HomeMy WebLinkAboutPK17-284 - Original - Evergreen Asphalt & Concrete, Inc. - Sealcoat Riverbend Golf Course Parking Lot - 09/11/2017ecords M em
KENT D ocumentWAgHINGToX
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to the City ilerk's Office. All portions are to be completed.
If you have questions, please contact the City Clerk's Office at 253-856-5725.
Vendor Name: Eve rqreen As phalt &Concrete. Inc.
Vendor Number:
JD Edwards Number
Contract Number:?Yn - 2s4
This is assigned by City Clerk's Office
Sealcoat Parkin q Lot - Riverbend 1 8 Hole Golf Cou rseProject Name:
Description: n Interlocal Agreement
E other:
E Change Order E Amendment XE Contract
Contract Effective Date: 09/OLlL7 Terminatio n Date: tL/01/I7
Contract Renewal Notice (DaYs):
Number of days required notice for termination or renewal or amendment
Contract Manager:Nancy Clarv Depart ment: Parks Facilities Division
Contract Amount:4?4.466.o
Approval Authority: fl Director I city Council eeting Date
Detail: (i.e. address, location, parcel number, tax id, etc'):
Mavor
KENT
WAsHrNotoN
PUBLIC WORKS AGREEMENT
between City of Kent and
Evergreen AsPhalt & Concrete, Inc'
THIS AGREEMENT is made by and between the city of Kent, a washington municipal corporation
(hereinafter the "City"), and Evergreen Asphalt & Concrete, Inc. organized under the laws of the State of
Washington, tocated and doing business at p,O, Box 1567, Kent,98035-1567, Shane Gilbertson,253 639-
37 7 g, eve rg reen.sha ne@comcast. net (he rei nafter the "Contractor").
AGREEMENT
The parties agree as follows:
I. DESCRTPTIqN OF WORK.
Contractor shall perform the following services for the City in accordance with the following
described plans and/or specifications:
Evergreen Asphalt & Concrete Repair shall provide all labor and materials to clean, repair,
sealcoat and restripe the parking lot at City of Kent Riverbend 1B Hole Golf Course, 2019 W.
Meeker, Kent, in accordance with Proposal 6536 dated 05/t2/L7, which is attached and
incorporated as Exhibit A.
Contractor further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices within the Puget Sound region in effect at the
time such services are Performed.
IL TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
section i above immediately upon execution of this Agreement, Upon the effective date of this
Agreement, the Contractor shall complete the work described in Section I within 60 days'
COMPENSATION. The City shall pay the Contractor a total amount not to exceed $24,466.20 including
any applicable Washington 'State Sales Tax, for the work and services contemplated in this Agreement.
fne City shall pay the Contractor ninety percent (90%) of the Contract amount upon completion and
acceptance of the work by the City, or at such earlier time as the City may determine is appropriate' The
City will pay the remaining Contract amount upon fulfillment of the conditions listed below and throughout
this Agreement.
A. No payment and Performance Bond, Because this contract, including applicable sales
t-axrc fess than g150,000, and pursuant to Chapter 39,08 RCW, the Contractor, in
lieu of providing the City a payment and performance bond, has elected to have the
City retain the iinal ten'percent (10%) of the Contract amount for a period of thirty
(gd) Oays after the date of final acceptance, or until receipt of all necessary releases
irom the State Department of Revenue, the State Department of Labor & Industries,
and the State Employment Security Department, and until settlement of any liens
filed under Chapter 60'28 RCW, whichever is later.
PUBLIC WORKS AGREEMENT - 1
(Over $20K, under $35K, and No Performance Bond)
Defeetle_ot Unauthorized Work. The City reserves its right to withhold payment
from Contractor for any defective or unauthorized work, Defective or unauthorized
work includes, without limitation: work and materials that do not conform to the
requirements of this Agreement; and extra work and materials furnished without the
City's written approval. If Contractor is unable, for any reason, to satisfactorily
complete any portion of the work, the City may complete the work by contract or
otherwise, and Contractor 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 Contract price specified
above. The City further reserves its right to deduct the cost to complete the
Contract work, including any Additional Costs, from any and all amounts due or to
become due the Contractor.
FiNaI Pavment: Waiver of CIaims. THE CONTRACTOR,S ACCEPTANCE OF FINAL
PAYMENT (EXCLUDING WITHHELD RETAiNAGE) SHALL CONSTITUTE A WAIVER OF
CONTRACTOR'S CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND
IDENTIFIED BY CONTRACTOR AS UNSETTLED AT THE TIME FINAL PAYMENT IS MADE
AND ACCEPTED.
IV, INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement, By their execution of this Agreement, and in
accordance with Ch. 51,08 RCW, the parties make the following representations:
A, The Contractor has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreefnent,
B. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
The Contractor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Contractor's services and is a service other than that furnished by the City,
or the Contractor is engaged in an independently established trade, occupation,
profession, or business of the same nature as that involved under this Agreement,
The Contractor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
The Contractor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Contractor's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
The Contractor has a valid contractor registration pursuant to Ch. 18.27 RCW or an
electrical contractor license pursuant to Ch. 19,28 RCW,
F
G The Contractor maintains a set of books dedicated to the expenses and earnings of
its business.
V. TERMINATION, The City rnay terminate this Agreement for good cause, "Good cause"
shall include, without limitation, any one or more of the following events:
A. The Contractor's refusal or failure to supply a sufficient number of properly skilled
workers or proper materials for completion of the Contract work.
PUBLIC WORKS AGREEMENT - 2
(aver $20K, under $35K, and No Performance Bond)
B
c
c
D
E
The Contractor's failure to complete the work within the time specified in this
Agreement,
The Contractor's failure to make full and prompt payment to subcontractors or for
material or labor,
D, The Contractor's persistent disregard of federal, state or local laws, rules or
reg u lations.
E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt'
F. The Contractor's breach of any portion of this Agreement.
If the City terminates this Agreement for good cause, the Contractor shall not receive any further
money due under this Agreement until the Contract work is completed. After termination, the City may
take possession of all reCords and data within the Contractor's possession pertaining to this project which
may be used by the City without restriction,
VI. PREVAILING WAGES. Contractor shall file a "statement of Intent to Pay Prevailing
Wages,,, with the State of Washington Department of Labor & Industries prior to commencing the Contract
work. Contractor shall pay previiling wages in effect on the date the bid is accepted or executed by
Contractor, and comply
'witn cfraptei ss. L2 of the Revised Code of Washington, as well as any other
applicable prevailing wage rate provisions. The latest prevailing wage rate revision issued by the
Department of Labor and Industries is attached.
VIL CHANGES, The City may issue a written change order for any change in the Contract work
during the performance of this Agreement. If the Contractor determines, for any reason/ that a change
order is necessary, Contractor must submit a written change order request to the person listed in the
notice provision section of this Agreement, section XV(D), within fourteen (14) calendar days of the date
Contractor knew or should have linown of the facts and events giving rise to the requested change. If the
City determines that the change increases or decreases the Contractor's costs or time for performance/
the City will make an equitable adjustment, The City will attempt, in good faith, to reach agreement with
the Contractor on all equitable adjustments. However, if the parties are unable to agree, the City will
determine the equitable adjustment as it deems appropriate. The Contractor shall proceed with the
change order *oik upon reJeiving either a written change order from the City or an oral order from the
City 6efore actually receiving the written change order, If the Contractor fails to require a change order
wit'hin the time specified in this paragraph, the Contractor waives its right to make any claim or submit
subsequent change order requests for that portion of the contract work. If the Contractor disagrees with
the equitable adjustment, the contractor must complete the change order work; however, the contractor
may elect to protest the adjustment as provided in subsections A through E of Section VIIi, Claims, below'
The Contractor accepts all requirements of a change order by: (1) endorsing it, (2) writing a
separate acceptance, or (3) not protesting in the way this section provides. A change order that is
accepted by Contractor as'provided in this iection shall constitute full payment and final settlement of all
claims for contract time and for direct, indirect and consequential costs, including costs of delays related
to any work, either covered or affected by the change.
VIII. CLAIMS, If the Contractor disagrees with anything required by a change order, another
written order, or an oral order from the City, including any direction, instruction, interpretation, or
determination by the City, the Contractor may file a ctaim as provided in this section, The Contractor shall
give written noiice to the City of all claims within fourteen (14) calendar days of the occurrence of the
events giving rise to the claims, or within fourteen (14) calendar days of the date the Contractor knew or
should have known of the facts or events giving rise to the claim, whichever occurs first . Any claim for
damages, additional payment for any reason, or extension of time, whether under this Agreement or
otherwise, shall be conclusively deemed to have been waived by the Contractor unless a timely written
claim is made in strict accordance with the applicable provisions of this Agreement.
PUBLIC WORKS AGREEMENT - 3
(Over $20K, under $35K, and No Performance Bond)
B
c
At a minimum/ a Contractor's written claim shall include the information set forth in subsections A,
itemslthrough5below.
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.
information:
Provide a signed written notice of claim that provides the following
The date of the Contractor's claim;
The nature and circumstances that caused the claim;
The provisions in this Agreement that support the claim;
The estimated dollar cost, if any, of the claimed work and how that estimate
was determined; and
An analysis of the progress schedule showing the schedule change or
disruption if the Contractor is asserting a schedule change or disruption,
Records. The Contractor shall keep complete records of extra costs and time incurred as a
result of the asserted events giving rise to the claim. The City shall have access to any of
the Contractor's records needed for evaluating the protest.
The City will evaluate all claims, provided the procedures in this section are followed. If the
City determines that a claim is valid, the City will adjust payment for work or time by an
equitable adjustment. No adjustment will be made for an invalid protest.
Contractor's Duty to Complete Protested Work. In spite of any claim, the Contractor shall
proceed promptly to provide the goods, materials and services required by the City under
this Agreement,
Failure to Protest Constitutes Waiver. By not protesting as this section provides, the
Contractor also waives any additional entitlement and accepts from the City any written or
oral order (including directions, instructions, interpretations, and determination).
Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this
section, the Contractor completely waives any claims for protested work and accepts from
the City any written or oral order (including directions, instructions, interpretations, and
determination).
IX. LIMITATION OF ACTIONS. CONTRACTOR MUST, IN ANY EVENT, FILE ANY LAWSUIT
ARISING FROM OR CONNECTED WITH THiS AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATE
THE CONTRACT WORK IS COMPLETE OR CONTRACTOR'S ABILiTY TO FILE THAT CLAIM OR SUIT SHALL BE
FOREVER BARRED, THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD.
X. WARRANTY. Contractor warrants that it will faithfully and satisfactorily perform all work
provided under this Agreement in accordance with the provisions of this Agreement. The Contractor shall
promptly correct all defects in workmanship and materials: (1) when Contractor knows or should have
known of the defect, or (2) upon Contractor's receipt of notification from the City of the existence or
discovery of the defect. In the event any parts are repaired or replaced, only original replacement parts
shall be used-rebuilt or used parts will not be acceptable, When defects are corrected, the warranty for
that portion of the work shall extend for an additional year beyond the original warranty period applicable
to the overall work. The Contractor shall begin to correct any defects within seven (7) calendar days of its
receipt of notice frorn the City of the defect. If the Contractor does not accomplish the corrections within
a reasonable time as determined by the City, the City may complete the corrections and the Contractor
shall pay all costs incurred by the City in order to accomplish the correction.
PUBLIC WORKS AGREEMENT - 4
(Over $20K, under $35K, and No Performance Bond)
1
2
3
4
5
B
c
D
E
XI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any sub-contract, the Contractor, its sub-contractors, or any person acting on behalf of the
Contractor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation,
national origin, or the presence of any sensory, mental, or physical disability, discriminate against any
person who is qualified and available to perform the work to which the employment relates.
Contractor shall execute the attached City of Kent Equal Employment Opportunity Policy
Declaration, Comply with City Administrative Policy 7.2, and upon completion of the contract work, file the
attached Com plia nce Statement.
XII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or
suits, including all legal costs and attorney fees, arising out of or in connection with the Contractor's
performance o1 thls 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 Contractor's work when completed shall not be
grounds to avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW
4.24,II5t then, in the event of liability for damages arising out of bodily injury to persons or damages to
property'caused by or resulting from the concurrent negligence of the Contractor and the City, its officers,
officials, employees, agents and volunteers, the Contractor's duty to defend, indemnify, and hold the City
harmless, and
'Contraltor's liability accruing from that obligation shall be only to the extent of the
Contractor's neg I igence.
IT IS FURTHER SPECIFiCALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFiCATION
PROVIDED HEREIN CONSTITUTES THE CONTRACTOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES
FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER,
In the event Contractor refuses tender of defense in any suit or any claim, if that tender was made
pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having
jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Contractor's part, then-Contractor s6att pay ati ttre 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 Contractor's Part,
The provisions of this section shall survive the expiration or termination of this Agreement'
XIII. INSURANCE. The Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by
this reference.
xIV. WORK PERFORMED AT CONTRACTOR'S RISK. Contractor shall take all necessary
precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the
performance of the contract work and shall utilize all protection necessary for that purpose. All work shall
be done at Contractor's own risk, and Contractor shall be responsible for any loss of or damage to
materials, tools, or other articles used or held for use in connection with the work.
XV. MISCELLANEOUSPROVISIONS.
PUBLIC WORKS AGREEMENT - 5
(Over $20K, under $35K, and No Performance Bond)
A' Recvclable Materials. Pursuant to Chapter 3,80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable, A price
preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this
Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those
covenants, agreements or options, and the same shall be and remain in full force and effect,
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any
dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
writing to an alternative dispute resolution process, In any claim or lawsuit for damages arising from the
parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred
in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or
award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's
right to indernnification under Section XII of this Agreement,
D, Written Notice, All communications regarding this Agreement shall be sent to the parties at
the addresses listed on the signature page of the Agreement, unless notified to the contrary, Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing,
E. Assignment, Any assignrnent 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 Contractor,
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative
of the City, and such statements shall not be effective or be construed as entering into or forming a part
of or altering in any manner this Agreement. All of the above documents are hereby made a part of this
Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any
language contained in this Agreerrtent, the terms of this Agreement shall prevail.
H. Compliance with Laws, The Contractor agrees to comply with all federal, state, and
rnunicipal laws, rules, and regulations that are now effective or in the future become applicable to
Contractor's business, equipment, and personnel engaged in operations covered by this Agreement or
accruing out of the performance of those operations,
I. Public Records Act. The Contractor acknowledges that the City is a public agency subject to
the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents,
notes, emails, and other records prepared or gathered by the Contractor in its performance of this
Agreement may be subject to public review and disclosure, even if those records are not produced to or
possessed by the City of Kent. As such, the Contractor 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.
PUBLIC WORKS AGREEMENT - 6
(Over $20K, under $35K, and No Performance Bond)
K' Cq&lft.ar'pfift'g ilft# #,'gfr#r}}rc8;by'.tpx oi'f,maltr. This Agreemen.t may be executed in any
number.of.ouffiiifrrrstituteanorginal,andallofwhichwilltogetherconstitute
this one Agreement. Further, upon executing this Agreemenf either party may deliver the signature page
to the other by fax or email and that signatire snail 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 withlhe authority of this Agreement and prior
to its effective date are ratified and affirmed, and the terrns of the Agreement shall be dserned
to have aPPlied.
PUBLIC WORKS AGREEMENT - 7
(Over $20K, under $35K, and No Pefformance Bond)
CITY OF
(slgnature)
Print
7//DATE
CONTRACTOR:
DATE -t
By
Print Name
(tttle)
Nancy ClarY
City of Kent
220 Fourth Avenue South
Kent, WA 98032
(253) 856-5084 (telePhone)
izsg) ese-6o8o (facsimile)
TO E SENT TO:
CITY OF KENT:
Shane Gilbertson
Evergreen AsPhalt & Concrete, Inc.
P.O. Pox 1567
Kent, WA 98035-1567
SENT TO:NOTICES TO BE
CONTRACTOR:
253 629 -3779 (telePhone)
(facsimile)
A
{n T
ED AS TO FORM:
Department
DECLARATION
CITYoFKENTEQUALEMPLoYMENToPPoRTUNITYPoLIcY
The city of Kent is committed to conform to Federal and state laws regarding equal opportunity'
As such all contractors, subcontraciors and suppliers who perform.work with relation to this
Agreement shap ."*piv- *itt,, il.,,"
'i"grlutionr' br *'r. city's equal employment opportunity
policies.
The foilowing questions specificaily identify the requirements the city deems necessary for any
contract'r, subcontractor or suppriei on *,ir specffic Agreement to adhere to. An affirmative
response is required on arr of the'roitowing qr.rtion, roritris Agreement to be valid and binding'
If any contractor, subcontractor or ruppiiJr *ittrutty misreprese-nts the*telves with regard to the
directives outlines, it will be considet"J . breach of contract and it will be at the city's sole
determination regaralng iuspension 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 otigin, tgl, o,. the preience of all sensory' mental or physical
disabilitY.
3, During the tirne of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicaiing commitment as an equal opportunity
emPloYer.
During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities,
Before acceptance of this Agreement, an adherence statement will be signed by me' the
prime Contractor, that the Prime Cotitiu.toi complied with the requirements as set forth
4,
5.
By:
For
By signing below, I agree to fulfill the five requirements referenced above'
Title:
above,
€AL
Date:- tG- r
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: L.2 EFFECTIVE DATE: JanuarY 1, 1998
SUBJECT;
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, musttake the following affirmative steps:
Provide a written statement to all new employees and
commitment as an equal opportunity employer.
subcontractors indicating
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.
MINORITY AND WOMEN
CONTRACTORS
SUPERSEDES: April 1, 1996
APPROVED BY Jim White, MaYor
1
EEO COMPLIANCE DOCUMENTS - 2
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
th A (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:
Fon
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
BIDDER RESPONSIBILITY CRITERIA
certification of compliance with wage Payment Statutes
This certification is required by state law (RCW 3/'04'35AQD to be submitted to the City
before the contract can be awarded,
The bidder hereby certifies that, within the three-year period immediately preceding the bid
solicitation date (05/1zlLT),the bidder is not a "willful" violator, as defined in RCW 49'48'082,
of any provision of chapters 49.46,49,48, or 49.52 RCW, as determined by a final and binding
citation and notice of assessment igsued by the Department of Labor and Industries or through a
civil judgment entered by a court of timited or general jurisdiction'
I certify under penarty of perjury under the raws of the state of washington that the foregoing is
true and correct.
Evergreen AsPhalt & Concrete, Inc'
BY,i
Signature of Authorized Official*
IPrinted Name:
?* t-t ^>-.filUe:
Date -\L- rl
City and State:>
*If a corporation, proposal must be .executed in the corporate.name b.v tne president or vice-
president (or anyZtiZ, corporate omiiiiiirmpanied 6y evidence of
.authoritv
to sign)' If a co-
'partnership, proposal must be executed by a partner'
EEO COMPLIANCE DOCUMENTS - 4
ragc L or Lv
State of Washington
Department of Labor & lndustries
Prevaiting Wage Section - Tetephone 360-902-5335
PO Box 44540, Otympia, WA 98504'4540
Washington State Prevailing Wage
The PREVAILING WAGES listed here inctude both the hourty wage rate
and the hourty rate of fringe benefits. On pubtic works projects,
worker's wage and benefit rates must add to not less than this total.
A brief description of overtime calculation requirements are
provided on the Benefit Code KeY.
Journey Level Prevailing Wage Rates for the Effective Date: 0511212017
Trade Job Holida Overti Note,ou Classific tion
King
King
Ki
; King
Ki
,xt
King
Ki
:Ki
;King
Ki
King
King
King
1H54s.2s 5DAsbestos Ahatemen!
Workers
Journey Level
5N 1CJourney Level 564.54Boitermakers
5A 1MJourney Level 554.32Brick Mason
5A 1MPointer-Cautker-Cteaner ss4.32Brick Mason
s22.84 5S 2FJanitorBui ldi nq Servic_q Emp lovge.i
5S ZFTraveting
Waxer/Shampooer
523.29Buitding -le.rvice Er0plovees
524,54 5S 2FWindow Cleaner (Non-
Scaffotd)
B*uildine Sqrvice Emplovees
2Fs27.33 5SBuitdinq Service Imptovees Window Cteaner
(Scaffotd)
1522,74Cabinet Makers (hlShop)Journey Level
5D 4CAcousticaI Worker 5s5.51Carpenters
ss5.51 5D 4CBridge, Dock And Wharf
Carpenters
Carpenters
4C$ss.51 5DCarpenterCarpenters
5D 4CCarpenters on
Stationary Toots
ss5.64Carpen_tgl"s
5D 4CCreosoted Material s55.61Carpenters
sss.51 5D 4CFtoor FinisherCarpenters
s5s.51 5D 4CFloor Layer-Carpcnlqs
s5s. s1 5D 4CScaffotd ErectorCarpenters
555.56 7A 1MJourney LevelCement Masons
5D 4CDiver5108.77Divers & Tenders
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Etectrical Fixture
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Electricians - lnside Cabte Spticer s73.20 7C 4E
Electricians " lnside Cable Spticer (tunnet)s78.5e 7C 4E
4Etlectricians - lnside Certified Wetder 570.75 7C
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57s.89 7C 4E
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Pole Sprayer 565.71 5A 4D
Eteculcians*- Power!ing
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Elevator Constructors 7D 4AMechanics8s.45
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1Ks5e.86 5BBoat Operatorlnland Boatmen
1Ks56.1 B 5BCooklnland Boatmen
1K556.1 8 5BDeckhandKinglnland Boatnren
1K557.26 5BDeckhand Engineerlntand Boatmen
1Ks58. se 5BLaunch Operatorlntand Foatm.qn
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7A 3lAirtrac Drit[ Operator 546.66Laborers
545.25 7A 3rBattast Regutar MachineLaborers
3l538.36 7ABatch WeighmanLaborers
3t545.25 7ABrick Pavers
3l545.25 7ABrush Cutter
7A 3ls45.25Brush Hog FeederLaborers
7A 3ls45.2sBurnerl-aborers
546.66 7A 3tCaisson WorkerLaborers
545.2s 7A 3lCarpenter TenderLaborers
3ls45.25 7ACaulkerLaborers
3ls46.09 7ACement Dumper-pavingLaborers
3ts4s.2s 7ALaborersCement Finisher Tender
7A 3ls45.2sChange House Or Dry
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Laborers Ctary Power Spreader 546.0e 7A 3t
Laborers Clean-up Laborer s45.2s 7A 3r
Laborers Concrete Dumper/chute
Operator
s46.0e 7A 3r
Laborers Concrete Form Stripper s45.25 7A 3l
Laborers Concrete Ptacement
Crew
546.0e 7A 3l
Laborers Concrete Saw
Operator/core Drilter
s46.09 7A 3l
Laborers Crusher Feeder 538.36 7A 3r
Laborers Curing Laborer 545,25 7A 3l
Laborers Demotition: Wrecking &
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54s.2s 7A 3t
Laborers Ditch Digger 545.2s 7A 3t
Laborers Diver 546.66 7A 3t
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Laborers Dump Person s45.2s 7A 3l
Laborers Epoxy Technician 54s.25 7A 3t
Laborers Erosion Control Worker s4s.25 7A 3t
Laborers Fatler & Bucker Chain
Saw
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Laborers Fine Graders s4s.2s 7A 3l
Laborers Firewatch s38.36 7A 3t
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Laborers Gabian Basket Builders s45.25 7A 3t
Laborers General Laborer $4s.25 7A 3t
Laborers Grade Checker &
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546.66 7A 3l
Laborers G rinders s45.2s 7A 3l
Laborers Grout Machine Tender s4s.2s 7A 3l
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546.66 7A 3l
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54s.25 7A 3t
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l.aborers Jackhammer 546.09 7A 3t
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7A 3ts38.36Pitot Car
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7A 3l546.09Pipe Pot TenderLaborers
7A 3ls46.09Pipe RetinerLaborers
3ls46.09 7ALaborersPipe Wrapper
3ls45.2s 7APot TenderLaborers
7A 3ts46.66PowdermanLaborers
7A 3ls45.25Powderman's HetperLaborers
3t546.09 7APower JacksLaborers
3t$46.0e 7ARailroad Spike Pulter -
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3t546.66 7ARaker - AsphattLaborers
3t546,66 7ARe-timbermanLaborers
7A 3t546.09Remote Equipment
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3t7As45,2sLaborersRip Rap Person
3ls46.0e 7ARivet BusterLaborers
3ts46.oe 7ARodderLaborers
7A 3ts4s.25Scaffotd ErectorLaborers
3l7A$4s.25Scale Person
3ts46.0e 7AStoper (over 20")Laborers
3l545,25 7AStoper SprayerLaborers
7A 3t546.0eSpreader (concrete)Laborers
7A 3ts45.25Stake HopperLaborers
7A 3ls45.2sStock PiterLaborers
3ls46.09 7ATamper & Simitar
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3ts46.0e 7ATamper (muttipLe &
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Laborers
3ls46.0e 7ATimber Person - Sewer
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Laborers Traffic ControI Laborer 541.02 7A 3t
LAborers Traffic Controt
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Laborers Truck Spotter 54s.2s 7A 3l
Laborers Tugger Operator s46.09 7A 3t
Laborer!TunneI Work-
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Laborers Tunnel Work-Guage and
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546.76 7A 3t
Kinq Laborers Tunnel Work-Miner 546.76 7A 3l
Laborers Vibrator s46.oe 7A 3t
Laborers Vinyl Seamer s4s.25 7A 3t
Laborers Watchman s34. 86 7A 3t
Laborers Wetder s46.09 7A 3t
Laborers Wett Point Laborer s46.09 7A 3t
Labsrcrr Window Washer/cleaner 534. 86 7A 3l
Laborers - Underqround
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Generat Laborer &
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1Ms54.32 5AMarble Setters Journey Level
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1s11.00Production WorkerModutar Br{itdinss
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28s40.60 6ZJourney LevelKingPainters
4Cs5s.76 5DJourney LevelPite Driver
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Page 8 of20
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Power Equinment Operators Cranes Friction: 200
tons and over
560.47 7A 3C
P. glruer Eq ui pegnt _Qperalors Cranes: 20 Tons
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Power Eguipment ODerators Cranes: 100 Tons
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150' 0f Boom (lnctuding
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s5e.28 7A 3C
Power Eauinment Onerators Cranes: 200 tons- 299
tons, or 250' of boom
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attachments
559. 88 7A 3C
Ps@ Cranes: 300 tons and
over or 300' of boom
inctuding jib with
attachments
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PoWer Equinment Op-erators Cranes: 45 Tons
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Povfer Equlpment Operators Crusher SsB.17 7A 3C
tower Eq uj pmen t Qp_qlalq rs Deck Engineer/deck
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P.oKer. E_q ui pment Operato rs Derricks, On Buitding
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Power Equipment Operators Dozers D-9 & Under 557.72 7A 3C
Power Eguipment Operators Dri[[ Oiters: Auger Type,
Truck Or Crane Mount
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Power Equipment Operators Dritting Machine s5e.28 7A 3C 8P
Pows:.f Hgu ipment Opg.r_At-qrs Elevator And Man-tift
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Type
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Bidwett And Gamaco &
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Power Equipment Operators Forktift: 3000 Lbs And
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557.72 7A 3C
Power Equipment Operators Forklifts: Under 3000
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3C558.17 7AMateriaI Transfer Devicenr
3C7A559.28Mechanics, At[ (teadmen
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3C558.6e 7AMotor Patrol Graders
7A 3C558.69Mucking Machine, Mote,
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3C55s.21 7AOit Distributors, Btower
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Power Ecuioment Operators
3C557,72 7AOutside Hoists
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Page 10 of20
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Crusher
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PQwer Equjpnlent Or:erators Posthote Digger,
Mechanical
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PslYet' Eg uipme[t Operators Pumps - Water sss.21 7A 3C
Power Equipment Operators Quad 9, Hd 41, D10 And
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s58.69 7A 3C
OperatorsPower Eoui Quick Tower - No Cab,
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s5s.21 7A 3C
Po:,ver Equi pmgnt Qperators 3CRemote ControI
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Betlman (Certified)
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"lrer-Eglrpmgrl Qp g r.a!o rs.Rotter, Other Than Ptant
Mix
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PoweI EqUipment Operators Rotler, Ptant Mix Or
Mutti-tift Materiats
5s7.72 7A 3C
Povyer Equjpme[t Operators Roto-mit[, Roto-grinder s58.1 7 7A 3C
Bower Equipment Ope[ators.Saws - Concrete s57.72 7A 3C
PoUter Equi pme,nt Opet.ators.Scraper, Setf Propetted
Under 45 Yards
ssB.1 7 7A 3C
Power_Equipment OperatgA Scrapers - Concrete &
Carry Att
5s7.72 7A 3C
Power Ectui pment Operators Scrapers, Self-
propetted: 45 Yards And
Over
S58.69 7A 3C
Pgwer Eq_Uipment Operatqrs Service Engineers -
Equipment
ss7.72 7A 3C
Power Equipment Operators Shotcrete/ gunite
Equipment
s55.21 7A 3C
Power Equiplnent Operators Shovet, Excavator,
Backhoe, Tractors
Under 15 Metric Tons.
557.72 7A 3C
Power tqqipment Ope Shovet, Excavator,
Backhoe: Over 30 Metric
Tons To 50 Metric Tons
ss8.69 7A 3C
lg-Wgr_-fggipmg1tt Opqato rr Shovet, Excavator,
Backhoes, Tractors: 1 5
To 30 Metric Tons
558.17 7A 3C
Power gquipment ODeIalLq$Shovet, Excavator,
Backhoes: Over 50
Metric Tons To 90
Metric Tons
s59.28 7A 3C
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Shovel, Excavator,
Backhoes: Over 90
Tons
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King Bump Cutter $s8.1 7A
3Cs58.6e 7AStipform PaversPgwer Equipment Qperators
3Cs58.69 7ASpreader, Topsider &
Screedman
Power Equipment Operqtors
3Cs58.17 7ASubgrader TrimmerKing
BP3C557.72 7ATower Bucket EtevatorsPqw,e. r Equipment OPerators
7A 3C5se.2BTower Crane Up To 175'
ln Height Base To Boom
Power Equjpment Ope.rators
3C5s9.88 7ATower Crane: over 175'
through 250'in height,
base to boom
Po!6:r Equipment Operatorl
7A 3C560.47Tower Cranes: over 250'
in height from base to
boom
Ppwgr tguipmqnt OPqrqlors
3C 8P5s8.69 7ATransporters, AlI Track
Or Truck Type
Poyver Eq-ui pmelt OQ-erators
3C557.72 7ATrenching MachinesPower Equipment Qperators
s58.1 7 7A 3CTruck Crane
Oiter/driver - 100 Tons
And Over
Power Eauioment Operators
3Cs57.72 7ATruck Crane
Oiter/driver Under 100
Tons
P-qwer .Eo ui p rLen t O-Pe rato r!
Power Eouioment Onerators 7A 3Cs58.1 7Truck Mount Portabte
Conveyor
3Cs58.69 7AWetderPower@
3Css5.21 7AWheel Tractors, Farmatl
Type
Power Ecr uipmqnt.-9perato rl
3Css8.1 7 7AYo Yo Pay Dozer
3Css8.6e 7AAsphatt Ptant OperatorsPower Equipnent
Operators- Underqround
Sewer &_Wa!er
7A 3Css5.21Assistant EngineerPower Equipment
Operatojs- U nderqround
3C$58.1 7 7ABarrier Machine (zipper)Power Eq_uipmenJ
O pe ra_to.r:s " jJ.Jr d e rq rou rul
Sewer & Water
3Css8.1 7 7ABatch Plant Operator,
Concrete
Powet Equjpmett
3Css5.21 7ABobcatPower Ecuipment
Operators--Underqround
Sewer& WAICI
3C$s5.21 7ABrokk - Remote
Demotition Equipment
Pgwe.r Equipnnent
Ope(ato rS : Ul:lder:q,!'ou nd
3C5ss.21 7ABroomsP_pwer E_quipnqnt
Ooerators- Undereround
Sewcl ! i/Vglgl
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Powgr tquipment
pperators- Unaerqr
Sewer & Water
Cabteways s58.6e 7A 3C
Power E_q_Uipment
Operatols- Underergund
5ejryer & water
Chipper s58.1 7 7A 3C BP
Power Equipment
Operators' ..UI derqrou nd
Sewer & Water
Compressor s5s.21 7A 3C
Power Equipment
Operators- Undelground
Sewer & Water
Concrete Pump: Truck
Mount With Boom
Attachment Over 42 M
s5B.6e 7A 3C
Powgr Equi.pment
Operdo$" Undereround
Sewer & Water
Concrete Finish Machine
-taser Screed
s5s.21 7A 3C
Pqwe$supnc$
Qpsrators - U ncl.erg lgund
Sewer &. Water
Concrete Pump -
Mounted Or Trailer High
Pressure Line Pump,
Pump High Pressure.
s57,72 7A 3C
Power EquipmeCI!
Operqtors' Underqround
Sewer & Water
Concrete Pump: Truck
Mount With Boom
Attachment Up To 42m
ss8.1 7 7A 3C
Pqwer EqUipment
O pe ratq rS:_-U n d e rq ro u nd
Sewer & W?ter
Conveyors s57.72 7A 3C
Po,4{qr. [qgip.n_ent
OperatuS- U.ndererould
Sewer & Water
Cranes Friction: 200
tons and over
s60.47 7A 3C
Power EgujpmentM
Sewer & Water
Cranes: 20 Tons
Through 44 Tons With
Attachments
ss8.1 7 7A 3C
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Sperclsrl*iJ n dersasn-d
Sewer & Water
Cranes: 100 Tons
Through 199 Tons, Or
150' 0f Boom (lnctuding
Jib With Attachments)
s5e.28 7A 3C
Power Ezujpmgtrt
OperqLors- Underqround
Sewel& Water
Cranes: 200 tons- 299
tons, or 250' of boom
inctuding jib with
attachments
s59.88 7A 3C
Power EquipmentM
Sewer &. Water
Cranes: 300 tons and
over or 300' of boom
inctuding jib with
attachments
560.47 7A 3C
loi.vqr .F_qUipment
Qperatofs- Undereround
Sswel ft Water
Cranes: 45 Tons
Through 99 Tons, Under
150' Of Boom (inctuding
Jib With Attachments)
5s8.6e 7A 3C
Power Equipment
Operators- Underqround
Sewer & Water
Cranes: A-frame - 10
Tons And Under
S55.21 7A 3C
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Page 12 of20
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through 199 tons
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3C557.72 7ACranes: Through 19
Tons With Attachments
A-frame Over 10 Tons
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Power Eqgipment
Operators- Undereround
Sewer & Water
Sewer &
7A 3C5s8.17Power Eg_qjpmen!
Opergtq_rs- Undereround
Sewer & Water
Crusher
7A 3Cs58.17Deck Engineer/deck
Winches (power)0perators- -Underg.round
King P
3Cs58.69 7ADerricks, On Buitding
Work
Power Equipment
Operators- Undersround
Sewer & Water
7A 3C5s7.72Dozers D-9 & UnderPow.er EqUj.pmgnl
0 pe rato rs -_U n d e re rou n d
3Cs57.72 7ADritt Oiters: Auger Type,
Truck Or Crane Mount
Polvet Equi.Unent
OpelAtor.s - U n dere rou nd
Sewer & Water
3C$s9.28 7ADritting MachinePower Equipment
Operators- Underqround
Sewer & Wa[er
7A 3C5ss.21Etevator And Man'tift:
Permanent And Shaft
Type
!o.wer_tqpipn-rent
Operators- U rIl-grsrounfl
seve.r-&l&a!cr
3Cs58.17 7AFinishing Machine,
Bidwett And Gamaco &
Simitar Equipmentr&
?ower-EquiAment
Q pe ra-to rs - U n-4gtgtg-t{ n d
7A 3C557.72Power Equipnlgnt
Operators- Underqround
Sewer & Water
Forktift: 3000 Lbs And
Over With Attachments
7A 3Cs5s.21Forktifts: Under 3000
Lbs. With Attachments
PsreLEzuiunoco!
Operators--Underground
3C7A558.1 7Grade Engineer: Using
Btue Prints, Cut Sheets,
Etc
Po_y.rer Eqdpmgnt
Op.gfatorl:. U[!lgreround
7A 3C555.21G radechecker/ stakemanPower Equippent
Operators' Underqlound
3Cs58.1 7 7AGuardraiI PunchPowgr EqUip.men!
Qoer-Alors- Underqrounsl
Sewer & Wate.l
3Cs58.69 7AHard Tai[ End Dump
Articulating Off- Road
Equipment 45 Yards. &
Over
P-ower Equipmenl!
Opgrato-rj - U[ de re rgu nd
Sewer & Water
7A 3C558.1 7Hard Tail End Dump
Articutating Off-road
Equipment Under 45
Yards
Power Equipment
Opql:ators- UnderqLound
Sewer & Water
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Drit[ Locator
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Page 14 of20
Pgwg-L-Lqglpment
OpeJ'ators- Underqround
: King 8P
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King Overhead, Bridge Type
100 Tons And Over
PQwer Equinment
Operators- Underqround
Sewer & Water
Horizontat/ di rectionat
Drit[ Operator
$s8.1 7 7A 3C
Power Equipm.-enl
Apsalss:-Undffsrcutd
Sewer & Water
Hydratifts/ boom Trucks
Over 10 Tons
s57.72 7A 3C
Power Equipment
SpssFrs:-Utdcrgloutd
Sewer & Water
Hyd ral.ifts/ boom Trucks,
10 Tons And Under
$ss.21 7A 3C
Power Equir:$erl!
Operators- Undersround
Sewer & Water
Loader, Overhead B
Yards. & Over
s59.28 7A 3C
Power Equipment
0perators' Und!:r:eround
Sewer & Water
Loader, Overhead, 6
Yards. But Not lncluding
B Yards
s58.6e 7A 3C
Pqwer Equipmen_t
QpCAlg|L.Qndelground
Sewer & WALet
Loaders, Overhead
Under 6 Yards
s58.1 7 7A 3C
Power fqUlBrni:ntM
Sewer tr Water
Loaders, Ptant Feed s58.17 7A 3C
Pgwqr-[quipment
pperatqrs- Un.dgrqroud
Sewer &. Water
Loaders: Etevating Type
Bett
ist.tz 7A 3C
Powgr.EqUjp.ment
Operp-!qfj;_- .U n dereroq nd
Sewer &, Water
Locomotives, At[ss8.1 7 7A 3C
P_pwer Equipnlett
-apga!ffL-ul]delground
Sewer &' Water
Material Transfer Device ss8.17 7A 3C
Pswgr-Equrp!rcn!
Qgega'1911 U n d erq r.ou n d.
Sewer & Water
Mechanics, Att (teadmen
- S0.50 Per Hour Over
Mechanic)
s5e.28 7A 3C
Power Equipment
Operators- Underqround
Sewer & Water
Motor Patrol Graders 5s8.6e 7A 3C
Power Equipnent
Operators- Unllereround
Sewqr &. Water
Mucking Machine, Mole,
Tunnel Dritt, Boring,
Road Header And/or
Shietd
$58.69 7A 3C
Po-wer EquiprIlgnt
ppe.rators- Un.clgrer
Sewer & Water
OiI Distributors, Btower
Distribution & Mulch
Seeding Operator
$ss.21 7A 3C
Power Equipment
Op€{Artors^ Underq rgu nd
Sewer & Water
Outside Hoists
(etevators And
Mantifts), Air
Tuggers,strato
557.72 7A 3C
Polvg'Equipment
0perators- Underqround
Sewer & Water
Overhead, Bridge Type
Crane: 20 Tons Through
44 Tons
ss8.17 7A 3C
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81812017
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7A 3CssB.6eOverhead, Bridge Type
45 Tons Through 99
Tons
Power Eqpipment
0perators- Underqround
Sewer & Water
3C$55.21 7APavement BreakerPo.:ye_r_Equjpmqnt
Ooerators- Underqround
SeUqf & W.atet
3Cs58.17 7APite Driver (other Than
Crane Mount)
Power Equipment
Ooerators- Undereround
Sewer & Water
3C7A557.72Ptant Oiler - Asphatt,
Crusher
Po.wer Equipment
Ooerators- Undereround
Sewer & Water
3Cs55.21 7APowg_f .F.guiqmen,t
0peratqrs- Undereround
Sewer & WateI
Posthole Digger,
MechanicaI
7A 3Csss.21Power PtantPower EquiPn-rent
Operators- Undqrergund
Sewer & Water
3Cs5s.21 7APumps - WaterPower EqpiBment
0perators- Undersround
Sewer &,.Wa-ter
3C$58.6e 7AQuad 9, Hd 41, D10 And
Over
Pguret jgutpmen!
Ooerators- Underground
Sewer -[ W4!g;
3C7Ass5.21Quick Tower - No Cab,
Under 100 Feet ln
Height Based To Boom
Power Lquipmept
Operators- U n 49f q ro-urul
Sewer & Water
7A 3Cs58.69Remote Controt
Operator On Rubber
Tired Earth Moving
Equipment
Pp.wer Equipmel$
Ooerators- Underground
Sewer & Waler
3C55s.21 7ARigger And BeltmanPower Eqql'pment
Ooerators- Undersround
7A 3C557.72Rigger/Signal Person,
Betlman (Certified)
Sewer & Water
Powgr EquiPI|lent
Operators- Underground
3C558.6e 7ARottagonPower Equipment
Operators: Undersfound
3C7Ass5.21Rotter, Other Than Ptant
Mix
Power [qUip.ment
Ooerators- Underground
Sewer & Walet
3C7A5s7.72Rotter, Ptant Mix Or
Mutti-tift Materiats
Power nment
Operators- Un-derqround
Sewer_& lvalel
3C558.1 7 7ARoto-mitt, Roto'grinderPower EquiPment
Opgrators- Underelound
Sewer & Water
3Cs57.72 7ASaws - ConcretePower EqqipFent
Onerators- Underqround
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https ://fortress.wa. gov/lniiwagelookup/prvWagelookup. aspx 8lBl20r7
Page 16 of20
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0oerators- Underaround
Sewer & Water
Scrapers - Concrete &,
Carry Att
5s7,72 7A 3C
Power Lqlripme-nt
Operato!-l- Undqreround
Sewel..& W.ate1
Scrapers, Self-
propetted: 45 Yards And
Over
ss8.69 7A 3C
Power Equipmgnt
Oqerators- Uqderqround
Sewer & Water
Service Engineers -
Equipment
557.72 7A 3C
Power Equipment
Operators- Underqround
Sewer & Watgl
Shotcrete/ gunite
Equipment
s55.21 7A 3C
Pow_er Equipment
Operaqe!'s- Undgraround
Sewer & Water
Shovel, Excavator,
Backhoe, Tractors
Under 15 Metric Tons.
557.72 7A 3C
Powel EguiprTgn,!
0perators- Undererg.Und
Sewer & Water
Shovet, Excavator,
Backhoe: Over 30 Metric
Tons To 50 Metric Tons
s58.69 7A 3C
Power Equipment
Qperators- Underground
Sewer &, Water
Shovel, Excavator,
Backhoes, Tractors: 15
To 30 Metric Tons
ss8.1 7 7A 3C
Po.wer Equipmen!
Qpetators: Undereround
$ewer & Water
Shove[, Excavator,
Backhoes: Over 50
Metric Tons To 90
Metric Tons
$59.28 7A 3C
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Operators- Underqround
Sewer [t Water
Shovel, Excavator,
Backhoes: Over 90
Metric Tons
s59.88 7A 3C
Power Equipment
Operators- Unjersroqnd
Sewer & Water
Stipform Pavers ss8.69 7A 3C
Power Equipment
Opera.t-ors - Underq rou nd
Sewer & Water
Spreader, Topsider &
Screedman
ssB.69 7A 3C
lsy€rlqutqmert
0perators- Underqround
Sewer & Water
Subgrader Trimmer ss8,1 7 7A 3C
Power [quipment
Opsrator.s - U ndere Lou nd
Sewer & Water
Tower Bucket Elevators 557.72 7A 3C
Powqr Egu'ipment
Qperators - Un d grgrour-rd
Sewer & Wate[
Tower Crane Up To 175'
ln Height Base To Boom
s59.28 7A 3C
Power EqUlpmqn-t
Operato_rs- Underqround
Sewer & Water
Tower Crane: over 175'
through 250'in height,
base to boom
ss9. 88 7A 3C
Power Equipment
Qperqtors-. U.n derqrou nd
Sewer & Water
Tower Cranes: over 250'
in height from base to
boom
560.47 7A 3C
PoweI Equipmen!
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Sewer & Water
Transporters, At[ Track
Or Truck Type
Ss8.6e 7A 3C
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3C7As58.17Truck Crane
Oiter/driver - 100 Tons
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Operators- Undgrqround
&
3C557.72 7ATruck Crane
Oiter/driver Under 100
Tons
&rwe.r. Equipmep_t
Opera-t_ors- Underq round
Sewer & Water
3Css8.1 7 7ATruck Mount Portabte
Conveyor
r
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O-pgrator:.s- . Undgrqrpu nd
3Cs58.6e 7AWetderPower Equipmen!
Operators- Undersround
3C555.21 7AWheel Tractors, Farmatt
Type
Pgvyer EqUlpment
0-perators- Undgrelound
Sewqr & Water
3C7A558. 1 7Yo Yo Pay DozerP..gwer flqyipqren!
Operaf ors: Underqrou-{ld
Sewer & Water
4As47.08 5AJourney Level ln ChargePower Line Ctearance Tree
Trimmers
5A 44,544.64Spray PersonPower Line Ctearance Tree
Trimmers
4A$47.08 5ATree Equipment
Operator
Power L.ir:re Clea.rance Tre-g
Trimmers
5A 4A542.01Tree TrimmerPgwer Line C.tearqnce T.ree
Trimmers
4As31.65 5ATree Trimmer
Groundperson
Power Line Clearance Tree
Trimmers
1Gs75.36 6ZJourney Level&eftisclaljqn-e-Au
5A 1Ms54.32Journey Leveltia
1$28.20Journey Level
1522.64Journey Levet
4C541.69 5DJourney LevelResidentiat Drvw.atl
5P 1Es5s.66Journey LeveIi
I530,44Journey Level
7L 1Hs39.40Journey Level
!526.28Journey LeveIResidentiaI lnsutation
!s23.03Journey Level
1524.09Residentiat Marble Setters Journey Level
1524.46Journey LevelResidential Parnte_u
L534.6eResidel.rti a.l, Ptu mb-qf s .S.
Pipefitters
Journey Level
1Gs7s.36 6ZJourney LevelResidentiaI Refriseration &
@
7F 1Rs45.eeJourney Level (Field or
Shop)
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Residentiat Sprjnkter Fitters
(tire Proteqtiof)
Journey Level 544,e8 5C 2R
ResidentialStoqe Masons Journey Level 554,32 5A 1M
Eesjdgn!!A!]grrAZz0
Workers
Journey Level 5so.zo 5A 1M
Finishers
ResidentiaI T errazzolTite Journey Level 521.46 1
ResidentiaI Tile Setteg Journey Level 525.17 1
Roofers Journey Level s47.51 5A 3H
Roojers Using lrritabte
Bituminous Materials
s50. s1 5A 3H
Sheet MetaI Workers Journey Level (Fietd or
Shop)
s75.46 7F 1E
Shipbujldine & Ship Repair Boitermaker s41.72 7M 1H
Shipbiritdine & ShiLBeBi[Carpenter s41.06 7T 28
Shipbuitdine & Ship Repair Electrician s41.09 7r 48
lbjpbujtdju_& shb neparr Heat & Frost lnsutator s65.68 5J 4H
Shipb_qilelina & Ship Repair Laborer s41.08 7T 48
Sbipburldjlqe Jbta8epai r Machinist s41.32 7T 48
Shiobuitdinq & Shio Repair Operator s41.03 7T 48
Shipbqildine & Ship Repair Painter s41.05 7r 48
Shipbuiidine & S_hip Repair Pipefitter s41.05 7T 48
Shipbuitdine & Ship Repair Rigger 541.12 7T 48
Shipbuitdine & Ship Repair Sheet Metal 541.04 7T 48
Shipbuitdjlq & Ship Repair Shipfitter s41.12 7T 48
Shipbuildine & Ship Repair Trucker 541.26 7T 48
5iipluildins & Ship Repair Warehouse 541.02 7T 4B
Shigbqjtdine & Ship Repar Wetder/Burner 541.12 7T 48
M(ttqgtlicat)
Sign lnstatter s22.e2 1
Sien Makers &lnstattets
(Etectrjca0
Sign Maker $21 .36 1
M
{Non-ElectricaU.
Sign lnstaller 527.28 L
SiqLll ake.rs & lnst?lterl
{Non-Eteclrieat)
Sign Maker s33.2s !
Soft Ftoor LaveE Journey Level $4s.86 5A 3D
Sotar C-gntrols For Windows Journey Level 512.44 1
Sprinkler Fitters (Ffe
Protection)
Journey Level s72.89 5C 1X
Staqe Rieeinq Mechanics
(Non StructuralJ
Journey Levet s13.23 L
Stone Masons Journev Level 5As54.32 1M
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Street And Parkinq Lot Journey Level s19.09 1
Survevors Assi stant Construction
Site Surveyor
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Survevors Chainman 557.17 7A 3C
Page 18 of20
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285As38.84Cable SpticerTetephpne LLne
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28s37.21 5Alnstatter (Repairer)
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5A 28s36.09Tetephone LinepersonT
285As20.33Tetevision
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28527.21 5ATelevision
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Telenhone Line
285A532. s5Tetevision System
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TF-!ephone. Linq
28529.1 8 5ATetevision TechnicianTeteohone Linq
Construqtlen - Outside
285A$36.09Tree TrimmerTetephong Line
1Ms50.26 5AJourney Level
1$21.6sJourney LevelTi[e Setters
1Bs41.09 5AFinisherTite, Marbte ft Terrazzo
7A 1Ks44.8sJourney Level
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Councit 28)
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5D 3As51.86Asphatt Mix To 16 Yards
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EXHIBIT A
PROPOSALIlivergreen Asphalt ct C<ltrcrete, Ittc'
P.O, Ilox 1567
Kcnt, WA 98035-1567
Ph/l;ax: 253-639-377I
&
'l'hc itbrrvr; priccs, sPcci lioirtions attd cottd itions orc satisluclor!' nntl arc hcrb,r' acccptud. Yott
irlc iu,ltltorizc(l to tio tllc tvork as spcci 1ic4, .i094, Payrncn t is cluc rvithin 30 clays, 1.5?b l)l:.lt
lvlON'l'll Stil{VlClr: CllAl{Clll ON Al.l t,AS'l Dt..[]: A(:COt JN 'fS. lN'l'l lli t,'lVI:iN'l'
l.l:l(1i\1.. r\Cl"lON tS lAKlr:N l'0 COl,l,licl'ANy AivlQt.rN.l'S
l)AY i\l,l-, l,Li(lAl, l:l;it;S & b:XI)tiNSl]5. 1'll
1'l lllt'l'Y (10) l)r\\'S.
Date Proposal#
5lt2l20l7 6536
E-mail Web Siter
r"rvcrgrccn.d i tkr!...i)contcost. nut [i vc'rgrucnnsplt lt It. co ttr
PROPOSAL SUBMIfiED TO:
Citl' rll'Kcnt
?20 Forrrlh Avr:ttttc
Kcnt, WA 98032
i\ttn Natc IInrPcr
JOB ADDRESSSUBMITTE,TERMS
)U[)uc on rccciPt
TotalRateDescriptionQtv
r4,650,00"1
2.1 5(),001"
r ,3 50,001'
1,750,00'r
2, I +?.001'
r4,650.00
2,350,00
r .3 50.00
1,750.00
2. r42,00
llivcrbqnd (.ioll' l8 I'lolc
5g,500 sq/l?r sealcoating s'ith conrursrcial cirilcl,g Pitvcment Scalct',
l)ricc inclu(lcs applf ing ? coals rl['scalcr:'
i,iriu.i* rt*rirl"g .q,rur-*, oil .r gusolinc stairts rt'itlr pclraseul prior to applf ing sualcr'
i;;;l;,;.* ct*nirig p.rki.g l't oi'<lcbris. trtoss and ilirt prior t. sculing
5J0 SQ I?'l'z\sphult Ilcrtttovc ilncl l{cPlilcc in 'l locntitLrts
Parking lot clurnirrg.'l'hc pu.king lot is cxlrcmcll.ilirr.v- rvirlr nross uncl othuf vcEctatigrt, l,ot rvill
lrtrvc ru be olclrt'crl hall'rrt u tinrs tbr llr$$stlIc rvoslling'
t{c Stripc its pct r:risring lirl'out
231{0 l,l; Clr'ilck rillsr. Illorv otrt crnoks ol'clebris and ljll$'itlt hot tnelt crtrck ljller
!)ricc lncluclcs Itruvail ing Wtr8,.:
Pricc ittcltldud 2 l\40t1
Sales Tax (10.0%) s2,?24.20Ac:clit)'l'AN(lli oF Pltol)osAl,
Total s21.466.20
lS QtJo Iz\'l'l0N
DUIi. YOtJ A(iitlil.i'lc)
IS 0Nl.Y \/r\l.ll) 1';111$ignature
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CO N STRUCTI_O N PROJ ECTS
A, Minimum ScoPe of Insurance
Contractor shall obtain insurance of the types described below:
1. Commercial General Liability insurance shall be written on ISO
o equivalent, with minimum limits of
$3,000,000 per occurrence and in the aggregate fo.r each l year
ioiicy deriod'. This coverage may be any c.ombination of primary,
umOieita or excess liability'cover'age affording total liability limits of
not less than $3,000,000 per occurrence and in the aggreggle., -products and CohpteteO Operations coverage shall be-provided, for
g neloA of 3 yeard followirig Substantial Completion of the work.
ifie Commeriial General Li;bility insurance shall be endorsed to
?i%'f:+[""11ilT'*:''oTl:"i"T:?'oilixl:?i'::"?fi',llu?30'uo'
under the Contactor's Commercial General Liability _
insuiance policy with respect to thg ! /orl1 performed for the
CiiV. All endoriements adaing_ Additional Insureds shall be
issired on form CG 20 10 11 85 or a form deemed equivalent,
p-r-orriaing the Additional Insureds with all policies and
endorsements set forth in this section'
2. Automobile Liability insurance covering all owned, non-owned,
ffiles. Coverage shall be written on Insurance
Services Office (ISO) form CA 00 01 or a substitute form providing
equivalent liability c6verage. If necessary, the policy shall be
endorsed to provide contractual liability coverage'
3. =Workers'
gompglrsa@ cove.rage. as required by the Industrial
tniurance laws of the State of Washington.
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,
insurance against clalms for injuries to persons or damage to property which may
arise from or in connection with the performance of the work hereunder by the
Contractor, their agents, representatives, employees or subcontractors.
E. Minimurn Amounts of Insurance
contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with
minimum limits of $3,000,000 per occurrence and in the aggregate
for each 1 year policy period. This coverage may be any
EXHIBIT B (Continued)
combination of primary, umbrella or excess liability coverage
affording total liability limits of not less than 93,000,000 per
occurrence and in the aggregate. Products and Completed
Operations coverage shall be provided for a period of 3 years
following Substantial Completion of the work,
Automobile Liability insurance with a minimum combined single
limit for bodily injury and property damage of 91,000,000 per
accident.
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and commercial General Liability:
1. The Contractor's insurance coverage shall be primary insurance as
respect the City. Any insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Contractor's
insurance and shall not contribute with it,
2. The Contractor's insurance shall be endorsed to state that coverage
shall not be cancelled by either party, except after thirty (30) days
prior written notice by certified mail, return receipt requested, has
been given to the City,
The City of Kent shall be named as an additional insured on all
policies (except Professional Liability) as respects work performed
by or on behalf of the contractor and a copy of the endorsement
naming the City as additional insured shall be attached to the
Certificate of Insurance. The City reserves the right to receive a
certified copy of all required insurance policies. The Contractor's
Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against
whom claim is made or suit is brought, except with respects to the
limits of the insurer's liability,
D. Contractor's Insurance for Other Losses
The Contractor shall assume full responsibility for all loss or damage from any
cause whatsoever to any tools, Contractor's employee owned tool5, machinery,
equipment, or motor vehicles owned or rented by the contractor, or the
contractor's aggnts, suppliers or contractors as well as to any temporary
structures, scaffolding and protective fences.
2
3
EXHIBIT B (Continued)
E. Waiver of Subrogation
The Contractor and the City waive all rights against each other any of their
Subcontractors, Sub-subcontractors, agents and employees, each of the other, for
damages caused by fire or other perils to the extend covered by Builders Risk
insurance or other property insurance obtained pursuant to the Insurance
Requirements Section of this Contract or other property insurance applicable to the
*oit . The policies shall provide such waivers by endorsement or otherwise.
F. AcceptabilitY of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less
than A:VII.
G, Verification of Coverage
Contractor shall furnish the City with original certificates and a gopy of the
ur"nOuiory unOoitements, including bu[ not lgcegsgijly limited to the additional
insured endorsement, evidi:ncing th6 Automobile Liability and_Commercial General
LiiUitity insurance of tfre Contraitor before commencement of the work'
l{, 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.
--ACORD"9-
EVERASP-02
GERTIFIGATE OF LIABILITY INSURANCE 7
DATE (MM/DDiYYYY}
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: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed'
lf SUBROGATION lS WAIVED, subject to the terms of the policy, certain poli
such endorsement(s).
cies may require an endorsement. A statement onand conditions
holder in lieu ofthis certificate does not confer rights to the certificate
#
ura Buscio
838-1 01 5
ura.busc
42587rNsrRFR a ' Deoositors lnsurance Comoanv
PRODUCER
Hub lnternational Northwest LLG
200 1st Avenue West, Suite 500
Seattle, WA 98119
19100rNsrpFR R , AMCO lnsurance Gomoanv
INSURER C :
INSTJRER D:
INSIJRER E :
INSURER F :
Evergreen Asphalt & Concrete, lnc.
P O Box 1567
Kent, WA 98035
INSURED
MAY
FORABOVE ETH PERIODPOLICYBEEHAVEISSUEDNTHETONSUREDNAMEDctEsPOLIFoRANCEINSUBELOWLISTEDTHsTOSFYCERTITTHATHEWTHENTTORESPECTTHISWHICHOFCONTRACTANYOTHERORDOCUMNGREQANYUREMENTORTERMCONDITIONNOTWTHSTANDITEDINDICAALLTOETHDESCRICIESHBEDNEREISUBJtsECTTERMS,INSUTHE AFFORDEDRANCE THEBY POLIICATEBEORISSUEDMAPERTAINCERTIF
B REDUCEEEN BYD CLAIMS.PAIDPOLICLIMES.tTs MAYHOWN HAVEANDEXCLUSIONSNcooDITIONSSUCHF
LIMITSPOLICY NUMBERWPE OF INSURANCE
X
1 00,
5
1,000,
2,000,
2,000,
o4t30t2017 04t30t2018xX
A
x
COMMERCIAL GENERAL LIABILITY
LIMIT
POLICY PRO-
JECT L]
CLAllilS-MADE OCCUR
PER:
LOC
,0
X 04t301201804t30t2017XXBAPD3007050259
AUTOMOSILE LIABILITY
ANY AUTO
O\^/l\lED
AUTOS ONLY
HIRED
AIJTOS ONLY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
2,000,000XX
2,000,000UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE 04t3012017 04130t20't8
DED X 0,000RETENTION $
X
1,000,000
1,000,000
1,000,000
04t30t20'|7 04t3012018
N/A
WORKERS COMPENSA]ION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?(Mandatory ln NH)
describ6 under
OPERATIONS /
Golf Course
DESCRIPTION OF
Re: Riverbend
attachedbe mor€if ls1RemaAddltlonalSchedule,rks may space required)LOCATIONS (ACORD 0,1,VEHICLES
contractwritten writtenorifbutrequiredbyafeadditionauredtnsforliabiralonlyvoluandgenelitynteersofficials,itsofKent,employeesCity ofthercG7323.attached Waiverand ubrogationrancelnsunon-contributory pers&cG7323 101AC0 A primaryattachedtheentendorsemperagreement
01A.AC01testheattachedcG7323perappl
City of Kent
400 West Gowe
Kent, WA 98032
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Lu#d
@ 1988-2015 ACORD CORPORATION. All rights reservedACORD 25 (2016t031
The ACORD name and logo are registered marks of ACORD
Policy #, . '8APD3007050259
COMMERCIAL AUTO
AC 01 02WA 03 10
THls ENDOR$EI\,IENT CHANGES THE poLtcy. PLEASE READ tr CAREFULLY.
E L'SNhIESS AUT'O EXTEhISION ET{DORS EruIENT-
WASI.IINGTON
This endorsementmodifies insurance provided under the foilowrng:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
A. CHANCES FOR TRAILEHS .AND FARM
EAUIPMENT
1. Under the COVERED AUTOS Section,
the following are added to paragraph C.
Certain Trailers, Mobile Equiprieni and
Temporary Substjtute Autos i
4. "Trailers" designed to be towed by aprivate passenger type ,,auto" or a
pickup, panel truck or'van if not usedfor buslness purposes, other than
farming or ranching.
5. Farm wagons or farm implements
while being towed by a covered ,,au_
to".
B, CHANGES FOR ADDITIONAL NEWLY
ACAUIRED VEHICLES
2, Paragraph B.2 of the COVERED AUTOS
SECTION is replaced by the following:. 2. lf Symbol(s) 7ar 87 is entered next to
a covorage in ltem Two of the Decla-
rations, an ,'auto,'you acquire will be. a covered ,auto' for that coverage
only if:
a. We already cover at least one
'auto" you own for that coverage
or it replaces an ,,auto" you pre-
viously owned that had that iov-
erage; and
b. You tell us within 30 days after
you acquire it that you want us to
cover it for that coverage.
The most we will pay for physical Dam_
age Coverage for ,,loss,'und6r this Cov-
erage Extension is $100,000 per ,,auto',,
gubject to the largest deductible applica-
ble to any "auto" for that Coverage.' '
C. BLANKET ADDITIONAL IN$URED
Any person or organization which you have
agreed to name as an additionalinsured in a
written contract, exeouted prior to an acci-
dent, other than a contract for the Jease or
rental of a vehicle is an "insured" for Liability
Coverage, but only to the extent that personor organization qualifies as an '.insured,,
under the Who ls An lnsured provision con-tained in the LIABILIW COVERAGE
SECTION of the Coverage Form
D. REPLACED EXCLUSIONS
The Expected or lntended lrijury Exclusion
in rhe LtABtLtTy covERAcE dEcttorrt is
replaced by the following:
Expected or lntended lnjury
"Bodily injury- or'property damage" which is
expected or intended by the "insured',. Thls
exclusion applies even if the resulting "bodl-
ly injury" or "property damage":
a. is of a different kind, quality or degree
than initially expected or inteirded;or
b. is sustained by a different person, entity,
real property, or personalproperty than
that initially expected or intended.
E. ADDITIONALEXCLUSIONS
The following exclusions are added to fre
LIABILITY COVERAGE SECTION :
Damage lo Named tnsured's property
Any claim or "suit* for 'property damage,' by
you or on your behalf against any other per_
son or entity that is also a Named lnsured
under this policy.
Abuse or Moleslalion
AC 01 02WA 0310
ACp BAPD30-0-7050259 L7,rE
lncludes copyrighted mat6riar or rnsurance services orfice, rnc., with its permission Page 1 of 4
75 0023682
15135 II,ISURED COPY ACO1O203t@0 0001
AC 01 02WA 0310
"Bodily injury" or'property damage" aris-
ing out of:
a, , The actual or threatened abuse or
molestation by anyone or any person
while in the care, custody or control
of any "insured", or
b, The negligent:
1) Employment;
2, lnvestigation;
3) Supervision;
4) Reporting to the proper authori-
ties, or failure to so report; or
5) Retention;
of a person for whom any "insured" is
or ever was legally responsible and
whose conductwould be excluded by
Paragraph a. above.
Abuse means an act which is committed
with the intent to cause harm.
Explosives
. "Bodily injury" or 'property damage"
caused by the explosion of explosives
you make, sell or transport,
Rolling Stores
lf a covered 'auto' is a rolling store, "bo-
dily injury" or "propedy damage" resulting
from dre handling, use or condition of any
item the 'insured" makqs, sells or diski-
butes lf the injury or darnage occurs attar
the "insured" has given up possession of
the item,'
Wrong Delivery of Llquid Producls
"Bodily injury" or "property damage" re-
sulting from lhe delivery of any liquid into
the wrong receptaole or to the wrong ad-
dress, or from the delivery of one liquid
for another, if the 'bodily injury" or "prop-
erty damage" occurs after the delivery
has been completed.
Delivery is considered completed even if
further servioe or maintenance work, or
correction, repair or replacement is re-
quirsd because of wrong delivery.
Professional Services
"Bodily injury":
a. Resulling from lhe providing or the
failure to provide any medical or oth-
er prolessional seruices.
b. Resulilng lrom food or drink furnished
with these services.
.Bodily injury" or "property damage" result-
ing from the handling of corpses.
F. MOTOR HOMEGONTENTS COVERAGE
1. For a covered 'auto" that is a motor home
the following exclusions are added to the
PHYSICAL DAMAGE COVERAGE
SECTION:
Molor Homo Contents
This insurance does not apply to:
a. 'Loss" to the covered "auto's" contents,
except equlpment usual to trucks or pri"
vate passengar "autosn,
b. "Loss" to W antennas, awnings or ca-
banas.
c. "Loss'to equipment designed to create
added living lacilities.
However, these exclusions do not apply if
Miscellaneous Personal Property Coverage
is provided by endorsementto this policy.,
G. ACCIDENTAL AIRBAG DISCHARGE
COVERAGE
Under Paragraph 8.3.a. of the PHYSICAL
DAMAGE COVERAGE SECTION, the {ollowing
is addbd:
Mechanicalbrbakdown does not include the ac-
cidentaldischarge of an airbag.
H. PHYSICAL DAMAGE LIMIT OF INSURANCE
Under PHYSICAL DAMAGE COVERAGE
SECTION, Paragraph C, Limit of lnsurance is
replaced by the following:
C. . Limit Of lnsurance
"t. The most we will pay for "loss" in any
one "accident" is the lesser of:
a. The actual cash value of the dam-
aged or stolen properly as of the. time of the nloss"; or
b. The cost of repairing or replacing
the damaged or slolen propefi.
2. $1,000 is the most we will pay for "loss'in any one "accident" to all electronic
equipment that reproduces, receives or
Page 2 of 4 lncludes copyrighted material of lnsurance Services Office, lnc., wilh its permission AC 01 02WA' 03 10
ACp BApD30-0-705@59 LTJE 15135 INSURED COPY ACot02031mo o{X)l 75 ffn3683
AC 01 02wA 03 10
transmits audio, visual or data sic,nals
which, at the time of ',loss", is:a. permaneritly installed in or upon
the covered 'auto,, in a housing,
opening or other location that isnot normally used by the ,auto,
manufacturer for the installation
of suoh equipment.
b. Removable from a permanenlly
installed housing unit as de-. scribed in paragraph 2.a. aboveor is an integral part of that
equipment;or
c. An integral part of such equip-
ment.
3, A.n adjustment lor depreciation andphysicalcondition will lie made in de_
termining actual cash value in the
event of total 'loss".
4. The cost of repairing or replacing
may:
a. Be based on an estimate which
includes parts furnished bv the
original equipment manufacturer
or olher sources includlng non_original equipment *unu"fu"t r,
ers and
b, lnclude a deduction for better_
ment for a part or parts that are
normally subject to repair or re-
placement during the-usoful life
of fre ,,auto', such as, but not li_
mited to tires alnd batteries,
Betterment means the difference
between the actualcash value ofa part imrnediately before the'loss. and the cost to replace
that part with a new part.
. 5. lf we offer to pay the actual cash val_
ue of lhe damaged or stolen proper-
ty, we will value auto advbrtiiing
wraps, palnt customization, and simi-
lar business related advertisino mod-
.ifioations, in addition to the-actual
cash value of the property. Auto ad.
vertising wraps, paint cudtomization,
and similar business related advertis-
ing modifications will be valued at the
cost to replace them with an adiust-
ment made for depreciation and
physical condition.
I. GLASS REPA,IR _WAIVER OF DEDUCTIBLE
Under Paragraph D. Deductible of the
PHYSICAL DAMAGE COVERAGE SECTION,
the followirrg is added:
No deductible applies to glass damage if the
glass ls repaired rather than replaced.
J. AMENDED DUTIES IN EVENT OF ACCIDENT,
CLAIM, SUIT, OR LOSS
The requirernent in Loss Condition 2.a. Duties ln
The Event Of Accident, Claim, Suit Or Loss - of
tho BUSINESS AUTO CONDITIONS SECTIONand the MOTOR CARRIER CONDTTIONS
IEC-IION that you must notify us of an ,acci-
dent", "claim", usuit',, or "loss,' applies only when
the 'accident", uclaim", ,,suit", or i,loss" is-knownto:
1. You, if you are an individual
2. A partner, if you are a partnership;
3. An exeoutive offioer or the employee desig-
nated by you to give such notice if you are a
corporation; or
4. A member, if you are a limited liability com_
pany-
K. UNINTENTIONAL FAILUHE TO DISCLOSE
HAZARDS
The BUSINESS AUTO coNDITIoNS SEOTIONand MOTOR OARR|ER CONDTTTONS
SECTION-B.Z. are amended by the addiilon of. the followlng:
lf you unintentionally fail to disclose any hazards
existing at the inception date of your policy, wewlll not deny coverage under ihis 'Coverage
Form because of such failure. However, tliis
provlsion does not affect our right to collect addi-
Honal premium or exercise oui right of cancella_
tion or nonrenewal.
L. AUTOS HIRED OR HENTED BY EMPLOYEES
lf hired or rented uautos" are covered,,autos' on
this policy, the following provisions apply:
A. Changes ln Llabilig Coverage
The following is added to the Who ls An ln-
sured Provlsion in the LlABlLlTy
COVERAGE SECTION:
An "employee" of yours is an "insured,, while
operating an "auto" hired or rented under acontract or agreement in that ,employee's"
AC 01 02WA 0310
ACP BApD30{.7050259 LTJE
lncludes copyrighted material ol lnsurance Services Otfice, lnc., with its permission Page 3 of 4
75 0023684
15135 ll,lSURED COpY AC{102031000 0001
AC 01 02WA,03 10
name, with your permisslon, while per-
forming duties related to the conduct of
your business.
B, Changes ln General Conditions
Paragraph 5.b. of the Other lnsurance
Condition and Paragraph 5.f. of the
Other lnsurance Condition in the Motor
Carrier Coverage Form is replaced by the
following:
For Hired Auto Physical Damage Covar-
age, the following are deemed to be cov-
ered'autos'you own:
1. Any covered "auto" you lease, hire,
rent or borrow; and
2, . Any covered "auto" hired or rented by
your "employee" under a contract in
that individual "employee's' name,
witlr your permission, while perform-
ing duties related to the conduct of
your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
M. EMERGENCY LOCKOUT. PRIVATE
PASSENGER VEHICLES
We will reimburse you up to $50 for reasonable
expense incurred for the services of a locksmitlr
to gain entry irfto your covered 'aulo" of the pri-
vate passenger type subject to these provisions;
1. Your door'key or key entry pad has been
lost, stolen or locked in your covered 'auto"
and you are unable to enter such *auto", or
2, , Your key or key ontry pad has been lost or
stolen and you have changed the lock to
prev6nt an unauthorized enlry;and
3. Original copies of receipts for seryices of a
locksmith must be provided belore reim-
bursemenlis payable.
N, LIBERALIZATION
Phragraph 3.of the Other lnsurance Condition in
tha Business Auto Coverage Form is replaced by
the following: lf we adopt any revision thatwould
broaden the coverage under this policy without
additional premium within 60 days prior to or dur-
ing the policy period, the broadenedcoverage will
immediately apply to this policy.
Atl terms and conditions of this policy apply unless modified by this endorsemenl.
Page 4 of 4 lncludes copyrighted material ol lnsurance Servioes Olfice, lnc., with ils permission AC 01 02WA 03 10
Acp gnpoooo-7oso2so LTJE 15135 INSURED COPY AG:0102031000 0@1 75 0023685
Policy # G1DO3007050259
COMMERCIAL GENEFAL LIAtsILITY
cG 73 23 11 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
LOST KEY COVERAGE
SECTION I - COVERAGES, COVERAGE A
BODILY INJUBY AND PROPERTY DAMAGE
LIABILITY, coverage is extended to include the
following:
lf a customer's master or grand key, excluding
electronic key card, is lost while in your care,
custody or control we will pay the cost of
replacing the keys, including the masler lock andall keys used in the same lock, the cost of
adjusting locks to accept the new keys, or the
cost to replace the locks, whichever is less.
Limit of lnsurance - The most we will pay for
"loss" arising out of any one "occurrence" is
$5,000.
SECTION V DEFINIT|ONS is amended as
follows:
The following definition applies to Lost Key
Coverage:
"Loss" means unintentional physical damage or
destruction to tangible property, including theft or
disappearance. Tangibte property dbes not
include money or securities.
VOLUNTARY PROPERTY DAMAGE
SECTION I _ COVERAGES, COVERAGE A
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, coverage is extended to include the
{ollowing:
At your request, we will pay for "property damage" to
property of others caused by you and while in your
possession, arising out of your business operalions
and occurring during the policy period.
Limit of lnsurance - The most we will pay for
"loss" arising out of any one "occurrence',ls
$500.
SECTION V - DEFINtTtONS is amended as
follows:
The following definition applies to Voluntary
Property Damage coverage:
"Loss" means unintentional damage or
destruction but does not include disappearance,
theft, or loss of use.
NON.OWNED WATERCHAFT
SECTION I * COVERAGES, COVERAGE A
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions is amended as lollows:
S. Aircraft, Auto Or Watercratt (2) (a) is
replaced with:
(a) Less than 51 feet long; and
EXPANDED PROPERTY DAMAGE COV.
ERAGE
For the purposes of this endorsement only:
SECTION I * COVERAGES, COVERAGE A
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, 2. Exclusions is amended as follows:
a. Exclusions j.(3), j.(S), and j.(6) are
deleted in their entirety.
b. Exclusion j.(4) is deteted in its entirety
and replaced by the following:
Personal property in the care custody or
control of the insured:
1. lor storage or sale at premises you
own, rent or occupy; or
2. while being transported by any
aircra{t, "auto" or watercraft owned
or operated by or rented to or loaned
to any insured.
c. The following exclusions are added;
1. The coverage provided by this
endorsement does not apply to
"property damage" arising out of the
disappearance or loss of use of
personal property.
2. The coverage provided by this
endorsement does noi apply to
"property damage" included in the"products-completed operations
hazard".
cG 73 23 11 11 lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
Page 1 of 6
cG 73 2311 1'l
Limit of lnsurance - The most we will pay
lor "property damage" provided by this
coverage in any one "occurrence" is $5,000.
Deductible - Our obligation to pay for a
covered loss applies only to the amount of
loss in excess of $250.
This insurance is excess over any other valid
and collectible insurance.
DAMAGE TO PREMISES RENTED TO YOU
SECTION I * COVERAGES, COVERAGE A
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, the last paragraph of 2. Exclusions
of is replaced by the following:
lf Damage to Premises Rented to You is
not otherwise excluded, exclusions c.
through n. do not apply to damage by fire,
lightning, explosion, smoke or sprinkler
leakage to premises while rented to you or
temporarily occupied by you with permission
of the owner. A separate limit of insurance
applies to this coverage as described in
Section lll-Limits of lnsurance.
SECTION III LIMITS OF INSURANCE,
paragraph 6 is replaced with:
6. Subject to 5. above, the Damage To
Premises Rented To You Limit is the most
we will pay under Coverage A for damages
because of "property damage" to any one
premises, while rented to you, or in the case
of damage by fire, lightning, explosion,
smoke or sprinkler leakage, while rented to
you or temporarily occupied by you with
permission of the owner. The limit is
increased to $300,000.
SECTION IV COMMERCIAL GENERAL
LIABILITY CONDITIONS, 4. Other lnsurance,
b. Excess lnsurance (1) (a) (ii) is replaced
with:
(ii) That is Fire, Lightning, Explosion,
Smoke or Sprinkler leakage insurance
for premises rented to you or temporarily
occupied by you with permission of the
owner.
SUPPLEMENTARY PAYMENTS
SECTION I - COVERAGES, SUPPLEMEN-
TARY PAYMENTS - COVERAGES A AND B is
amended as follows:
1. 1. b. replaced with:
b. Up to $2,500 for cost of bail bonds
required because of accidents or tralfic
law violations arising out of the use of
any vehicle to which the Bodily lnjury
Liability Coverage applies. We do not
have to furnish these bonds.
2. 1. d. replaced with:
d. All reasonable expenses incurred by ihe
insured at our request to assist us in the
investigation or defense of the claim or
"suit", including actual loss of earnings
up to $500 a day because of time off
from work.
NEWLV FORMED AND ACOUIRED
ORGANIZATIONS
SECTION II - WHO IS AN INSURED iS
amended as follows:
1. 3. a. is replaced with:
a, Coverage under this provision is
afforded only until the 180tn day after you
acquire or form the organization or tho
end of the policy period, whichever is
earlier;
ADDITIONAL INSURED - WHEN REQUIRED
IN AN AGREEMENT OR CONTRACT WITH
YOU PRIMARY AND NON-CONTRIBUTORY
The following is added to SECTION ll- WHO lS
AN INSURED
4. Any person(s) or organization(s) with whom
you have agreed in a valid written contract or
written agreement that such person or
organization be added as an additional
insured on your policy during the policy
period shown in the Declarations. Such
person or organization is an additional
insured only with respect to liability for
"bodily injury", "property damage" or
"personal and advertising injury".
The person or organization added as an
insured by this endorsement is an insured
only to the extent you are held liable due to:
a, Lessors of Leased Equipment
Maintenance, operation or use of
equipment leased to you by such person
or organization. This insurance does not
apply to any "occurrence" which takes
place alter the equipment lease expires.
However, their status as additional
insured under this policy ends when their
lease, contract or agreement with you
lor such leased equipment expires.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
Page 2 of 6 cG 73 23 11 11
b. Managers or Lessors of premises
The ownership, maintenance or use of
that part of the premises you own, rent,
lease or occupy.
This insurance does not apply to:
(1) Any "occurrence" which takes place
after you cease to be a tenant in that
premises.
(2) Structural alterations, new con-
struction or demolition operations
performed by or on behalf of the
person or organization.
However, their status as additional
insured under this policy ends when you
cease to be a tenant of such premises.
c. State or Political Subdivision
Permits
Operations performed by you or on your
behalf 1or which the state or political
subdivision has issued a permit.
This insurance does not apply to:
(1) "Bodily injury" or "property damage"or "personal or advertising injury"
arising out of operations performed
for the slate or municipality; or
(2) "Bodily injury" or "property damage,'
included within the ,,products-
completed operations hazard".
However, such state or political
subdivision's status as additional insured
under this policy ends when the permit
ends.
d. Owners, Lessees, or Contractors
"Bodily injury", "property damage,' or
"personal and advertising injury" caused, in
whole or in part, by:
(1) Your acls or omissions; or
(2) The acts or omissions of those acting on
your behalf ;in the perlormance of your ongoing
operations performed for that additional
insured, whether the work is performed by
you or on your behalf.
cG 73 23 11 11
The insurance does not apply to:
(1) "bodily injury", "property damage", or
"personal and advertising injury" arising
out of the rendering of or the lailure to
render any professional architectural,
engineering or survey services,
including:
(a). The preparing, approving, or failing
to prepare or approve maps, shop
drawings, opinions, reports, survey,field orders, change orders or
drawings and specifications: or
(b) Supervisory, inspection, architec-
tural or engineering activities.
(2) "Bodily injury" or "property damage',
occurring after:
(a) All work, including materials, partsor equipment lurnished in
connection with such work, on theproject (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
(b) 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 otherthan another contractor orsubcontractor engaged in
performing operations for a principal
as a part ol the same project.
However, a person or organization's
status as additional insured under this
policy ends when your operations for
that additional insured are completed.
With respect to paragraph 4 of SECTTON il
WHO lS AN INSURED, Condition 4. Other
lnsurance of Section lV Commercial
General Liabillty Conditions is replaced by the
following:
4. Other lnsurance
lf other valid and collectible insurance is
available to the insured for a loss we cover
under Coverages A or B of this Coverage
Part, our obligations are limited as follows:-
a. Primary lnsurance
This insurance is primary if you have
agreed in a written contract or written
agreement:
lncludes copyrighted matedal of Insurance Services Office, lnc.,
with its permission.
cG 73 2s 11 11 Page 3 of 6
cG 73 23 11 11
(1) That this insurance be primary. lf
other insurance is also primary, wewill share with all that other
insurance as described in c. below;
or
(2) The coverage afforded by this
insurance is primary and non-
contributory with the additional
insured's own insurance.
Paragraphs (1) and (2) do not apply
to other insurance to which the
additional insured has been added
as an additional insured or to other
insurance described in paragraph b.
below.
b. Excess lnsurance
This insurance is excess over:
(1) Any o{ the other insurance, whether
primary, excess, contingent or on
any other basis:
(a) That is Fire, Extended
Coverage, Builder's Risk,
lnstallation Risk or similar
coverage for "your work";
(b) That is lire, lightning, or
explosion insurance for
premises rented to you or
temporarily occupied by you with
permission ol the owner;
(c) That is insurance purchased by
you to cover your liabilily as a
tenant for "property damage" to
premises rented to you or
temporarily occupied by you with
permission of the owner; or
(d) lf the loss arises out of the
mainlenance or use of aircraft,
"autos" or watercralt to the
extent not subject to Exclusion
g. of Section I - Coverage A -Bodily lnjury And Property
Damage Liability.
(e) That is any other insurance
available to an additional
insured under this endorsement
covering liability arising out of
the premises or operations, or
products completed operations,
for which the additional insured
has been added as an additional
insured by that other insurance.
(2) When this insurance is excess, we
will have no duty under Coverages A
or B to defend the additional insured
against any "suit" if any other insurer
has a duty to defend the additional
insured against that "suit", lf no
other insurer defends, we will
undertake to do so, but we will be
entitled to the additional insured's
rights against all those other
insurers.
(3) When this insurance is excess over
other insurance, we will pay only our
share of the amount of the loss, if
any, that exceeds the sum of:
(a) The total amount thai all such' other insurance would pay lor
the loss in the absence of this
insurance; and
(b) The total of all deductible and
self-insured amounls under all
that other insurance.
(4) We will share the remaining loss, if
any, with any olher insurance that is
not described in this Excess
lnsurance provision and was not
bought specifically to apPlY in
excess of the Limits of lnsurance
shown in the Declarations of this
Coverage Part.
c. Method Of Sharing
lf all of the other insurance available to
the additional insured permits
contribution by equal shares, we will
follow this method also. Under this
approach each insurer contributes equal
amounts until it has paid its applicable
limit of insurance or none ol the loss
remains, whichever comes lirst.
lf any of the other insurance available to
the additional insured does not permit
contribution by equal shares, we will
contribute by limits. Under this method,
each insurer's share is based on the
ratio of its applicable limit of insurance to
the total applicable limits of insurance of
all insurers.
lncludes copyrighted material of lnsurance Services Office, lnc',
with its permission,
Page 4 of 6 cG 7323 11 11
EI\NPLOYEE BODILY INJURY TO ANOTHER
EMPLOYEE
SECTION II _ WHO IS AN INSURED The
{ollowing Paragraph is added io 2.a.(1)
Paragraphs 2.a.(1)(a), (b) and (c) do not
apply to "bodily injury" to a co-,,employee,'inthe course of the co-,,employee's"
employment by you, or to "bodily injury,'to a
co-"volunteer worker" while performing
duties related to the conduct of your
business.
BROAD FOHM NAMED INSURED
SECTION ll * WHO lS AN INSURED The
{ollowing Paragraph is added to 2.
e. Any business entity incorporated or
organized under the laws of the United State
of America (including any State thereof), its
lerritories or possessions or Canada
(including any Province thereof) in which the
Named lnsured shown in the Declarations
owns, during the policy period, an interest of
more than fifty percent. lf other valid
collectible insurance is available to any
business entity covered by this solely by
reason of ownership by the Named lnsured
shown in the Declarations in excess of fifty
percent, this insurance is excess over the
other insurance, whether primary, excess,
contingenl, or on any other basis.
AGGREGATE LIMIT PEF LOCATION
SECTION lll - LIMITS OF TNSURANCE The
following paragraph is added to paragraph 2:
The General Aggregate Limit under Sectionlll Limits of lnsurance applies separately to
each of your locations owned by or rented to
you or temporarily occupied by you with the
permission of the owner. For the purposes ofthis provision, location means premises
involving the same or connecting lots, or
premises whose connection is interrupted
only by a public street, roadway, waterway or
railroad right-otway.
AGGREGATE LIMIT PER PROJECT
SECTION lll - LIMITS OF TNSURANCE The
following paragraph is added to paragraph 2:
The General Aggregate Limit under Section
, lll Limits of lnsurance applies separately to
each of your construction projects away from
premises owned by or rented to you.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
cG 73 23 11 11
MEDICAL PAYMENTS
SECTION III LIMITS OF INSURANCE,
Paragraph 7. is replaced:
7. Subject to 5. above, the higher of:
a. $'10,000; or
b. The amount shown in the Declarations
for Medical Expense Limit is the most
we will pay under Coverage C {or all
medical expenses because of "bodily
injury" sustained by one person.
This coverage does not apply if Coverage C -Medical Payments is excluded either by the
provisions of any coverage forms attached to the
policy or by endorsement.
KNOWLEDGE OF AN OCCURRENCE
SECTION IV COMMERCIAL GENERAL
LIABILITY CONDITIONS, The fotlowing is added
to 2. Duties ln The Event Of Occurrence,
Offense, Claim Or Suit condition:
e. Knowledge of an occurrence, offense, claim
or suit by an agent or employee of anyinsured shall not in itself constitule
knowledge of the insured unless you, a
partner, if you are a partnership; or an
executive officer or insurance manager, if
you are a corporation receives such notice of
an occurrence, offense, claim or suit from
the agent or employee.
f. The requirements in Section lV
Conditions Paragraph 2.b. will not be
considered breached unless there is
knowledge of occurrence as outlined in
paragraph e, above.
UNINTENTIONAL FAILURE TO DISCLOSE
HAZARD
SECTION IV COMMERCIAL GENERAL
LIABILITY CONDITIONS, 6. Representations is
amended to include:
d, Your failure to disclose all hazards or prior
"occurrences" or offenses existing as of the
inception date of the policy shall not
prejudice the coverage afforded by this
policy provided such failure to disclose all
haeards or prior "occurrences" or offenses is
not intentional. This provision does not
affect our right to collect additional premium
or exercise our right of cancellation or non-
renewal.
cG 73 23 11 '11 Page 5 of 6
cG732311 11
WAIVER OF SUBROGATION
SECTION IV COMMERCIAL GENERAL
LIABILITY CONDITIONS, 8. Transfer of Rights
of Recovery Against Others to Us is amended
to include:
lf required by a written contract executed
prior to loss, we waive any right ol
subrogation we may have against the
contracting person or organization because
of payments we make lor injury or damage
arising out of your ongoing operations or
"your work" done under a contract with that
person or organization and included in the
"products-completed operations hazards".
I.IBERALIZATION
SECTION IV COMMERCIAL GENERAL
LIABILITY CONDITIONS, 10. Liberalization is
added as follows:
lf we revise this coverage form to provide more
coverage without additional premium charge,
your policy will automatically provide the
additional coverage as of the day the revision is
effective in your state.
BROADENED BODILY INJURY DEFINITION
(MENTAL ANcU|SH)
SECTION V * DEFINITIONS is amended as
follows:
1. 3. "Bodily injury" is deleted and replaced with
the following:
"Bodily injury" means physical injury,
sickness or disease to a person and, if
arising out of the foregoing, mental anguish,
mental injury, shock or humiliation, including
death at any time resulting therefrom.
All terms and conditions of lhis policy apply unless modified by this endorsement.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
Page 6 of 6 cG 73 23 11 11
Proj
Page I of4
State of Washington
Department of Labor & lndustries
Prevaiting Wage Section - Tetephone 360-902'5335
PO Box 44540, Otympia, WA 98504-4540
Statement of lntent to Pay Prevailing Wage
Pro ect
ect Detail - Dashboard
Affidavit lD: Status: APProved
On 8/24/2017
Document
Received Date:
8/24/2017
lntent
ID:
858414
Company Details
Company Name:
Address:
Contractor Registration No.
WA UBI Number
Phone Number
lndustrial lnsurance Account lD
EmaiI Address
Fited By
Prime Contractor
Company Name
EVERGREEN ASPHALT & CNCRT
rNc
P O BOX 1567
KENT, WA, 98035
EVERGAC974K2
602244570
253-639-3779
14227600
eve rgreen . shane@comcast. net
Gitbertson, Shane
EVERGREEN ASPHALT &
CNCRT INC
http s : //fortre s s . w a. gov I lni/w age I o okup/IntentD etai I s . aspx 8l2sl20l7
Contractor Registration No.
WA UBI Number
Phone Number
Project lnformation
Awarding Agency
Awarding Agency Contact
Awarding Agency Contact Phone
N um ber
Contract Number
Project Name
Contract Amount
Bid due date
Award Date
Project Site Address or Directions
Payment Details
Check Number:
Transaction ld:
I nte nt Details
Expected project start date: (MM-
DD-YYYY)
ln what county (or counties) witt
the work be performed?
ln what city (or nearest city) witt
the work be performed?
Page 2 of 4
EVERGAC974K2
602244570
2s3-639-3779
KENT, CITY OF
220 . 4TH AVE S KENT, WA -
98032 - s89 s
Nate Harper
253-856- 5000
6537
Riverbend Gotf Course
536,489.20
5/12/2017
8/10/2017
1 0s908835
9 /12/2017
Kent
King
536,489.20
http s : //fortre s s . wa . gov I lnilwag e I o okup/IntentD etai I s . aspx Bl25t20r7
What is the estimated contract
amount? OR is this a time and
materiats estimate?
Witt this project utitize American No
Recovery and Reinvestment Act
(ARRA) funds?
Specifically, witt this project utitize No
any weatherization or energy
efficiency upgrade funds (ARRA or
otherwise)?
Does your company intend to hire No
ANY subcontractors?
Does your company intend to hire No
subcontractors to perform ALL
work?
Witt your company have emptoyees Yes
perform work on this Project?
Do you intend to use anY No
apprentices? (Apprentices are
considered employees. )
How many owner/oPerators 2
performing work on the Project
own 30% or more of the comPanY?
Journey Level Wages
Page 3 of 4
#
WorkersCountyTradeOccupationWageFringe
544.85 So.oo 6KingTraffic Control Stripers Journey Level
Public Notes
n Show/ide Existin otes
https ://fortress.wa .gov llnilwagelookup/IntentDetails. aspx 8l2sl20r7
KENT
EVERCREEN ASPT'IALT & CONCRF)]'E INC]
PO BOX 1567
KENT, WA 9f1035
City of Kent
Business License
Pleuse tear at perJbration
!V^f,frlNot0{
I(ENT
RUSINESS I,ICENSE
LICENSE MUST BE PAID ANNUNI,LY BY
JANUAIIY lst'I'O AVOID PIINAL,TY
Issunncc of Liccnsc l)ocl Not lmply Licensee's
Compliunce with St[te nnd l,ocrtl Lnrvs
Per R0W ll2, I4 local sales
aud usc trtx must be coded
No, l7l5 ftrr all qualified
sale:s rvithin the city of
Ke nt,
WAB!ttriolor
'I'HIS LICENSE iYIUST DB POSTED IN A CONSPICUOUS
I'LACE. NO'T'I'RANSFI'ITAtsLD OR ASSIGNABI,[
Year i 2017
NAIVII AND ADDITESS OF BUSINESS
Br,oc:-2140738
IJV]]ROIiERN ASPLIAI-T' & C]ONCREl-E INC
r 8744 Sll 282ND S1'
I(HNT, WA 9f1042
MAYOR
The City of l(ent
Ar ;20 4 l'll Avli -c(J
KliNl'. tY^Silll.l01 0N t80l2
REQUEST FOR MAYOR'S STGNATURE
o\^\
\4
KENT Print on Cherry-Cr:lored Paper
Routing Information:
(ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
Approved by
Be Routed Through The Law Department
Shaded Areas To Be ComPleted BY A Staff
WAsHrtsaroN
CITYOF KENT
CITY CLERK
I
Phone (Originator):X5082 VOriginator: Nate Harper
Date Required: 997 LL/ L7Date Sent: Og/06/t7
Contract Termination Date, II/ L0/t7Return Signed Document to: 51Un.y Clafy
Date Finance Notified:
(Only required on contracts
S2o-o00 and over or on anv Grant)0B/2e/17VENDOR NAME:
Evergreen Asphalt & Concrete, lnc
Date Risk Manager Notified tOB/OB/L7
(Reouired on Non-Citv Standard Contracts/Aqreements)
DATE OF COUNCILAPPROVAL' N/A
Account Number: F00508 .64850 .g47 gHas this Document been S
Authorized in the Budqet?NO
Brief Explanation of Document:
Evergreen Asphalt & Concrete, Inc, shall provide all labor and materials to clean, repair,
sealcoat and restripe the parking lot at the Riverbend 1B Hole Golf Course, This project
will be paid for out of the Facilities Capital Fund.
f{fi! | zon (rh is area to be completed the
Received:
Approval of Law Dept,:
Law Deptr-fprmr entfl r e r
hent)
f
\tl 7ft t)
A Fbr*o *-DateT6hffii5d tott{5vul{lJl-l I 'I I dte..-
Received:
,'tr I I. ?at/
Recommendations and comments: S\ttr$eD BY twqv D\,' - . OUt":"Jr?j5*t
{gn-*^1 ft,rr-o<'r> rv CfF,lL{<-': 04{t t+ --'
rr"tj lWay}r
D'SEOSHHCEIVED \l,zlrt
Date Returoed:
3FP l2 lrrt