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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