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HomeMy WebLinkAboutCAG2022-064 - Original - Heritage Portable Buildings, LLC - Hogan Park at Russell Road Utility Shed Construction - 02/17/2022ApprovalOriginator:Department: Date Sent:Date Required: Authorized to Sign: Director or Designee Date of Council Approval: Grant? Yes No Type:Review/Signatures/RoutingComments: Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Basis for Selection of Contractor: Termination Date: Local Business? Yes No* Business License Verification: Yes In-Process Exempt (KCC 5.01.045) If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Notice required prior to disclosure? Yes No Contract Number: Agreement Routing Form For Approvals, Signatures and Records Management This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms. Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20 Budget Account Number: Budget? Yes No Sup/Mgr: rev. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY * Memo to Mayor must be attached Jan Apple Dir. Assist: Jan Applegate 4 Jan Applegate Parks, Recreation & Community Services 02/11/2022 as soon as possible n/a 10006600.66200.5450 4 4 N/A Contract 2474546 Other as soon as possible Other 04/30/2022 4 4 4 $16,756.45 GL GOODS & SERVICES AGREEMENT - 1 ($20,000 or Less, incl. WSST) GOODS & SERVICES AGREEMENT between the City of Kent and Heritage Portable Buildings, LLC THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Heritage Portable Buildings, LLC organized under the laws of the State of Washington, located and doing business at 353 Pease Road, Burlington, WA 98233; Contact: John Chupp, Phone: 425-984-3268 (hereinafter the "Vendor"). AGREEMENT I.DESCRIPTION OF WORK. The Vendor shall provide the following goods and materials and/or perform the following services for the City: Vendor to build and deliver a shed to Hogan Park at Russell Road, located at 24400 Russell Road, Kent WA 98032 per attached Order ID: 122636 dated 01/28/2022 attached and marked as Exhibit A. The Vendor acknowledges and understands that it is not the City’s exclusive provider of these goods, materials, or services and that the City maintains its unqualified right to obtain these goods, materials, and services through other sources. II.TIME OF COMPLETION. Upon the effective date of this Agreement, the Vendor shall complete the work and provide all goods, materials, and services by April 30, 2022. III.COMPENSATION. The City shall pay the Vendor an amount not to exceed SIXTEEN THOUSAND SEVEN HUNDRED FIFTY SIX DOLLARS AND FORTY FIVE CENTS ($16,756.45), including applicable Washington State Sales Tax, for the goods, materials, and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: Vendor shall submit an invoice to APInvoices@KentWA.gov upon completion and acceptance of contract work. Card Payment Program. The Vendor 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 GOODS & SERVICES AGREEMENT - 2 ($20,000 or Less, including WSST) by check and is available for the convenience of the Vendor. If the Vendor voluntarily participates in this Program, the Vendor will be solely responsible for any fees imposed by financial institutions or credit card companies. The Vendor shall not charge those fees back to the City. If the City objects to all or any portion of an invoice, it shall notify the Vendor and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. A.Defective or Unauthorized Work. The City reserves its right to withhold payment from the Vendor for any defective or unauthorized goods, materials or services. If the Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services from othe r sources, and the Vendor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Agreement price specified above. The City further reserves its right to deduct these additional costs incurred to complete this Agreement with other sources, from any and all amounts due or to become due the Vendor. B.Final Payment: Waiver of Claims. VENDOR’S ACCEPTANCE OF FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A.The Vendor has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B.The Vendor maintains and pays for its own place of business from which the Vendor’s services under this Agreement will be performed. C.The Vendor has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained the Vendor’s services, or the Vendor is engaged in an i ndependently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D.The Vendor is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E.The Vendor has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by the Vendor’s business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F.The Vendor maintains a set of books dedicated to the expenses and earnings of its business. V.TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. VI.CHANGES. The City may issue a written amendment for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines, for any reason, that an amendment is necessary, the Vendor must submit a written amendment request to the GOODS & SERVICES AGREEMENT - 3 ($20,000 or Less, including WSST) person listed in the notice provision section of this Agreement, Section XV(D), within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increase s or decreases the Vendor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the amended work upon receiving either a written amendment from the City or an oral order from the City before actually receiving the written amendment. If the Vendor fails to require an amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the adjustment as provided in subsections A through E of Section VIII, Claims, below. The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. A n amendment that is accepted by the Vendor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. VII.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 (“force majeure event”). Performance that is prevented or delayed due to a force majeure event shall not result in liability to t he 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 liab ility 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 Vendor 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 Vendor 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 Vendor 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 Vendor to fulfi ll its obligations under this Agreement. Except as expressly contemplated by this section, all other costs will be borne by the Vendor. VIII.CLAIMS. If the Vendor disagrees with anything required by a n amendment, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Vendor may file a claim as provided in this section. The Vendor shall give written notice to the City of all claims within fourteen (14) calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts or events giving rise to the claim, whichever occurs fir st. Any claim for damages, additional payment for any reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively deemed GOODS & SERVICES AGREEMENT - 4 ($20,000 or Less, including WSST) to have been waived by the Vendor unless a timely written claim is made in strict accordance with t he applicable provisions of this Agreement. At a minimum, a Vendor's written claim shall include the information set forth in subsections A, items 1 through 5 below. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. A.Notice of Claim. Provide a signed written notice of claim that provides the following information: 1.The date of the Vendor's claim; 2.The nature and circumstances that caused the claim; 3.The provisions in this Agreement that support the claim; 4.The estimated dollar cost, if any, of the claimed work and how that estimate was determined; and 5.An analysis of the progress schedule showing the schedule change or disruption if the Vendor is asserting a schedule change or disruption. B.Records. The Vendor shall keep complete records of extra costs and time incurred as a result of the asserted events giving rise to the claim. The City shall have access to any of the Vendor's records needed for evaluating the protest. The City will evaluate all claims, provided the procedures in this section are followed. If the City determines that a claim is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. C.Vendor's Duty to Complete Protested Work . In spite of any claim, the Vendor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. D.Failure to Protest Constitutes Waiver . By not protesting as this section provides, the Vendor also waives any additional entitlement and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). E.Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section, the Vendor completely waives any claims for protested work and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). IX.LIMITATION OF ACTIONS. VENDOR MUST, IN ANY EVENT, FILE ANY LAWSUIT ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM TH E DATE THE CONTRACT WORK IS COMPLETE OR VENDOR’S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. X.WARRANTY. The Vendor warrants that it will faithfully and satisfactorily perform all work provided under this Agreement in accordance with the provisions of this Agreement. In addition to any other warranty provided for at law or herein, this Agreement is additionally subjec t to all warranty provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington. The Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, and will perform in accordance with their specifications and the Vendor’s representations to City. The Vendor shall promptly correct all defects in workmanship and materials: (1) when the Vendor knows or should have known of the defect, or (2) upon the Vendor’s receipt of notification from the City of the existence or discovery of the defect. In the event any part of the goods are repaired, only original replacement parts shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for GOODS & SERVICES AGREEMENT - 5 ($20,000 or Less, including WSST) that portion of the work shall extend for an additional year beyond the original warranty period applicable to the overall work. The Vendor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. XI.DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. The Vendor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. XII.INDEMNIFICATION. The Vendor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Vendor's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of the Vendor's work when completed shall not be grounds to avoid any of these covenants of indemnification. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event the Vendor refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Vendor’s part, then the Vendor shall pay all the City’s costs for defense, including all reasonable expert witness fees and reasonable attorneys’ fees, plus the City’s legal costs and fees incurred because there was a wrongful refusal on the Vendor’s part. The provisions of this section shall survive the expiration or termination of this Agreement. XIII.INSURANCE. The Vendor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. XIV.WORK PERFORMED AT VENDOR'S RISK. The Vendor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at the Vendor's own risk, and the Vendor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XV.MISCELLANEOUS PROVISIONS. A.Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B.Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. GOODS & SERVICES AGREEMENT - 6 ($20,000 or Less, including WSST) C.Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties’ performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section XII of this Agreement. D.Written Notice. All communications regarding this A greement 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 Vendor. G.Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H.Compliance with Laws. The Vendor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to the Vendor'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 Vendor 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 Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records ar e not produced to or possessed by the City of Kent. As such, the Vendor agrees to cooperate fully with the City in satisfying the City’s duties and obligations under the Public Records Act. J.City Business License Required . Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. K.Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. All acts consistent with the authority of this Agreement and prior GOODS & SERVICES AGREEMENT - 7 ($20,000 or Less, including WSST) to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. VENDOR: By: Print Name: Its: DATE: CITY OF KENT: By: Print Name: Brian Levenhagen Its: Parks Deputy Director NOTICES TO BE SENT TO: VENDOR: John Chupp Heritage Portable Buildings, LLC 353 Pease Road Burlington, WA 98233 (425) 984-3268 (telephone) n/a (facsimile) NOTICES TO BE SENT TO: CITY OF KENT: Todd Dow City of Kent 220 Fourth Avenue South Kent, WA 98032 (253)856-5135 (office) or (206) 430-2057 (cell) (telephone) (253)856-6120 (facsimile) ATTEST: Kent City Clerk Carmen Hershberger (Feb 11, 2022 16:16 PST) Carmen Hershberger Carmen Hershberger Human Resources 02/11/2022 Brian Levenhagen (Feb 17, 2022 14:16 PST) EEO COMPLIANCE DOCUMENTS - 1 of 3 DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City’s equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City’s sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: __________________________________________ For: _________________________________________ Title: ________________________________________ Date: ________________________________________ Carmen Hershberger (Feb 11, 2022 16:16 PST) Carmen Hershberger Heritage Portable Buildings, LLC Human Resources 02/11/2022 EEO COMPLIANCE DOCUMENTS - 2 of 3 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City’s nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City’s equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 3 of 3 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: __________________________________________ For: _________________________________________ Title: ________________________________________ Date: ________________________________________ Tax Rate 8.700% Order Type Sale Product Type Building Product Build Build to order Order ID: 122636 Quote Form Order Information Store:Covington Sales Person:John Chupp Quote Date:01/28/2022 *Special orders may extend beyond the estimated delivery period. www.heritageportable.com snohomish@heritageportable. com (425) 984-3268 Contact Information Name:Todd Dow Phone:(206) 430-2057 Building Location Address:24400 Russell Rd Home Phone:Address:24400 Russell Rd City / State / Zip:Kent / Washington / 98032 /Email:tdow@kentwa.gov City / State / Zip:Kent / Washington / 98032 / Building Information Building Design:12x16 Birch Bay Building Material Color Price Serial Number:Siding LP Smartside Siding No Paint $0.00 Model Name:12x16x8 Gable Roof Trim LP Smartside Trim No Paint $0.00 Shell Price:$9,359.30 Roof Shingle Roof Antique Black $0.00 Quantity Building Options Price Total 1 9' x 7' Roll-up Door Gable Wall $710.00 $710.00 4 12' Wide Loft (($/lf))$46.00 $184.00 1 Tall Walls on Gable Roof (up to 9') -must add...$976.00 $976.00 1 10" Overhangs (Full Perimeter)$281.60 $281.60 1 No Floor Discount 12' wide -$44.00 -$44.00 1 2x6 studs on walls over 8' tall $422.40 $422.40 400 Additional Options *See Notes $1.00 $400.00 1 House Wrap Walls with Tyvek (or similar)$192.00 $192.00 1 No Paint Discount -$192.00 -$192.00 1 Ridge Vent $64.00 $64.00 Subtotal:$2,994.00 Tax?Order Options Price Site Build *price includes no paint discount $2,500.00 Pilot Cars $366.00 Subtotal:$2,866.00 Notes: Additional Options: Cost for reinforcing front wall, for transport This unit will be built at manufacturing plant and delivered and placed on concrete slab, provided by city of Kent, Building will be secured to slab by city employees Shell Price:$9,359.30 Building Materials:$0.00 Building Options:$2,994.00 Building Total:$12,353.30 Order Options:$2,866.00 Order Total:$15,219.30 Sales Tax:$1,292.24 Total Amount:$16,511.54 *Prices subject to change. All quotes are valid for 7 days from date of quote. Purchase this building outright or use rent-to-own! RTO Options Security Deposit:$300.00 24 Month:$799.29 36 Month:$621.67 48 Month:$545.86 60 Month:$493.68 Purchase Outright Deposit:$6,604.62 Initial RTO payment is the security deposit + 1 month(s) rent. Free delivery and setup within 50 miles! Finish this order online - coming soon! Payment is due in full upon delivery. There will be a $50 charge for NSF checks. Cancellation after 3 days from the day of order is subject a restocking fee equal to the down payment or the security deposit. Full refunds will be issued for serious illness or Acts of God. Change orders must be made no later than three days after the order date. Changes made after three days will incur a $75 Change Order Fee. Customer is responsible for all building permits and compliance with local regulations. Customer is responsible for ensuring adequate clearance for delivery. Deliveries over 50 miles from a dealer are charged a rate of $3.50/mile. Heritage Portable Buildings, LLC is not responsible for yard or property damage due to lack of access or unfavorable conditions. Heritage Portable Buildings, LLC is not responsible to anchor buildings to the ground. If the neighboring property must be crossed or entered, the customer is responsible for obtaining written permission prior to delivery. In the event of an incomplete or default payment, Heritage Portable Buildings, LLC has the right to enter the property without prior notice and repossess the building. EXHIBIT A Tax Rate 8.700% Order Type Sale Product Type Building Product Build Build to order Order ID: 122636 Building Configuration Order Information Store:Covington Sales Person:John Chupp Order Date:01/28/2022 Est. Delivery Period:02/18/2022 - 02/25/2022 *Special orders may extend beyond the estimated delivery period. www.heritageportable.com snohomish@heritageportable. com (425) 984-3268 Contact Information Name:Todd Dow Phone:(206) 430-2057 Building Location Address:24400 Russell Rd Home Phone:Address:24400 Russell Rd City / State / Zip:Kent / Washington / 98032 /Email:tdow@kentwa.gov City / State / Zip:Kent / Washington / 98032 / [sig|req|signer1|Customer Signature][date|req|signer1|Date] Contact Signature Date EXHIBIT B INSURANCE REQUIREMENTS FOR SERVICE CONTRACTS Insurance The contractor shall procure and maintain for the duration of the Agreement, insurance against'ilul*-iot injuries-to petsot'''s or dama-9! to property which may arise from or in lonn"ction with th'e performance ofthe work hereunder UV ifr" Contractor, their agents, representatives, employees or subcontractors. A. Minimum ScoPe of Insurance Contractor shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all. owned,-non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services OffJc" (ISOjioffi CnbO Or 61. a substitute form.provid.ing equivalent liability .ou6rig.. if nec"tsi.y, tt'''" policy shall be endorsed to provide contractual liabilitY coverage' 2. Commercial General Liability insurance sha,ll be written on ISO occurrenceErm CC OO Ot and shall cover liability arising from p re m ises, ;il;;i't;t, i nO"pundent contractors, prod ucts-com pleted bperations, be.ionjlinjury and advertising injury, and liability assumed ,hb"iinlnJ,ir"d contract. The Comhercial General Liability insurance if'tif t Ue endorsed to provide the Agg19gat9 ?S5 Project Endorsem"ni ISO form CG 25 b3 11 85. The Citt shall be named as an insured under the Contractor's Commercial General LlaDlllty insurance pofii' witfr respect to the wor! pe.rformed for the City using ISO additiSnat-insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage' 3. Workers' compensation coverage a.s. required by the Industrial Insr-rrance laws of the State of Washington' B. Minimum Amounts of Insurance contractor shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined sffiY injurY and ProPertY damage of $1,000,000 Per accident' 2. Commercial General Liabili!y.lnsurance shall be written with l b each occurrence' $2'000'000 genlrar aggregate inb a $2,000,000 products-completed 6Perations aggregate limit' EXHIBIT B (Continued ) C. Other Insurance Provisions The insurance policies are to contain, or be endo.rsed to contain, the following prorirLnr foi AutomoOif " Liability and Commercial General Liability insurance: 1. The contractor,s insurance coverage shall be primary insu.rance as respect tne City. nny tnsuiance, self-insuFance, _or ins_urance pool.coverage maintaineO OV ifre CiiV ihitt Oe eicess df tne Contractbr's insurance and shall not contribute with it. 2. The contractor's insurance shall be endorsed to state that coverage shall noiU" Cancetled OV eitf"'ut party, except aft.el thirty (30) days,prior written notice6y c'ettiii"a 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 i;-;;pi pioreisionar lianiriivl ai iespects work performed bv or on behalf of the contractoi unO a copy'of the endorsement naming the City as additional insured shall be attached to the certificale qf-Insuralge' The City reseru"t ih. .igf'ti to receive a certified coPY qf gJt required insurance pori.iJr.- 1" contr"uctor's Commercial Generai t-iaOitity insurance shall also contain alLute tiuting tftJt -ouetage shall apply separately,to each inirr"A againsi wnom claim- is made or Juit is brought, except with ielpects ti tne 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 A:VII. E. Verification of Coverage contractor shall furnish the city with original certificates and a copy of the ..""Oii"ty "nObit"t"ntt, in-iuding bul not.necessarily limited to the additional insured endorsement, evidencjng the insurance requirements of if't" Conttuctor 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' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 2/3/2022 RIS Insurance Services P.O.Box 1059 Anacortes WA 98221 Julie Gannon-Ronald 360-399-7846 360-293-2385 julieg@risnet.com OHIO SECURITY INS.CO.24082 HERIT-2 THE OHIO CASUALTY INS CO 24074HERITAGEPORTABLEBUILDINGS,LLC HERITAGE STRUCTURES,LLC 353 PEASE RD BURLINGTON WA 98233 1661643542 A X 1,000,000 X 1,000,000 15,000 1,000,000 2,000,000 X Y BKS59858395 6/15/2021 6/15/2022 2,000,000 B SCHED EQUIPMENT BMO57413440 4/1/2021 4/1/2022 LIMIT DEDUCTIBLE $135,560 $500 City of Kent is additional insured as respects work performed by Heritage Portable Buildings CITY OF KENT 220 Fourth Avenue South KENT WA 98032 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION CG 20 10 04 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 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. Department of Labor & Industries Certificate of Workers' Compensation Coverage February 3, 2022 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). WA UBI No.603 502 535 L&I Account ID 621,189-00 Legal Business Name HERITAGE PORTABLE BUILDINGS LLC Doing Business As HERITAGE PORTABLE BUILDINGS L Workers' Comp Premium Status:Account is current. Estimated Workers Reported (See Description Below) Quarter 4 of Year 2021 ''21 to 30 Workers'' Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor?No Washington Motor Vehicle LiabilityAllstate,Wa,lingfon Motor Vehicle LiabilityAllstate, I Insurance Identification Card Insurance Idenfificafion Card Allstate Fire and Casualty Insurance Company Allstate Fire and Casualty Insurance Company Paul K and Heidi R Gingerich Paul t3 and Heidi H Gingerich 16533 Walking M Ln 16533 Walking M Ln Mount Vernon WA 98273-8300 I Mount Vernon WA 98273-8300 POLICY NUMBER YEAR / MAKE / MODEL 964 949 629 2004 Chevy Trk Silverado4wd EFFECTIVE DATE VEHICLE ID NUMBER 02/24/22 1GCHK23214F200281 EXPIRATION DATE 08/24/22 This card must be carried in the -vehicle at all times as evidence of insurance. POLICY NUMBER YEAR/MAKE/MODEL 964 949 629 2004 Chevy Trk 5ilverado4wd EFFECTIVE DATE VEHICLE ID NUMBER 02/24/22 1GCHK23214F200281 EXPIRATION DATE 08/24/22 This card must be carried in the vehicle at all times as evidence of insurance. .............—...............— --------...-_..; ®u have an accident orloss-. If you have an accident or loss: Get medical attention if needed, ° Get medical attention if needed, Notify the police immediately, Obtain names, addresses, phone numbers (work & home) and license plate numbers of all persons involved, including passengers and witnesses. Call1-800-ALLSTATE (1-800-255-7828), logon to allstate,com or contact your Allstate agent as soon as possible, Dow Ins Agency Inc (360) 653-5561 122 State Avenue Marysville, WA 98270 . Notify the police immediately. Obtain names, addresses, phone numbers (work & home) and license plate numbers of all persons involved, including passengers and witnesses, Call 1-800-ALLSTATE (1-800-255-7828), logon to allstate,com or contact your Allstate agent as soon as possible, Dow Ins Agency Inc (360) 653-5561 122 State Avenue Marysville, WA 98270 ,, PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD Although not required in this state, may be used with ACORD 350, four part perforated watermark 20 lb. paper or ACORD 360, four part perforated watermark 32 lb. paper. An Authorized insurer shall issue at least two insurance identification cards and the card or an image of the card displayed on a wireless communication device meets this requirement. PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD ADOT NUMBER: ADOT NUMBER: ADOT NUMBER: ADOT NUMBER: 4 0200 Employers Mutual Casualty Co 6E16022 1/23/2022 1/23/2023 HERSH HAULING, LLC PO BOX 125 BOW, WA 98232-0125 0200 Employers Mutual Casualty Co 6E16022 1/23/2022 1/23/2023 HERSH HAULING, LLC PO BOX 125 BOW, WA 98232-0125 0200 Employers Mutual Casualty Co 6E16022 1/23/2022 1/23/2023 HERSH HAULING, LLC PO BOX 125 BOW, WA 98232-0125 0200 Employers Mutual Casualty Co 6E16022 1/23/2022 1/23/2023 HERSH HAULING, LLC PO BOX 125 BOW, WA 98232-0125 2019 DODGE/3500 3C7WRTCL2KG592445 2016 WKM/TRAILER 1W9GR4520GC530406 2016 WKM/TRAILER 1W9GR4621GC530445 2022 WKM/TRAILER 1W9GR4321MC530719 Porch-Stribling-Webb, Inc. P.O. Box 549 132 E. Main Street Waverly, TN 37185 (931) 296-4271 Porch-Stribling-Webb, Inc. P.O. Box 549 132 E. Main Street Waverly, TN 37185 (931) 296-4271 Porch-Stribling-Webb, Inc. P.O. Box 549 132 E. Main Street Waverly, TN 37185 (931) 296-4271 Porch-Stribling-Webb, Inc. P.O. Box 549 132 E. Main Street Waverly, TN 37185 (931) 296-4271 4 4 4 The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD Although not required in this state, may be used with ACORD 350, four part perforated watermark 20 lb. paper or ACORD 360, four part perforated watermark 32 lb. paper. An Authorized insurer shall issue at least two insurance identification cards and the card or an image of the card displayed on a wireless communication device meets this requirement. PERSONALCOMMERCIALCOMPANY EXPIRATION DATEEFFECTIVE DATEPOLICY NUMBER VEHICLE IDENTIFICATION NUMBERYEARMAKE/MODEL AGENCY/COMPANY TELEPHONE NUMBER: AGENCY/COMPANY ISSUING CARD INSURED SEE IMPORTANT NOTICE ON REVERSE SIDE ARIZONA INSURANCE IDENTIFICATION CARD ADOT NUMBER: ADOT NUMBER: ADOT NUMBER: ADOT NUMBER: 4 0200 Employers Mutual Casualty Co 6E16022 1/23/2022 1/23/2023 HERSH HAULING, LLC PO BOX 125 BOW, WA 98232-0125 2008 TOYOTA/CAMRY 4T4BE46K28R033145 Porch-Stribling-Webb, Inc. P.O. Box 549 132 E. Main Street Waverly, TN 37185 (931) 296-4271 The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as The card or an image of the card that is displayed on a wireless communication device is satisfactory evidence if the person is asked by the department of transportation to verify financial responsibility on the motor vehicle. 3. The card meets the requirement or an image of the card that is displayed on a wireless communication device meets the requirement. 2. A person is required to possess evidence of financial responsibility within the motor vehicle. 1. ACORD 50 AZ (2018/08)© 2006-2018 ACORD CORPORATION. All rights reserved. VEHICLE AND PRESENTED UPON DEMAND THIS CARD MUST BE KEPT IN THE INSURED vehicle involved. Name of Insurance Company and policy number for each2. Name and address of each driver, passenger and witness.1. soon as possible. Obtain the following information: IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as 02/09/2022 Porch-Stribling-Webb, Inc. P.O. Box 549 132 E. Main Street Waverly, TN 37185 Employers Mutual Casualty Co 21415 Hersh Hauling, LLC Matthew W Hershberger 353 Pease Road Burlington, WA 98233 A A CargoA 01/23/2022 01/23/2023 25,0006C16022 Proof Of Coverage Proof Of Coverage Proof Of Coverage, 6D16022 01/23/2022 01/23/2023 1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000 6E16022 01/23/2022 01/23/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD 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) 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 EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY 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 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 Home (/) / Basic Information Legal Entity Name UBI License Type Reissuance Application Id License Heritage Portable Buildings, LLC 6035025350010002 BLOC 2843 222921 Basic Information (/Basiclnformation/Index? idType=2&encryptedld=jdt9GEHc2Yp6WIhgGOKEng3LLpK993LLpK99) Business Information (/Businesslnformation/Index? idType=2&encryptedld=jdt9GEHc2Yp6WIhgGOKEng3LLpK993LLpK99) Payment (/Payment/Index?idType=2&encryptedld=jdt9GEHc2Yp6WIhgGOKEng3LLpK993LLpK99) Review (/Review?idType=2&encryptedld=jdt9GEHc2Yp6WIhgGOKEng3LLpK993LLpK99) Notes (/AdminNotes?idType=2&encryptedld=jdt9GEHc2Yp6WIhgGOKEng3LLpK993LLpK99) Business Name Heritage Portable Buildings, LLC Trade Name (DBAs) Heritage Portable Buildings, LLC Address Type Address City Main Business Address 353 Pease Rd Burlington Main Mailing Address 353 Pease Rd Burlington ♦Add Business/Mailing Address Email Address * email@email.com Phone Number 330-231-8960 State Postal Code Parcel Number WA 98233-3110 WA 98233-3110 Unified Business Identifier 6035025350010002 Legal Entity Type LLC Non -Profit No Naics Code * 321999 - All Other Miscellaneous Wood Product Manufacturing Type of Business * ❑ Wholesaling O Retailing 0 Manufacturing ❑ Construction ❑ Transp./Commun./Util. ❑ Finance/Insur./RE ❑ Health Industry ❑ Sales/Mktg ❑ Hotel/Motel/Lodge ❑ Nonprofit ❑ Publishing/Printing ❑ Adult Family Home ❑ Short Term Rentals ❑ Communal Residence ❑ Food Service ❑ Mobile Business Total # of Full -Time employees (including working owners) 33 Total # of Part-time employees 0 Business Description * Manufacture Portable Buildings Estimated Annual Gross Income in Kent: $2,001 - $200,000 ❑ Service & Other ❑ Govt. ❑ Education ❑ Rental Housing ❑ Professional Services ❑ Day Care ❑ Group Home ❑ Other Title Name Address City State Postal Code v v /. v Contact Carmen Hershberger 353 Pease Rd Burlington WA 98233-3110 hr@heritageportable.com ( Does your business generate, collect, transport and dispose of wastewater? No Kent Open Date 2/3/2022 Home based business? No Ambulance type business? No 220 Fourth Ave. S. Kent, WA Finance Customer Service 253- 98032 856-5210 rM v Save 91 (https://www.facebook.com/CityofKent) El (https:Htwitter.com/cityofkent) 13 (https://www.youtube.com/user/KentTV21) 13 (https:Hvimeo.com/kenttv2l) Signature: Email: Signature: Email: Signature: Email: Signature: Email: japplegate@kentwa.gov Garin Lee (Feb 11, 2022 14:18 PST) glee@kentwa.gov rlashley@kentwa.gov Melissa McCormick (Feb 17, 2022 15:18 PST) Melissa McCormick cityclerk@kentwa.gov Heritage_Portable_Buildings.Feb2022 Final Audit Report 2022-02-17 Created:2022-02-11 By:Janice Applegate (japplegate@kentwa.gov) Status:Signed Transaction ID:CBJCHBCAABAA9_QhkQQvuhh-ZXtqt0PGwHHxBCK2ds4W "Heritage_Portable_Buildings.Feb2022" History Document created by Janice Applegate (japplegate@kentwa.gov) 2022-02-11 - 4:51:15 PM GMT- IP address: 146.129.252.126 Document e-signed by Janice Applegate (japplegate@kentwa.gov) Signature Date: 2022-02-11 - 5:03:41 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Garin Lee (glee@kentwa.gov) for signature 2022-02-11 - 5:03:44 PM GMT Email viewed by Garin Lee (glee@kentwa.gov) 2022-02-11 - 10:16:57 PM GMT- IP address: 146.129.252.126 Document e-signed by Garin Lee (glee@kentwa.gov) Signature Date: 2022-02-11 - 10:18:39 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Carmen Hershberger (hr@heritageportable.com) for signature 2022-02-11 - 10:18:41 PM GMT Email viewed by Carmen Hershberger (hr@heritageportable.com) 2022-02-11 - 10:22:42 PM GMT- IP address: 76.121.122.29 Document e-signed by Carmen Hershberger (hr@heritageportable.com) Signature Date: 2022-02-12 - 0:16:35 AM GMT - Time Source: server- IP address: 76.121.122.29 Document emailed to Ronald Lashley (rlashley@kentwa.gov) for signature 2022-02-12 - 0:16:38 AM GMT Email viewed by Ronald Lashley (rlashley@kentwa.gov) 2022-02-17 - 7:14:05 PM GMT- IP address: 146.129.252.126 Document e-signed by Ronald Lashley (rlashley@kentwa.gov) Signature Date: 2022-02-17 - 7:19:59 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Brian Levenhagen (bjlevenhagen@kentwa.gov) for signature 2022-02-17 - 7:20:01 PM GMT Email viewed by Brian Levenhagen (bjlevenhagen@kentwa.gov) 2022-02-17 - 7:42:25 PM GMT- IP address: 146.129.252.126 Document e-signed by Brian Levenhagen (bjlevenhagen@kentwa.gov) Signature Date: 2022-02-17 - 10:16:02 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Kim Komoto (kkomoto@kentwa.gov) for signature 2022-02-17 - 10:16:04 PM GMT Email viewed by Kim Komoto (kkomoto@kentwa.gov) 2022-02-17 - 10:32:12 PM GMT- IP address: 146.129.252.126 Document e-signed by Kim Komoto (kkomoto@kentwa.gov) Signature Date: 2022-02-17 - 10:34:25 PM GMT - Time Source: server- IP address: 146.129.252.126 Document emailed to Melissa McCormick (cityclerk@kentwa.gov) for signature 2022-02-17 - 10:34:27 PM GMT Email viewed by Melissa McCormick (cityclerk@kentwa.gov) 2022-02-17 - 11:15:55 PM GMT- IP address: 146.129.252.126 Document e-signed by Melissa McCormick (cityclerk@kentwa.gov) Signature Date: 2022-02-17 - 11:18:37 PM GMT - Time Source: server- IP address: 146.129.252.126 Agreement completed. 2022-02-17 - 11:18:37 PM GMT