HomeMy WebLinkAboutAgreements/Contracts - Public WorksK19-012
CONTRACT
THIS AGREEMENT, between the Board of County Commissioners of Grant County, State
of Washington, acting under and by virtue of Chapter 36.77 of the Revised Code of Washington,
as amended, hereinafter called the County, and , for itself, its
heirs, executors, administrators, successors and assigns, h einafter calle I the Contractor.
WITNESSETH:
That in consideration of the payments, covenants, and agreements, hereinafter
mentioned, and attached and made a part of this agreement, to be made and performed by the
parties hereto, and the parties hereto covenant and agree as follows:
DESCRIPTION OF WORK:
1. The Contractor shall do all work and furnish all tools, materials, and equipment
necessary to improve and complete 2019 Crushing and Stockpiling, located in Grant County,
Washington, as proposed in a bid opened 1:45 P.M., Tuesday, January 8, 2019 in accordance
with and as described in the herein attached plans and standard specifications, and in full
compliance with the terms, conditions, and stipulations herein set forth and attached, now
referred to any by such reference incorporated herein and made part hereof as fully for all
purposes as if here set forth at length, and shall perform any alterations in or additions to the
work covered by this contract and every part thereof and any force account work may be
ordered as provided in this contract and every part thereof.
2. The Contractor shall provide and be at the expense of all materials, labor, carriage,
tools, implements and conveniences and things of every description that may be requisite for
the transfer of materials and for constructing and completing the work provided for in this
contract and every part thereof.
3. The County hereby promises and agrees with the Contractor to employ, and does
employ the Contractor to provide the materials and to do and cause to be done the above
described work and to complete and finish the same according to the attached plans and
specifications and the terms and conditions herein contained, and hereby contracts to pay for
the same according to the attached specifications and the schedule of unit or itemized prices
hereto attached, at the time and in the manner and upon the conditions provided for in this
contract and every part thereof. The County further agrees to employ the Contractor to
perform any alterations in or additions to the work covered by this contract and every part
thereof and any force account work that may be ordered and pay for same under the terms of
this contract and the attached plans and specifications.
4. The Contractor for himself, and for his heirs, executors, administrators and assigns, and
successors and assigns, does hereby agree to the full performance of all the covenants herein
contained upon the part of the Contractor.
5. It is further provided that no liability shall attach to the County by reason of entering
into this contract, except as expressly provided herein.
2019 CRUSHING AND STICKPILING
ntract — rage
IN WITNESS WHEREOF, the said Contractor has executed this instrument, and the said
Board of County Commissioners of Grant County has caused this instrument to be executed by
and in the name of said Board by its Members, duly attested by its Clerk, the day and year
below written, and the seal of said Board to be hereunto affixed on said date.
ATTEST:
Clerk of the oard
APPROVED AS TO FORM:
day of f �Uartde % 2019
YA.Z��-
Deputy Pros cut ng Attorney
2019 CRUSHING AND STICKPILI
1-1 da 12019
Signature
:71f
J Print Name
Firm Name
�?u 3nx 1"A
Address
City State Zip
( ao�) 'ly3-�u55C7
Phone
BOARD OF COUNTY COMMISSIONERS
OF GRANT COUNTY, WASHINGTON
Done this � day of , 2019
contract —
Member
I
CONTRACT BOND
KNOW ALL MEN BY THESE PRESENTS:
That we, the undersigned, DeAtley Crushing Company, Inc. as
principal, and Travelers Casualty and Surety Company of America a
corporation organized and existing under the laws of the State of Connecticut as
surety corporation, and qualified under the laws of the State of Washington to become surety
upon bonds of contractors with municipal corporations, as surety, are jointly and severally held
and firmly bound to Grant County, Washington, in the penal sum of
Nine Hundred Fifty Eight Thousand Four Hundred Sixty and 00/100 Dollars
($ 958,460.00 ) for the payment of which sum on demand we bind ourselves and our
successors, heirs, administrators or personal representatives, as the case may be.
This obligation is entered into in pursuance of the statutes of the State of Washington,
the Ordinances of Grant County, Washington.
Dated at , Washington, this day of , 2019.
The conditions of the above obligation are such that:
WHEREAS, on January 8, 2019, the Board of County Commissioners of said Grant County
has let or is about to let to the Principal, a certain contract, the said contract providing for the
improvement of 2019 Crushing and Stockpiling, located in Grant County, Washington, (which
contract is referred to herein and is made a part hereof as though attached hereto), and
WHEREAS, the said Principal has accepted, or is about to accept, the said contract, and
undertake to perform the work therein provided for in the manner and within the time set
forth;
NOW, THEREFORE, if the said Principal shall faithfully perform all of the provisions of
said contract in the manner and within the time therein set forth or within such extensions of
time as may be granted under said contract, and shall pay all laborers, mechanics,
subcontractors and material men, and all persons who shall supply said Principal or
subcontractors with provisions and supplies for the carrying on of said work, and shall hold said
Grant County harmless from any loss or damage occasioned to any person or property by
reason of any carelessness or negligence on the part of said Principal, or any subcontractor in
the performance of said work and shall indemnify and hold Grant County harmless from any
damage or expense by reason of failure of performance as specified in said contract or from
defects appearing or developing in the material or workmanship provided or performed under
said contract, and until the same is accepted, then and in that event this obligation shall be void
but otherwise it shall be and remain in full force and effect.
Countersigned:
Travelers Casualty and Surety Company of America
Licensed Agent/Surety Co.
Conover Insurance Services, LLC
1804 W. Lewis St., Pasco, WA 99301
( 509 ) 545-3800
Firm, Street Address (No P.O. Box), Phone of Local Office of Agent
tley Crus ' g Co any, Inc.
Principal
r --
v--
irs n K. Jdan A orney-inFact; Surety
Approved as to form:
2019
Prosecuting Attorney
Contract — Page
Travelers Casualty and Surety Company of America
AM Travelers Casualty and Surety Company
TRAVELERS J St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint Kirsten K. Jordan, of Pasco, Washington, their true and lawful
Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in
the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts
and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February,
2017.
-.0 'OWEN
•
WORM
QML • '�1 cowLF�lC
State of Connecticut
City of Hartford ss.
By: 61%%
Robert L. Raney, Se or Vice President
On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations
by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal. a �1
My Commission expires the 30th day of June, 2021
*�,M Mane C. Tetreault, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in
full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by
one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only
of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies, which remains in full force and effect.
Dated this j day of J G.4w C `et
IMj. v A,yp
"KIRK
IM < GAS ' l
Kevin E. Hughes, Assi tant Secretary
To verify the authenticity of this Power ofAttomey, please call us at 1-800-421-3880.
Please refer to the above-named Attomey4n-Fact and the details of the bond to which the power is attached.
' 1 ®
ACORO CERTIFICATE OF LIABILITY INSURANCE
16-.�.
DATE (MM/DD/YYYY)
01/15/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Conover Insurance
NAME CT Jacqueline Hernandez, ACSR
PHONE (509) 545-3800 FAX
No Ext No : (509) 547-7960
E-MAIL jackieh@conoverinsurance.com
ADDRESS:
1804 West Lewis Street
INSURER(S) AFFORDING COVERAGE NAIC A
INSURER A: American Economy Insurance Company 19690
Pasco WA 99301
INSURED
INSURER 13: American Guarantee & Liability Insurance Company 26247
INSURER C: Great American Ins Co 16691
DeAtley Crushing Company
INSURER D: Zurich -American Insurance Company 16535
PO Box 759
INSURER E:
INSURER F:
Lewiston ID 83501
UV V lcnrauca
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
ILTR
TYPE OF INSURANCE
( D
WVD
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD
LIMITS
X COMMERCIAL G ENERALLIABILITY
EACH OCCURRENCE $ 1,000,000
-DAMAGE TO RE 200,000
PREMISES Ea occurrence $
CLAIMS -MADE � OCCUR
MED EXP (Any one person) $ 10,000
A
Y
01C174054160
01/01/2019
01/01/2020
PERSONAL & ADV INJURY $ 1,000,000
GEWLAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY ❑X PRO ❑ LOC
JECT
OTHER:
a accident) LIMIT $ 2,000,000
E
AUTOMOBILE LIABILITY
BODILY INJURY (Per person) $
X ANY AUTO
BODILY INJURY (Per accident) $
B
OWNED SCHEDULED
BAP378494005
01/01/2019
01/01/2020
AUTOS ONLY AUTOS
HIRED NON -OWNED
PROPERTY DAMAGE $
Per accident
AUTOS ONLY AUTOS ONLY
Hired Auto Physical $
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE $ 8,000,000
AGGREGATE $ 8,000,000
C
JX
EXCESS
CLAIMS -MADE
T00066081307
01/01/2019
01/01/2020
DED RETENTION $_
$
PR EH
WORKERS COMPENSATION
/� STATUTE R
E.L. EACH ACCIDENT $
AND EMPLOYERS' LIABILITY Y/N1,000,000
D
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
EXCLUDED?
N/A
WC932718006/CA, OR, ID
01/01/2019
01/01/2020
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
OFFICER/MEMBER
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS below
EL Each Accident 1,000,000
WASHINGTON STOPGAP
010174054160
01/01/2019
01/01/2020
EL Disease - Ea Empl 1,000,000
A
EL Disease - Policy Limit 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: 2019 Crushing and Stockpiling. Grant County is additional insured. Forms: General Liability Additional Insured/Primary Additional Insured blanket Form
#CG 79 00 07 87; General Liability Per -Project Agg per Form NCG 25 03 05 09.
CERTIFICATE HOLDER
`'"r"���^r
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Grant County Department of Public Works
ACCORDANCE WITH THE POLICY PROVISIONS.
124 Enterprise St. S.E.
AUTHORIZED REPRESENTATIVE
Ephrata WA 98823
'0
. .nen nn.c Af•non f•ffDDP1DATInN All riahts reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
tk!,ierty_M,U__tU,q.
INSURANCE
COMMERCIAL GENERAL LIABILITY
GG 79 00 07 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY. CHANGES
IL 12 01 11 85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE
BLANKET ADDITIONAL INSURED (CONTRACTORS)
1. WHO IS AN INSURED - (SECTION 1) IS
AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION
THAT YOU AGREE IN A "WRITTEN CONTRACT
REQUIRING INSURANCE" TO INCLUDE AS AN
ADDITIONAL INSURED ON THIS COVERAGE PART,
BUT:
A. ONLY WITH RESPECT TO LIABILITY FOR
"BODILY INJURY", "PROPERTY DAMAGE" OR
"PERSONAL INJURY"; AND
B. IF, AND ONLY TO THE EXTENT THAT, THE
INJURY OR DAMAGE IS CAUSED BY ACTS OR
OMISSIONS OF YOU OR YOUR SUBCONTRACTOR IN THE
PERFORMANCE OF "YOUR WORK" TO WHICH THE
"WRITTEN CON`L'RACT REQUIRING INSURANCE"
APPLIES. THE PERSON OR ORGANIZATION DOES
NOT QUALIFY AS AN ADDITIONAL INSURED WITH
RESPECT TO THE INDEPENDENT ACTS OR OMISSIONS
OF SUCH PERSON OR ORGANIZATION.
2. THE INSURANCE PROVIDED TO THE ADDITIONAL
INSURED BY THIS ENDORSEMENT IS LIMITED
AS FOLLOWS:
A. IN THE EVENT THAT THE LIMITS OF
INSURANCE OF THIS COVERAGE PART SHOWN IN THE
DECLARATIONS EXCEED THE LIMITS OF LIABILITY
REQUIRED BY THE "WRITTEN CONTRACT REQUIRING
INSURANCE", THE INSURANCE PROVIDED TO THE
ADDITIONAL INSURED SHALL BE LIMITED TO THE
LIMITS OF LIABILITY REQUIRED BY THAT "WRITTEN
CONTRACT REQUIRING INSURANCE". THIS ENDORSE-
MENT SHALL NOT INCREASE THE LIMITS OF INSUR-
ANCE DESCRIBED IN SECTION III - LIMITS OF
INSURANCE.
B. THE INSURANCE PROVIDED TO THE ADDITIONAL
INSURED DOES NOT APPLY TO "BODILY INJURY",
"PROPERTY DAMAGE" OR "PERSONAL INJURY"
ARISING OUT OF THE RENDERING OF, OR FAILURE
TO RENDER, ANY PROFESSIONAL ARCHITECTURAL,
ENGINEERING OR SURVEYING SERVICES, INCLUDING:
i. THE PREPARING, APPROVING, OR FAILING TO
PREPARE OR APPROVE, MAPS, SHOP DRAWINGS,
Copyright, Insurance Services Office, Inc., 1983
CG 79 00 07 87 Page 1 of 2 EP
AFP4MFTA2-(1?P IINTOfil- S20 -0234Y
t!t I bcrty M4,t aI-
INSURANCE
COMMERCIAL GENERAL LIABILITY
CG 79 00 07 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
POLICY CHANGES
IL 12 01 11 85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE
OPINIONS, REPORTS, SURVEYS, FIELD ORDERS OR
CHANGE ORDERS, OR THE PREPARING, APPROVING,
OR FAILING TO PREPARE OR APPROVE, DRAWINGS
AND SPECIFICATIONS; AND
ii. SUPERVISORY, INSPECTION, ARCHITECTURAL
OR ENGINEERING ACTIVITIES.
C. THE INSURANCE PROVIDED TO THE ADDITIONAL
INSURED DOES NOT APPLY TO "BODILY INJURY" OR
"PROPERTY DAMAGE" CAUSED BY "YOUR WORK" AND
INCLUDED IN THE "PRODUCTS -COMPLETED OPERA-
TIONS HAZARD" UNLESS THE "WRITTEN CONTRACT
REQUIRING INSURANCE" SPECIFICALLY REQUIRES
YOU TO PROVIDE SUCH COVERAGE FOR THAT
ADDITIONAL INSURED, AND THEN THE INSURANCE
PROVIDED TO THE ADDITIONAL INSURED APPLIES
ONLY TO SUCH "BODILY INJURY" OR "PROPERTY
DAMAGE" THAT OCCURS BEFORE THE END OF THE
PERIOD OF TIME FOR WHICH THE "WRITTEN
CONTRACT REQUIRING INSURANCE" REQUIRES YOU
TO PROVIDE SUCH COVERAGE OR THE END OF THE
POLICY PERIOD, WHICHEVER IS EARLIER.
3. THE INSURANCE PROVIDED TO THE ADDITIONAL
INSURED BY THIS ENDORSEMENT IS EXCESS OVER
ANY VALID AND COLLECTIBLE "OTHER INSURANCE",
WHETHER PRIMARY, EXCESS, CONTINGENT OR ON ANY
OTHER BASIS, THAT IS AVAILABLE TO THE
ADDITIONAL INSURED FOR A LOSS WE COVER UNDER
THIS ENDORSEMENT. HOWEVER, IF THE "WRITTEN
CONTRACT REQUIRING INSURANCE" SPECIFICALLY
REQUIRES THAT THIS INSURANCE APPLY ON A
PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBU-
TORY BASIS, THIS INSURANCE IS PRIMARY TO
"OTHER INSURANCE" AVAILABLE TO THE ADDITIONAL
INSURED WHICH COVERS THAT PERSON OR ORGANIZA-
TION AS A NAMED INSURED FOR SUCH LOSS, AND
WE WILL NOT SHARE WITH THAT "OTHER
INSURANCE" BUT THE INSURANCE PROVIDED TO
THE ADDITIONAL INSURED BY THIS ENDORSEMENT
STILL IS EXCESS OVER ANY VALID AND COLLECTI-
BLE "OTHER INSURANCE", WHETHER PRIMARY,
EXCESS, CONTINGENT OR ON ANY OTHER BASIS,
THAT IS AVAILABLE TO THE ADDITIONAL INSURED
WHEN THAT PERSON OR ORGANIZATION IS AN
Copyright, Insurance Services Office, Inc., 1983
CG 79 W 07 87 Page 1 of 2 EP
AFP-META2-03-PRINT607 -6520-7292-Y
'Ok,
t1l�CT MUtmo- COMMERCIAL GENERAL LIABILITY
INSURANCE r____
CG 79 00 07 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES
IL 12"' 01 11 85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE
ADDITIONAL INSURED UNDER SUCH "OTHER
INSURANCE".
4. AS A CONDITION OF COVERAGE TO THE
ADDITIONAL, INSURED BY THIS ENDORSEMENT:
A. THE ADDITIONAL INSURED MUST GIVE US
WRITTEN NOTICE AS SOON AS PRACTICABLE OF A
"OCCURRENCE" OR AN OFFENSE WHICH MAY RESUL
IN A CLAIM. TO THE EXTENT POSSIBLE, SUCH
NOTICE SHOULD INCLUDE:
i. HOW, WHEN AND WHERE THE "OCCURRENCE"
OR OFFENSE TOOK PLACE;
ii. THE NAMES AND ADDRESSES OF ANY INJURED
PERSONS AND WITNESSES; AND
iii. THE NATURE AND LOCATION OF ANY INJURY
OR DAMAGE ARISING OUT OF THE "OCCURRENCE"
OR OFFENSE.
B. IF A CLAIM IS MADE OR "SUIT" IS BROUGHT
AGAINST THE ADDITIONAL INSURED, THE
ADDITIONAL, INSURED MUST:
i. IMMEDIATELY RECORD THE SPECIFICS OF THE
CLAIM OR "SUIT" AND THE DATE RECEIVED; AND
ii. NOTIFY US AS SOON AS PRACTICABLE.
THE ADDITIONAL INSURED MUST SEE TO IT THAT WE
RECEIVE WRITTEN NOTICE OF THE CLAIM OR "SUIT"
AS SOON AS PRACTICABLE.
C. THE ADDITIONAL INSURED MUST IMMEDIATELY
SEND US COPIES OF ALL LEGAL PAPERS RECEIVED
IN CONNECTION WITH THE CLAIM OR "SUIT",
COOPERATE WITi US IN THE INVESTIGATION OR
SETTLEMENT OF THE CLAIM OR DEFENSE AGAINST
THE "SUIT", AND OTHERWISE COMPLY WIH ALL
POLICY CONDITIONS.
D. THE ADDITIONAL INSURED MUST TENDER THE
DEFENSE AND INDEMNITY OF ANY CLAIM OR "SUIT"
TO ANY PROVIDER OF "OTHER INSURANCE" WHICH
WOULD COVER THE ADDITIONAL INSURED FOR A LOSS
WE COVER UNDER THIS ENDORSEMENT. HOWEVER,
THIS CONDITION DOES NOT AFFECT WHETHER THE
INSURANCE PROVIDED TO THE ADDITIONAL INSURED
BY THIS ENDORSEMENT IS PRIMARY TO "OTHER
INSURANCE" AVAILABLE TO THE ADDITIONAL
INSURED WHICH COVERS THAT PERSON OR ORGANIZA-
TION AS A NAMED INSURED AS DESCRIBED IN
Copyright, Insurance Services Office, Inc., 1983
CG 79 00 07 87 Page t of 2 EP
AFP -M ETA2-03-PFiINT001-0520.023^4-Y
4§e Mutual.
INSURANCE
COMMERCIAL GENERAL LIABILITY
CG 79 00 07 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES
IL 12 01 11 85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE
PARAGRAPH 3. ABOVE.
5. THE FOLLOWING DEFINITION IS ADDED TO
SECTION V - DEFINITIONS:
"WRITTEN CONTRACT REQUIRING INSURANCE" MEANS
THAT PART OF ANY WRITTEN CONTRACT OR AGREE-
MENT UNDER WHICH YOU ARE REQUIRED TO, INCLUDE
A PERSON OR ORGANIZATION AS AN ADDITIONAL
INSURED ON THIS COVERAGE PART, PROVIDED THAT
THE "BODILY INJURY" AND "PROPERTY DAMAGE"
OCCURS AND THE "PERSONAL INJURY" IS CAUSED
BY AN OFFENSE COMMITTED:
A. AFTER THE SIGNING AND EXECUTION OF THE
CONTRACT OR AGREEMENT BY YOU;
B. WHILE THAT PART OF THE CONTRACT OR
AGREEMENT IS IN EFFECT; AND
C. BEFORE THE END OF THE POLICY PERIOD.
Copyright, Insurance Services Office, Inc., 1983
CG 79 00 07 87 Page 1 of 2 EP
AFF-META2-03-PN INT001-Ct2p-02J6-Y
Llberty lljutual,
INSURANCE
COMMERCIAL GENERAL LIABILITY
CG 79 00 07 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES
IL 12 01 11 85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE
FORM CG7630(0988), EXCLUSION - BLASTING, IS
HEREBY DELETED IN ITS ENTIRETY.
Copyright, Insurance Services Office, Inc., 1983
CG 79 00 07 67 Page 1 of 2 EP
AFP•META2-03-PFlIN7001.0520.0238-Y
Liberty! lYjytua .
IHsuR.ANtE
COMMERCIAL GENERAL LIABILITY
CG 79 00 07 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
POLICY CHANGES
IL 12 01 11 85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
PHYSICIANS, SURGEONS AND DENTISTS PROFESSIONAL LIABILITY INSURANCE
FORM CG7630(0988), EXCLUSION - BLASTING, IS
HEREBY DELETED IN ITS ENTIRETY.
Copyright, Insurance Services Office, Inc., 1983
GG 79 DO 07 87 Page i of 2 EP
AFP-META2-03-P RINT001-IK20.023&Y
1hLiberty M_ u_t_ual.
INSURANCE
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
CG 25 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Project(s):
ALL PROJECTS OF THE NAMED INSURED
UNLESS SPECIFICALLY EXCLUDED
information required to complete this Schedule, if not shown above, will be shown In the Declarations.
A. For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under Section I — Coverage A,
and for all medical expenses caused by acci-
dents under Section I Coverage C, which can
be attributed only to ongoing operations at a sln-
gle designated construction project shown In the
Schedule above:
1. A separate Designated Construction Project
General Aggregate Limit applies to each
designated construction project, and that
limit is equal to the amount of the General
Aggregate Limit shown in the Declarations.
2. The Designated Construction Project Gen-
eral Aggregate Limit Is the most we will pay
for the sum of all damages under Coverage
A, except damages because of "bodily
Injury" or "property damage" included in the
"products -completed operations hazard"
and for medical expenses under Coverage
C regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
e'
Construction Project General Aggregate
Limit for that designated construction project.
Such payments shall not reduce the General
Aggregate Limit shown in the Declarations
nor shall they reduce any other Designated
Construction Project General Aggregate
Limit for any other designated construction
project shown in the Schedule above.
4. The limits shown in the Declarations for
Each Occurrence, Damage To Premises
Rented To You and Medical Expense con-
tinue to apply. However, instead of being
subject to the General Aggregate •Limit
shown in the Declarations, such limits will be
subject to the applicable Designated Con-
struction Project General Aggregate Limit.
B. For all suras which the insured becomes legally
obligated to pay as damages caused by
"occurrencesll under Section I — Coverage A
and for all medical expenses caused by acci-
dents under Section i — Coverage C, which
cannot be attributed only to ongoing operations
at a single designated construction project shown
in the Schedule above:
c. Persons or organizations making claims 1. Any payments made under Coverage A for
or bringing "suits". damages or under Coverage C for medical
3. Any payments made under Coverage A for expenses shall reduce the amount available
damages or under Coverage C for medical under the General Aggregate Limit or the
expenses shall reduce the Designated Products -completed Operations Aggregate
Limit, whichever is applicable; and
t
CG 25 03 05 09
o Insurance Services Office, Inc., 2008
Page 1 of 2
EP
AFR ME TA?-0&PRiNT(XJ1 OSZGC� 1A -Y
2. Such payments shall not reduce any Desig-
nated Construction Project General Aggre-
gate Limit.
C. When coverage for liability arising out of the
"products -completed operations hazard" is pro-
vided, any payments for damages because of
"bodily injury" or "propery damage" included in
the "products -completed operations hazard" will
reduce the Products -completed Operations
Aggregate Limit, and not reduce the General
Page 2 of 2
Aggregate Limit nor the Designated Construction
Project General Aggregate Limit.
D. If the applicable designated construction p�ject;
has been abandoned, delayed, or abandoned and
then restarted, or if the authorized contracting
parties deviate from plans, blueprints, designs,
speclfications or timetables, the project will still
be deemed to be the same construction project.
E. The provisions of Section III — Limits of Insur-
ance not otherwise modified by this endorsement
shall continue to apply as stipulated.
A P•META2nPRINT00!,0520.0215-Y
DEATLEY CRUSHING COMPANY
Department of Labor & Industries
Page 1 of 2
Certificate of Workers' Compensation Coverage
January 16, 2019
WA UBI No. 601 920 593
L&I Account ID 964,511-00
Legal Business Name
Doing Business As
Workers' Comp Premium Status:
Estimated Workers Reported
(See Description Below)
Account Representative
Licensed Contractor?
License No.
License Expiration
DEATLEY CRUSHING COMPANY
DEATLEY CRUSHING COMPANY
Account is current.
Pending current quarter filing
Employer Services Help Line, (360)
902-4817
Yes
DEATLCC0131-3
02/09/2020
What does "Estimated Workers
Reported" mean?
Estimated workers reported represents the
number of full time position requiring at least
480 hours of work per calendar quarter. A single
480 hour position may be filled by one person,
or several part time workers.
industrial Insurance Information
Employers report and pay premiums each
quarter based on hours of employee work
already performed, and are liable for premiums
found later to be due. Industrial insurance
accounts have no policy periods, cancellation
dates, limitations of coverage or waiver of
https://secure.Ini.wa.gov/verifyIDetails/liabilityCertificate.aspx?UBI=601920593&LIC=D... 1/16/2019
• DEATLEY CRUSHING COMPANY
subrogation (See RCW 51 .1 2.050 and
51 .16.190).
Page 2 of 2
https://secure.Ini.wa. gov/verify/Details/liabilityCertificate. aspx?UBI=6019205 93 &LIC=D... 1/16/2019