HomeMy WebLinkAboutCAG2020-163 - Amendment - #3 - A&M Consulting - Signature Pointe Levee - 12/05/2023 FOR CITY OF KENT OFFICIAL USE ONLY
Sup/Mgr:
Agreement Routing Form DirAsst:
• For Approvals,Signatures and Records Management Dlr/Dep:
KE N T This form combines&replaces the Request for Mayor's Signature and Contract Cover (optional)
W ASH INGTGN Sheet forms.
Originator: Department:
Karin Bayes for Thomas Leyrer Public Works
Date Sent: Date Required:
c 12/05/2023 12/8/2023
Q Director or Designee to Sign. Date of Council Approval:
Q N/A
Budqet Account Number: Grant?:Yes:No
D20085
Budget?W]YesDNo Type: N/A
Vendor Name: Category:
A&M Consulting Contract
Vendor Number: Sub-Category:
Amendment
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Project Name: Signature Pointe Levee
E
Project Details: Extend the time of completion to December 31, 2025
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Agreement Amount: $0 Basis for Selection of Contractor: Other
*Memo to Mayor must be attached
a�
Start Date: 12/5/2023 Termination Date: 12/31/2025
Q Local Business?0YesF--]No* If meets requirements per KCC3.70.100,please complete'Vendor Purchase-Local Exceptions"formonCityspoce.
Business License Verification:YesElln-ProcessElExempt(KCC 5.01.045)
Notice required prior to disclosure? Contract Number:
F_IYesF�No CAG2020-163
Comments:
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Date Routed to the City Clerk's Office: 12/5/23 Interlocal Agreement has been uploaded to website: ❑
ad«W22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements
rev.20210513
KENT
W n S H I N O T D,
AMENDMENT NO. 3
NAME OF CONSULTANT OR VENDOR: A & M Consulting
CONTRACT NAME & PROJECT NUMBER: Signature Pointe Levee (13-3003)
ORIGINAL AGREEMENT DATE: June 5, 2020
This Amendment is made between the City and the above-referenced Consultant or Vendor
and amends the original Agreement and all prior Amendments. All other provisions of the original
Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force
and effect. For valuable consideration and by mutual consent of the parties, Consultant or
Vendor's work is modified as follows:
1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add
additional work or revise existing work as follows:
In addition to work required under the original Agreement and any prior
Amendments, the Consultant or Vendor shall:
No change to the scope of work, however an amendment is
needed to extend the time of completion to December 31, 2025,
due to contracted work will not be completed in 2023 and may
continue into 2024/2025 depending on the KCFCD.
2. The contract amount and time for performance provisions of Section II "Time of
Completion," and Section III, "Compensation," are modified as follows:
Original Contract Sum, $9,240
including applicable WSST
Net Change by Previous Amendments $0
including applicable WSST
Current Contract Amount $9,240
including all previous amendments
Current Amendment Sum $0
Applicable WSST Tax on this $0
Amendment
Revised Contract Sum $9,240
AMENDMENT - 1 OF 2
Original Time for Completion 6/30/2021
(insert date)
Revised Time for Completion under 12/31/2023
prior Amendments
(insert date)
Add'l Days Required (f) for this 730 calendar days
Amendment
Revised Time for Completion 12/31/2025
(insert dare)
The Consultant or Vendor accepts all requirements of this Amendment by signing below, by
its signature waives any protest or claim it may have regarding this Amendment, and
acknowledges and accepts that this Amendment constitutes full payment and final settlement of
all claims of any kind or nature arising from or connected with any work either covered or affected
by this Amendment, including, without limitation, claims related to contract time, contract
acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise
provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and
warranty provisions of the original Agreement.
All acts consistent with the authority of the Agreement, previous Amendments (if any), and
this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed,
and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be
deemed to have applied.
The parties whose names appear below swear under penalty of perjury that they are
authorized to enter into this Amendment, which is binding on the parties of this contract.
IN WITNESS, the parties below have executed this Amendment, which will
become effective on the last date written below,
CONSULTANT/VENDOR: CITY OF KENT:
By: By: 04,h-,
Print Name: A rn aM 4-' 6 Print Name: Derek Hawkes, P.E.
Its ow', �"r- Its: Design Engineering Manager
DATE: ��- `� DATE: V 2
ATTEST: APPROVED AS TO FORM:
(applicable if Mayors signature required)
Kent City Clerk Kent Law Department
1(6-11/30/2023
AMENDMENT - 2 OF 2
1
-4c4 CERTIFICATE OF LIABILITY INSURANCE nnTE(NI3IrY)
_ 1 a14312023423
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 poiicy(les) must be endorsed. If SUBROGATIONIS WAIVED,
subject to the terms and conditions of the policy,certain policies may requlre an endorsement.A statement on this certificate does not
confer rights to the certificate holder In lieu of such endorsement[sy.
PRODUCER CONTACT
A J GALLAGHER RISK MGMNT SVCSIPHS NAft
PHONE (8$8)920-6259 Fax
83556228 (AIC,No,Ext): (AIC,No):
The Hartford Business Service Center
3600 Wiseman Blvd E-MAIL
San Antonio,TX 78251 ADDRESS:
IHSIJRER[8]AFFORDING COVERAGE NAICfI
INSURED INSURERA: Hartford Casualty Insurance Company 29424
ARNOLD TOMAC DBA A&M CONSULTING INSURER B:
18119 NE 30TH ST INSURER C:
REDMOND WA 98052-5902
INSURER D:
INSURER E
N
INSURER F: ry
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD o
INDICATED.NOTWITHSTANDI NG 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.
INS TYPE OF INSURANCE ADDL SU9R POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD M DDIYYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED $300,000 XI PREMISES c rc Ce
X General Liability MEd EXP(Any one person) $10,000
A x 83 SBM UK5025 11/01/2023 11101/2024 PERSONAL&ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY❑PRO- LOC PRODUCTS-COMPIOP AGG $4,000,000
JECT
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2.000,000
ANY AUTO BODILY INJURY(Per person)
ALL OWNEDIx
SCHEDULED .i ,
A AUTOS AUTOS 83 SBM UK5025 11/01/2023 11/01/2024 SOCILY INJURY[Per accident) it
HIRED NON-OWNED PROPERTY DAMAGE :Ili
x AUTOS AUTOS (Psracddent)
ri�l:l
UMBRELLA LIAR OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS- AGGREGATE
HMADF
ED RETENTION$
WoRKek COMPENSATION PER DTH-
AND EMPLOYERS'LIABILITY TA T
ANY YIN E.L.EACH ACCIDENT $1,000.000
A PROPRIETORIPARTNERIEXECUTiVE NIA 83 SBM UK5025 11/01/2023 11/01/2024
OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000
(Mandatory In NH)
If yes,descritm under E.L.DISEASE-POLICY LIMIT $1,000,000
QESC RI PTI F OPERATIO S below
A EMPLOYMENT PRACTICES 83 SBM UK5025 11/01/2023 11/0112024 Each Claim Limit $5,000
LIABILITY Aggregate Limit $5,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Add lgcnal Remarks Schedule,may be attached If more space Is required)
Those usual to the Insured's Operations,CertiflCate Holder Is an Additional Insured per the Business Liab1Nty Coverage Form SS0008 attached to this
poilcy.
CERTIFICATE HOLDER CANCELLATION
The City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Public Works Engineering BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
222 4TH AVE S IN ACCORDANCE WITH THE POLICY PROVISIONS.
KENT WA 98032 AUTHORIZED REPRESENTATIVE
Q 1988.2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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ARNOLD TONAC DSA A & N
THE
28129 N.S. 30TH SMMT
HARTFaRD
REDMOND WA 98052
Policy Number: 83 SBM UK5025
Renewal Date: 11/01/2 3
Thank you for being a loyal customer of The Hartford.
#1: Your Hartford Policy
Enclosed are renewal documents for your policy, which is scheduled to renew on 11/01/23 . Along
with a new Declarations Page, which details the coverages provided by your policy, we are enclosing
important policy documents. Please be aware that you will receive an invoice separately for this new
policy term approximately 30 days prior to the renewal date; no action is required now.
To ensure the premium you paid for this past policy term was accurate, we may contact you by letter,
phone or email to conduct a premium audit. If contacted, we will advise what information is needed to
complete the audit.
#2: Your Business Insurance Coverage Checkup
Now is a great time to complete a business insurance coverage checkup with a Hartford Insurance
Professional. Because you wear so many hats each day, you may not be thinking about how changes to
your business can impact the type and amount of insurance coverage needed to protect it.
Together we will evaluate how your needs may have changed over the past year. Examples include:
- Has your mailing address and/or the physical location of your business changed?
Has there been any increase/decrease in the amount of business property/equipment you own?
- Has there been any increase/decrease in your company's payroll or sales?
- Have you added or eliminated any vehicles used in your business operations?
Are the bill plan and deductible on your policy right for our business? ,..E`
p Y Y
During the review we may make coverage recommendations, provide peace of mind solutions,
and possibly reduce your costs. Here is all you need to do:
- Call toll free (865) 457-8730 , and select our renewal review service option any
weekday from 7 A.M.to 7 P.M.CST and request your business insurance check-up.
- To best serve you, please have your Policy Number or Account Number and a Copy of
your current Renewal Policy in hand when you call.
#3: Servicing Your Needs
To login or register for our Online Business Service Center, g❑ to www.thehartford,com/servicecenter
where any time,day or night you can:
Pay your bill, view payment history and enroll in Auto Pay
Request Auto ID Cards and Certificates of Insurance
View electronic copies of billing and policy documents and sign up for pap
erless delivery
#4: if You've Had A loss or Accident... Report It Immediately
We want to help! Contact us as quickly as possible at 1-800-327-3636.
- Representatives are available 24-7 to assist in helping you recover from your loss.
On behalf of A T GALLAGNMR RISK UGMT SVCS/PSS and The Hartford, we appreciate the
opportunity to have been of service to you this past year and look forward to serving your business
insurance needs for the upcoming year.
' Sincerely,
Your Hartford Team
■
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IMPORTANT NOTICE TO POLICYHOLDERS
0
THE HARTFORD CYBER CENTER WEBSITE ACCESS
Thank you for choosing The Hartford for your business insurance needs.
You are receiving this Notice because you purchased a business owner's policy from The Hartford, (your Policy
was issued by The Hartford writing company identified on your policy Declarations page) which includes access to
The Hartford Cyber Center. This portal was created because we recognize that businesses face a variety of
cyber-related exposures and need help managing the related risks. These exposures include data breaches,
computer virus attacks and cyber extortion threats.
Through The Hartford Cyber Center, you have access to:
❑ A panel of third party incident response service providers
o Third party cybersecurity pre-incident service providers and a list of approved services to help protect
your business before a cyber-threat occurs
a Risk management tools, including self-assessments, best practice guides, templates, sample incident
response plans, and data breach cost calculators
❑ White papers, blogs and webinars from leading privacy and security practitioners
o Up-to-date cyber-related news and events, including examples of privacy and security related events
Accessing The Hartford Cyber Center is easy
1. Visit www.theharlford.comlcybercenter
2. Enter policyholder information
3. Access code: 952689
4. Login to The Hartford Cyber Center
This Notice does not amend or otherwise affect the provisions of your business owner's policy.
Coverage Options: `
The Hartford offers a variety of endorsements to your business owner's policy that can help protect your business
from a broad range of cyber-related threats. Please review your coverage with your insurance agent or broker to
determine the most appropriate cyber coverages and limits for your business.
Claims Reporting:
If you have a claim,you can report it by calling The Hartford's toll-free claims line at 1-806-327-3636.
Should you have any questions, please contact your insurance agent, broker or you may contact us directly.
We appreciate your business and look forward to being of continued service to you,
Please be aware that:
❑ The Hartford Cyber Center is a proprietary web portal exclusively provided to customers of The Hartford.
Please do not share the access code with anyone outside your Organization.
o Registration is required to access the Cyber Center. You may register as many users as necessary.
o Contacting a service provider about any issue does not constitute providing The Hartford notice of a claim
as required under your insurance policy. Read your insurance policy and discuss any questions with your
agent or broker.
The Hartford Cyber Center provides third party service provider references and materials for educational
purposes only. The Hartford does not specifically endorse any such service provider within The Hartford Cyber
Center and hereby disclaims all liability with respect to use of or reliance on such service providers. All service
providers are independent contractors and not agents of The Hartford. The Hartford does not warrant the
performance of the service providers, even if such services are covered under your Business Owners Policy. We
strongly encourage you to conduct your own assessments of the service providers' services and the fitness or
adequacy of such services for your particular needs.
Form SS 89 93 07 16 Page 1 of 1
0 2016, The Hartford
Insurance Policy Billing Information
Thank you for selecting The Hartford for your business insurance needs. w
Shortly, you will receive your first bill from us. You are receiving this Notice so you know
what to expect as a valued customer of The Hartford. Should you have any questions after
reviewing this information, please contact us at 866-467-8730, and we will be happy to
assist you.
o Your total policy premium will appear on your policy's Declarations Page. You will be billed based on the payment
plan you selected.
o You may pay the "minimum due" as it appears on your insurance bill or pay the policy balance in full.
o An installment service fee is added to each installment. A late fee will also be applied if the "minimum due" is not
received by the due date shown on your bill. Service and late payment fees do not apply in all states.
o if you selected installment billing, any credit or additional premium due as the result of a change made to your
policy,will be spread over the remaining billing installments. Additional premium due as a result of an audit will be
billed in full on your next bill date following the completion of the audit.
o If you elected Electronic Funds Transfer {EFT}, policy changes may result in changes to the amount automatically
withdrawn from your bank account. The invoice you receive following a policy change will include future withdrawal
amounts. if you need to adjust or stop your next scheduled EFT withdrawal, please contact us at least 3 days
prior to the scheduled withdrawal date at the telephone number shown below.
o If you selected installment billing and pay the premium for your first policy term on time,at renewal, your account
may qualify for our"Equal Installment"feature.This means that the percentage due for each installment, including
the initial renewal installment, will be the same throughout the policy term —helping you better manage cash flow.
Equal installments will continue as long as you pay your premiums on time and no cancellation notices are issued
for any policy on your account. If you no longer qualify for Equal Installments, future renewals will be billed based
on the payment plan you selected, which includes a higher initial installment amount.
o If your policy is eligible for renewal, your bill for the upcoming policy term will be sent to you approximately 30 days
prior to your policy's renewal date. If your insurance needs change, please contact us at least 60 days prior to your
ilEil
renewal date so we can properly address any adjustments needed.
o One bill convenience -- you have the option of combining all eligible Hartford policies on one single bill allowing
you to make one payment for all policies on your account as payments are due.
You're In Control
In addition to selecting a bill plan option that best meets your budget, you have the flexibility to decide how you r
payments are made ...
o Repetitive EFT:Sign up for Repetitive EFT payments and have payments automatically withdrawn from your bank
account.This option saves you money by reducing the amount of the installment service fee.
4 Pay online: Register at www.thehartford.com/servicecenter.Online Bill Pay is Quick, Easy and SecureI
o Pay by Check: Send a check with your remittance stub in the envelope provided with your bill.
o Pay by Phone: Gall toll-free 1-866-467-8730.
Should you have any questions about your bill,please call Customer Service toll-free number:
1-866-467-8730-7AM -7PM CST. We look forward to being of service to you.
Form 100722 11th Rev. Printed in U.S.A.
POLICY NUMBER: 83 SBM UX5025
Q
THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN
RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK
INSURANCE ACT.
DISCLOSUREICAP ON LOSSES - TERRORISM
RISK INSURANCE ACT
SCHEDULE
Terrorism Premium:
$ $5.00
A. Disclosure Of Premium United States or to influence the policy or
In accordance with the federal Terrorism Risk affect the conduct of the United States
Insurance Act, as amended (TRIA), we are required Government by coercion
to provide you with a notice disclosing the portion of C. Disclosure Of Federal Share Of Terrorism
your premium, if any, attributable to coverage for Losses
"certified acts of terrorism" under TRIA. The portion The United States Department of the Treasury will
of your premium attributable to terrorism coverage is reimburse insurers for 80% of insured losses
shown in the above Schedule of this endorsement. attributable to "certified acts of terrorism" under : :t
B. The following definition is added with respect to the TRIA that exceeds the applicable insurer deductible. l3il
provisions of this endorsement: However, if aggregate industry insured losses .:
1. A "certified act of terrorism" means an act that is attributable to "certified acts of terrorism" under -
certified by the Secretary of the Treasury, in TRIA exceed $100 billion in a calendar year, the
accordance with the provisions of TRIA, to be an Treasury shall not make any payment for any portion
act of terrorism under TRIA. The criteria of the amount of such losses that exceeds $100
contained in TRIA for a "certified act of terrorism" billion. The United States government has not
include the following: charged any premium for their participation in
a. The act results in insured losses in excess of covering terrorism losses.
$5 million in the aggregate, attributable to all D. Cap On Insurer Liability for Terrorism Losses
types of insurance subject to TRIA; and If aggregate industry insured losses attributable to
b. The act results in damage within the United 'certified acts of terrorism" under TRIA exceed $100
States, or outside the United States in the billion in a calendar year and we have met, or will
case of certain air carriers or vessels or the meet, our insurer deductible under TRIA, we shall
premises of an United States mission; and not be liable for the payment of any portion of the
c. The act is a violent act or an act that is amount of such losses that exceed $100 billion. In
dangerous to human life, property or such case, your coverage for terrorism losses may
infrastructure and is committed by an be reduced on a pro-rats basis in accordance with
individual or individuals as part of an effort to procedures established by the Treasury, based on its
coerce the civilian population of the estimates of aggregate industry losses and our
estimate that we will exceed our insurer deductible.
Form SS 83 76 12 20 Page 1 of 2
� 2020,The Hartford
(Includes copyrighted material of Insurance Services Office, Inc., with its permission)
In accordance with the Treasury's procedures, would otherwise be excluded under this Coverage"
amounts paid for losses may be subject to further Form, Coverage Part or Policy, such as losses
adjustments based on differences between actual excluded by any pollution, pathogenic, nuclear
losses and estimates. hazard or war exclusions which may be included on
L Application of Other Exclusions this Policy.
The terms and limitations of any terrorism exclusion, F. All other terms and conditions remain the same
the inapplicability or ornission of a terroriser►
exclusion, or the inclusion of terrorism coverage, do
not serve to create coverage for any loss which
Page 2 of 2 Form SS 83 76 12 20
25 This Spectrum Policy consists of the Declarations,Coverage Forms, Common Policy Conditions and any
50 other Forms and Endorsements issued to be a part of the Policy.This insurance is provided by the stock
❑K insurance company of The Hartford Insurance Group shown below.
SBM
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INSURER: HARTFORD CASUALTY INSURANCE COMPANY
ONE HARTFORD PLAZA, HARTFORD, CT 06155
a
COMPANY CODE: 3 0
THElf
Policy Number: 83 SBM UK5025 DV HARTFORD
SPECTRUM POLICY DECLARATIONS ORIGINAL,
Named Insured and Mailing Address: ARNOLD TOMAC DBA A & M
(No., Street,Town, State,Zip Code) CONSULTING
18119 N.E. 30TH STREET
REDMOND wA 98052
Policy Period: From 11/01/23 To 11/01/24 1 YEAR
12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire.
Name ofAgent/Broker: A J GALLAGHER RISK MGMNT SVCSIPHS
Code: 556226
Previous Policy Number: 72 SBM UK5025
Named Insured is: INDIVIDUAL
Audit Period: NON-AUDITABLE
Type of Property Coverage: NONE
Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we
agree with you to provide insurance as stated in this policy.
TOTAL_ANNUAL PREMIUM IS: $425 MP t :
Countersigned by 08/04/23
Authorized Representative Date
Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE)
Process Date: 08/04/23 Policy Expiration Date: 11/01/24
INSURED COPY
SPECTRUM POLICY ❑ECLARATIONS (Continued)
POLICYNUMBER: 83 SSM UK5025
Locations), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by
Number below.
Location: 001 Building: 001
18119 N.E. 30TH STREET
REDMOND WA 98052
Description of Business:
REAL ESTATE APPRAISER
Deductible: NO COVERAGE
BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE
BUILDING
NO COVERAGE
BUSINESS PERSONAL PROPERTY
REPLACEMENT COST NO COVERAGE
PERSONAL PROPERTY❑F OTHERS
REPLACEMENT COST NO COVERAGE
MONEY AND SECURITIES
INSIDE THE PREMISES NO COVERAGE
OUTSIDE THE PREMISES NO OVERAGE
Form SS 00 0212 06 Page 002 (CONTINUED ON NEXT PAGE)
Process Date: 08/04/23 Policy Expiration Date: 11/01/24
SPECTRUM POLICY ❑ECLARATIONS (Continued)
POLICY NUMBER: 83 SBM UK5025
BUSINESS LIABILITY LIMITS OF INSURANCE
m
LIABILITY AND MEDICAL EXPENSES $2, 000,000 0
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MEDICAL EXPENSES -ANY ONE PERSON $ 10, 000
PERSONAL AND ADVERTISING INJURY $2,000,000
DAMAGES TO PREMISES RENTED TO YOU $ 300,000
ANY ONE PREMISES
AGGREGATE LIMITS $4, 000,000
PRODUCTS-COMPLETED ❑PERATIONS
GENERAL AGGREGATE $4,000, 000
EMPLOYMENT PRACTICES LIABILITY
COVERAGE: FORM SS 09 01
EACH CLAIM LIMIT $ 5, 000
DEDUCTIBLE -EACH CLAIM LIMIT
NOT APPLICABLE
AGGREGATE LIMIT $ 5,000
RETROACTIVE DATE: 11012005
This Employment Practices Liability Coverage contains claims made coverage. Except as may be otherwise
provided herein, specified coverages of this insurance are limited generally to liability for injuries for which claims are
first made against the insured while the insurance is in force. Please read and review the insurance carefully and ;.
discuss the coverage with your Hartford Agent or Broker. `
The Limits of Insurance stated in this Declarations will be reduced, and may be completely exhausted, by the
payment of "defense expense" and, in such event, The Company will not be ❑bligated to pay any further
"defense expense" or sums which the insured is or may become legally obligated to pay as "damages".
BUSINESS LIABILITY OPTIONAL
COVERAGES
HIRED/NON-OWNED AUTO LIABILITY $2,000, 000
FORM: SS 01 70
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Form SS 00 02 12 06 Page 003 (CONTINUED ON NEXT PAGE)
Process Date: 08/04/23 Policy Expiration Date: 11/01/24
SPECTRUM POLICY DECLARATIONS (Continued)
POLICYNUMBER: 83 SBM UX5025
BUSINESS LIABILITY OPTIONAL COVERAGES LIMITS OF INSURANCE
(Continued)
RRPLOYZRS LIABILITY AND STOP GAP
BODILY INJURY BY ACCIDENT
RACK ACCIDEW $1, 000, 000
BODILY INJURY BY DISEASE
ZA'K EMPLOYER $1, 000, 000
BODILY INJURY BY DISEASE
POLICY LIMIT $1,000, 000
APPLICABLE TO LOCATIONS IN THE
FOLLOWING SITATE W :
WASKINGTON
WAIVER OF SUBROGIATION:
]PORN 88 12 15
LOCLTXON: 001 BUILDING: 001
NAME: IF ANY
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Form SS 00 02 12 06 Page 004 (CONTINUED ON NEXT PAGE)
Process date: 08/04/23 Policy Expiration Date: 11/01/24
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUM13ER: 83 SBM UK5025
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ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS
LIABILITY COVERAGE IN THIS POLICY.
LOCAVZON 001 BUILDING 001
TYKE MANAGER LESSOR
III SEE FORK III 12 00
�e•r
Farm SS 00 02 12 06 Page 005 (CONTINUED ON NEXT PAGE)
Process Date: 08/04/23 Policy Expiration Date: 11/01/24
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 83 SBM UK5025
Form Numbers of Farms and Endorsements that apply:
SS 00 01 03 14 SS 00 05 12 06 SS 00 08 04 05 SS 00 45 12 06
SS 00 64 09 16 SS 01 28 05 17 SS 01 70 09 09 5S 89 93 07 16
SS 00 60 09 15 SS 41 02 04 05 SS 41 63 06 11 SS 05 03 03 00
SS 05 47 09 15 SS 51 10 03 17 IH 12 07 02 21 SS 09 01 12 14
SS 09 25 12 14 SS 09 67 09 14 SS 09 70 12 14 SS 09 71 12 14
SS 10 04 09 98 SS 12 15 03 00 IH 99 40 04 09 IH 99 41 04 09
SS 83 76 12 20
IH 12 00 11 85 ADDITIONAL INSURED - MANAGER/LESSOR
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S.
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Form SS 00 02 12 06 Page 006
Process Date: 08/04/23 Policy Expiration Date: 11/01/24
SPECTRUM POLICY ❑ECLARATIONS (Continued)
POLICY NUMBER: 83 SBM UK5025
SUPPLEMENTAL DECLARATIONS:
0
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A service fee of$ 6.00 is charged for each installment when your premium is paid in
installments. The service fee is $ 6.Q 0 per withdrawal when you select an electronic
fund transfer payment plan. The service fee will be added to the premium amount
shown ❑n your premium billing statement.
Form SS 00 45 12 46
Process Date: 08/04/23 Policy Expiration Date: 11/01/24
QUICK REFERENCE - SPECTRUM POLICY
DECLARATIONS
and
COMMON POLICY CONDITIONS
I. DECLARATIONS
Named I nsured and Mailing Address
Policy Period
Description and Business Location
Coverages and Limits of insurance
II. COMMON POLICY CONDITIONS Beginning on Page
A. Cancellation 1
B. Changes 1
C. Concealment, Misrepresentation Or Fraud 2
D. Examination Of Your Books And Records 2
E. Inspections And Surveys 2
F. Insurance Under Two Or More Coverages 2
G. Liberalization 2
H. Other Insurance- Property Coverage 2
I. Premiums 2
J. Transfer Of Rights Of Recovery Against Others To Us 2
K. Transfer Of Your Rights And Duties Under This Policy 3
L. Premium Audit 3
Form SS 00 06 12 06
COMMON POLICY CONDITIONS
m
All coverages of this policy are subject to the foilowing conditions.
v
g
A. Cancellation (6) Failure to:
1. The first Named Insured shown in the (a) Furnish necessary heat, water,
Declarations may cancel this policy by mailing sewer service or electricity for 30
or delivering to us advance written notice of consecutive days or more, except
cancellation. during a period of seasonal
2. We may cancel this policy by mailing or
unvccupancy; or
delivering to the first Named Insured written (b) Pay property taxes that are owing
notice of cancellation at least: and have been outstanding for
a. 5 days before the effective date of more than one year following the
cancellation if any one of the following date due, except that this provision
conditions exists at any building that is will not apply where you are in a
Covered Property in this policy: bona fide dispute with the taxing
authority regarding payment of
(1) The building has been vacant or such taxes.
unoccupied 60 or more consecutive b. 10 days before the effective date of
days. This does not apply to: cancellation if we cancel for nonpayment
(a) Seasonal unoccupancy; or of premium.
(b) Buildings in the course of c. 30 days before the effective date of
construction, renovation or cancellation if we cancel for any other
addition. reason.
Buildings with 65% or more of the rental 3. We will mail or deliver our notice to the first
units or floor area vacant or unoccupied are Named Insured's last mailing address known to
considered unoccupied under this us.
provision. 4. Notice of cancellation will state the effective
(2) After damage by a Covered Cause of date of cancellation. The policy period will end
Loss, permanent repairs to the building: on that date.
a Have not started; and
( ] 5. 1# this policy is canceled, we will send the first
(b) Have not been contracted for, Named Insured any premium refund due. SuchIi
within 30 days of initial payment of refund will be pro rata. The cancellation will be
loss. effective even if we have not made or offered
a refund.
(3) The building has: g. If notice is mailed, proof of mailing will be
(a) An outstanding order to vacate; sufficient proof of notice.
(b) An outstanding demolition order; or T. If the first Named Insured cancels this policy,
(c) Been declared unsafe by we will retain no less than $100 of the
governmental authority. premium.
(4) Fixed and salvageable items have B. Changes
been or are being removed from the This policy contains all the agreements between
building and are not being replaced, you and us concerning the insurance afforded.
This does not apply to such removal The first Named Insured shown in the Declarations
that is necessary or incidental to any is authorized to make changes in the terms of this
renovation or remodeling. policy with our consent. This policy's terms can be
amended or waived only by endorsement issued by
us and made a part of this policy.
Form 5S 00 05 12 06 Page 1 of 3
D 2006, The Hartford
COMMON POLICY CONDITIONS
C. Concealment, Misrepresentation Or Fraud I. premiums
This policy is void in any case of fraud by you as it 1. The first Named Insured shown in the
relates to this policy at any time. It is also void if Declarations:
you or any other Insured, at any time, intentionally a. Is responsible for the payment of all
conceal or misrepresent a material fact concerning: premiums; and
1. This policy; b. Will be the payee for any return premiums
2. The Covered Property; we pay,
3. Your interest in the Covered Property; or 2. The premium shown in the Declarations was
4. A claim under this policy. computed based on rates in effect at the time
D. Examination Of Your Books And Records the policy was issued. If applicable, on each
renewal, continuation or anniversary of the
We may examine and audit your books and records effective date of this policy, we will compute the
as they relate to the policy at any time during the premium in accordance with our rates and rules
policy period and up to three years afterward, then in effect.
B. Inspections And Surveys 3. With our consent, you may continue this policy
We have the right but are not obligated to: in force by paying a continuation premium for
1. Make inspections and surveys at any time; each successive one-year period. The premium
must be.
2. Give you reports on the conditions we find; and a. Paid to us prior to the anniversary date; and
3. Recommend changes, b. Determined in accordance with Paragraph
Any Inspections, surveys, reports or 2. above.
recommendations relate only to insurability and the Our forms then in effect will apply. If you do
premiums to be charged. We do not make safety not pay the continuation premium, this policy
Inspections, We do not undertake to perform the will expire on the first anniversary date that we
duty of any person or organization to provide for the have not received the premium.
heafth or safety of any person. And we do not
represent or warrant that conditions: 4. Changes in exposures or changes in your
1. Are safe or healthful; or business operation, acquisition or use of
locations that are not shown in the Declarations
2. Comply with laws, regulations, codes or may occur during the policy period, If so, we
standards. may require an additional premium. That
This condition applies not only to us, but also to any premium will be determined in accordance with
rating, advisory, rate service or similar organization our rates and rules then in effect.
which makes insurance inspections, surveys, reports J. Transfer Of Rights Of Recovery Against Others
or recommendations. To Us
F. Insurance Under Two Or More Coverages Applicable to Property Coverage:
If two or more of this policy's coverages apply to the 1f any person or organization to or for whom we
same loss or damage, we will not pay more than the make payment under this w'
p Y policy has rights to
actual amount of the loss or damage. recover damages from another, those rights are
G. Liberalization transferred to us to the extent of our payment. That
If we adopt any revision that would broaden the person or organization must do everything
coverage under this necessary to secure our rights and must do nothing
g policy t without additional after loss to impair them. But you may waive your
premium within 45 days prior to or during the policy
period, the broadened coverage will immediately rights against another party in writing:
apply to this policy. 1. Prior to a loss to your Covered Property,
H. Other Insurance -Property Coverage 2. After a loss to your Covered Property only if, at
If there is other insurance covering the same loss or time of loss, that party is one of the following:
damage, we will pay only for the amount of covered a. Someone Insured by this insurance;
loss or damage in excess of the amount due from b. A business firm:
that other insurance, whether you can collect on it or (1) owned or controlled by you; or
not. But we will not pay more than the applicable
Limit of Insurance. (2) That owns or controls you; or
Page 2 of 3 Form SS 00 05 12 06
s
COMMON POLICY CONDITIONS
c. Your tenant. L. Premium Audit
You may also accept the usual bills of lading or a. We will compute all premiums for this policy in
shipping receipts limiting the liability of carriers. accordance with our rules and rates. 9
N
This will not restrict your insurance. b. The premium amount shown in the Declarations
K. Transfer Of Your Rights And Duties Linder This is a deposit premium only. At the close of each o
audit period we will compute the earned o
Policy premium for that period. Any additional
Your rights and duties under this policy may not be premium found to be due as a result of the
transferred without our written consent except in the audit are due and payable on notice to the first
case of death of an individual Named Insured. Named Insured. If the deposit premium paid
If you die, your rights and duties will be transferred for the policy term is greater than the earned
to your legal representative but only while acting premium, we will return the excess to the first
within the scope of duties as your legal Named Insured.
representative. Until your legal representative is c. The first Named Insured must maintain all
appointed, anyone having proper temporary custody records related to the coverage provided by this
of your property will have your rights and duties but policy and necessary to finalize the premium
only with respect to that property. audit, and send us copies of the same upon our
request.
Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been
countersigned by our duly authorized representative.
C�
Kevin Barnett,Secretary M. Ross Fisher,President
r
ETC
Form S5 00 06 12 06 Page 3 of 3
POLICY NUMBER: 83 SBM UK5025
a
0
N
m
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
s
0
0
P
ADDITIONAL INSURED - MANAGER/LESSOR
THE CITY OF RENT
PUBLIC WORKS ENGINEERING
222 FOURTH AVE. SO.
KENT WA 98032
f"•
Form IH 12 00 11 85 T SEQ.NO. 0 0 2 Printed in U.S.A. Pugs 0 0�
Process Date: 0 810 412 3 Expiration Date: 1110112 4
INSURED COPY
0
THE
HARTFORD
Named Insured: ARNOLD TOMAC DBA A & M
Policy Number: 83 SBM UK5025
Effective Date: 11/01/2 3 Expiration Date: 11/01/2 4
Company Name: HARTFORD CASUALTY INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REACT IT CAREFULLY.
TRADE OR ECONOMIC SANCTIONS ENDORSEMENT
This insurance does not apply t❑ the extent that trade or economic sanctions or other laws or regulations
prohibit us from providing insurance, including, but not limited to,the payment of claims.
All other terms and conditions remain unchanged.
k'.
Form IH 99 41 04 09 Page 1 of 1
In accordance with the Treasury's procedures, would 0Ih(iwi!,(! be excluded under this Coverage
amounts paid for losses may be subject to further Form, Coverage Part or Policy, such as losses
adjustments based on differences between actual excluded by any pollution, pathogenic, nuclear
tosses and estimates, hazard or war exclusions which may be included on
E. Application of Other Exclusions this Policy.
The terns and limitations of any terrorism exclusion, F. all other terms and conditions remain the same
the inapplicability or omission of a terrorism
exclusion, or the inclusion of terrorism coverage, do
not serve to create coverage for any loss which
Page 2 of 2 Form S5 83 76 12 20
J+
POLICY NUMBER: 72 S€ih'i UtC5025
Y
THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN
RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE'TERRORISM RISK
INSURANCE ACT.
DISCLOSUREICAP ON LOSSES TERIPa WdSM
5C IEDULE
l-errorism Preimium:
$
United states or to influence the policy of
A. Disclosure Of Premium affect the conduct of the United Slates
in accordanct: with the feclerill Terrorism Risk Government by coer0011
In,tiritncF� Ac:t, as aineiittecl (TRIA). ►ie WO rcttuifed
lrs provide you wilh a notice disclasiny lhc: portion of C. Disclosure Of Federal Share of Terrorism
ur pre'uniurn, if arty. attributable to coverage for Losses
"certified acts of lerrorisni" uil[ler TRW l'lre portiori The United States Department of the Treasury will
of your premium attributable to terrorism coverage is reirtibui'se insurer:; for flOuhl of Insured lossr:S
shown in the above Schodule of this endcrsoment. alb-il'UlAble to "r[:milled arts of terrorism" u:tder
},..
B. The following definition is added with respect to the TRIA that exceeds me applicable insurer ded"Otihli.. s.
t•lowever,nt: if acltfiet}ate industry insured losses
provisions of this endorserne '
1. A "certified act of terrorism" rttetins all art tht"( is attributable to "certified acts of terrurisrn" utider t'
certified by tho Sucretttry or the Treastiry, in TRIA exceed $100 billion in a calendar year, (tie
cccordance with Ille provisioris of TRW to be an Treasury shall not make any paylr►ent for any portion
rir;l of terrorists under TIBIA. fltic crikerYa of iir[: amount of such losses that i.xceeds �u1g0
contained in TRfA for a"certified act of terrorism" billion. The United States government has not
include the following: charged any premium for their participation in
a. The act results in insured losses in excess of covering terrorism losses
$5 million in the aggregate, attributable to all D. Cap On Insurer Liability for Terrorism Losses
types of insurance subject to TRIG; and it aggr(,,gato. industry instirc,d tosses attribstal.il[: to
b. The acl results in damage within the United ..Cortiffetl arts of iei-r0ri5oV under TRIA exceed $100
slates, or outside the United States in the bif)iOn in al calendar year and we have n-iet, yr will
case of certain air carriers or vossf,ls or the fneet, our instsrer deduclible uruler TRIA, we shall
premises of an United Stales mission; and clot be. liable for the payment of any Mention ref tilt:
[:. The act is a violent act or an act that is ainount of Islic:it 1055es that excerbrt ti'i 00 hil;icin. In
dangerous to hurnar► life: property or such case, your coverage for terrorism lasses may
infrastructure and is cornmittBd by an be reduced on a pro-rata basis in accordance with
Individual or individuals as part of an effort to procedures established by the Treasury, based on its
coerce the civilian population of the estimates of aggregate industry losses and our
estimate that we will exceed our insurer deductible.
Page i of 2
Form S5 83 76 12 20 -o 2020,The Hartford
(Includes copyrighted rnaterial of insurance Services Office, lor., with its permission)
Named Insured- AVMLD TONAC DBA A
Policy Number: 72 SBM UK5025
Effective Date: 11/01/2 2 Expiration Date: 11/01/23
Company Name: HARTF'ORt3 CASUALTY TWSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
TRADE OR ECONOMIC SANCTIONS ENDORSEMENT
This insurance does not �pjjjy to the extr:nt that tinde ar e(:Onpmic sanctions or ollscr laws or regulations
prohibit us frorn providing including,but surf limited to.the payment of ClatITis
All other terms and conditions remain unchanged-
l
Fort IH 99 41 04 09 Page I of 1
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
GOODS AND SERVICES ENDGRSENJENT WASH.. iNGTON
This endorsement modifies insurance provided under all coverage Parts of this Policy.
We: rTtay offer'or make "goods Of selvic(:k' �1vgtiialtle 11) YOU thrnurtlr iilis trn[lcrTrvritinct C[linf 1�b4D a Vide(l'0' r
slitsidlafy, or 1111aftlti.rte(I t11ird Parties i15 a pi1r'l of this flolii;y. 'l llt' "rgowls or servires" ir1R1y he pravitled f(�i �r
r,;harcto. Ott a rlis(:ntrnl, on el slrlysi(lixe[t basis, tar fl-vo of cll�1r90, h] 501T1e (;W.e5, aura rT1cry rrrctrivt: a fer trtrlTi they
tuyaffiiitlled third ladies that provide "go(xis or services". We (I() oat warrant of guafatlte(; t1le "000(13 01'
Nt�fvicee' p(ovidod icy 111ir[I Wirtivs, an[t such third pipits snail be solely liablo and 1'evipoll5ibl fort e, "(c adr-
(), sen+ices" they provider T1W "gnocts or services- � ltorocl of 11�ades available by Nis nlay
be ot-
discontinued ai any time.
This e:ntlnrsernerlt is Sullie(,t to RGW 41330.1500)(r), which prohibits insurance companies from providing
privos, goods, wares, gift cards, gift cellif(Rites, (1r nurehandise of an aggregate value in excess of $100 per'
permn iii the AW)rNAW'ill i"Iy rcrosr:ctiliv[:1avc�ivt: inrjtith period.
"Goods or services" means goods, Products or services, including but riot limited to risk lnitigati❑n, safety,
andlor loss prevention services or equipment
�i
I
Page 1 of 1
IH 12 OT 02 21
2021,The Hartford
POLICY NUMBER:72 SBM UK5025 w Y°
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAi, INSURED - KANAGERILESSOR
THE CITY OF KENT
PUBLIC WORKS ENGINEERING
222 FOURTH AVE, SO.
KMT iqA 36032
i;
Form IM 12 QD 11 85 T SEd.NO. 402 Printer!in U.S.A. PROO 04 Expiration gate: 11 1 01I23
Process Date- 911912 2
INSURED COPY
COMMON POLICY CONDiTIONS
c. Your tenant. L. Premium Audit
You may also accept the usual bills of lading or a. We will compute all premiums for this policy in
accordance with our rules and rates.
shipping receipts limiting the liability of carriers. •-
This will not restrict your insurance. h. The. prernilirn arrraunl shown in llle,L)nclarki ions
is�n deposil prtrrnitlnr only Ill llse CIO SC UI CHU11
K. Transfer of Your Rights And Duties Under This atrt.tii l)cririat ws: will Corral}trtr'- I"(.'. r•vrrserl
Policy preiniuni fur that P ,riarl. Any andditiUnilf
Your rights and duties under this policy may not be pripl%liurll fnlrnrl Ire lie (Iue ar ji resell Of the
-transferred without our written consent except in the fnulil girt; slue arld I)ay"nhte: tin notice to tire firm
case of death of an individual Named Insured. Nalmod Irrst,"Od if tlae dl�s nrsiil prell"um p.ti[l
if ycxr die, your rigllts and duties will be transferred for the policy term is greater than the earned
to your legal raprrselitative put only whit[: acting premium. we will return the exct', to the first
within the scope of duties as your legal Named insured.
representative. Until your legal reprxusentative is c. The first Named Insured must maintain all
appointed, anyone iraving prosper temporary Custody records related to the coverage provided by this
Of your property will have your rights ancd duties but policy and necessary to finalize the pren'rlum
only with respect to that property• audit, and send us copies of the same upon our
request.
Our President and Secretary have signed this policy. Where required by taw, the Declarations page has also been
countersigned by our duly authorized representative.
Kevin Barnett.5earetary patigias�liigt,President
Form SS 00 05 12 06 Page 3 of 3
COMMON POLICY CONDITIONS
C. Concealment, Misrepresentation Or Fraud L Premiums
This policy is void in any case of fraud by you as it 1 The first Named Insured shown in the
relates to this Policy at any time. It is also void if Declarations:
you or any Other insured, at any time, inioniionally a, is responsible for the payment of all
conceal or misrepresent a material fact catic:rninri; premiums; and
1. This policy; b. Will be the payee for any return premiums
2. The Covered Property; we pay.
3. Your interest in the Covered Property;or 2. The premium shown in the Declarations was
4. A claim under this policy. computed based on rates in effect at the tune
the policy was issued. It applicable, On each
D. Examination Of Your Books And Records renewal, continuation or anniversary of the
We may examine and audit your books and records effective date of this policy,we will cornpu(e the
as they rNnte to the policy at any (line during the premium Sri accordance with our rates and rules
policy period and up to three years afterward. then in effect.
E. Inspections And Surveys 3. Willi our ronsent, you may continue this policy
We have the right but are not obligated to: in force by par ying a continuation premium for
each successive one-year period, The. premium
1. Make inspections and surveys at any time; must be_
2. Give you reports on the conditions we find; and a. Paid to its prior to the anniversary date; and
3. Recommend changes. b. Determined in accordance with Paragraph
Any inspections, surveys, reports ar 2. above,
rc�r:asrrut►[:slcl.rlior►s relate only to insurability and tiro Our forms Ilion tct effect will apply. i1 you elo
i)rerrririn►s to he charged. We do not snake safety 114)I pay the continuation premium, this policy
irisilryctions, We (to not ru►dorlake to purform the will expire an the first anniversary date that we
duty of any pr:tmm rrr organization to provide im the have not received the premium
lic alth or salr:ty of any pefs.on. And wry do not
represent or warrant that conditions: 4. Changes i» exposures or changes in your
business operation, acquisition or use csf
t. Are safe or healthful; or business
that are not shown in the ❑eclaralians
2. Comply with laws, regulations, codes or may occur during the policy period. If so, we
standards. may require an additional premium, That
Thu.;c:olidihocr applies not cuily to us, but also to ally premium will be determined in accordance with
ration, advisory. i.,i(o service or similar organization our rates and rules then in effect.
which marker.iosurarnce sirspections, surveys, rut►orts J. Transfer Of Rights Of Recovery Against Others
rrr 1,00Jt►s11e11rlatiolm To Us
F. Insurance Under Two Or More Coverages Applicable to Property Coverage:
If Nvo or more of this Policy's cownrages -ipply to the if any person or organization to or for whom we
sy►rn . loss or damage, we will not pay morel than the make payment under Ibis policy has rights to
actual amount of the loss or damage. "00,0ver damages From another, those rights are
G, Liberalization Iransferred to us to the extent of our paynmrll. That
If we adopt any revision that would broaden the person or orr,3ani;_,ation mast do everylhin{I
coverage under this necessary to secure our rights and must cto Plot Iling
S policy without additional after loss to impair them. But you may waives yn►r►
pnorrrium with i n 45 d<uys prior to or during the policy rights a►g�tlnsi another Marty in writing.
p[triod, tho broadened coverage will iminediarlely
apply to this Policy. 11. Prior to a loss to your Covered Property.
H. Other Insurance -Property Coverage 2. After a loss to your Covered Property only if, at
If th,tnv is other hisni-miry em,pring the S:►rn a losms or time of loss, that party is nno of the following:
darnagn, we will prty only for the anlaunl of covered a. Someone insured by this insurance;
loss or damage in excess of Ilm arnount due from b. A business firm:
that other insurance. whether you can collect oil it or,
'lot. Bill we will not pay more than the applicable 4tf Owned or controlled by you;or
Limit of lirsorance. (2) That owns or controls you; or
Page 2 of 3 Form S5 00 05 12 06
5,N
COMMON POLICY CONDITIONS
All coverage$of this policy are subject to the following conditions.
(
A. Cancellation 5) Failure to:
a Furnish necessary heat, water,
1. The first Named Insured shown in the { � sewer service or electricity for 3�
Declarations may cancel this policy by ')'ailing consecutive days or more, except
or delivc:iing to us advance written notice of during a period of seasonai
cancellation. unoccupancy,or
2. We may cancel this policy by mailing or
delivering to the first Na.:nled Insured written [hy Pay property taxes are owing
notice of cancellation at leash and have been outstanding for
tst
more than one year following the
a. 5 days before the effective dais of date due, except that this provision
cancellation if any one of the following wilt not apply where you are in a
conditions exists at any building that is bona fide dispute with the taxing
Covered property in this policy: authority regarding payment of
(1) The building has been vacant cr such taxes.
unoccupied 60 or more consecutive b 10 days before the effective date of
days.This does slot apply to: cancellation if we, cancel for nonpayment
(a) Seasonal unoccupancy; or of premium.
(b) Buildings in the course of c. 34 days before the effective date of
construction, renovation or cancellation if we cancel for any other
addition. reason.
Buildings with 65% or more of the rental 3. We wilt mail or deliver our notice to the first
units or floor area vacant or unoccupied are: Named Insured's fast mailing address known to
considered unoccupied under this us.
provision. 4. Notice of cancellation will state the effective
(2) After' danzarclih by a Covered C:mrw of date of cancellation. The policy period will end
LOSS, permanont repairs to ttie i►rrilding: on thaf date.
(a) Have not started; and S. if this policy is canceled, we will send the first
Such(b) Have not been contracted for, Named Insured any premium refund due. Such
within 30 days of initial payment of refund will be pro rota. The cancellation will be
effective even if we have not made ar offered
loss. a refund.
(3) The building has: 6. If notice is mailed, proof of mailing will be
(a) An outstanding order to vacate; sufficient proof of notice.
(b) Ali outstanding demolition order; or 7. If the first Named Insured cancels this policy,
(c) Been declared unsafe by we will retain no less than $100 of the
governmental authority. premium.
(4) been and salvo}cable items have B. This pot�y contains all the agreements between
hrzr}n or are bei»r removed from the
building and are not being replaced. you and us concerning the insurance afforded,
This does not apply to such removal The first Named Insured shown in the Deciarations
that is necessary or incidental to any is authorized to make changes ill the terms of this
renovation or remodeling• policy with our consent. This policy's terms can by
amended or waived only by endorsement issued by
us and made a part of this policy.
Form s5 00 05 12 06 page 1 of 3
0 2005,The Hartford
QUICK REFERENCE - SPECTRUM POLICY
DECLARATIONS
and
COMMON POLICY CONDITIONS
I. DECLARATIONS
Named Insured and Mailing Address
Policy Period
Description and Business Location
Coverages and Limits of Insurance
II. COMMON POLICY CONDITIONS Beginning vn Page
A. Cancellation .I
B. Chanaes 9
C. Concealment, Misrepresentation Or Fraud 2
D. Examination Of Your Books And Records 2
E. Inspections And Surveys 2
F. Insurance Under Two Or More Coverages 2
G. Liberalization 2
H. Other Insurance - Property Coverage 2
I. Premiums 2
J. Transfer Of Rights Of Recovery Against Otfrers To Us 2
K. Transfer Of Your Rights And Duties Under This Policy 3
L. Premium Audit 3
Form SS 00 05 12 06
COMMON POLICY CONDITIONS
Form $6 00 06 12 06
C 2006, The Hartford
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 72 sBm lIK5025
SUPPLEMENTAL DECLARATIONS.
6.0 0 is charged far each installment when your premium is paid i
service r" e of $ n
A service
lrl�ents. The service fee is $ {,.ab per withdrawal when you select an electronic
instafund transfer payment plan. The service fee will be added to the premium amount
shown on your premium billing statement.
Form SS 00 45 12 06
Policy Expiralinrs Date: 11101l23
Process mate: 09/19/22
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER- 72 S+SM UH5025
Fenn Numbers. of Forms and Endorsements that apply:
SS 00 01 03 14 SS 00 05 12 06 SS 00 08 04 05 SS 00 45 12 06
ES 00 64 09 16 SS 01 28 05 17 SS 01 70 09 09 Sol B9 93 07 16
SS 00 60 09 15 SS 41 02 04 05 SS 41 63 06 11 SS 05 03 03 00
SS 05 47 09 15 SS 51 10 03 17 IH 12 07 02 21 SS 09 01 12 14
SS 09 25 12 14 SS 09 67 09 14 SS 09 70 12 14 SS 09 71 32 14
SS 10 04 09 98 SS 12 15 03 00 IH 99 40 04 09 IH 99 41 04 09
SS 63 76 12 20
IH 12 00 11 85 ALTITIONAL INSUF+ED -- MANAGER/LESSOR
F=afm SS 00 02 12 06 Page 0U6
Process Date: 09/19/22 Policy Expiration Date: 11/01/23
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 72 SBM Ulf5025
ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS
LIABILITY COVERAGE IN THIS POLICY.
LOCATION 001 BUILDING 001
TYPE 4',RANA(;xR LESSOR
N" . SM& SoRm TR 12 00
p'•C
Form SS 00 02 12 06 Page 005 [CONTTNJEL) ON NEXT PAGE)
Process {late: 09/19/22 Policy Expiration Date: 11/01/23
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: '72 SBM UK5025
BUSINESS LIABILITY OPTIONAL COVERAGES LIMITS OF INSURANCE
(Continued)
iSMkLOYMRS LIABILITY AND STOP GILD
BODILY INJURY BY ACCIDE14T
MACH ACCIDEM $1,000, 000
BODILY IN,11TRY 15Y DISEASE
EAC13 RKPLOYI:I, $1,000,000
RODILY XNAMY BY Dxavasm
POLICY LIMIT $1,000,000
APPI.IC"LA TO LOCATIONS IN Tllrk
FOLLOWxrIC1 STATE(5)
WASHINGTON
WAIVER Or SULIntgc,ATION:
FORM SS 12 15
LOCATION: 001 BUILDING: 001
NAM: IF ANY
Form S5 00 02 12 06 Page 004 (['_OD711 i1NUED ON NEXT PAGE)
Process Date: 09/19/22 Policy Expiration Date: 11101/23
SPECTRUM POLICY DECLARATIONS (Continued)
POLtCY NUMBER: 72 SBM UK5025
BUSINESS LIABILITY LIMITS OF INSURANCE
LIABILITY AND MEDICAL EXPENSES $2,000 1 00O
MEDICAL EXPENSES-ANY ONE PERSON $ 10,000
PERSONAL AND ADVERTISING INJURY $2,000,400
DAMAGES TO PREMISES RENTED TO YOU $ 300,000
ANY ONE PREMISES
AGGREGATE LIMITS $4,000, 000
PRODUCTS-COMPLETED OPERATIONS
GENERAL AGGREGATE
EMPLOYMENT PRACTICES LIABILITY
COVERAGE: FORM SS 09 01
EACH CLAIM LIMIT Y 5,DOD
DEDUCTIBLE.EACH CLAIM LIMIT
NOT APPLICABLE
AGGREGATE LIMIT $ 5,000
RETROACTIVE DATE:11012005
This Ernploymestt Practices Liability Covel,ag : corztains claims made coverage. Except as may be otherwise
Provided h�;rein, specified rnvr:rcules of this ii►:;iir'al'Ge are limited�l000laally to liability For il1jrrl s for'which clErirtas Ire
first made arlrrrnSt 03e irtsarr[al while file insurance is in Poir;e. pleasE: read and review the itisrtr mce carefully aitd
discuss the coverage with your Hartford Agent or B(oker.
The Limits of Insurance stated in this Declarations wilt be retitrced, and may be completely exhausted, by tho
payment of "defense expense" and, in such event., The Compa'Ay will not be obligated to pay any further
"defer;se expense" or sufris which the insured is or may become legally ob igated 110 I)ay as "(I,%nlages".
BUSINESS I,IABIbITY OPTIONAL
COVERAGES
HIRED/NON-OWNED AUTO LIABIbITY $2,000,000
FORM: SS 01 70
Form SS 00 02 12 06 Page 003 tCONTINULM ON NEXT PAGEl
Process Date: 09/19/22 Policy Expiration Date: 11/01/23
I
SPECTRUM POLICY DECLARATIONS (Continued)
POLICYNUMBER: 72 SBM UK5025
I.-0C11tiQn(,9), BWICling(s), BLISIneSS of Named Insoved and Schedule of Coverages for Premises as designated by
Number below
Location; 001 Building: 001
18119 N.E. 30TH STREET
REDMOND WA 98052..
Description of Business:
REAL .ESTATE APPRAISER
Deductible: NO COVERAGE
BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE
BUILDING
NO COV'SRAGE
BUSINESS PERSONAL PROPERTY
REPLACEMENT COST NO COVERAGE
PERSONAL PROPERTY OF 0THEfRS
REPLACEMENT COST NO COVERAGE
MONEY AND SECURITIES
INSIDE THE PREMISES NO COVEFArGE
OUTSIDE THE PREMISES No COVERAGE
Form 55 00 02 12 06 Page 002 (CONTINUED ON NEXT PAGE)
Process Date: 09/19/22 Policy Expiration Date: 11.101/2.3
25 This Spectrum palicy consist%of the ueciaravans,uuvu1dyG F v,11 lo,-Il-I IV,-- ,,.... ._._-._ --..••
50 other forms and F-ndorsements issued to he a park of the Policy. This insurance is provided by the stock
UK insurance company Of The f•lariford Insurance Group shown below-
SBM `1�
INSURER: HARTFORD CASUALTY INSURANCE COMPANY
ONE HARTFORD PLAZA, HARTFORD, CT 06155
COMPANY CODE: 3
1-11,
Policy Number: 72 S13M UK5025 DX ��ARIA`0131.)
SPECTRUM POLICY DECLARATIONS ORIGINAL
Named Insured and Mailing Address: ARNOLD TOMAC DBA A & M
(No., Street,Town, State,Zip Code) CONSULTING
18119 N.E. 30TH STREET
REDMOND wA 98052
Policy Period: Fray;t 11/01/22 To 1-4 1011)13 1 YE'Ak
12:01 a.irt.,:landard time at your'Willing address shown above. Exception 12 moon in New HanipsliiW
Name of Agent/Broker: AJ GALLAGHER & CO INS BRKRS CAIPRS
Code: 255202
Previous Policy l\lUm Ter: 72 SBM UK5025
Named Insured is: INDIVIDUAL
Audit Period: NON-AUDITABLE
Type of Property Coverage: NONE
Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy,we
�s�.l�et:aditll yr,u to f1z'0vide irtsur;ince.as stated in this policy.
TOTAL ANNUAL PREMIUM IS: - $425 MP
IN RECOGNITION OF THE MULTIPLE COVERAGES INSURED WITH THE HARTFORD, YOUR
F ,
POLICY PREMIUM INCLUDES AN ACCOUNT CREDIT
COuntersigrted by 09/19/22
Authorized Representative Date
Form SS 00 02 12 06 Page 001 SC:ONVINUE1) ON Nri:x'11 PAGE)
Process Date: 09/19/22 policy(=xpiratinn i]ate: 11101I23
INSURED COPY