Et Similar Electric, Air $53.35 7A 4V 8Y View Et Gas Operated Tools King Laborers Tamper (Multiple Et Self- $53.35 7A 4V 8Y View propelled) King Laborers Timber Person - Sewer (Lagger, $53.35 7A 4V 8Y View Shorer Et Cribber) King Laborers Toolroom Person (at Jobsite) $52.39 7A 4V 8Y View King Laborers Topper $52.39 7A 4V 8Y View King Laborers Track Laborer $52.39 7A 4V 8Y View King Laborers Track Liner (Power) $53.35 7A 4V 8Y View King Laborers Traffic Control Laborer $47.48 7A 4V 9C View King Laborers Traffic Control Supervisor $50.31 7A 4V 9C View King Laborers Truck Spotter $52.39 7A 4V 8Y View King Laborers Tugger Operator $53.35 7A 4V 8Y View King Laborers Tunnel Work -Compressed Air $129.67 7A 4V 9B View Worker 0-30 psi King Laborers Tunnel Work -Compressed Air $134.70 7A 4V 9B View Worker 30.01-44.00 psi King Laborers Tunnel Work -Compressed Air $138.38 7A 4V 9B View Worker 44.01-54.00 psi King Laborers Tunnel Work -Compressed Air $144.08 7A 4V 9B View Worker 54.01-60.00 psi King Laborers Tunnel Work -Compressed Air $146.20 7A 4V 9B View Worker 60.01-64.00 psi King Laborers Tunnel Work -Compressed Air $151.30 7A 4V 9B View Worker 64.01-68.00 psi King Laborers Tunnel Work -Compressed Air $153.20 7A 4V 9B View Worker 68.01-70.00 psi King Laborers Tunnel Work -Compressed Air $155.20 7A 4V 9B View Worker 70.01-72.00 psi abouttlank 3/4 8/11 /2021 abouttlank King Laborers Tunnel Work -Compressed Air $157.20 7A 4V 9B View Worker 72.01-74.00 psi King Laborers Tunnel Work-Guage and Lock $54.11 7A 4V 8Y View Tender King Laborers Tunnel Work -Miner $54.11 7A 4V 8Y View King Laborers Vibrator $53.35 7A 4V 8Y View King Laborers Vinyl Seamer $52.39 7A 4V 8Y View King Laborers Watchman $40.36 7A 4V 8Y View King Laborers Welder $53.35 7A 4V 8Y View King Laborers Well Point Laborer $53.35 7A 4V 8Y View King Laborers Window Washer/Cleaner $40.36 7A 4V 8Y View abouttlank 4/4 8/11/2021 about:blank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Washington State Prevailing Wage The PREVAILING WAGES listed here include both the hourly 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: 8/11/2021 County_ Trade Job Classification Wage Holiday Overtime Note *Risk Class King Traffic Control Stripers Journey Level $49.13 7A 1 K View about:blank 1 /1 Ben Levenhagen Job# Kent Parks, Recreation and Community Services Customer PO# 220 4th Ave South Kent Phone: WA Cell: 98032 Fax: E-Mail: Glenn Nelson Park Overlay 3216 S 268th St Kent, WA 98032 Weekday Work - Prevailing Wages Apply ITEM QTY UM Unit Amount 1 192.00 TONS $155.00 $29,760.00 2 1.00 LS $1,500.00 $1,500.00 3 $31,260.00 30 Days Net 30 unless agreed otherwise and specified by contract Exclusions: This quote does not include the following: Washington State Sales Tax or Resale Certificate. Third party affilation costs. Paving repairs that exceed quoted depth will be invoiced at $250.00 per ton. No warranty on sealer applied over oil spots, alligated asphalt areas or reverse percolation. Material pricing is subject to change, and shall be adjusted by documented material costs from suppliers. This document & the exclusions/inclusions listed above shall be included as an appendix to any subcontract between Eagle Asphalt Sealcoating Company LLC and the General Contractor. Any changes, additions, deletions to this original contact MUST be approved in writing by the Project Manager and the measurements and approved by both parties. This quote does not include any items not listed on this quote. The undersigned agrees to pay EAGLE ASPHALT SEALCOATING COMPANY,LLC interest of 1.5% per month. Or at the maximum rate allowed by law if less on any past due accounts, plus reasonable attorney's fees, and cost incurred in collection of said account. Sincerely, Fax: 253-862-3855 Address: This quote & its terms have been approved by: July 20, 2021 Fees, bonds, utilities, permits or union affiliation. Material testing, soil sterilization, surveying, staking or layout. Not responsible for others prep work or subgrade failures. A city, county or state approved traffic control plan or certified flaggers. Quote Zip: Job Name: DESCRIPTION Stripe Overlay On-site: Attention: Contractor: Address: City: State: Cell: 253-266-5996 Bryce Wilson Bryce@eagle-asphalt.com Office: 253-862-9554 Terms: TOTAL: Holiday, night, weekend work or overtime wages or special plant openings for weekend work. Quote valid: ____________________________________________________ Water/vacuum trucks or pressure-washing. Sprinkler or gate loops. Security during or after hour, we are not responsible for any damages caused by others. "Stand by time" If required $250.00 per hour. Customer Signature Date authorized on-site representative or General Contractor. Approved changes to the original contract must have verified field Bryce Wilson 253-856-5120 - - Blevenhagen@KentWA.gov EXHIBIT B INSURANCE REOUIREMENTS FOR SERVICE CONTRACTS 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 and shall cover liability arising from premises, operations, independent contractors, products -completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The City shall be named as an insured under the Contractor's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Automobile Liabilit 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 limits no less than $1,000,000 each occurrence, $1,000,000 general aggregate and a $1,000,000 products -completed operations aggregate limit. 2. Automobile Liabilit insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. EXHIBIT B (Continued) 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 insurance: 1. The Contractor's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 2. The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 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. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. 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 insurance requirements of the Contractor before commencement of the work. F. 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. INSR ADDL SUBRLTRINSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE XL Insurance America Greenwich Insurance Company 7/15/2021 Propel Insurance Tacoma Commercial Insurance 1201 Pacific Ave, Suite 1000 Tacoma, WA 98402 Marci Berger 800 499-0933 866 577-1326 marci.berger@propelinsurance.com Eagle Asphalt Sealcoating Co., LLC PO Box 1564 Sumner, WA 98390 24554 22322 A X X X PD Ded:1,000 X X X NPC100364101 05/19/2021 05/19/2022 1,000,000 500,000 15,000 1,000,000 2,000,000 2,000,000 B X X X X X NBA100364301 05/19/2021 05/19/2022 1,000,000 B X X X 10000 NEC600613001 05/19/2021 05/19/2022 4,000,000 4,000,000 A N NPC100364101 WA Stop Gap 05/19/2021 05/19/2022 1,000,000 1,000,000 1,000,000 The City of Kent is included as additional insured per the attached forms. Waiver of Subrogation applies per attached form(s). City of Kent 220 Fourth Avenue South Kent, WA 98032 1 of 1#S4701810/M4623810 EAGLASPHClient#: 165974 MRB001 of 1#S4701810/M4623810 This page has been left blank intentionally. POLICY NUMBER: NPC100364100 COMMERCIAL GENERAL LIABILITY CG20100413 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 Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Blanket as required by written contract. Blanket as required by written contract. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 insured(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 20 10 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Q Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: NPC100364100 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Blanket as required by written contract. Blanket as required by written contract. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ENDORSEMENT # This endorsement, effective 12:01 a.m. , forms a part of Policy No. issued to Eagle Asphalt Sealcoating Co., LLC by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY XL Plus Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read this endorsement carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force — Bodily Injury or Property Damage B. Damage To Premises Rented To You Extension • Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage • Limit increased to $300,000 C. Aircraft Chartered with Crew D. Non -Owned Watercraft E. Personal and Advertising Injury — Assumed by Insured Contract F. Increased Supplementary Payments • Cost for bail bonds increased to $5,000 • Loss of earnings increased to $1,000 per day G. Broadened Named Insured H. Blanket Additional Insured — Managers or Lessors of Premises I. Blanket Additional Insured — Lessor of Leased Equipment J. Injury to Co -Employees and Co -Volunteer Workers K. Knowledge and Notice of Occurrence or Offense L. Unintentional Omission M. Liberalization N. Blanket Waiver of Subrogation O. Incidental Medical Malpractice Injury P. Extension of Coverage — Bodily Injury Q. Coverage Territory Form XIL 436 1208 © 2008, XL America, Inc. Page 1 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. A. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE Exclusion a. Expected Or Intended Injury of Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I — Coverages is deleted in its entirety and replaced by the following: [This insurance does not apply to:) Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. DAMAGE TO PREMISES RENTED TO YOU EXTENSION 1. The last paragraph of 2. Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I - Coverages is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damages to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. A separate limit of insurance applies to this coverage as described in Section III- Limits of Insurance. 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Paragraph 6. of Section III- Limits of Insurance is deleted in its entirety and replaced by the following: 6.a. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, explosion, lightning, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire, explosion, lightning, smoke, aircraft or vehicle or riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage or any combination of any of these. b. The Damage to Premises Rented to You Limit will be the higher of: (1) $300,000; or (2) The amount shown on the Declarations for Damage to Premises Rented to You Limit. Form XIL 436 1208 © 2008, XL America, Inc. Page 2 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 4. Paragraph 9.a. of the definition of "insured contract' under Section V- Definitions, is deleted in its entirety and replaced by the following: ["Insured contract' means:] a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage to premises while rented to you, or temporarily occupied by you with the permission of the owner is not an "insured contract'. 5. This Article B. does not apply if coverage for Damage to Premises Rented to You of Coverage A. Bodily Injury And Property Damage Liability of Section I — Coverages is excluded by endorsement. C. AIRCRAFT CHARTERED WITH CREW 1. The following is added to the exceptions contained in Exclusion g., Aircraft, Auto or Watercraft in Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage of Section I — Coverages: [This exclusion does not apply to:) Aircraft chartered with crew to any insured. 2. This Article C. does not apply if the chartered aircraft is owned by any insured. 3. The insurance provided by this Article C. shall be excess over any valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. D. NON -OWNED WATERCRAFT 1. The exception contained in Subparagraph (2) of Exclusion g. Aircraft. Auto or Watercraft in Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I — Coverages is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) 50 feet long or less; and (b) Not being used to carry persons or property for a charge; This Article D. applies to any person who, with your expressed or implied consent, either uses or is responsible for the use of the watercraft. 3. This insurance provided by this Article D. shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. E. PERSONAL AND ADVERTISING INJURY —ASSUMED BY INSURED CONTRACT 1. Exclusion e. Contractual Liability in Part 2., Exclusions of Coverage B. Personal And Advertising Injury Liability of Section I — Coverages is deleted in its entirety and replaced by the following: Form XIL 436 1208 © 2008, XL America, Inc. Page 3 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. [This insurance does not apply to:) e. Contractual Liability "Personal and Advertising Injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages: 1. That the insured would have in the absence of the contract or agreement; or 2. Assumed in a written contract or agreement that is an "insured contract"; provided the "personal and advertising injury" is caused by an offense which occurs subsequent to the execution of the contract or agreement. 2. Subparagraph f. of the definition of "insured contract' Section V.- Definitions is deleted in its entirety and replaced by the following: f. That part of any other contract or agreement pertaining to your business, including an indemnification of a municipality in connection for work performed for a municipality, under which you assume the tort liability of anther party to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third party or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. 2. This Article E. does not apply if Coverage B. Personal And Advertising Injury Liability is excluded by endorsement. F. INCREASED SUPPLEMENTARY PAYMENTS Subparagraphs 1. b. and d. of Supplementary Payments — Coverages A And B of Section I - Coverages are amended as follows: 1. In Subparagraph b., the amount we will pay for the cost of bail bonds is increased up to $5,000. 2. In Subparagraph d., the amount we will pay for a loss of earnings is increased up to $1,000 a day. G. BROADENED NAMED INSURED 1. The Named Insured in Item 1. of the Declarations is as follows: The person or organizations named in Item 1. of the Declarations and any organization, other than a partnership or joint venture, over which you maintain ownership or majority interest on the effective date of the policy. However, coverage for any such organization will cease as of the date that you no longer maintain ownership of, or majority interest in, such organization. 2. This Article G. does not apply to any person or organization for which coverage is excluded by endorsement. Form XIL 436 1208 © 2008, XL America, Inc. Page 4 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. H. BLANKET ADDITIONAL INSURED — MANAGERS OR LESSORS OF PREMISES 1. Section II -Who Is An Insured is amended to include as an insured any person or organization with whom you have agreed in a written contract executed prior to loss (an "additional insured"), but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the following provisions: a. Limits of Insurance. The Limits of Insurance afforded to the "additional insured" shall be the limits you agreed to provide, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the "additional insured" does not apply to: (1) Any "occurrence" that takes place after you cease to be a tenant in that premises; (2) Any premises for which coverage is excluded by endorsement; or (3) Structural alterations, new construction or demolition operations performed by or on behalf of such "additional insured". 2. The insurance afforded to the "additional insured" is excess over any valid and collectible insurance available to such "additional insured", unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. I. BLANKET ADDITIONAL INSURED —LESSOR OF LEASED EQUIPMENT 1. Section II -Who Is An Insured is amended to include an "additional insured" (as defined in Article H. above), but only with respect to their liability arising out of maintenance, operation or use by you of equipment leased to you by such "additional insured", subject to the following provisions: a. Limits of Insurance. The Limits of Insurance afforded to the "additional insured" shall be the limits which you agreed to provide, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the "additional insured" does not apply to (1) Any "occurrence" that takes place after the equipment lease expires; or (2) "Bodily injury" or "property damage" arising out of the sole negligence of such additional insured. 2. The insurance provided to the "additional insured" is excess over any valid and collectible insurance available to such "additional insured", unless you have a written contract for this insurance to apply on a primary or contributory basis. J. INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS 1. Section II- Who Is An Insured is amended to include your "employees" as insureds with respect to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to your "volunteer workers" while performing duties related to the conduct of your business, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. Form XIL 436 1208 © 2008, XL America, Inc. Page 5 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. Section II — Who Is An Insured is amended to include your "volunteer workers" as insureds with respect to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business, or to your "employees" employment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the conduct of your business. K. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit of the Section IV - Commercial General Liability Conditions: Notice of an "occurrence" or of an offense which may result in a claim under this insurance shall be given as soon as practicable after knowledge of the "occurrence" or offense has been reported to any insured listed under Paragraph 1. of Section II -Who Is An Insured or any "employee" (such as insurance, loss control, risk manager or administrator) designated by you to give such notice. Knowledge of any other "employee(s)" of an "occurrence" or of an offense does not imply that you also have such knowledge. Notice shall be deemed prompt if given in good faith as soon as practicable to your workers compensation insurer. This applies only if you subsequently give notice to us as soon as practicable after any insured listed under Paragraph 1. of Section II — Who Is An Insured or an "employee" (such as an insurance, loss control, or risk manager or administrator) designated by you to give such notice discovers that the "occurrence", offense or claim may involve this policy. L. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Representations, of Section IV- Commercial General Liability Conditions: The unintentional omission of, or unintentional error in, any information provided by you shall not prejudice your rights under this insurance. However, this Article L. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws or regulations. M. LIBERALIZATION The following is added to Section IV -Commercial General Liability Conditions: Liberalization After the issuance of this policy, if we adopt a change in our forms or rules which would broaden the coverage provided by any form that is a part of this policy without a premium charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such broader coverage in your state. Form XIL 436 1208 © 2008, XL America, Inc. Page 6 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. N. BLANKET WAIVER OF SUBROGATION The following is added to Section IV -Commercial General Liability Conditions: Waiver of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. O. INCIDENTAL MEDICAL MALPRACTICE INJURY 1. For insurance applicable to this Article O, the definition of "bodily injury" in Section V - Definitions is amended to include, "Incidental Medical Malpractice Injury". 2. The following definition is added to Section V- Definitions: "Incidental medical malpractice injury" means "bodily injury", mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; c. First aid; or d. "Good Samaritan Services". As used in this Article O., "Good Samaritan Services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Paragraph 2.a.(1)(d) of Section II -Who Is An Insured does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in Paragraph 2. above and while acting within the scope of their employment by you. Any "employees" rendering "Good Samaritan Services" will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to Paragraph 2. Exclusions of Coverage A. — Bodily Injury And Property Damage Liability of Section I — Coverages: [This insurance does not apply to:) Willful Violation of Penal Statute Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purposes of determining the applicable Limits of Insurance, any act or omission, together with all related acts or omissions in the furnishing of services described in Paragraph 2.a. through 2.d. above to any one person, will be considered one "occurrence". 6. This Article O. does not apply if you are in the business or occupation of providing any of the services described in Paragraph 2. above. Form XIL 436 1208 © 2008, XL America, Inc. Page 7 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 7. The insurance provided by this Article O. shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. P. EXTENSION OF COVERAGE — BODILY INJURY The definition of "bodily injury" Section V- Definitions is deleted in its entirety and replaced by the following: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. Q. COVERAGE TERRITORY The definition of "coverage territory" Section V- Definitions is deleted in its entirety and replaced by the following: 4. "Coverage territory" means anywhere in the world. This insurance does not apply to: a. "bodily injury" or "property damage" that takes place; or b. "personal and advertising injury" caused by an offense committed outside the United States of America (including its possessions and territories), Canada and Puerto Rico, unless a "suit" on the merits (to determine the insured's responsibility to pay damages to which this insurance applies) is brought in the United States of America (including its possessions and territories), Canada or Puerto Rico. This insurance does not apply to damage, loss, cost or expenses in connection with any "suit" brought outside the United States of America (including its possessions and territories), Canada or Puerto Rico. Form XIL 436 1208 © 2008, XL America, Inc. Page 8 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: NPC100364100 GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Policy aggregate limit applies per work site. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by 'occur- damages or under Coverage C for medical rences" under Section I — Coverage A, and for all expenses shall reduce the Designated Con - medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- 1. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen - completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 0 B. For all sums which the insured becomes legally C obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 ❑ POLICY NUMBER: XIC 421 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XL PLUS BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COVERAGE DESCRIPTION A. Temporary Substitute Auto Physical Damage B. Who Is An Insured 1. Broad Form Insured 2. Employees As Insureds 3. Additional Insured By Contract, Agreement or Permit 4. Employee Hired Autos C. Supplementary Payments D. Amended Fellow Employee Exclusion E. Physical Damage Coverage 1. Rental Reimbursement 2. Extra Expense — Broadened Coverage 3. Personal Effects Coverage 4. Lease Gap 5. Glass Repair —Waiver Of Deductible F. Physical Damage Coverage Extensions 1. Additional Transportation Expense 2. Hired Auto Physical Damage G. Business Auto Conditions 1. Notice Of Occurrence 2. Waiver Of Subrogation 3. Unintentional Failure To Disclose Hazards 4. Primary Insurance H. Bodily Injury Redefined I. Extended Cancellation Condition XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A. Temporary Substitute Auto Physical Damage SECTION I — COVERED AUTOS, C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos is changed by adding the following: If Physical Damage coverage is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Physical Damage coverage: 1. Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; C. Servicing; d. "Loss"; or e. Destruction. B. Who Is An Insured SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is changed by adding the following: 1. Broad Form Insured For any covered "auto", any subsidiary, affiliate or organization, other than a partnership or joint venture, as may now exist or hereafter be constituted over which you assume active management or maintain ownership or majority interest, provided that you notify us within ninety (90) days from the date that any such subsidiary or affiliate is acquired or formed and that there is no similar insurance available to that organization. However, coverage does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. Employees As Insureds Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow, in your business or your personal affairs. 3. Additional Insured By Contract, Agreement Or Permit Any person or organization with whom you have agreed in writing in a contract, agreement or permit, to provide insurance such as is provided under this policy, provided that the "bodily injury" or "property damage" occurs subsequent to the execution of the written contract, agreement or permit. 4. Employee Hired Autos An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 2 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, b. is replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. Supplementary Payments SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments is changed as follows: Item (2) is deleted and replaced by the following: (2) Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Item (4) is deleted and replaced by the following: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. D. Amended Fellow Employee Exclusion SECTION II — COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee does not apply. The insurance provided under this Provision D. is excess over any other collectible insurance. E. Physical Damage Coverage SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage is changed by adding the following: 1. Rental Reimbursement a. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. b. We will pay only for those expenses incurred during the policy period beginning twenty-four (24) hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 3 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. 3. 4. (1) The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. (2) Thirty (30) days. C. Our payment is limited to the lesser of the following amounts: (1) Necessary and actual expenses incurred. (2) $50 any one day per private passenger "auto"; $100 any one day per truck; $1,500 any one period per private passenger "auto"; $3,000 any one period per truck; or Higher limits if shown elsewhere in this policy. d. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. Extra Expense — Broadened Coverage We will pay for the expense of returning a stolen covered "auto" to you. Personal Effects Coverage If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $500 for "personal effects" stolen from the "auto". As used in this endorsement, "personal effects" means tangible property that is worn or carried by an "insured". "Personal effects" does not include tools, jewelry, money or securities. Lease Gap In the event of a total "loss" to a covered "auto" shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease/loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchases with the loan or lease; and (5) Carry-over balances from previous loans or leases. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 4 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 5. Glass Repair — Waiver Of Deductible No deductible applies to glass damage if the glass is repaired rather than replaced. F. Physical Damage Coverage Extensions SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended by the following: 1. Additional Transportation Expense Sections a. and b. are amended to provide a limit of $50 per day and a maximum limit of $1,000. 2. Hired Auto Physical Damage The following section is added: Any "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" for physical damage coverage. The most we will pay for each covered "auto" is the lesser of: (1) the actual cash value; (2) the cost for repair or replacement; or (3) $50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage Coverage. For each covered "auto" a deductible of $100 for Comprehensive Coverage and $1,000 for Collision Coverage will apply. G. Business Auto Conditions SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions is changed by the following: 1. Notice Of Occurrence Section 2. — Duties In The Event Of Accident, Claim, Suit Or, Loss, a. is changed by adding the following: If you report an injury to an "employee" to your workers' compensation carrier and if it is subsequently determined that the injury is one to which this insurance may apply, any failure to comply with this condition will be waived if you provide us with the required notice as soon thereafter as practicable after you know or reasonably should have known that this insurance may apply. 2. Waiver Of Subrogation Section 5. Transfer Of Rights Of Recovery Against Others To Us is changed by adding the following: However, this Condition does not apply to any person(s) or organization(s) with whom you have a written contract, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under such contract with that person or organization. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 5 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions is changed by the following: 3. Unintentional Failure To Disclose Hazards The following condition is added. - Your unintentional failure to disclose all hazards as of the inception date of the policy shall not prejudice any insured with respect to the coverage afforded by this policy. 4. Primary Insurance Condition 5. Other Insurance is changed by adding the following: For any covered "auto" this insurance shall apply as primary and not contribute with any other insurance where such requirement is agreed in a written contract executed prior to a "loss". H. Bodily Injury Redefined SECTION V — DEFINITIONS, C. "Bodily injury" is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. Extended Cancellation Condition COMMON POLICY CONDITIONS (Form IL 00 17), A. Cancellation, 2.b. is replaced by the following: The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before the effective date of cancellation if we cancel for any other reason. All other terms and conditions of this policy remain unchanged. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 6 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CITY OF KENT - Business Licensing BUSINESS LICENSE NOTICE P.O. Box 84665 Seattle, WA 98124-5965 For Licensing Period =z KENT (253)856-5210 CustomerService@KentWA.gov January 1, 2021 - December 31, 2021 Date Due January 01, 2021 Amount Due $101.00 Business License No. BLOC-2140492 Check each box -as appropriate: New Owner Kent Relocation _j Out of Business BUSINESS NAME - MAILING ADDRESS (revise below as needed) LOCATION ADDRESS (IF DIFFERENT) EAGLE ASPHALT SEAL COATING CO LLC PO BOX 1564 SUMNER, WA 98390 EAGLE ASPHALT SEAL COATING CO LLC 14017 16TH ST E SUMNER, WA 98390 1. Business Phone: 253 862 9554 Email: V.,t-# % A ' m(e,—&Ovo. t4>4A 2. Business Owners: (If new Owner. please check the "New Owner" box above the mailing address and refer to cover letter for information.) Name: DARRELL WOOD Hm Address: SAME AS ABOVE City: State: Zip Code: Hm Phone: '°'2W- 4. Emergency Contacts for Business located in Kent: ,31A 1111111111111111111111111111111111111111111111111111111111111111RIIi1111111111111111111111111111111111111111111111111111111 - -1 _ Permit (item s24) Permit #: 2140492 Teen Fee (Item 1473) Permit ID: 165769 Customer (item 754) IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIl1111 5. Description of Business: STRIPING/SEAL COATING/CURBING 6. Employees at Kent Location as of 10/31/2020: Full Time: Part Time: 2 7. TRN#: 602289832 8. UBI#: 602289832 tyg�p 9. SIC Code: 10. NAICS Code: �/ % OM 0 11. Floor Space Used: Sq.Ft 12. Mark if any of the following are on the premises: Amusement Den -ices _ Gambling* Karaoke/Cabaret *Pull Tabs, Punch Boards. Card Rooms I hereby certify that the statements and information furnished by me on this application are true and complete to the best of my knowledge. I also acknowledge that the statements and information furnished by me on this application are public records and are available for public inspection pursuant to State of Washington RCW 42.17.260. Signature ..' " « i {'� ' Date ITI LOO 20 Mail in the enclosed envelope with Check / Print Name ✓jC j ( Money Order Payable to: CITY OF KENT tY1 �y1bG✓ I. r g Job Title Phone # Emailm Please make a copy of the completed form for your records. Signature: �a nice ApPi g AmIgaQ PDT) Email: japplegate@kentwa.gov Signature: Garin Lee (Aug 11, 202115:08 PDT) Email: glee@kentwa.gov Signature: Email: rlashley@kentwa.gov Signature: &— BrianBnan Levenhag7e (Aug 17, 202115:28 PDT) Email: bj[evenhagen@kentwa.gov Eagle -Asphalt. Glenn Nelson_PW.Agreement Final Audit Report 2021-08-17 Created: 2021-08-11 By: Janice Applegate Qapplegate@kentwa.gov) Status: Signed Transaction ID: CBJCHBCAABAAgeJaeKVNQ1MaujilAP4cBVgZCPGmA67R "Eagle —Asphalt. Glenn Nelson_PW.Agreement" History Document created by Janice Applegate (japplegate@kentwa.gov) 2021-08-11 - 9:29:07 PM GMT- IP address: 146.129.252.126 .`-Document e-signed by Janice Applegate (japplegate@kentwa.gov) Signature Date: 2021-08-11 - 9:45:15 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Garin Lee (glee@kentwa.gov) for signature 2021-08-11 - 9:45:17 PM GMT Email viewed by Garin Lee (glee@kentwa.gov) 2021-08-11 - 10:07:09 PM GMT- IP address: 146.129.252.126 E� Document e-signed by Garin Lee (glee@kentwa.gov) Signature Date: 2021-08-11 - 10:08:05 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Bryce Wilson (bryce@eagle-asphalt.com) for signature 2021-08-11 - 10:08:07 PM GMT 3 Email viewed by Bryce Wilson (bryce@eagle-asphalt.com) 2021-08-11 - 10:08:32 PM GMT- IP address: 50.212.212.221 Document e-signed by Bryce Wilson (bryce@eagle-asphalt.com) Signature Date: 2021-08-12 - 10:01:19 PM GMT - Time Source: server- IP address: 50.212.212.221 Document emailed to Ronald Lashley (rlashley@kentwa.gov) for signature 2021-08-12 - 10:01:22 PM GMT Email viewed by Ronald Lashley (rlashley@kentwa.gov) 2021-08-17 - 3:55:42 PM GMT- IP address: 146.129.252.126 E� Document e-signed by Ronald Lashley (rlashley@kentwa.gov) Signature Date: 2021-08-17 - 4:03:47 PM GMT - Time Source: server- IP address: 146.129.252.126 0 Adobe Sign 24 Document emailed to Brian Levenhagen (bjlevenhagen@kentwa.gov) for signature 2021-08-17 - 4:03:49 PM GMT t Email viewed by Brian Levenhagen (bjlevenhagen@kentwa.gov) 2021-08-17 - 10:28:03 PM GMT- IP address: 146.129.252.126 Ao Document e-signed by Brian Levenhagen (bjlevenhagen@kentwa.gov) Signature Date: 2021-08-17 - 10:28:53 PM GMT - Time Source: server- IP address: 146.129.252.126 Agreement completed. 2021-08-17 - 10:28:53 PM GMT 0 Adobe Sign