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HomeMy WebLinkAboutCAG2022-377 - Original - Utilities Service Co., Inc. - 212th Treatment Plant Backwash Recycle Pump Inspection - 09/14/2022ApprovalOriginator:Department: Date Sent:Date Required: Authorized to Sign: Director or Designee Date of Council Approval: Grant? Yes No Type:Review/Signatures/RoutingComments: Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Basis for Selection of Contractor: Termination Date: Local Business? Yes No* Business License Verification: Yes In-Process Exempt (KCC 5.01.045) If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Notice required prior to disclosure? Yes No Contract Number: Agreement Routing Form For Approvals, Signatures and Records Management This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms. Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20 Budget Account Number: Budget? Yes No Dir Asst: Sup/Mgr: Dir/Dep: rev. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY (Optional) * Memo to Mayor must be attached GOODS & SERVICES AGREEMENT - 1 ($20,000 or Less, incl. WSST) GOODS & SERVICES AGREEMENT between the City of Kent and Utilities Service Co., Inc. THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Utilities Service Co., Inc. organized under the laws of the State of Washington, located and doing business at 12608 E. Marginal Way South, Seattle, WA 98168, Phone: (206) 246-5674, Contact: AJ Whaley (hereinafter the "Vendor"). AGREEMENT I. DESCRIPTION OF WORK. The Vendor shall provide the following goods and materials and/or perform the following services for the City: The Vendor shall provide labor and equipment to remove backwash recycle pump for inspection to determine what repairs are needed. For a Scope of Work and Vendor's quote, see Exhibit A which is attached and incorporated by this reference. The Vendor acknowledges and understands that it is not the City’s exclusive provider of these goods, materials, or services and that the City maintains its unqualified right to obtain these goods, materials, and services through other sources. II. TIME OF COMPLETION. Upon the effective date of this Agreement, the Vendor shall complete the work and provide all goods, materials, and services by December 31, 2022. III. COMPENSATION. The City shall pay the Vendor an amount not to exceed Four Thousand, Two Hundred Ninety Three Dollars and Ninety Cents ($4,293.90), including applicable Washington State Sales Tax, for the goods, materials, and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: Vendor shall be paid after execution of agreement and submittal of invoice. Card Payment Program. The Vendor may elect to participate in automated credit card payments provided for by the City and its financial institution. This Program is provided as an alternative to payment GOODS & SERVICES AGREEMENT - 2 ($20,000 or Less, including WSST) by check and is available for the convenience of the Vendor. If the Vendor voluntarily participates in this Program, the Vendor will be solely responsible for any fees imposed by financial institutions or credit card companies. The Vendor shall not charge those fees back to the City. If the City objects to all or any portion of an invoice, it shall notify the Vendor and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. A. Defective or Unauthorized Work. The City reserves its right to withhold payment from the Vendor for any defective or unauthorized goods, materials or services. If the Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services from other sources, and the Vendor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Agreement price specified above. The City further reserves its right to deduct these additional costs incurred to complete this Agreement with other sources, from any and all amounts due or to become due the Vendor. B. Final Payment: Waiver of Claims. VENDOR’S ACCEPTANCE OF FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Vendor has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Vendor maintains and pays for its own place of business from which the Vendor’s services under this Agreement will be performed. C. The Vendor has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained the Vendor’s services, or the Vendor is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Vendor is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Vendor has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by the Vendor’s business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Vendor maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. VI. CHANGES. The City may issue a written amendment for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines, for any reason, that an amendment is necessary, the Vendor must submit a written amendment request to the GOODS & SERVICES AGREEMENT - 3 ($20,000 or Less, including WSST) person listed in the notice provision section of this Agreement, Section XV(D), within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Vendor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the amended work upon receiving either a written amendment from the City or an oral order from the City before actually receiving the written amendment. If the Vendor fails to require an amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the adjustment as provided in subsections A through E of Section VIII, Claims, below. The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. An amendment that is accepted by the Vendor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. VII. FORCE MAJEURE. Neither party shall be liable to the other for breach due to delay or failure in performance resulting from acts of God, acts of war or of the public enemy, riots, pandemic, fire, flood, or other natural disaster or acts of government (“force majeure event”). Performance that is prevented or delayed due to a force majeure event shall not result in liability to the delayed party. Both parties represent to the other that at the time of signing this Agreement, they are able to perform as required and their performance will not be prevented, hindered, or delayed by the current COVID-19 pandemic, any existing state or national declarations of emergency, or any current social distancing restrictions or personal protective equipment requirements that may be required under federal, state, or local law in response to the current pandemic. If any future performance is prevented or delayed by a force majeure event, the party whose performance is prevented or delayed shall promptly notify the other party of the existence and nature of the force majeure event causing the prevention or delay in performance. Any excuse from liability shall be effective only to the extent and duration of the force majeure event causing the prevention or delay in performance and, provided, that the party prevented or delayed has not caused such event to occur and continues to use diligent, good faith efforts to avoid the effects of such event and to perform the obligation. Notwithstanding other provisions of this section, the Vendor shall not be entitled to, and the City shall not be liable for, the payment of any part of the contract price during a force majeure event, or any costs, losses, expenses, damages, or delay costs incurred by the Vendor due to a force majeure event. Performance that is more costly due to a force majeure event is not included within the scope of this Force Majeure provision. If a force majeure event occurs, the City may direct the Vendor to restart any work or performance that may have ceased, to change the work, or to take other action to secure the work or the project site during the force majeure event. The cost to restart, change, or secure the work or project site arising from a direction by the City under this clause will be dealt with as a change order, except to the extent that the loss or damage has been caused or exacerbated by the failure of the Vendor to fulfill its obligations under this Agreement. Except as expressly contemplated by this section, all other costs will be borne by the Vendor. VIII. CLAIMS. If the Vendor disagrees with anything required by an amendment, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Vendor may file a claim as provided in this section. The Vendor shall give written notice to the City of all claims within fourteen (14) calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts or events giving rise to the claim, whichever occurs first. Any claim for damages, additional payment for any reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively deemed GOODS & SERVICES AGREEMENT - 4 ($20,000 or Less, including WSST) to have been waived by the Vendor unless a timely written claim is made in strict accordance with the applicable provisions of this Agreement. At a minimum, a Vendor's written claim shall include the information set forth in subsections A, items 1 through 5 below. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. A. Notice of Claim. Provide a signed written notice of claim that provides the following information: 1. The date of the Vendor's claim; 2. The nature and circumstances that caused the claim; 3. The provisions in this Agreement that support the claim; 4. The estimated dollar cost, if any, of the claimed work and how that estimate was determined; and 5. An analysis of the progress schedule showing the schedule change or disruption if the Vendor is asserting a schedule change or disruption. B. Records. The Vendor shall keep complete records of extra costs and time incurred as a result of the asserted events giving rise to the claim. The City shall have access to any of the Vendor's records needed for evaluating the protest. The City will evaluate all claims, provided the procedures in this section are followed. If the City determines that a claim is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. C. Vendor's Duty to Complete Protested Work. In spite of any claim, the Vendor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. D. Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Vendor also waives any additional entitlement and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section, the Vendor completely waives any claims for protested work and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). IX. LIMITATION OF ACTIONS. VENDOR MUST, IN ANY EVENT, FILE ANY LAWSUIT ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATE THE CONTRACT WORK IS COMPLETE OR VENDOR’S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. X. WARRANTY. The Vendor warrants that it will faithfully and satisfactorily perform all work provided under this Agreement in accordance with the provisions of this Agreement. In addition to any other warranty provided for at law or herein, this Agreement is additionally subject to all warranty provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington. The Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, and will perform in accordance with their specifications and the Vendor’s representations to City. The Vendor shall promptly correct all defects in workmanship and materials: (1) when the Vendor knows or should have known of the defect, or (2) upon the Vendor’s receipt of notification from the City of the existence or discovery of the defect. In the event any part of the goods are repaired, only original replacement parts shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for GOODS & SERVICES AGREEMENT - 5 ($20,000 or Less, including WSST) that portion of the work shall extend for an additional year beyond the original warranty period applicable to the overall work. The Vendor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. XI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. The Vendor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. XII. INDEMNIFICATION. The Vendor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Vendor's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of the Vendor's work when completed shall not be grounds to avoid any of these covenants of indemnification. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event the Vendor refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Vendor’s part, then the Vendor shall pay all the City’s costs for defense, including all reasonable expert witness fees and reasonable attorneys’ fees, plus the City’s legal costs and fees incurred because there was a wrongful refusal on the Vendor’s part. The provisions of this section shall survive the expiration or termination of this Agreement. XIII. INSURANCE. The Vendor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. XIV. WORK PERFORMED AT VENDOR'S RISK. The Vendor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at the Vendor's own risk, and the Vendor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XV. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. GOODS & SERVICES AGREEMENT - 6 ($20,000 or Less, including WSST) C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties’ performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section XII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and the Vendor. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Vendor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to the Vendor's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Vendor acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Vendor agrees to cooperate fully with the City in satisfying the City’s duties and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. All acts consistent with the authority of this Agreement and prior VENDOR: By: Print Name Its DATE ultzlu- CITY OF KENT: By Chad Bieren Disnailysisnd byCbd Bieten ONr C=US, E=cbieten@kenNa.gov, O=City of Kad. Ou=PublicWorb. CN=Chd Aieren D&:mz@.14 r3:11:407m Print Name: Its: DATE: Chad Bieren, P,E. Public Works Director to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. P;Udmln\contracls\Danl GOODS & SERVICES AGREEMENT. 7 ($20,000 or Less, including WSST) NOTICES TO BE SENT TO: VENDOR: AJ Whaley Utilities Servlce Co., Inc. 12608 East Marginal Way S Seattle, WA 98168 (206) 246-5674 (telephone) (206) 248-34 10 (facsimile) NOTICES TO BE SENT TO: CITY OF KENT: Chad Bieren, P,E. City of Kent 220 Fourth Avenue South Kent, WA 98032 (2s3) 856-5500 (telephone) (2s3) 856-6500 (facsimile) ATTEST: Kent Citv Clerk DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: --dL=A� For: il h It h e re Title: ���s i c[� ►� 7" Date: EEO COMPLIANCE DOCUMENTS - I of 3 EEO COMPLIANCE DOCUMENTS - 2 of 3 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City’s nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City’s equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 3 of 3 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: __________________________________________ For: _________________________________________ Title: ________________________________________ Date: ________________________________________ Scope of work:The City of Kent 2t?th Treatment Plant Backwash Recycle Pump is currently seizedand inoperable. The city requests that the pump be removed and inspected todetermine what is needed for repairs.Exhibit A Urrr,rrrns Snnvrcn Co., INC.12608 E MARGINAL WAY SSEATTLE, WA 98168PHONE: 206-246-5674FAX: 206-248-3410EMAIL: usci4@comcast.netDate:81812022Attn: DustinRe: City of KentWe are pleased to submit the following estimate for your consideration: Furnish laborand equipment to remove back wash recycle pump for inspection of repairsEstimate: $3900.00This estimate is good for 30 days and does not include taxes, permits, or shipping andhandling if needed. This job is bid as close to actual requirements as possible; however,due to the nature of this particular job, additional work may be needed for unforeseencircumstances. Customer will be notified when additional work is identified andestimated for approval. Additional work will be billed at our current labor rates andadditional materials at cost plus l5%.Thank you.Ed MolaEstimatorPlease indicate acceptance by completing the information requested below and faxing oremailing estimate back to us. Thank you.DateAccepted ByPO#Title EXHIBIT B INSURANCE REQUIREMENTS FOR SERVICE CONTRACTS Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Contractor shall obtain insurance of the types described below: 1. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The City shall be named as an insured under the Contractor’s Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 3. Workers’ Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: 1. Commercial General Liability insurance shall be written with limits no less than $2,000,000 each occurrence, $2,000,000 general aggregate and a $2,000,000 products-completed operations aggregate limit. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $2,000,000 per accident. EXHIBIT B (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Contractor’s insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor’s insurance and shall not contribute with it. 2. The Contractor’s insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor’s Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer’s liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Contractor. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/9/2022 (425) 409-4417 36838 Utilities Service Company, Inc. 12608 E Marginal Way S Tukwila, WA 98168 24620 15580 A 1,000,000 X X MP0004016006845 10/30/2021 10/30/2022 1,000,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000B 042294030 10/30/2021 10/30/2022 3,000,000C X X CXS0014182 10/30/2021 10/30/2022 3,000,000 Certificate holder is listed as additional insured per policy endorsement forms. Waiver of subrogation applies per policy endorsement forms. Insurance is primary and non-contributory per policy endorsement forms. City of Kent 220 Fourth Ave S Kent, WA 98032 UTILSER-01 AWRIGHT HR Benefits, Inc. 1595 NW Gilman Blvd, Ste 6B Issaquah, WA 98027 Ashlee Wright awright@washingtontechnology.org Mesa Underwriters Specialty Insurance Co Progressive Casualty Insurance Co Scottsdale Ind Co X X X X X X X X X Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS LIABILITY BUNDLE GOLD This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Summary of Coverages Provided by This Endorsement: Blanket Additional Insureds – As Required by Contract with Completed Operations Page 5 Blanket Waiver of Transfer of Rights of Recovery Page 7 Construction Per Project General Aggregate Limit - $5,000,000 Page 4 Contractual Liability (Railroads)Page 8 Contractual Liability Amendment (Personal and Advertising Injury)Page 5 Damage to Premises Rented to You - $1,000,000 Page 6 Liberalization Clause Page 7 Lost Key Coverage - $10,000 sublimit Page 3 Primary and Non-Contributory Provision Page 7 Property Damage – Care, Custody, or Control - $100,000 sublimit Page 3 Short-Term Pollution Event – Limited Coverage - $50,000 Page 2 Waiver of Governmental Immunity Page 8 Page 1 of 8 Insured Copy Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 SHORT TERM POLLUTION EVENT – LIMITED COVERAGE Paragraph 2. Exclusions f. Pollution of SECTION I - COVERAGES – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, does not apply to “bodily injury” or “property damage” due to an “occurrence” arising out of a “short-term pollution event” if the operations meet all standards of any statute, ordinance, regulation or license requirement of any federal, state or local government which apply to those operations. Subject to SECTION III – LIMITS OF INSURANCE, the most we will pay under Coverage A for “bodily injury” or “property damage” due to an “occurrence” arising out of a “short-term pollution event” is a sublimit of $50,000. This limit is included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. The following is added to SECTION V - DEFINTIONS: A. "Short-term pollution event" means a discharge, dispersal, release or escape of "pollutants" which: 1. Begins during the policy period; 2. Begins at an identified time and place; 3. Ends, in its entirety, at an identified time within forty-eight (48) hours of the beginning of the discharge, dispersal, release or escape of the "pollutants"; 4. Is not a repeat or resumption of a previous discharge, dispersal, release or escape of the same pollutant from essentially the same source within twelve (12) months of a previous discharge, dispersal, release or escape; 5. Does not originate from an "underground storage tank"; and 6. Is not heat, smoke or fumes from a "hostile fire.” To be a "short-term pollution event", the discharge, dispersal, release or escape of "pollutants" need not be continuous. However, if the discharge, dispersal, release or escape is not continuous, then all discharges, dispersals, releases or escapes of the same "pollutants" from essentially the same source, considered together, must satisfy Provisions 1. through 6. of this definition to be considered a "short-term pollution event.” B. "Underground storage tank" means any storage tank, including any attached pumps, valves or piping, buried below the surface of the ground or water, or which, at any time, had been buried under the surface of the ground or water and then subsequently exposed by any means. For the purposes of this definition, buried means that at least 10% of it is below the surface of the ground or water. Page 2 of 8 Insured Copy Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 LOST KEY COVERAGE The following is added to Paragraph 2. Exclusions j. Damage to Property (4) under SECTION I - COVERAGES COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY: We will pay up to $10,000 for each “occurrence” for the actual and necessary expense you incur to rekey or to adjust locks to accept new keys or, if required, new locks including cost of their installation at the customer’s premises as a result of direct physical loss of or damage to their keys entrusted to you, subject to the following: A. Such insurance as is afforded by this endorsement shall not apply to damages caused by misappropriation, conversion, secretion, infidelity or any act of dishonesty on the part of any Insured, its “employees” or agents; B. The total liability of the Company for all damages as the result of any one “occurrence” shall not exceed the limit of liability stated above; C. The Company’s obligation to pay damages on behalf of the Insured applies only to the amount of damages in excess of the deductible amount set forth in the policy. D. The Limit of Insurance for this coverage is based on each “occurrence” and is subject to a $25,000 aggregate limit. PROPERTY DAMAGE – CARE, CUSTODY, OR CONTROL The following is added to Paragraph 2. Exclusions j. Damage to Property under SECTION I – COVERAGES COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) do not apply for the limited purpose of providing the coverage and sublimits of liability as set forth below. We will pay those sums that the insured becomes legally obligated to pay as damages arising out of “property damage” to: A. Personal property in the care, custody or control of the insured; and B. That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the “property damage” arises out of those operations. The most we will pay under A. and B. above in any one “occurrence” or for all damages during any one policy period is a sublimit of $100,000. These limits are included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. Our right and duty to defend the insured against any “suit” for damages under A. and B. above ends when we have used up the applicable sublimit of liability in the payment of judgments or settlements under it. Page 3 of 8 Insured Copy Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 CONSTRUCTION PER PROJECT AGGREGATE A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under SECTION I – COVERAGES COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under SECTION I – COVERAGES - COVERAGE C – MEDICAL PAYMENTS, which can be attributed only to ongoing operations at a single construction project: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to a maximum of $5,000,000. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of “bodily injury” or “property damage” included in the “products completed operations hazard”, and for medical expenses under Coverage C, regardless of the number of: (a) Insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bringing “suits.” 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for any given construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under SECTION I – COVERAGES COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under SECTION I – COVERAGES - COVERAGE C – MEDICAL PAYMENTS, which cannot be attributed only to ongoing operations at a single construction project: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION III – LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. Page 4 of 8 Insured Copy Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 CONTRACTUAL LIABILITY AMENDMENT — (PERSONAL AND ADVERTISING INJURY) If it is required in a written contract, written agreement or written permit with the Named Insured that any contractual liability exclusion for “personal and advertising injury” be removed from the policy, then Paragraph 2. Exclusions e. Contractual Liability of SECTION I – COVERAGES - COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY is deleted in its entirety and replaced with the following: e. Contractual Liability “Personal and advertising Injury” for which the insured has assumed liability in a contract or agreement arising out of an “advertisement.” This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. BLANKET ADDITIONAL INSUREDS – AS REQUIRED BY CONTRACT Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization with whom you have agreed in a written contract, written agreement or written permit to add as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for “bodily injury” or “property damage” or, to the extent applicable under the Coverage Part to which this endorsement applies, “personal and advertising injury” caused, in whole or in part, by: A. Your ongoing operations, “your product,” or premises owned or used by you. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to “bodily injury”, “property damage” or, to the extent applicable under the Coverage Part to which this endorsement applies, “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong-doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or, to the extent applicable under the Coverage Part to which this endorsement applies, the offense which caused the “personal and advertising injury,” involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. B. Your maintenance, operation or use of equipment, other than aircraft, “auto” or watercraft, rented or leased to you by such person or organization. A person or organization’s status as an additional insured under this endorsement ends when their contract or agreement with you for such rented or leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any “occurrence” which takes place after the rental agreement or equipment lease expires. C. Your lease of premises from any person or organization, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you. This insurance does not apply to any “occurrence” which takes place after you cease to be a tenant of that premises. Page 5 of 8 Insured Copy Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 D. Your ownership, maintenance or use of your premises but only with respect to the liability of any person or organization as mortgagee, assignee or receiver. This insurance does not apply to any “occurrence” which takes place after the mortgage is satisfied, or the assignment or receivership ends. E. Your operations performed by you or on your behalf for any state or governmental agency or subdivision or political subdivision, but only with respect to that state or governmental agency or subdivision or political subdivision for which a permit or authorization has been issued. F. Your completed operations arising out of “your work.” Such person or organization is an additional insured only with respect to their liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard” when that contract, agreement, or permit requires the additional insured be added with respect to liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage", or "personal and advertising injury" caused by or arising out of work or operations performed by any “insured” or any contractor(s) or subcontractor(s) working directly or indirectly on behalf of any “insured” in connection with the new residential construction of the following: 1. Condominium or cooperative unit; 2. Town house; or 3. Single family house. New residential construction includes the conversion of an existing structure or structures to condominium or cooperative building(s) or complex(es), but does not include remodeling, repair or maintenance operations performed on any individual condominium, cooperative unit, town house, single family house or any other residential unit after it has been certified for occupancy or put to its intended use. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured, or the written permit issued, prior to the “bodily injury” or “property damage” or, to the extent applicable under the Coverage Part to which this endorsement applies, “personal and advertising injury.” DAMAGE TO PREMISES RENTED TO YOU The Limit of Insurance for Damage To Premises Rented To You referenced in Paragraph 6 of SECTION III is increased to $1,000,000. Page 6 of 8 Insured Copy Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 PRIMARY AND NON-CONTRIBUTORY PROVISION The following is added to Paragraph 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: With respect to any person or organization included as an additional insured under this policy, this insurance shall be excess over any other insurance that person or organization has and such other insurance shall be primary unless: A. The additional insured is a Named Insured under such other insurance; B. You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis; and C. The written contract or written agreement has been signed by the Named Insured, or written permit issued, prior to the “bodily injury” or “property damage” or, to the extent applicable under the Coverage Part to which this endorsement applies, “personal and advertising injury.” LIBERALIZATION The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If we revise this Coverage Part to provide more coverage without additional premium charge, subject to our company rules, your policy will automatically provide the additional coverage as of the day the revision is effective. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for “bodily injury” or “property damage” arising out of your ongoing operations or “your work” done under a written contract or written agreement and included in the “products-completed operations hazard,” if: A. You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement prior to loss; B. Such person or organization is an additional insured on your policy; and C. You have assumed the liability of that person or organization in that same contract, and it is an “insured contract”. The section above only applies to that person or organization identified above, and only if the “bodily injury” or “property damage” occurs subsequent to the execution of the written contract or written agreement. Page 7 of 8 Insured Copy CONTRACTUAL LIABILITY (RAILROADS) The following is added to Paragraph 9. “Insured Contract” of SECTION V – DEFINITIONS: Paragraph c. is deleted in its entirety and replaced with the following: c. Any easement or license agreement; Paragraph f. (1) is deleted in its entirety. WAIVER OF GOVERNMENTAL IMMUNITY We will waive, both in the adjustment of claims and in the defense of “suits” against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. Includes copyrighted material of Insurance Services Office, Inc., with its permission.MUS 01 01 20158 0321 All other terms and conditions of this policy remain unchanged. Page 8 of 8 Insured Copy COMMON POLICY DECLARATIONS Policy Number: New Renewal Rewrite Previous Policy Number: From ToPolicy Period: Named Insured: Tax State: Agent and Mailing Address:Agent Number: Business Description: Select Coverage Part (for which insurance is being afforded) Commercial General Liability Commercial Property Commercial Inland Marine Commercial Crime Garage TRIA Other (Describe) $ $ $ $ $ $ $ $ $ $ Total Other Charges Total Total Advance Premium Premiums Shown are payable at inception or as indicated on the individual Coverage Declarations. Form(s) and Endorsement(s), including edition dates, made a part of this policy at the time of issue:See Schedule of Forms By: Date Authorized Agent MUS 01 01 10002 1116 Mailing Address: MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY Surplus Lines Broker Name:Surplus Lines Broker Number: State Control Number (NJ & PA): Form of Business Individual Joint Venture Partnership Limited Liability Company Organization (other): Liquor Liability $ Owners & Contractors Protective $ Farm & Ranch $ A Stock Company 40 Wantage Avenue, Branchville, NJ 07890 Corporation DBA: Policy Taxes and Fees at 12:01 A.M. Standard Time at your mailing address shown below. MP0004016006845 XNo Flat Cancellation 10/30/2021 10/30/2022 Utilities Service Company, Inc. 12608 E Marginal Way S Tukwila WA 98168 04016 Amwins Access Insurance Services, LLC - Redondo Beach, CA 435 N Pacific Coast Hwy #200 Redondo Beach CA 90277 WA Amwins Access Ins Services, LLC 828344 X Insured is a machine/repair shop that fixes pumps used in trenches. X 4,650.00 Policy Fee $790.00 Amwins Inspection Fee $125.00 Surplus Lines Tax $111.30 Stamping Fee $5.57 4,650.00 1,031.87 5,681.87 11/03/2021 Insured Copy SCHEDULE OF FORMS AND ENDORSEMENTS Named Insured Policy Number Effective Date: MUS 01 01 10003 1013 MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY Utilities Service Company, Inc. MP0004016006845 10/30/2021 Forms Applicable - COMMON POLICY FORMS MUS 01 01 10001 0321 POLICY JACKET MUS 01 01 10002 1116 COMMON POLICY DECLARATION MUS 01 01 10003 1013 SCHEDULE OF FORMS & ENDORSEMENTS MUS 01 01 10007 1013 MINIMUM EARNED PREMIUM ENDORSEMENT MUS 01 01 10043 1013 PRIVACY NOTICE IL 00 17 11 98 COMMON POLICY CONDITIONS MUS 01 01 10041 1013 WA SERVICE OF SUIT ILN 142 06 06 WA FRAUD STATEMENT Forms Applicable - GENERAL LIABILITY MUS 01 01 20001 0417 GENERAL LIABILITY COVERAGE PART DECLARATIONS MUS 01 01 20004 0916 LIABILITY DEDUCTIBLE MUS 01 01 20058 0816 EXCL - LEAD CONTAMINATION MUS 01 01 20063 0919 EXCL - PUNITIVE DAMAGES MUS 01 01 20080 0816 EXCL - EARTH MOVEMENT MUS 01 01 20082 0816 EXCL - ASBESTOS MUS 01 01 20084 0816 NON-STACKING OF LIMITS ENDORSEMENT MUS 01 01 20094 0718 AMENDMENT OF CONDITIONS-PREMIUM AUDIT MUS 01 01 20109 1013 UNDERGROUND UTILITIES LIMITATION MUS 01 01 20112 1013 EXCL - OCCUPATIONAL DISEASE MUS 01 01 20125 0421 EXCL - INJURY TO EMPLOYEES, TEMPORARY WORKERS, CONTRACTORS, AND VOLUNTEERS MUS 01 01 20130 0920 NEW RESIDENTIAL CONSTRUCTION LIMITATION MUS 01 01 20139 0617 EXCL - INFRINGEMENT OF INTELLECTUAL PROPERTY MUS 01 01 20147 1019 CONTINUOUS INJURY OR DAMAGE LIMITATION ENDORSEMENT MUS 01 01 20158 0321 CONTRACTORS LIABILITY BUNDLE GOLD CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY COVG FORM CG 04 35 12 07 EMPLOYEE BENEFITS LIABILITY COVG CG 04 42 11 03 WA - STOP GAP - EMPLOYERS LIABILITY COVG ENDT CG 21 06 05 14 EXCL - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERS INFO AND DATA-RELATED LIAB. - W/LIM BODILY INJ CG 21 32 05 09 EXCL - COMMUNICABLE DISEASE CG 21 47 12 07 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG 21 55 09 99 EXCL - TOTAL POLLUTION EXCLUSION WITH A HOSTILE FIRE EXCEPTION CG 21 67 12 04 EXCL - FUNGI OR BACTERIA CG 21 96 03 05 EXCL - SILICA OR SILICA-RELATED DUST CG 24 26 04 13 AMENDMENT OF INSURED CONTRACT DEFINITION IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCL ENDT CG 21 73 01 15 EXCL OF CERTIFIED ACTS OF TERRORISM CG 01 81 05 08 WA CHANGES Insured Copy