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CAG2022-021 - Amendment - Amendment 3 - A & M Consulting - 224th Street Phase 3 (West) - S. 216th St & 98th Ave S - 10/22/2024
FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form Dir Asst: • For Approvals,Signatures and Records Management Dir/Dep: KE N T This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional) WASHINGTON Sheet forms. Originator: Department: Karin Bayes for Abdulnaser A. Public Works Date Sent: Date Required: c 10/22/2024 10/25/2024 CL Director or Designee to Sign. Date of Council Approval: Q N/A Budget Account Number: Grant?[:]YesZNo R90110 Budget?W]YesE]No Type: N/A Vendor Name: Category: A&M Consulting Contract Vendor Number: Sub-Category: = Amendment 0 Project Name: 224th Street Phase 3 (West) - S. 216th St & 98th Ave S E `o Project Deta'ls: Extend completion date to December 31, 2025 _ 40 40 Agreement Amount: $0 Basis for Selection of Contractor: Other 47 `Memo to Mayor must be attached 3 Start Date: Upon Execution Termination Date: 12/31/2025 Q Local Business?F--]YesF--]No* If meets requirements per KCC3.70.100,please complete"Vendor Purchase-Local Exceptions'form on Cityspace. Business License Verification:YesElln-ProcessElExempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: F1YesF]No CAG2022-021 Comments: a1 _ 3 4) H •� i N 3 f0 _ V1 Date Routed to the City Clerk's Office: 10/22/24 Interlocal Agreement has been uploaded to website: adccW22313_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements rev.20210513 • KENT WASHINGTON AMENDMENT NO. 3 NAME OF CONSULTANT OR VENDOR: A & M Consultina CONTRACT NAME & PROJECT NUMBER: 2241h Street Project Phase III ORIGINAL AGREEMENT DATE: January 24, 2022 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 to coordinate with PSE, Lumen, and Comcast for all utilities relocation and undergrounding work. 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, $9,450 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $9,450 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $9,450 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/2022 (insert date) Revised Time for Completion under 12/31/2024 prior Amendments (insert date) Add'I Days Required [f} for this 365 calendar days Amendment Revised Time for Completion 12/31/2025 (insert date) 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 ENT: By: � vL By; 4m�� Print Name: �[ �!`'� �'�(�1AW � Print Name: Carla Maloney, P.E. Its �"qq Its: Desi n Eng neerin Manager 12 -2 DATE: 10 If3 2 r DATE: ATTEST: APPROVED AS TO FORM: (applicable if Mayors signature required) �A� Kent City Clerk Kent Law Department kb-10/10/2024 AMENDMENT - 2 OF 2 CERTIFICATE Off' LIABILITY INSURANCE Q�a/03/2024 , THIS CERTIFICATE 18 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 C014STITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. f IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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), PRODUCER CONTACT A J GALLAGHER RISK MGMNT SVCSIPHS Ec 83556228 PHONE (f388y 92U-8259(AIC,No,Hxt): A1C,Noy: G The Hartford BLSineSS Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURHR[sI AFFORDING COVERAGE NAICti INSURED msURER A: Hartford Underwriters Insurance Company 30104 ARNOLD T'OMAC DSA A&M CONSULTING INSURER B '18119 NE 30TH ST INSURER C REDMOND WA 98052-5902 INSURER T INSURER o INSURER E INSURER F: 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 INOICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPf=CT 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 PAIL]CLAIMS, INSR ADDL SUER POLICY EPF POLICY EXP LIMITS L TYPE OF INSURANCE 711 NSR w POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 u!T.` DAMAGE TO RENTED ' CLAIMS-MADF x OCCUR S a� $1,000.00a yr. PRE X General Liability MED EXP(Any one person) 510,000 rn A x 83 SBM BP4VNA 11/01/2024 1110112025 PERSONAL&ADV INJURY $2,000 ODD r: GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $4,000,000 JPOLICY❑PRO- ❑LOC PRODUCTS-COMPIOPAGG $$4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINE}SINGLE LIMIT $2 000 000 ANY AUTO BODILY INJURY(Per persoi5) A ALL OWNED SCHEDULED 83 SBM BF4VNA 11/01/2024 11101/2025 BODILY INJURY I Per acddent) AUTOS AUTOS FARED NOIy-OWNED PROPERTY QAMAGG X. AUTOS I AUTOS (Per au.-0e111) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS WAR CLAIMS- AGGREGATE MADE DEQ I RETENTION$ WORKER$COMPENSATION PFfT OTH. AN 0 EMPWYERS'LIABILITY s TUTE E ANY YIN ESL.EACH ACCIDENT $1,000,000 A PROPRIETCRIPARTNERIEI(ECUTIVE ENI A 83 SSM BF4VNA 11/01/2024 1-1/0'1/2025 OFFICERIMEMBER EXCLUDGD7 E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory In NH) II yes.describe under E.L.DISEASE-POLICY LIMIT $I,0(}D,QflD DE SERI PINON OF_OEF RAT10 N S I A Employment Practices Liabtlity 83 SBM RF4VNA 11/01/2024 '1110112025 Each AggClaregate to Li $25,000 Insurance Annual Rggraga#e Limit25,0t74 DESCRPTrON OF OPERA'no N5 hL0C4Tf01V51 VEHICLES(ACLIRD 101.Addillonal Rsrnarks Schedule,may be attachod If more space Is rngwod) Those usual to the Insured's Operations,Certificate Holder is an Additional Insured but only as required by a valid written contract,agreement,or permit as provided by Blanket Additional Insured By Contract Endorsement,Form SL3032 attached to this pollcy. 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. KEN T WA 98032.5838 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights res(:rved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD s _4 Q 4 HANK YOU FOR RENEWING YOUR POLICY WTH US If you're receiving this renewal through the mail directly from The Hartford, please note that we've only attached new, changed or updated documents. These include your new declarations page, which outlines your coverage, as well as any notices and brochures with updated inforwation. We leave out unchanged documents to help cut down on paperwork and mailing costs. You can keep the attached documents filed alongside those from your previous policy if you wish. If you're receiving this renewal electronically, or it's been mailed by your agent, it may include all of your documents-even ones that haven't changed. In either case, keep in mind that you can view, download or print any of these documents online. Just register or log into your account com and click on "Documents". For added convenience, you can also pay your hill, request a Certificate of Insurance, check claims status, update preferences and more. .:,:a Form G-069-0 02019. The Hartford Page 1 of 1 R� p MWOLD WOMAC DBA A & M rim E 19119 N.M. 30TH 8i1,R3ZT HARTFORD REDMOND WA 98052 Policy Number: 03 SBM UK5025 Renewal Date: 11/01/2 3 Thank you for being a byal 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 terns 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 mating 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 ❑F'sales? - Have you added or eliminated any vehicles used in your business operations'> - Are the bill plan and deductible on your policy right for your business? 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: ' iew service option any - Call toll free (666) 467-B730 , and select our renewal rev weekday from 7 A.M.to 7P.Ni.CST and request your business insurance check-up- - To hest serve you, please have your Policy Number or Account Number and a Copy of your current Renewal policy in hand when yore call. # 3: servicing Your Needs To login or register for our Online Business Service (enter, go to www.thehartford.comiservicecerrter 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 paperless 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 11elPing you recover from your ions, On behalf of A J ®ALLAARtR RISK RMW SVCS/PRO and The Hartford, we appreciate the opportunity to have been of service to you this pasi. year and look forward to serv#ng your business insurance needs forthe upcoming year. Sincerely, Your Hartford Team C IMPORTANT NOTICE TO POLICYHOLDERS 0 THE HARTFORD DYBER CENTER WESSITE 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: n 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 o Risk management toots, including self-assessments, best practice guides, templates, sample incident response plans, and data breach cost calculators o 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.thehartford.c❑riVeybercenter 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 lousiness 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 r: determine the most appropriate cyber coverages and Iirnits for your business. Claims Reporting: it you have a claim, you can report it by calling The Hartford's toll-free claims IIne at 1-800-327-3636. 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: o The Hartford Cyber Center is a proprietary wela portal exclusively provided to customers of'The Hartford. Please do not share the access code with anyone Outside your organization. a Registration is required to access the Cyber Center. You may register as matey users as necessary. a 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 I Oc 2016. The 1-i8rtford Insurance Policy Bwlfing Information Thank you for selecting The Hartford for your business insurance needs. ih Shortly, you will receive your first bill from us. You are receiving this Notice so you know g 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 aplaear on your policy's Dr, clarations page. You will bo billed based on the payment plan you selected. o You may pay the"minimum clue" as it appears on your insurance bill or pay the policy balance in full. received installment service due dateesh added to each your bill. service ean late payment fees do nop "Minimum is apply in all stat due" is not Y If you selected installment billing, any credit or additional prernlurn clue as the result of a change made to your policy, will be spread over the remaining hiding installments. Additional premium duo 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 foltowinq a policy change will include future withdrawal amounts. if you need to adjust of stop your next scheduled EFT withdrawai, please contact us at least 3 days prior to the scheduled withdrawal date at the telephone nurnber shown below. * If you selected installment billing and pay the premiums for your first policy team ❑n 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. If your policy is eligible for renewal, your biIt for the upcoming policy term will be sent to you approximately 30 days lease contact us at least 60 days prior to your prior to your policy's renewal date. If you :lilt: r insurance needs change, p ;il�El renewal date so we can properly address any adjustments needed. U 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 to addition to selecting a bill plan option that best meets your budget, you have the flexibility to decide hove your 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, a Pay online:Register at www.thellariford.com/service eenter,Online Bill Pay is Quick, Easy and Secure! * Ray by Check: Send a check with your remittance stub in the envelope provided with your bill. o pay by Phone: Call toll-free 1-866-467-8730. Should you have any questions about your bill,please call Customer Service toll-free n Lim bur. 1-866-467-8730 -7AIVI --7PIA CST. we look forward to being of service to Vou. s Form 100722 11th Rev. Printed in U.S.A. i ��� POLICY NUMBER: 83 SBMUK5025 N THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE RECLJIREMEIVTS OF THE TERRORISM RISK INSURANCE ACT. D� CLOSURE/CAP ON LOSSES - TERRORISM RISK INSURANCE ACT - - -- scl•lEDuLE 1 Terrorism Premium: $ $6.00 A. Disclosure of Premium United States or to influence the policy or affect the conduct of the United states to accordance with the federal 'rerrorism Risk Government by coercion Insurance Act, as amended (TRift we are required to provide YOU with a notice disclosing the portion of Lam. Disclosure Of Federal Share Of Terrorisrrz 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 premiurr► 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 B. The following definition is added with respect to the TRIA that exceeds the applicable insurer deductible. ,E<< provisions of this endorsement: insured losses Fltrwever, if aggregate industry 1. A "certified act of terrorism" means an act that is attributable to "cedtified acts of terrorism" Linder ! certified by the Secretary of the Treasury, in TRIA exceed $10Q billion in a calendar year, the accordance with the provisions of TRIA, to be an rreasury small 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: chargers any premium for their participation in a. The act results in insured lossos in excess of covering terrorism losses. $5 million in the aggregate, attributable to all D. Cap On Insurer Liability for Terrorism Lasses types of insurance subject to TRIA; and if aggregate industry insured tosses attributable to b. The act results in damage within the United Picertified acts of terrorism" Linder 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 Lander TRIA, we shall premises of all 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 or sL clvLrcase, Your coverage for terrorism losses May nt Of Such losses that exceed $1oo billion. In dangerous to human life, property infrastructure and is committed 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 lasses and Our estimate that we will exceed our insurer deductible, Form SS 83 76 12 20 Page 1 of 2 � 2020, The Hartfor(l rr,nli�rlac rnrwrinh#arl material of Insurance Services Office, Inc., with its permission) In accordance with the 'i'reasury's procedures, would otherwise he excluded under this Coverage amounts paid for lasses may be subject to further Farm, Coverage part or policy, such as losses adjustments based on differences between actual excluded by any poll«tion, pathogenic, nuclear and estimates, Hazard or war exclusions which may be included on E. 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 ❑mission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage For any loss which l�- Paqu 2 of 2 Fora SS 83 76 12 20 0 P a 8 IMPORTANT NOTICE TO POLICYHOLDERS 7o help your insurance Iceep pace with increasing casts, we have increased your amount of insurance . . . giving you better protection in case of either a partial, or total loss to your property• If you feel the now arnount is riot the proper one, please contact your agent or broker. •fii. ii 25 This Spectrum Policy consists of the Declarations,Coverage Fo['MS, 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 UK insurance company of The Hartford Insurance Group shown below. SBM v a INSURER: HARTFORD CASUALTY INSURANCE COMPANY N m ONE HARTFORD PLAZA, HARTFORD, CT 06155 � 0 COMPANY COIDE: 3 a THE 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 Cade) CONSULTING 18119 N.R. 3 0 Tip STREET REDMOND WA 98052 Policy Period: From 11/01/23 To 11/01/24 1 YEAR 12:01 a.m., Standard time at yotn-mailing address shown above, Exception: 12 noon in New Hampshire, Name of Agent/Broker: A J GALLAGHER RISK MGMNI' SVCS/PHS Core: 556228 Previous Policy Number: 72 SBM UK5025 Named Insured is: INDIVIDUAL Audit Period: WON-AUDITABLE Type of Property Coverage: NONE Insurance Provided: In return for the payment of the prerniuin and subject to all of the terms of this poIicyr we agree with you to provide Insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $425 MP Countersigned by 08/04/23 Authorized Representative Cate Form 5S 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) Process Date: 0 810 4/2 3 Policy Expiration Date: 11/01 /2 4 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMISER: 83 SBM UK5025 Location(s), Builriing(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Dumber below. Locadon: 003- Building: 001 161.1.9 N.F. 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 OF OTHERS REPLACEMENT COST No co ERAGE 4 r MONEY AND SECURITIES � INSIDE THE; PREMISES NO COVERAGE OUTSIDE THE PREMISES NO COVERAGE Form SS 00 02 12 oB Page 002 (CONTINUED ON NEXT PAGE) process Date: 03/04/23 Paticv Exnik,.a*inn natA• 11 jn1 /,)a SPECTRUM POLICY DECLARATIONS (Corttirlued) POLICY NUMBER: 83 SBM UK5025 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $2,000,000 4 6 Q n u MEDICAL EXPENSES -ANY ONE PERSON $ 101000 PERSONAL AND ADVERTISING INJURY $2,000,000 DAMAGES TO PREMISES RENTED TO YOU $ 300,000 ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS-COMPLETED OPERATIONS $�, 0 0 0,i)0[] GENERAL AGGREGATE $4,ow), on 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:1101,2005 This Employment Practices Liability Coverage contains claims rrrade 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 lnsurance is in force. Please read and review the insurance carefully and discuss the coverage with your Hartford Agent or Broker-. l�E{i 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 obligated 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 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) POLICY NUMBER: 83 SBN UK5025 BUSINESS LIABILITY OPTIONAL COVERAGES LIMITS OF INSURANCE (Continued) LOYZR8 LIABIx,,XTY AM STOP t&P BODILY INJURY BY A,CCIDR T MRCS ACCIDENT $1, 000, 000 BODILY INJURY BY DISEASE RACH ZHPLOYZZ $1., 0 0(l, 0 0 0 BODILY INJURY aI DIMSE POLICY LIMIT $1, 0 0 0,0 0 0 dIPPLICAHLIC TO LOCATIONS IN THM IrOLLCWING 8TATZ($) a Wi1SRZKOTON WAIVZR 01F SUBIROGAT110M FORM as 12 is LOCATION: 001 BUILDING: 001. is IF Auk' Form 8s 00 02 12 06 Page 004 (CONTINUED ON NEXT PAGE) Procoss Date: 0 8/04/2 3 O i,r.. G v�;ad4...- n,.*-. 1 1 1 n1 1 n A SPECTRUM POLICY [DECLARATIONS (Continued) POLICY NUMBER: 83 SBM UK5025 t 0 CJ 0 r� n ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATXON 001 BUILIXING 1101 TYPE 1Ed.I11 AGER LESSOR SEE FORM IM 12 OQ Form SS 00 02 12 06 Page 005 (CONTINUED ON NEXT PAGE) �.. .... n�4�. nR IAA/9A PalicV Expiration Date: 11/01/24 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 63 SHM 0K5025 Form Nmmbars of Farms and Endorsements that apply: SS 00 01 0j 14 SS 00 05 1.2 05 SS 00 06 04 05 SS 00 45 12 06 SS 00 64 09 16 SS 01 28 05 1.7 SS 01 70 09 09 SS 09 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 1.0 03 17 Ili 12 07 02 21 SS 09 01 12 14 SS 09 25 12 14 SS 09 67 09 14 SS 09 70 12 JA SS 09 '71 12 14 SS 10 04 09 98 SS 12 15 03 00 IH 99 40 04 09 TH 99 41 04 09 SS B3 76 1.2 20 1H 12 00 1.1 85 ADDITIONAL, INSURED - MANAGER/LESSOR Form S5 00 02 12 06 bags 006 Process Date- 08/04/2 SPECTRUM POLICY ❑ECLARATIONS (Continued) POLICY NUMBER: 83 SBM TIK5025 SUPPLEMENTAL ❑ECLARA7IONS: 0 v G v U A service tee of $ 6.00 is charged for each installment when your premium Is paid in installments. The ser►oice fee is $ 6.0a per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. 0 Farm SS 00 45 12 OS Process Date: 08/04/23 Policy Expiration Date: 11/01 /24 0 0 0 a COMMON POLICY CONDITIONS Form SS 00 05 12. 06 r!x �1n71p Tl.n 6.JnrFfnrrl QUICK REFERENCE - SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Mailing Address Policy Perlod Description and Business Location Coverages and Urnits of Insurance It. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 B. Changes 1 C. Concealment, Misrepresentation Or Fraud 2 b. Examination Of Your Books And Records 2 E. inspections And SUI-VOys 2 F. insurance Under•Two Or More Coverages 2 G. Liberalization 2 H. Other Insurance- Property Coverage 2 L Prerniums 2 J. Transfer Of Bights 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 n ni All coverages of this policy are subject to the Following conditions. r 6 A. Cancellation (5) 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 unoccupancy; or delivering to the first Named Insured written (h) 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 wlf 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 faxes. unoccupled 50 or more consecutive days. This does not apply to: b• '10 clays before the effective date of cancellation if we cancel for nonpayment (a) Seasonal unoccupancy; or of premium. tb) Buildings In the course of c. 30 days before the effective date of construction, renovation ar cancellation if we cannel for any other addition. reason. Buildings with 655% or more of the rental 3, Mlle will mail or deliver our notice to the first units or floor area vacant or unoccupied are Named Insurer's last maMnrd 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 pet-loci will end Cross, permanent repairs to the building: on that date. �,st: (a) Have not started, and 5. if this policy is canceled, we will send the first ;;i.' ( j b) Have not been contracted for, Named insured any premium refund due. Such ;ll 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: 5. 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 7. If file first Named Insured cancels this policy, (c) Been declared unsafe by we will retain no less than $100 of the governrnental authority. premium. (4) Fixed and salvageable iterns 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 Uur consent. This policy's terms can be amended or waived only by endorsement issued by us and made: a part of this policy. Form $S 00 Oa 12 06 Page 1 of 3 r• • nnr_ Thr. WnrFfnrrl COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud I. Premiums This policy is void in any case of fraud by you as it t. 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 4. This policy; b, Will be the payee for any return preminrrrti 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. ExaminationOf Your Books And Records the policy was issuers. If applicable, on each renewal, continuation or anniversary of the Vile 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 Lilo to three years afterward. then in effect. E. Inspections And Surveys 3. With our consent, you may continue this policy We have the right but are not obligated to: in farce by paying a continuation premiurn for each successive one-year period. The premium I. Matra inspections and surveys at any time: each 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 matte safety riot 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. Health or safety of any person. And we do not represent or warrant that conditions. 4. Chanties 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 -i his condition applies not only to cis, 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 irisurarlce 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 rnoro of this policy's coverages apply to the If any person or organization to or for whom we same loss or damage, we will not pay more than the make payment under this policy has rights to actual amount of the loss or darnage, recover- damages from another, those rights are C. Liberalization transferred to us to the extent of our payment. That If we adopt any revision that would broaden the Berson or organization must do everything coverage under this policy without additional necessary to secure our rights and must do nothing premium within 45 days prior to or during the policy after loss to impair them. But you may waive your rights against another early in writing; period, the broadened covai,ige will immediately rights Prior to a loss to nLrr Covered Property. apply to this policy. Y P y. H. Other Insurance-Property Coverage 2. After a loss to your Covered Property onty 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 1). A business firm: that other insurance, whether you can collect on it or (1) Owned or controlled by you; or riot. But we will not pay more than the applicable Limit of Insurance. (2) That owns or controls your or Pane 2 of 3 r,•...., ecz Art nr a n nn COMMON POLICY CONDITIONS c. Your tenant. L. Premiurn 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 ❑ur rules and rates, o N This will not restrict your insurance. b. 'me premium amaunt shown in the Declarations ,e K. Transfer Of Your Rights And Duties under This is a deposit premium only. At the close of each Policy audit period we will compute the earned o Your rights and duties under this policy may not be premium for that period. Any additional transferred without our written consent except in the premium Found to be due as a result of the case of death of an individual Named Insured. audit are clue and payable on notice to the first 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 Narned Insured. representative, Until your legal representative is e. 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, Kevin Barnett,Secretaiy M.Ross Fisher,President Fnrm SS On nS 12 46 Page 3 of 3 POLICY NUMBER: 83 SBM UK5025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGER/LESSOR THE CITY OF KENT PUBLIC WORKS ENGINEERING 222 FOURTH AVE. SO. xENT WA 98032 i" �f r Foram IN 12 Did 1105 T SEQ.NO. 0 0 2. Printed In U.S.A. Pago 0 01 Process Data: 0 810 4 12 3 Expiration Dsto. I1/01.12 4 INSURED COPY THE 0 HARTFORD � Named Insured: WWOLD TUXAC DBA A Policy Number: 83 SBM ❑K5025 Effective Date: 11/01/23 Expiration Date: 11/01/24 Company Name: HARTF'ORD CASUALTY INSURANCE COMP 'THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, 1noluding, but not IiniRed to,the payment of ciairns. All other terms and conditions remain unchanged. Form IH 99 41 04 09 Page 1 of 1 To help your insurance kstip pace with increasing costs• we have increased your amount of Insurance . . . giving you batter pr❑it)rtion in C:lsn of oiIher a par Iia1l,or total lass to your property. if you feel the new amount is not the proper one, please contact your agent or broker. l�r Form PC-37 -0 Printed in U.S.A. In accordance with the Treasury's procedures, would otltciw-w be excluded under this CovernUo amounts paid for losses rney tie subject to further Form. Covrtrurle Part or Policy, such as losses adjustments based on differences hetween actual excluded by any pollution, pathogenic, nucloar lasses and estimates, hazat(I or war exclusions which may be included on E. Application of Other Exclusions this Policy. The tarns and limitations of any terrorism exclusion, F. All other Perms and conditlons remain the same the inapplicability or emission of a terrorism exclusion, or the inclusion of terrorism coverage, do not wive to create coverage for any lass which Page 2 of 2 Form y5 33 76 12 20 s r POLICY NUMBER. '12 SSM i110542!i THIS ENDORSFfdIE=N1 IS Al"TACHED TO AND MADE FIART M YOUR POUCY IN RESPONSE TO "THE 015LLOSURE RP01IIREMEN TS OF' TFiE 'TERROR'ISM RISK INSURANCE AGI . DISCLOSU EIGAW ON LOSSES Tlf,,RR KK SM RKSK �NISURAWCE ACT .i�FiEt]Ut_C_ 7'mrodsrn Premium; $5.00 A. Disclosure of Premium affect Stales of to influence the policy of affect tilt conduct of the United Slatmi In .lcccslYtannrxs with trle fetlet-al 'Im'i'misiii Rissh Govornmeill by coerci0r3 lll:ilil'.allt:>: Act. il:i all1cmdad (MIA). VM oft-: 1'01.11iirod to I'ji,ovide yol+ wills n Inflict, disdusing the pollis>'ii oil C. Disclosure Of Federal share Of Terrorism youf laronlium. if ally. ottrilrida hie to c avol'rlcle Vm Losses "ctal'1!lif,(I nuts of lerl'ni'isill" uiide:i I'RIA. I'lle pork ipn The United States ❑epaiimenl of the 'treasury wli! of your premium attribulachie to terrorism (xiverage is rcaimhur�r insurers; itsr 6004) of insurert IIs`i4GS shown In the above Schrrhile of this enriovio ment. atibirruim)1e to "rc:rtified alc:t-e of tern"ri,111" WI I I " B. The following definition is added with respect to ttre TRIA that exceeds,tlrc applicable insurer do(Ill ctib11 provisions of this end❑rsr merit' I•lowt-.,ver, if aggrar}ate industry insures! 1, A"cerlitied act of lerrorlsm" almllss EIiI Ad chart is atiritnrlable to "ur riified acts of larrudsnl" urlllul cerlifie d by ilner Sccretktry Ai tine Trrralsury, in TRIA exceed $100 billion In a calendar" year. the acimedsunc e Will, iiIp provisiolr:s of TRIA. to Ix± an Trea.ury shall not inake any paylltenl llrr:Jny portion tlrl of lel,forisill tnuler TI;RiA The mileria of Ilu: amount of such losses tila]l uxcweds $100 contained in TRIA for a"certified act of terrorism" billion. Tile United States 90vr3rniinent Itas not include the following: charged any prernitunt for their participation ill a. The act I'L' IRS ii] insured losses in am.ess of covering terrorism losses $5 million in the aggregate, attributable to all D. Cap On insurer Liability for Terrorism Losses types of insurinco subject to TRIA; and It ailgo.glab" industry Ilr"tirod li w;45 a►thil'ruial.rlc; to b, The act results in daniage within the United -certified arts caf tr;rrclrisrn"midor Tl-iIA exce-o'd $-100 ;intes, or oui:;ide the United Slakes in the billlion in a rolr wkir yCor -'md Ma Il8v0 Wet. Of rarill ease of cel'tain ail' carriers ol" vos-,ol:; or the inout. ot,( isnstirc:l tiecluc:tible urtrier TEMPI. we Ujuill premises of an United States mission; and ring he liabip for Ilia flaylnOill of ally 901tioli of 1110 c, The act is a violent art or an act that is ammini of srrc:li losses itsal exuntld SIN hiiEinn Its dangerous to human fife, prnperiy of such case, your coverage for terroriwn losses May infrastructure and is carnrrliltc:rJ by an be reduced an a pro-rats basis in accordance with Individual or individuals as pact of an effort to procedures established by the Treasury. based oil its coerco the rivilialn porruiatiort of the estimates of aggregate industry losses and our eslimale that vie will exceed our Insurer dedurtlble Form SS 83 76 12 24 o 2020,T Page 1 of 2ThehiNrlfn►d (hlrhtdes copyrieglrted ruaitorial al insurance Services Office, Iru:.. with its pormissio 11) r' 1-T)11 l) Named fissured: ARNOLD TAKAC DR& A N Policy Number. 72 SBm LIK5425 Effective We: 11 ja1122 Expiration pate: 11101/2 3 C0111pany Name: HARTFORD CASUAyry INSURAUTCL COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This ir7surarice: class not .zl)lily to th1: [xtool that Iiuele Or (.":0riomic satictialts o1 �:ilusr laws or req[ilations piohibit us f(Orn providing i+as:lrralice, inahu}ing,hrrt I of liln'stod I+),fhA payment OICla;rn: All othar tGOTIS and conditions remain unchangehi- page 1 of I Form IH 99 4104 09 ;;. " THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GOODS AND SERVICES ENDORSEOMENT VVASit� INGTO N This endorsement modifies insurance prnvided under all Coverage Parts of this Policy. VVu itr..ly offtrr trr rnslkrt "slnrul:, crr :�rrivis:Us, availabW tol Yuri Ills(mull Illis 111100twlifiil[J Wrr�frllry, ri non ila:;taltll wlltasirlouy. Ur 1i112tllllitils d 111i,(I IxIIIles iia ;i 01111 1)1 this.fnriir:y I'I "4!ofwI.,i of S;:rvtt:r.% rrlay ho Illovided frig A r:h;•rlllL, at i1 ifiS{wilill, of Itr:r-: Ill mJ111t'• [;rl Efi- VAI f1say w(:r`w a fet' 1i11n1 11w tinaflilialml 11111-d f)wticis Ili.'i[ f1i'tiviLft^ "goods of tit;lvirl"". We (to rlrrl wari"111I or 1 ual—ailleo 1iuo "goods t1i services" pr oviduct by Ihirtl p al hos, "Ind sait.11 thilll pal li;rri n11:111 bo sillely WIMP and I fispolisilAv. lol 111J-' "Ifr odli of sruvic.es" 1110y provitin. 'flu+ "goM.., III s:crvcct::�' olli w'd to Ilialk., availa blo by ur; M:ly i:r: 1110 (lod ill discontln lad at any time. This ontlr>'rsralbeill is stihlcrsl In I2(:W rlti 3i1 1's11(I}(r.}, which p,Dhil)its insurance companies from 111r1vlding prilvs, g oods, vrr w". gift r::I I'd s, ttilt c eI'tiIic:rrlC.4. ill 1111"rc11andIse of au ag41re:gate value in excess of y l00 per pwisirin ill Ihl ri41rlrr�y�ltrr ill Billy rtinSc:rillivt iwalve-nionth period, "Goads or services'" means goods, products or services, iflclutfing hilt not limited to risk mitigalinn, safety. and/or loss prevention services of equipinew IH 12 07 02 21 r Page i of i .7�02i, Tile I-iaillnrcl pc)t NUMBER. ,;13M UK5025-IcY �. THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURPD •- 14ANAGFIR/LL•'SSQI1 THE CITY OF' I[IrNT pUBLIC WQItKS ENGINEERING 222 FOURTH AVE, SCS. ICL•'NT WA 98037. Farm iH 12 DD I 186 T SEG.NO. 0 0 2 Printed in U.S.A. NOS �r�IExpirallan Meta: 1,I J 01102 3 Prbcesa t}nte: 09/19122 INSLHZT:i7 [:flPY COMMON POLICY CONDiTIONS c. Your tenant. L. Premium Audit You may also acc(-pl the ustrrl bills of fading or a. We will compote all premiums for [his policy In shipping r'rceipts lirnitrng thr.Ualaifily of carriers, accordance with our rules and rates. This will riot restrict your insurance. f I1v I•iunturrrr a mou+rt Alovni in Iho 0o,11.1'nfiolm i r Rr rlellosil I.ruimum only Al t1w Glose of"A:h #S. Transfer ❑f Your Rights And buttes Under This -srrrlil 170.0 1d we will carrrfrrrle Ih.: earr od Policy prenuum Im HIM i-J01" d. Any addillonai Your rignis and duties under this policy may not be prolifl un forrrul to III! r#rrkl mi a rmaill of the -Rransferraci without our written consent except in the mixilt Rio Aire and puy"Iblo o[r noli :e to flu: Ilr:;l case of deallt of an individual Named Insured. Named Immifed 11 the dn'l•o.-01 111,4111141111 paid If you [iln, your riylrte, and Julies will bf., transfurred for thr> polig l(:rfn is groalor ihaoi the carried t[) yor)r legal rppIpSoniativo but crnly whit[: artirrg prrmri im. we will return the to (lae first wlttfin the scope of duties as y[uu 10iFil Named Insured. ref]rraSr rttatlivc, Unlll your logtrl rep')es[:nl.itive is c-. The first Named Insured roust rrrainlain all appointed. Anyone, haviftfl #ar[rl�er tertf#,orary cugloslY r[:crr&related to the coverage provi[te[l by this Of your propoity will irave your righlS Mmd rtrrfir:d; 17r11 policy and necessary) to 1`418112e ttrsr premium only wllh respect to that property. audit. ;tnd send us copies of t#te same upon our request. Our President and Secretary have signed tills policy. Where required by law,the Declarations page has also boan countersigned by Our duly authorized representative. Kevin H-mrietr,SeerPrnry prxtgtas Cluoi.P+esuleni ��tl AI �Ea'I Farm SS 00 06 12 UG Page 3 of 3 COMMON POLICY CONDITIONS C. Concealment,Misrepresentation Or Fraud I. Premiums This policy is void in any case ril frauid f)y you as it 1. the first Named Insured shown in the relates to this policy at any time: It is mist void if Declarations.* you or any other insured. at any time, i+tlooliosuilly a. Is rosponsibio loi- the payalimil. of all conceal or i'nisrapresent a material [net cunii:trrminq: premiurlm and 1. This policy; b. Will he the payee for any return promiums 2. The Covered Property; we pay. 3. Your interest in [tie Covered Property; as' 2. The premium shown in thu Declarations was 4. A claim under this policy. computed basocl on rates in effect at the time the policy was issued. If applicable, an each V. Examination Of Your Books And Records renewal. co+nlinuatiun or anniversary r,f tho We may examine and audit your hooks and records t;floclive dale of 11ris policy, we will compute the as they relate to the policy at any time during the prcgoiuni in a cl ord,atice will) nur rate:: watt +ales policy period and up to three years aflerward then in effect, E. Inspections And Surveys 3. Willi our consent, you may conlinou Ilik,polity We have the right but are not obligated tw Ill force by paying a continut)lion proiniurn for r ach succe%sive ollugear period. The prenliunf 1. Make inspections and surveys at Rny time; lrrust he: 2. Give you reports an the conditions we find; and a. Paid to us prior to the anniversafy date; and 3. Racornmend charsg". h. Determined in accordance with Paragroph Any inspections. stirvoyts. R1130 is or 2.above. rr:rxsirunarulrshcaii:. o lato wily In inssurnhiiity .foci the Our lorrrms the.il ill eflocl will apply it you rin prernrtnris to lnr ':Ir,+rt-lud. IrWu rill nil Ise:alto -afoly 1101 pay Ilia c0111innalfor+ I►relillolrl, it+is policy ilmou:lloirs Wil (it) $lot Irfsrk)rO+lto to purfouls II)v will expire on the first anniverti3sy dale that wry rittiy of any pur."olr tri orgai+l�rMicus t() Irrsivide ter 111v li;trvt! I101 rt"ccived life pwinium froalfl► or s0lviy cut a+sy llov;oji And wry do not represent or warrant that conditions: 4. Changes ins:xposi n�HS ear t;hsfixtu�f in your 1. Are safe or healthful,, or business n1►era►lion, a►r:rltiisilic�n• or uric of itx:nitans ils.sl 81V )Hsi shown in Iht Declai ahans 2. Comply with laws, regulations, codes or may occur during the policy period. If so, we standards. may requim an additional premium►. That -I Ire.; crnuilit)ufr allpilr:s not oisty to us, hul alno io Hily premiurn will be determined in accordance with mlirltl, odvi:sory, stair: Sol'vi4+1 or sirnilcai orU..+m/.ition wir rates and rules then in elfeet, which make-i Eli:rrll'�inr u itispoctions, survey:;. introits 1 Transfer Of Rights Of Recovery Against Others ear To Us F. Insurance Under Two Or More Coverages Applicable to Property Coveraggw If two or morn of this policy's r,:nlotii-ages:+fBilly to the if any person or organization to or for whom we :ttrine loss or damaoo, we% will nol pay murri than the make parynivol u+utur this pulicsy has rights to actual amount of the loss or damage. rerover da►inal)es (ram rutother, thase rlgi►ts are G. Liberalization hanslerred to of,to thtr extent of our paiyinnni. That if we adopt any revision that would broaden the person or oryanirahott emusl do evorything raecvssary to stactite wo rights ailtd must (to nwhintl coverage uinderr this policy without additibnai slits' ibis tp irlti'r.►ii 1hi;ns. Silt YOU May w.sivt; solo pr��rr+turn willuii�i.i elaiv:r prior to or deicing the I+{rtiCy rigt►t.a against�incttflnr I)ttrly in welling: potiod, tho hruadcnt-n1 coverage will irnmedialely apply to this polity. 1. Prior to a loss to your Covered Property. H. Other Insurance-Property Coverage 2. After a loss to your Coveie d Property only it, at ti tlls:is' i5 ail►er insinnnraa utivt:riru+,j the •;:+ilia Iorr:, or tirne of loss, that party is one of the following; rlwnc+fdl;.wta will Irrly only rrir ore arilou+ti of covuled a. Someone insured by this insurance; loss Or damage In t3xcoss of tho amotntl Clue from b, A business firm.- that olhor Insurance, whether you earn collvcl on it ur (1) Owned or controlled by you; or not. 13u1 we will not pay more than the applicable Limit of Inrrtirtsiice. (2) That owns or controls you: or Page 2 of 3 Form SS 1)0 05 12 06 COMMON POLICY CONDITIONS All coverages of this policy are subject to tlir:iollowing condilions. A. Cancellation (5) Failure to.- I. Tile first Named insured shown in the lay Furnish necessary heat, water, c)ectarrrlions may cancel this policy by matling sewer service nr 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 loolicy by mailing nr unor;r:Lrpanr:y; or delivering to the first Named Insured wrillen (b) Pay }property taxers that are owing notice of cancellation at lease: and have been outstanding for 11101-e than one year, following the a. 5 clays before the effective date Of date Clue, except that this provision cancellation it ally one of the folluwifig will not apply where you are in a conditions exists at any building that is bona fide dlspLde with the taxing Covered Property in this{whey; auttlo:'i!y 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 jay Seasonal unocctipancy:or of premium. tb) Bt ldings in the course Of c, 30 days before the effective date of construction, renovations or cancellation if we cannel for any other addition, reason. Buildings with 55Yo or more of the renlal 3, We will mail or deliver our notice to the first units or floor area vacant or unoccupied nFe Named Insured's last mailing address known to considered unoccupied under this us. provision. 4. Notice of cancellation will state the effective (2) After damagi, by a Covered t.::r+r%r1 of date of cancellation. The policy period will end Loss, perivi anitnt repairs to the Lmitding: on that data. (a) Have clot stailed, and 6. If this policy is canceled, we will send the first (by Have not been contracted for, Named Insured any premlurn refund due. Such within 30 days of initial payment of refund will be pro rata. The cancellation will be affective even if we have not made or offered loss. a refund. (3) The building has: 6. if notice is mailed, proof of ntailing will be ta) An outstanding order to vacate: sufficient proof of notice, (h) All outstanding demolition order;or 7. it 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) Fixod and salvageable items have B. Changes been or are being removed from tiie This policy contains all the agreements between building and are not being replaced. you and ens 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 bF amended or waived only by endorsement issued by us and made a part of this}policy. Form SS 00 05 12 06 +';ut: 1 (4 .3 0 240t3,The Hartford QUICK REFERENCE -SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Malting Address Policy Perlod Descdption and Business Location Coverages and Limits of Insurance li. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 S. Changes 1 C. Concealment, Misrepresentation❑r Fraud 2 D. Examination Of Your Books And Records 2 E. Inspections And Surveys 2 F. Insurance Under TvoD Or More Coverages 2 G. I-lberalication 2 H. Outer Insurance- Property Coverage 2 I. Premiums 2 J. Transfer Of Rights Of Recovery Against Othars To Us 2 K. Transfer Of Your Bights And Duties Under TN.%Policy 3 L. Premiurn Audit 3 Form 68 00 0612 06 COMMON POLICY CONDITIONS Form 55 OU DS 12 QG ] Z006, The Hartford SPEGTRt1M POl~ICY DECLARATIONS (continued) POLICY NUMBER: '12 s9m 0Y,'' 2'i Sl1PP[,I=MENTAL DECLARATIONS: A service i-0 of $ 6.01)is changed for each installment when your premium is Laid in installatents. Tile service fee is $ 6.ua per Withdrawal when yflu select an electronic fund transfer payment flan. The service fee will be added to the premium amount shown on your premium billing statement. Fofm 5S OQ 45 12 DG process Date: 491 1 9 12?. Policy Fxpirativi�Hate: 13 lt7:L 123 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5025 Forin Numbers of Perms and Endorsements that apply: S,5 00 01 03 14 SS 00 05 12 06 SS 00 00 04 05 SS 00 45 12 06 SS 00 64 09 .16 SS 01 20 05 l7 SS 01 70 09 09 SS 69 93 07 16 5S 00 60 09 15 SS 41 02 04 05 SS 41 63 06 11 SS 05 03 03 01) SS 05 47 09 15 S5 51 10 03 17 Iki 12 07 ill 21 SS 09 0-1 12 .14 SS 09 25 12 14 SS 09 67 09 1.4 S5 09 70 12 14 SS 09 71 32 :14 SS 10 04 09 98 SS 12 15 03 00 111 99 40 U4 09 TH 99 41 04 09 59 83 74 12 20 Ili 12 00 11 85 AL)DITIONAL 1NSL1FtXr; NeANAG R/LESSOR Form SS 00 02 12 06 Page 006 Process Date: 091:19/22 Pnllcy Expiration Date: 11/01/23 SPECTRUM POLICY DECLARATIONS [Continued) POLICY NUMBER: 72 ;13M uKS025 ADDITIONAL INSUREDS_ E FOLLOWING OWING A IN RE ADDITIONAL LI INSUREDS FOR BUSINESS L LOCATION 001 bUXLDXNG 001 TYPE LESSOR Form SS QU 07 1�QB Page 005 (C0NTJ:WjJ!,U OW NEXT' VAGE) Process Date. 091�-9 r�� policy [.xE7ir;jx;ar►Date.. ].�.r��1 r7 3 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: '72 SBM UK'3025 BUSINESS LIABILITY OPTIONAL COVERAGES LIMITS OF INSURANCE (Continued) 'WVL0yCZR8 LIABILITY AWO STOP (411V SODXLY INJURY By ACCInp-irl, MACH Acclf]1tiNT $1.,000,009 BODILY IX0'njCX DY DISKA9z ZkCR >�bJ' PLt7X,L), $1, 000, 000 BODILY ImimtY BY Dlaxksx POLICY LIMIT $l,QQO,U00 APPYATCABLK TO 14WATIifW IN TOLr.OWXNO S'�akTLl(.,) WASHINGTON WAIVZR O1r t49WAZ[7OATION FARM S8 12 15 mmuc s I F kuy Faf'm SS 00 02 12 06 page 004 jCONTINUED t;l@ r1}?x r PAGI•:f Process mate; 09119I2a Policy Expiration Date: 111011'J.3 SPECTRUM POLICY DECLARATIONS (continued) POLICY NUMBER: 72 S13M UK5025 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES MEDICAL EXPENSES -ANY ONE PERSON 1(),000 PERSONAL AND ADVERTISING INJURY DAMAGES TO PREMISES RENTED TO YOU $ 300, 000 ANY ONE PREMISES AGGREGATE LIMITS $5,000,000 PRODUCTS-COMPI-ETED OPERATIONS a4,40a,UD[1 GENERAL AGGREGATE EMPLOYMENT PRACTICES LIABILITY COVERAGE: FORM SS 09 01 EACH CLAIM LIMIT $ 5,000 DF,DUCTIBLE-EACH CLAIM LIMIT NOT d1PPL-LCABLX AGGREGATE LIMIT $ 5,000 RETROACTIVE DATE: 71012005 This Etnploylriewlt Practices Liability G[>'1�t!I'�tii[: t;[alat:tlll:� s-lainl� rll.ldr: catrer:a�e• Exccpl 86 Way be oll►r:rwise provid[ai IW'sVilt, SPOt--iIi(:ti covefrtsles of 0Ir it):it11al.C:[; Ire Ii1 Wed tralW,',►Ily to Ii alaiVity fnr IltiuriE�s ia, wi►ich altlili}s:u'F ill:aut:cl Willie 111r: ir!SUt'0111A is i!1 fown. PIC-asv' read ?Irtil review Ilia first m,acie' sul:luasl Ill(,. instlr�slx:e c�arr!#Illly �>lui [Aist:tlss Ilse Co vLl,,jg4t wilia your I•{tlrll[]fi:l Ag}t�lt1 ter Cil'L1tC[f• by Titre Limits of Illst}rance statn[I ill this Declarations Will be C c Ile ad, `ice ilmat bay e[1 o(t1 leltecllytexiaayst-d, irxthr pityrnal-it of "dofense expense" and, in such OVClat, 'flle o P Y If delarlse cxpotlse" r1f st+ms vVftie:It tlle: itl3tlretl i: or may become legally Obligated to pity as"danaage1s". k31.1:i.1'N}:i sS I,I-AH L1,1TY of"1'10NA1+ 00VFRAt;E i H.rRk, /hION-OWNED AU11.10 L,l.AA1I` . Ty 1!()K14: SS 01 7[} Form 5S UO 02 f2 OB Rage 003 I{'t)M1 J zuari:I� ON NEXT PAc,E) 12 Process Data: 06 Z2 Poticy >"_xfsirraliorr Date; 1L/01-123 SPECTRUM POLICY DECLARATIONS (Continued) POL.ICYNUMBER: 72 STiM UK5029 L.owition(s).Ouilding(s), Business of Named Insored rind Schedule of COvHfages for Premises as designated by NOn*er below Location: 001 t3Clilciilig: I107. 18119 N.E. 30TII STREET REDMOND WA 98052 Description of Business: REAL ESTATE APPRAISER Deductible; NO COVERAGE BUILDING ANO BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST NO COVERAGE PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES NC1 COVEP�.AGE OUTSIDE THE PREMISES No COVERAGE Form SS 40 42 12 06 Page 002 (CONTINUED CAN NEXT PACE) Process Date: 0 9/19/22 Policy Expiration Date: 11/01/2..3 21) 11115;)VV:L1u111 ru lit,y — &-- -- . 5 0 other forms and Errdoiselnents ISS1,10 to he a part of the Policy. This instrreirlce is provided by the sloe t;tt ilis,Iranct3 eotnpany of The Hartfald Insuraiwe Gloup shomi below, SBM iNSURER: HAFt'1'FORD CASUALTY INSURANCE COMPANY ONE HAH'VrORD PLAZA, HARRTFORD, CT 06155 COMPANY CODE' 3 policyNtrntber: V2 Slim uK5025 DX ��AI;'f 1:0K 1.? SPECTRUM POLICY DECLARATIONS ORIGINAL, Named Insured and Mailing Address: Ar1RNOLD A1SCfi,'I'TOMAC 013A A & M (No., S(reet,Tovm, State,Zip Cade) - 18119 N,E. 3 UTf i STREET REDMOND wA 98052 I'lolicy period: From 1.1101122 To 1 t 1 t1:t 1!_i 1 Yi-:AR 1;,,04 a.m.,Stmidai'd time at your mai ir+g addross shown above. Exceptiolti: 12 nuuil in New Hamir-Ilife Name of Agent/8raker: AJ GAuAGHE'R & CO 7NS BRKRS CA/VHS Code: 255202 Previous Policy Number: 72 SBN IJK5025 Named Insured is: INDTVIDUAL Audit Period: NUN-AUDITAHLE: Type of Property Coverage: NONE 11I4ur:Lli Ce Provided: If, return islr the pays-tent❑f ttoe plerr}lurto and subjet:t to all at the terrtts of this policy,we .ut,ee Lviti►you to Im0Vide it)SLII01We as stated in this polif.y. TOTAL ANNUAL PREMIUM IS: $425 MP IN RFCOGNITIONI Or THE MULTIPLE COVE:RhGER INSURED i<•JITH 'rHE HAR`I'FORD, YO(JR i. pol,IC:Y EREMIUM INCLUDES AN ACCOUNT CREDIT. r,} Colintersiigned by 09/19/22 Authorized Represerrtalive Date Farm SS 0�02 12 Ofi Page 001 (CONr'I[+li FA) ON tds�:XT PAGE) Process Date: U9119127, policy i"xisir.ition 1:1.oie: 11101 123 I.h];;[rfiCC] COPY