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Home My WebLink AboutCAG2020-163 - Amendment - #2 - A&M Consulting - Signature Pointe Levee - 06/08/2022ApprovalOriginator: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 Dir Asst: Sup/Mgr: Dir/Dep: rev. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY (Optional) * Memo to Mayor must be attached CAG2020-163 Amendment #2 AMENDMENT - 1 OF 2 AMENDMENT NO. 2 NAME OF CONSULTANT OR VENDOR: A & M Consulting CONTRACT NAME & PROJECT NUMBER: Signature Pointe Levee ORIGINAL AGREEMENT DATE: June 5, 2020 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor’s work is modified as follows: 1.Section I of the Agreement, entitled “Description of Work,” is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: No change to the scope of work, however an amendment is needed to extend the time of completion to December 31, 2023 due to the design work will not be completed by June 30, 2022. 2.The contract amount and time for performance provisions of Section II “Time of Completion,” and Section III, “Compensation,” are modified as follows: Original Contract Sum, including applicable WSST $9,240 Net Change by Previous Amendments including applicable WSST $0 Current Contract Amount including all previous amendments $9,240 Current Amendment Sum $0 Applicable WSST Tax on this Amendment $0 Revised Contract Sum $9,240 Original Time for Completion (insert date) Revised Time for Completion prior Amendments (insert date) Add'I Days Required (t) Amendment Revised Time for Completion (insert date) +6/30/21under for this s49 calendar days 12/31/23 The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the .Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT: L� By: f Aft04 By: i sign Print Name:I'�,w J rd&A, {signature) Print Name: Carla Maloney, P.E. Its Its Desi n ineerin Manner �1 Z� l le DATE: DATE: + ATTEST•` APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Kent City Clerk A d M Co sutlln$ - Signature Pointe Rmd alLeyrer AMENDMENT - 2 OF 2 DA'IE (U[rDDrYYrY) 10lo3no21 IHIS GERIIFICAIE IS ISSUED AS A MATTER OF INFORilANON ONLY AND CONFERS NO RIGHTS UPON THE CERTTFICATE HOLDER THI$ CERTIFICATE DOES T{OT AFFRI{ATIVELY OR NEGATfVELY AMEND, E(TEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC|ES BELOlil. THIS CERTIFTCAIE OF IHSURANGE DOES NOT CONST|TUTE A CONTRACT BETTUEEN THE TSSU|NG TNSURER{S), AUTHORIZED REPRESENTANVE OR PRODUGER AND THE GERTIFIGATE HOLDER IMPORTANT: lf tre cerlificab holder is an AIIDITIONAL Ii.ISURED, the policy(ies] must be en&ised. lf SUBROGATIONIS WAMD, subject to ttte tenn$ and condifons of the policy, certain policies may require an en&rsemenl A sffiment on lhis cerlificate &es not confrer righls io tlre certificaie holder in lieu of such endorcement(s)- PRODUCER AJ GALLAGHER & CO INS BRKRS CAJPHS 72255202 The Hartbrd Business Service Center 36'00 Wiseman Blvd San Antonio, TX78,251 PI{ONE (AtG, No. Extl:(AlG. No!: 2 EJ\,AIL ADDRESS: 1{Alc[rNsuRER{S) AFr{rRDlilc GOVERAGE INSURED ARNOLD TOMAC DBA A & M CONSULTING 18119 NE 3OTH ST REDMOND WA 98052-5902 rilsuRERA: HartfordCasualtylnsuranceCompany 2%,24 IIISURER B : INSURERG: I]'ISURERD i INSURER E; IIISURER F CERTIFICATE OF LIABILITY INSURANGE @ 198&2015 ACORD CORPORATION- All rights reserved. The AGORD name and logo are registered marks of AGORD N ITHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWrIFISTANDING ANY REOUIREMENT. TERM OR CONDTTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESGRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDTTIONS OF SUCH POLICIES. LIMITS SHOWN MAY FI,AVE BEEN REDUGED BY PAID CLAJMS. INSTl tTp TYPEOFIHSURANCE ADDL TNCE SUAR um POUGY NUUSER POUCY EFF Illll'NDIYYYVI POUCY EXP ,Itutnn/r/ YvYl LtftTs A COMMERCIAL GENERAL UABIUTY X X 72 SBM UK5O25 fita!2021 11tO1t2022 EACH OCCURRENCE $2,000.000 DAMAGETO RENTED PPFMICFS ,F.lrdrtEn.a'l $300.000 X MED EXP (Any one pa6on)$10.000 PERSONAL&AIIV INJURY $2,000.000 GEN'L AGGREGATE U MIT APPUES PR PRO- JEGT LOCX GENERALAGGREGATE $4.000.000 PRODUCTS.COMP/OP AGG $4,000.000 A AUTOUOSIL-E UAEILITY ANYAUTO ALLOWNED AUTOS HIRED AUTOS SGHEDULED AUTOS NON€WNED AUTOSXX 72 SBM UK5O25 fin1na21 11t01t20?2 COMBINED SINGLEUMIT s2.000,000 BODILY INJURY (Per peson) BODILY INJURY {Per acciderd) PROPERTYDAMAGE (Per accidenl) UMSRELIA LIAB EXCESS LIAB OOGUR cLAln4s, MADE EACH OCCURRENCE AGGREGATE RFIENTION $ A ItgRI{ERS GOUP€ltSATI0t{ AND EIIPLOYER8' LTAEILITY ANY PROPRI ETORJPARTNER'EXECUNVE OFFICERIIVIEMBER EXCLUDED? (tandcdory ln NH) lf yes. dxcribe under nFSCRImON OF OPFRATIONS hclro Yrtif N'A 72 SBM UK5O25 fin1t2021 fit4il2022 IPER I IOTH- l"yorrrc i l=o E.L EACH AGCIDENT sl.0m,000 E.L DISEASE€AEMPLOYEE $1.000,000 E.L DISEASE-POUCY UMIT $1,000.000 A EMPLOYMENT PRACTICES LIABILITY 72 SBM UK5025 11101t2021 11t0il2422 Eaci Claim Umit Aggregate Limit $5.000 $5,000 DESCRIPITOIUOFOPERATIONS I LACATIONS IVEHICLES (ACORD 101, Additional Romarts Sch6dul€, may ba attachod if moro spa@ is required) Those usual to the lnsured's Operations. Certificate Holder is an Addilionat lnsured per the Business Liabilig Coverage Form SS000B athched to this policy. City Public Works En gineering 222 4TH AVE S KENT WA 98032 SHOULD ANY OF THE ABOVE DESGRIBED POLICIES BE GANGELLED BEFORE THE EXPIRA11ON DATE THEREOF, NOTICE wlLL BE DELIVERED INAGCORDAiICE WIn{ THE POUCY PROVISIONS. AUTHOREED REPRESEIiITATN'E duaa.r$ {azfr*-a-*t ACORD 25 (2016/03) POLICY NUMBER: 72 sBMuKs025 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DI$CLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSUREICAP ON LOSSES - TERRORISM RISK INSURANCE ACT o N o d o ooo SCHEDULE Terrorism Premium:$ $s. oo A. Disclosure Of Premium ln accordance with the federal Terrorism Risk lnsurance Act, as amended ORIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA' The portion of your premium attributable to terrorism coverage is shown in the above Schedule of this endorsement. B. The following definition is added with respect to the provisions of this endorsement: 1, A "cedified act of terrorism" means an act that is certified by the $ecretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Governmeni by coercion C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for 80o/o of insured losses attributable to "certified acts of terrorism" under TRIA that exceeds the applicable insurer deductible. However, if aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. D. Cap On lnsurer Liability for Terrorism Losses lf aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a salendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. ln such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. Form SS 83 76 t2 20 Page I of 2 a 2020, The Hartford flncludes coovriohted material of lnsurance Services Office, lnc., with its permission) ln' accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverag Form, Coverage Part or Policy, such as losses excluded by any pollution, pathogenic, nuclear hazard or war exclusions which may be included on this Policy. F. All other terms and conditions remain the same Page 2 of 2 Form SS 8376 12 20 tr oN @ o oooIMPORTANT NOTICE TO POLICYHOLDERS To help your insurance keep pace with increasing costs, wo have increased your amount ol insurance . . . giving you better proteetion in cass ol either a partial, or total loss to your property. lf you feel the new amount is not th6 proper one, please contact your agent or broker. f,' [, r' l.lt.I I', I 25 50 UK SBM This $pectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any other Forms and End6rsemenis issued to be a part of the Policy. This insurance is provided by the stock insurance company of The Hartford lnsurance Group shown below. INSURER: HARTFORD CASUALTY INSUBANCE COMPANY ONE HARTFORD PI,AZA, HARTFORD, CT 06].55 OOMPANYCODE: 3 ,#F# g Policy Numher: 72 SBM UK5025 Dx SPECTRUM POLICY DECLARATIONS ORIGINAiJ Named lnsured and Mailing Address: ARNoLD ToMAc DBA A & M (No., Street, Town, State, Zip Code) coNsuLTrNG ].811.9 N.E. 3OTH STREETREDMOND WA 98052 Poticy Period: From Ltl}l-/zL To LL/0L/22 L YEAR 12..01 a.m.,Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire NameofAgent/Broker: A,f GALLAGHER & CO INS BRKRS CA/PHS Gode: 255202 Previous Policy Number: 72 SBM UK5025 NAMEd INSUTEd iS: INDIVIDUAL Audit PCTiOd: NON-AUDITABI,E Type of Property Coverage: NONE lnsurance provided: ln return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTALANNUAL PREMIUM IS: $425 MP IN RECOGNITION OF TTIE MUI,TIPI,E COVERAGES INSUB.ED WITH THE IIARTFORD' YOUR POLICY PREMIUM INCIJUDES AN ACCOUNT CREDIT' t Countersigned bY (fota-rd tutr-o*A-*, Authorized RePresentative 09 /20 /2L Date Form SS 00 02 12 06 Process Date: 09 /20 /2L Page 001 (CO!fiIINUED ON NEXT PAGE) Policy ExPiration Datet Lt / 0t / 22 SPE0TRUM POLICY DECLARATIONS {Gontinued} POLICYNUMBER: 72 sBYt uKs025 Location(s), Building(s), Business of Named lnsured and $chedule of Coverages for Premises as designated by Number below. Location: 00L Building: 00L ].8119 N.E. 3OTH STREET REDMOND WA 98052 Description of Business: REAI, ESTATE APPRAISER Deductible: No co\rERAcE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COI/ERAGE BUSIhIESS PER$ONAL PROPERTY REPLACEMENT COST NO COVERAGE PERSONAL PROPERry OF OTHERS REPLACEfVIENT COST NO COVERAGE MONEY AND SECURTTIES INSIDE THE PREMISES OUTSIDE THE PR.EMISES Form SS 00 02 12 06 Process Date: 09 /20 lZt NO COVERAGE NO COVERAGE Page 002 (CONTINUED ON NEXT PAGE) Policy Expiration Date: LLlAL/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5O25 BUSINESS LIABILITY LIABILITY AND MEDICAL EXPEN$ES MEDICAL EXPENSES . ANY ONE PERSON PERSONAL AND ADVERTISING INJURY Form SS 00 02 12 06 Process Date: 09 /2A /2L Page 003 (CONTTNIJED ON NEXT PAGE) Policy Expiration Date: t1/ 0t/22 LIMITS OF INSURANCE $2, 000, 000 $ J-0, ooo $2, ooo, 000 o N 6 o ooo DAMAGES TO PREMISES RENTED TO YOU ANY ONE PREMISES $ 300,000 AGGREGATE LIMITS PRODUCTS.COMPLETED OPERATIONS $4, 000, 000 GENERAL AGGREGATE EMPLOYMENT PRACTICES LIABILITY COVERAGE; FORtvI SS 09 0L EACH CLAIM LIMIT DEDUCTIBLE - EACH CLAIM LIMIT NOT APPLICABiJE AGGREGATE LIMIT RETROACTIVE DATE: 11012 0 0s $4, ooo, ooo $ 5,000 $ 5,000 This Employment practices Liability Goverage conlains claims made coverage. Except as may be otherwise provided heiein, specified coverages of tfris insurance are limited generally to liability for injuries for which claims are iirst made againsi the insured while the insurance is in force. Please read and review the insurance carefully and discuss the coverage with your Hartford Agent or Broker. The Limits of lnsurance stated in this Declarations will be reduced, and may be completely exhausted, by the payrnent of "defense expense" and, in such event, The Gompany will not be obligated to pay any further i'defense expense" or sums which the insured is or may become legally obligated to pay as "damages". BUSINESS I,IABII,ITY OPTIONAI, COVERAGES HIRED/NON-OV{NED AUTO IJIABTLITY FORM: SS 01 70 $2,000, 000 SPECTRUM POLICY DECLARATIONS (Continued) POLICYNUMBER: 72 sBM uK502s BUSINESS LIABILITY OPTIONAL COVERAGES {Continrcd) EFIOvgRg &reBIf.'IIIC AM glKtP OAP BODILY $GTI'RY BT NCCTDISWErer tccruryrl BODIITV n[atUnY BY DIgEf,gE Ef,CE lnIPrlOI'E BODILV IHi'ORY BC DIEIETSE POIIICS !$tr,t[ TPPLICTBLE IIO IroCf,llIONg IN IISE FOIilOICING ST}'llE(S): TITSHIDKITON WAI\IIR OI SUARdhTIO!I:rorui ss 12 15 I.oCtl[IOrN: 001 BUILDIIIG: 001![l!G: Ir il[T Form $S 00 02 12 06 Process Date: 09 /20 /2I LIMITS OF INSURANCE $1, ooo, o0o $1, 000, 000 $1, 000, 000 Page 004 (CONTINUED 0N NEXT PAGE) Policy Expiration Date. Lt/0L/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5025 ADDITIONAL INSUREDS: THE FoLLCIfVING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITYCOVERAGE IN THIS POLICY. o N @ b o oo &ocf,l|rIoil trPE ldf,lcE 001 BUrLDrre 001 UaIIACIER LEggOn gGE FORII IE 12 OO t:'t. It Form SS 00 02 12 06 Drnaaec hata' 09 /24/2I Page 005 (CONTINUED ON NEXT PAGE) Policv Expiration Datet IL/AL/22 SPEGTRUM POLICY DECLARAT0NS (Continued) POLICY NUMBER: 72 sBM UK5025 Form Numbers of Forms and Endorsements that apply 0411 85 ADD]TIONAL ]NSURED _ MANAGER/i,ESSOR Form SS 00 02 12 06 Process Date: 09/24/2L ss 00ss 00ss 00ss 05ss 09ss 12 0L 64 60 47 67 15 L2 03 09 09 09 09 03 00 14 L6 L5 15 ss 00 05ss 01- 28ss 4l- 02ss 51 10ss 09 70rH 99 40 12 05 04 03 OB 70 63 01 7L 4L 00 01 4L 09 09 99 ss ss ss ssec IH 06 L7 05 L7 L4 09 04 83 ss ss ss ss ss ss 05 09 Ll- L4 L4 00 89 05 09 L0 45 12 06 93 07 1-6 03 03 00 25 L2 L4 04 09 9876 t2 20 T2L4 00 09 06 t2 L2 a4 09 IH Page 006 Policy Expiration Datei tt/01/22 o N @ o a COMMON POLICY CONDITIONS Form $S 00 05 12 05 a anaa TL^ u^J6^-i QUICK REFERENCE - SPECTRUM POLICY DEGLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named lnsured and Mailing Address Policy Period Description and Business Location Coverages and Limits of lnsurance II. COMMON POLICY CONDITIONS A. Cancellation B. Changes C. Concealment, Misrepresentation Or Fraud D. Examination Of Your Books And Records E. lnspections And Surveys F. lnsurance Under Two Or More Coverages G. Liberalization H. Other lnsurance - Property Coverage l. Premiums J. Transfer Of Rights Of Recovery Against Others To Us K. Transfer Of Your Rights And Duties Under This Policy L. Premium Audit Beginning on Page 1 I 2 2 2 2 2 2 2 2 3 3 i.::i ir1l: Form SS 00 05 12 06 COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. go N @ o ooo A. Cancellation 1. The first Named lnsured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named lnsured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy: (1) The building has been vacant or unoccupied 60 or more consecutive days. This does not aPPIY to: (a) Seasonal unoccupancy; or (b) Buildings in the course of construction, renovation or addition. Buildings with 659o or more of the rental units or floor area vacant or unoccupied are considered unoccuPied under this provision. {2} After damage by a Covered Cause of Loss, permanent repairs to the building: {a} Have not started; and (b) Have not been contracted for, within 30 days of initial payment of loss. (3) The building has: (a) An outstanding order to vacate; (b) An outstanding demolition order; or {c} Been declared unsafe bY governmental authoritY. (4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not aPPIY to such removal that is necessary or incidental to any renovation or remodeling. (5) Failure to: (a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy; or (b) Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effeciive date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named lnsured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. lf this policy is canceled, we will send the first Named lnsured any premium refund due. Such refund will be pro rata. The cancellation will be effective even if we have not made or offered a refund, 6. lf notice is mailed, proof of mailing will be sufficient proof of notice. 7, lf the first Named lnsured cancels this policy, we will retain no less than $100 of the premium. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named lnsured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. 1.. { Form SS 00 06 12 06 Page'l of 3 COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud This policy is void in any case 0f fraud by you as it relates io this policy at any time. lt is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This PolicY; 2. The Covered ProPertY; 3. Your interest in the Covered Property; or 4. A claim under this PolicY. D. Examination Of Your Books And Records We may examine and audit your books and records as they relate to the policy at any time during the policy period and up to three years afterward. E. lnspections And $urveYs We have the right but are not obligated to: L Make inspections and surveys at any time; 2. Give you reports on the conditions we find; and 3. Recommend changes. Any inspections, surveys, reports or recommendations relate only to insurability and the premiums to be charged, We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of any person. And we do not represent or warrant that conditions: 1. Are safe or healthful; or 2. Comply with laws, regulations, codes or standards. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations, F. lnsurance Under Two Or More Coverages lf two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage' G. Liberalization lf we adopt any revision that would broaden the coverage under this policy without additional premium within 45 days prior to or during the policy period, the broadened coverage will immediately apply to this PolicY. H. Other lnsurance - Property Coverage lf there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applisable Limit of lnsurance. l. Premiums 1, The first Named lnsured shown in the Declarations: a. ls responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2, The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. lf applicable, on each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. 3. With our consent, you may continue this policy in force by paying a continuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with Paragraph 2. above' Our forms then in effect will apply. lf you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the Premium. 4. Changes in exposures or changes in your business operation, acquisition or use of locations that are not shown in the Declarations may occur during the policy period. lf so, we may require an additional premium. That premiurn will be determined in accordance with our rates and rules then in effect. J. Transfer Of Rights Of Recovery AEainst Others To Us Applicable to ProPertY Coverage: lf any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment' That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another pariy in writing: 1. Prior to a loss to your Covered Property. 2. After a loss to your Covered Property only if, at time of loss, that party is one of the following: a. Someone insured by this insurance; b. A business firm: {1) Owned or controlled bY You; or (2) That owns or controls You; or Page 2 of 3 Form S$ 00 05 12 06 I c. Yourtenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. K. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named lnsured' lf you die, your rights ancl duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Kevin Barnett, Secretary W:#t qor,&!"fg^t' a COMMON POLICY CONDITIONS L. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. b. The premium amount shown in the Declarations is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Any additional premium found to be due as a result of the audit are due and payable on notice to the first Named lnsured. lf the deposit premium paid for the policy term is greater than the earned premium, we will return the excess to the first Named lnsured. c. The first Named lnsured must maintain all records related to the coverage provided by this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Douglas Elliot, President @ + o Our president and Secretary have signed this policy. Where required by law, the Declarations page has also been countersigned by our duly authorized representative. t: l. d Form SS 00 05 12 06 Page 3 of 3 POLICY NUIIIBER: 72 sBM uK5025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDIfIOI{AIr INSURED - MAI{AGER/iTESSOR rHE CITY OF KH$E PUBI,IC WORI(S ENGINEERING 222 FOURTH A\IE. SO. KET\TI WA 98032 #o (o o ooo I' rt4. ft lr.. Form ltl 12 (Xl 11 85 T SEO. ll0. 002 Procccr Dale: 09 /2A /21 Pdmed h U.S.A. Page 00f Expiratlon Da?prt LL / 0t / 22 INSURED COPY #f#o o 6 a ooo Named lnsured: Policy Number: Effective Date: Company Name: IRN0LD |loilfc DBtr t & !l 72 SBM UK5025 LT/IL|2L Expiration Date: tt/AL/2Z HARTFORD CASUAIJTY INSURANCE COMPAI\TY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions remain unchanged trn..' I TJ. Form lH 99 41 04 09 Page 1 of I rPOLlc"Y NUMBER: ?2 sBM uKs025 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY INRE$PONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORI$M RISK INSURANCE ACT. DISCLOSURE/CAP ON LOSSES . TERRORISM RISK INSURANCE ACT $s.00 tr United States or to influence the policy or affect the conduct of the United States Government by coercion C. Disclosure Of Federal $hare Of Terrorism Losses The United States Department of the Treasury willreimburse insurers for B0o/o of insured l6sses attributable to "certified acts of terrorism,' under TRIA that exceeds the applicable insurer deductible. However, if aggregate industry insured losses attributable to ,'certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100billion. The United $tates government has not charged any premium for their participation in covering terrorism losses. D. Cap On lnsurer Liability for Terrorism Losses lf aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. ln such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. ;o@ ooo Disclosure Of Premium ln accordance with the federal Terrorism Risk lnsurance Act, as amended CfRn), we are required to provide you with a notice disclosing the portion ofyour premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The portion of your premium attributable to terrorism coverage is shown in the above Schedule of this endorsement. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be anact of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributabte to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the Form SS 83 80 {2 20 Process Date:A9|2AE1 Page I of 2 Policy Expiration Date: 1 1101 122 : It'1il ,.:'i! irl'l J.,L.! o 2020, The Hartford t Further information regarding the reason for the coverage change(s) is available from the company or your agent or broker. You may receive other notices of coverage changes for the upcoming policy term under separate cover. Those olher changes will apply in addition to the changes described above. This is not a bill. You will receive a separate bill for all or part of the premium due for your renewal policy. lf you do not pay the amount shown by the due date as stated in the bill, your insurance coverage will expire or be cancelled for non-payment of premium. lf you have any questions about your policy or about your overall insurance needs, please contact your Hartford agent or broker. Form lH 70 50 {2 10 Page 2 .POLICYHOLDER NOTICE . WASHINGTON Date: 09 /20 /2I PolicyNumber: 72 SBM UK5025 Renewal Datei tLl0I/2t Your Hartford Agent: nir ctA&LroruR & co INg BRKR$ cn/pas #F#Noo o (BBB) 920-6259 ril[OIrD TOIIAC DBt n & !l coNsu&,rr$Gt 18I.19 N.E. 3OTE g|lRruT nEDMO!rD wr 98052 Dear Valued Hartford lnsured, Your current policy provided by The Hartford will expire shortly. The purpose of this notice is to advise you of certain changes to your policy upon renewal. A. Policy Premiu[[ The new premium for your policy for the upcoming term is indicated below. This premium amount is based on current information known to us and may be subject to change based on any additional information we may receive from you or your Hartford agent or broker. More information on your premium determination can be obtained from your agent or broker, or from The Hartford. Renewal premium =$ 425.00 Amount of lncrease = $ The reason(s) forthe increase in premium is due to one or more of the following: 1. A change in rates or the method of calculating premium. 2. A change in your exposures, loss experience, or other risk characteristics. B. Coverage Changes (if applicabte) Your policy for the upcoming term will include certain reductions or additional restrictions in coverage, as indicated by an (x) below. lf your state requires a notice of nonrenewal as a result of the indicated changeli), this is our notice to you in compliance with the applicable law. ( ) lncrease in Deductible to: ( ) Reduction in Limits to ( ) Reductions in Coverage: ( ) Other Changes or Restrictions in Coverage: The coverage change is due to the following indicated reason(s): ( ) Your exposures, loss experiencet or other risk characteristics indicate a need for the change ( ) A change in our rules, forms or underwriting guidelines for yourtype of policy. Form lH 70 50 12 l0 Paqe I - ln accordance with the Treasury's procedures, . amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would othenruise be excluded under this Coverage Form, Coverage Part or Policy, such as losset excluded by any pollution, pathogenic, nuclea hazard or war exclusions which may be included or this Policy. F. All other terms and conditions remain the same Page 2 of 2 Form SS 83 80 12 20